Newbie's AHI higher than at sleep study

[Pugsy]

Did they measure you for size?
I don't know if a medium would be better or not.
What size frame are you using?...maybe you need a smaller frame.
Typically the package is with a medium frame and there is one that is a little smaller around and that might help with the tension.

I don't know about using ramp or not. If it were me I would continue with the slow climb upwards with the minimum...you might get lucky and quite well with a little less minimum than we think you are going to need.
But I tend to be ultra conservative with my approach to things.
I suppose you could try it and if it ends up not working out well (most likely in terms of sleep quality if it is going to be a problem) you can always go back to what we are doing now.

Plus...here's the rub...if you should fall asleep prior to the end of ramp it's possible that some apnea events would be untreated due to the lower pressure during ramp unless Smart/Auto Ramp is used and I don't know that I trust it.

With doing it with the lower minimum initially...if you need more the machine will respond...in ramp it won't be able to do anything until ramp is over.

[dorilu]

They only measured me for cushion size, not the frame. I'm using a medium frame. My DME is like a little mom and pop place. They pretty much believe in one size fits all. They don't carry anything but the standard sizes of anything.
They had to order the small cushion and I was without a mask at all for 5 days.

They only get an order in once a wk.
I'm hoping that won't affect my compliance with insurance. I was brand new and didn't know anything else to do except wait for the mask to come in.
Then I found this forum and I have learned so much and I realize I have to take control in finding the right masks and sizes and many other things that I had not realized.

I tend to be conservative in my approach to things too, so I am more comfortable with the idea of gradually increasing the pressure and see how it goes. I think I will increase to 7 tonight and on to 8 tomorrow night if all goes well.

[palerider]

based on your pressure chart, I'd say 10 or 11.

I agree but since she's been using much lower for so long she's afraid of a big leap. It's for this reason we are going a bit slower. If she hadn't been using lower for a while it wouldn't likely be that much of an issue.

the only reason I suggest such a big leap is that her average pressure is higher than that, so she's sleeping with that higher pressure all night, and the machine is struggling, because it keeps trying to get back down to that too low minimum, which causes events and the pressure has to go up again (explanation for the benefit of dorilu)

[Pugsy]

Your compliance is fine...don't worry about that part.
All you have to do to meet minimum "compliance" requirements is use the mask and machine for at least 4 hours a night for 70% of the nights available. They would have made an allowance for the time the machine wasn't used waiting for another mask.
Compliance doesn't include therapy effectiveness...just how many hours you use the machine. Heck...awake time counts.

The small frame can be found on EBay...this is the cheapest I found in the small $21.25 with free shipping...new, still sealed.
http://www.ebay.com/itm/Philips-Respiro ... SwXeJYF1Kc

I don't know if it will help or not. When I tried the DreamWear I probably would have done better with the small but using the fleece side covers got me real close. If I was wanting to use it full time I would have went ahead and got the small frame.

Something to think about...and/or check with your DME about trying the Small and wait for them to get it.
Be sure to ask what it would cost you if you use your DME.

If there's no room to tighten the back strap without compressing the cushion into your nose then a smaller frame is the next logical step.
What other mask did you try and not like? I forget.

[Pugsy]

the only reason I suggest such a big leap is that her average pressure is higher than that, so she's sleeping with that higher pressure all night, and the machine is struggling, because it keeps trying to get back down to that too low minimum, which causes events and the pressure has to go up again (explanation for the benefit of dorilu)

I know and I hear you...but if she is nervous about the big leap she may not be able to get to sleep easily to use that higher pressure that she has already been using while asleep.
I just want her to focus on getting to sleep fairly easily right now since she has had some trouble falling asleep.
I didn't want to inadvertently feed the insomnia monster.

She knows where she needs to go but just a bit timid about getting there in a big leap...she will get there and it won't take too long taking the slow boat. 1 cm increase each night is doable (and only means maybe 4 more nights) and will give her confidence that she can do it.
We are already leaps and bounds better than things were.

