Newbie Question - My First Night

[Pugsy]

Not sure why the number is different either and no way to tell just from this snippet.

Need the entire detailed report to really answer your questions.
See this thread for examples.
viewtopic/t158560/How-to-post-images-for-review.html

[thompsdw]

Thanks again. Looks like the mask lead was a singular event. Is this the detail you want to see?

[Pugsy]

Yes, that's much better thank you.

Not sure why the difference in the AHI between SH and DreamMapper but it probably has something to do with the fact that you turned the machine off and then back on again during the night creating multiple sessions and DreamMapper may not have the complete night to base the numbers on.

I would increase the minimum again...1 cm.
You didn't have much of a leak problem until the pressure increased...maybe fitting it a little closer to where it wants to go will lessen the chance of it happening again...and you need more minimum anyway.

[thompsdw]

Thank you again for your help. I wouldn't be seeing the same improvement if I was waiting on a dr appt to make small adjustments. When I get up and go to the restroom, I have been doing that most nights. You can see it in the other traces, but it is easy to leave it on and lying on the bed. The earlier traces seemed to match better, so not sure.

[thompsdw]

I have one more question - How do I know that the nasal pillow works in my case? In other words, if the pressure keeps going up - maybe my mouth is open at night. Maybe I should try a full face mask first?

[Pugsy]

The pressure doesn't keep wanting to go up because of leaks (no matter where they are from) and in fact the machine is more apt to reduce the pressure a bit in an effort to get the leaks back under control.
The pressure wants or needs to go up because of the OAs, hyponeas, snores and flow limitations which all point to sub optimal pressures.

If your mouth was open all night the leaks would be bigger and happen all night.
Now I don't know if that one large leak segment is mouth opening or simply mask movement...they look the same on the leak graph.

Nasal pillow masks have less real estate or footprint on the face...full face masks have much larger area touching the skin needing to be kept sealed. I see no need to go down the full face mask road at this time from what we see here.

Your leak graph for last night...actually better than mine for last night.

Besides...sometimes people need more pressure with a full face mask than they do with a nasal mask because the lower straps alter the airway a little.

My suggestion...quit worrying about the leaks at this time and worry about them later if they wake you up much.
For now concentrate on optimizing the pressure and simply being able to sleep.

[thompsdw]

Really appreciate the help!! Is there such a pressure on the low side that is too high? Cause other issues? Sorry if the questions are dumb, just trying to learn here and you're a great teacher.

[palerider]

Here's an example of what Pugsy was talking about... this guy had really bad leaks, and his auto machine started *reducing* pressure to try and get the mask to seal:

[zonker]

Really appreciate the help!! Is there such a pressure on the low side that is too high? Cause other issues? Sorry if the questions are dumb, just trying to learn here and you're a great teacher.

NO! there is NO dumb question, because you are trying to figure things out. if you don't ask, you won't know.

there may be many reasons that the lower pressure being too high can cause problems. in my own case, i can't tolerate a lower pressure higher than 9.5 because, for me, a higher pressure would cause too much painful gas, which would interfere with my sleep.

i'm sure there are other reasons. this is just why it would be a bad idea for me.

[thompsdw]

Thank you. It makes sense now. An open mouth is just as much a leak as a poor seal. The CPAP is just trying to hold a pressure to prevent the events. I just moved across the country and had the sleep study done with one employer and then switched to another company and insurance. It was a mess trying to get the machine, so I decided to purchase it outright versus keep fighting insurance. That's why I have so many questions. I really didn't have anyone to ask questions too. This forum has been invaluable and I really appreciate the support.

[Pugsy]

Is there such a pressure on the low side that is too high? Cause other issues

No, not really.
While I know that these pressures seem high now...they really aren't all that high. Did you know that a pressure of 20 cm won't even blow up a balloon?

There are a couple of side effects to any pressure though....aerophagia or air in the belly discomfort..can be minor or disabilitating. This is fairly common.
There are some things that can be done to reduce the discomfort though.
There's a small number of people who with any cpap pressure (doesn't necessarily have to be a high pressure) that will develop a large number of centrals and enough to cause a problem. There are things that can be done to fix that issue also.

No dumb or stupid questions. You should have seen the ones I came up with 9 years ago.
Don't ever be afraid to ask for clarification on anything if you are unclear about something.

[thompsdw]

Well, last night was not the best night. I am going to attach the detailed traces. The same phenomenon happened like the one I posted earlier. I got up, used the restroom, went back to bed and things went South. I did turn off the machine again when I went to the restroom. I also did not increase the pressure based on your suggestion last time. The reason is that I am starting to get some discomfort early in the morning from swallowing air. It passes quickly in the morning, but it is uncomfortable at the point of getting out of bed. I was going to wait a little for things to stabilize before I increased. As usual, any advice is appreciated.

[Pugsy]

Approx how long did it take you to get back to sleep after the bathroom break?
Approx how many wake ups last night?

[thompsdw]

Went back to sleep pretty quick. I would estimate <20 minutes. I don't remember getting up at all last night other than the bathroom trip, but I must have been restless last night. I can tell by the yawns today.

[Pugsy]

Yeah...looks like a crappy sleep night which likely explains the yawns today. I am thinking probably more awake/semi awake breathing going on than you might remember.

Hold off on the pressure increases until the belly settles down and then just do 0.5 cm increases.