[palerider]

We are already leaps and bounds better than things were.

indeed...

follow the pugsy, the pugsy is good, the pugsy knows

[dorilu]

My report wasn't good this morning. It may be because of the electricity going off last night right before I went to bed.
I lay there waiting for it to come back on, and fell asleep. I had horrible nightmares and woke choking and gasping for air a couple hours later.
I recall this happening a few times before I was diagnosed with OSA, but it didn't happen very often.
The power came back on in another half hour and I turned on my machine and went back to sleep, but woke constantly with my mask leaking.
I would adjust until it stopped, drift back to sleep only to start leaking again. This was the pattern all night so I guess it's not surprising to see my score jump back up.

As for the mask, I called my DME yesterday. He said he didn't even know if he could get a small frame, said that the medium should work, and that my insurance only covered 1 mask exchange in the first 30 days, which I have already used, and this was because at the start they gave me the lg N10, which was definitely the wrong size and which I exchanged for the Dreamware. He said to call my Dr and ask him to write a prescription for the smaller frame and also for the heated hose that I ask about, because that was the only way my insurance would cover them. I may look into purchasing the one you gave me the link to, Pugsy, or I may try to purchase a different mask. I like the Dreamware though, and hope I can make it work.

I didn't notice a lot of difference with the increase of pressure though, so maybe I could increase more than 1 cm tonight?

I will post my results.

[dorilu]

[Pugsy]

Can't really put much importance into last night's report. You already admit to a lot of wake ups so there's a high probability that a good number of what is shown is SWJ.

Would you like to try the ResMed P10 nasal pillow mask (see the link in my equipment profile)? I have a spare I would be willing to loan you to try to see if you like it or not well enough to invest in one of your own.

[dorilu]

Thank you, Pugsy.
Yes, I would like to try the P10, and would gladly accept your generous offer of a loan to try it.

[grayghost4]

In response to your PM ... I thought it better to respond here so others can comment and/or object to my advice.

I do have one ASV machine a 960P new for sale I also have several new and used bipaps(vpap)... but before I would make that jump I have other thoughts.

When I started I went through everything that you are going through. I think the your major problem is leaks. I had the same problem, lots of mouth leaking, and no fullface mask made a difference (when I go to sleep everything relaxes and the mouth opens and the mask shifts and starts leaking, as you can see from my avatar ) ... also had a dentist make a MAD ... thinking that might help but it was nothing but pain. I now use a Amara View mask, which is like a nasal pillow but also covers the mouth.

The first thing I would do is turn on EPR and set to 3 (this will make it similar to a vpap)... that may allow you to sleep through the pressure increases and also raise the starting pressure ... also turn off ramp with EPR on you may find you don't need ramp.

I also found I can't keep my mouth closed with out a simple mouth guard like this:

https://www.amazon.com/Best-Dental-Nigh ... mouthpiece

I have found that a cervical collar works better than a chin strap, they come in several styles and sizes :

https://www.amazon.com/Ergonomic-Cervic ... ollar&th=1

[Guest]

Good advice and while I think a mouthguard can & does help I was looking at that one just the other day but the one linked doesn't have good reviews. There are others on Amazon that do but I can't recommend one just yet either.

fwiw - a mouthguard from a dentist can cost $250-$300 so it may be worthwhile trying Amazon. I think the biggest problem is getting a good fit but for say $20-25 I would be willing to try it. Or you can try a sports store but I think the Amazon return policy is prob better.

[grayghost4]

they are available from many different sources ... I have been told Walmart has them ...I get mine from Ebay ... but shipping is several weeks.

http://www.ebay.com/itm/Anti-Snore-Slee ... SwEetV-OZ-

I have found that the ones with an opening to breath through defeats the purpose of sealing the mouth to prevent leaking.

[dorilu]

Thank you grayghost, for your reply. I will gladly try your suggestions.
I have never used EPR, and I will turn that on tonight.
I just placed an order for the mouthguard and will look into purchasing a cervical collar.
I appreciate your help and Guest's, as well, on the best mouthguard to try.
It's encouraging to know that you and others have had similar problems to mine and overcame them.

[jtravel]

EPR or exhale pressure relief worked wonders for my AHI.
At a setting of 3 the highest available on a standard Apap Machine I get about 3 cm pressure relief when exhaling on the highest pressures.
The amount of pressure relief changes depending on the inhale pressure on my System one 560
It took me a good 6 months of looking at Sleepyhead data and making small changes but my AHI is under 1 now on a nightly basis.
I was getting high AHI of 10-15 when I first started using my Apap.