New large leaks after 18 months of normal leaks... (w/ chinstrap)

[GrumpyHere]

re: chipmunk cheeks. Got them last night. Any suggestions on coping with them?

You could try scunci/hairband/headband a la jay / zonker.

They put pressure on your lips and cheeks, thus reducing the possibility of chipmunk cheeks.

The jay post

viewtopic.php?p=1089718&f=1&t=112758&p= ... s#p1086296





The zonker post

viewtopic.php?f=1&t=184804&p=1417085&hi ... d#p1417085

[ozij]

Also seems like I should up the max even more.

I don't see why. You don't have many obstrucitve events at all, those you do have, occur when the pressure drops - so upping the max won't prevent them. The machine seems to be raising the pressure in response to something else - probably flow limitations. If you're sleeping well, leave things as they are. If not - consider raising your minimum pressure.

For some of us, flow limitations cause the machine to take the pressure as high as we will let it, and are not resolved.
In that case, higher pressure doesn't do much good, but certainly makes leak control more difficult.

[vintage]

re: chipmunk cheeks. Got them last night. Any suggestions on coping with them?

You could try scunci/hairband/headband a la jay / zonker.

They put pressure on your lips and cheeks, thus reducing the possibility of chipmunk cheeks.

The jay post

viewtopic.php?p=1089718&f=1&t=112758&p= ... s#p1086296





The zonker post

viewtopic.php?f=1&t=184804&p=1417085&hi ... d#p1417085

I'll take a look. Chipmunk cheeks woke me up last night a bunch of times... so much so that I turned off the CPAP at 530am. Thanks for the tip.

[vintage]

Also seems like I should up the max even more.

I don't see why. You don't have many obstrucitve events at all, those you do have, occur when the pressure drops - so upping the max won't prevent them. The machine seems to be raising the pressure in response to something else - probably flow limitations. If you're sleeping well, leave things as they are. If not - consider raising your minimum pressure.

For some of us, flow limitations cause the machine to take the pressure as high as we will let it, and are not resolved.
In that case, higher pressure doesn't do much good, but certainly makes leak control more difficult.

Here's the reasoning behind why I said that:

Curious what your thinking is behind setting max to 20? Thanks!

I always advocate for a max of 20 except in exceptional circumstances, because all you're doing by setting the max lower is potentially preventing your auto machine from doing it's job.

Zonker pointed that out in his explanation, your machine hit it's max pressure, and couldn't go as high as it wanted to in order to normalize your breathing.

The machine won't increase the pressure unless it needs to, so why not remove the restriction, and let the machine do it's job?

[ozij]

though would love any insights from reading the Oscar tea leaves (or a pointer on where I can learn to do so!)

Your min pressure should be more like 8.4, it's too low for you.

This was suggested by palerider almost a week ago - you haven't done it.

I can't see the images Zonker responded to, but I can see two of three recent images in which you spent 95% at the time in pressure lower than 12, i.e. for 95% of the time you did not even hit the present max.

Upping the pressure for those other 5% may cause more leaks - and it's leaks you're complaining about. I suggest you start with upping your min, see how that affects your sleep and your results, and if you're not sleeping well, go ahead and give the higher max a try.

[Pugsy]

Another thought....sometimes when the minimum is increased a bit and more optimal in actually preventing the airway collapse the machine may not even need to go as high as it is wanting to go now.

I keep remembering a woman from some years back who was using essentially a wide open range of 5 to 20 and she was spending a LOT of time at pressures over 16 cm and her pressure graph was all over the place because she needed a lot more than the 5 minimum. So she worked her way up to 9 cm minimum and once there things settled down and she never ever even hit 13 cm max. Go figure that one.

While a lot of us do leave the range more wide open because the machine will only go to where it thinks it needs to go....sometimes where it wants to go creates more problems than it fixes so when that happens we limit where the machine might want to go. Increasing leak problems is certainly a problem that qualifies for a reason to limit the max especially if the time the machine wants to go higher is really not all that much anyway.

Your minimum pressure is your most critical setting when using a range of pressures unless you are hitting the maximum pretty much all night long and then if you did that we would have a different discussion.

[zonker]

vintage?

the link is broken on your dropbox files and we can't see your previous oscar charts.

maybe try imgur.com? it's free and very, very solid.

[palerider]

Also seems like I should up the max even more.

I don't see why. You don't have many obstrucitve events at all, those you do have, occur when the pressure drops - so upping the max won't prevent them. The machine seems to be raising the pressure in response to something else - probably flow limitations. If you're sleeping well, leave things as they are. If not - consider raising your minimum pressure.

For some of us, flow limitations cause the machine to take the pressure as high as we will let it, and are not resolved.
In that case, higher pressure doesn't do much good, but certainly makes leak control more difficult.

Until it hits 20 (or 25) you don't know if the FL's will be resolved.

FL's disturb sleep too, they increase the work of breathing and reduce the rest and recovery one should get from sleeping.

[palerider]

though would love any insights from reading the Oscar tea leaves (or a pointer on where I can learn to do so!)

Your min pressure should be more like 8.4, it's too low for you.

This was suggested by palerider almost a week ago - you haven't done it.

Hasn't done anything I suggested...

[ozij]

Until it hits 20 (or 25) you don't know if the FL's will be resolved.

Theoretically correct.
Based on the following assumption:
The machine you use is identifying your breathing pattern correctly
The machine you use is responding appropriately.

Following that logic, nobody should stop at a pressure of 20 if their flow limitations are not resolved, they should try a machine that gives a maximum of 25, because you won't know if the FL's will be resolved.

My trust in the Auto algorithms' ability to identify and respond appropriately is far lower than is palerider's, I have other assumptions and am therefore far more wary of a wide open max.
That said, people can try it an see what happens to their sleep and how they feel - this is about individual response.
Not trusting the algorithm, I would rather push my max up gradually and see how I respond.

palerider, Pugsy and I do agree that starting out at a min pressure that is too low is a sure way of disrupting your sleep by letting the machine down to the level at which events occur.
... Unless you're using the "Autoset for Her", in which case the machine may freeze you on a minimum which is too high -- that's not too good either...

[vintage]

though would love any insights from reading the Oscar tea leaves (or a pointer on where I can learn to do so!)

Your min pressure should be more like 8.4, it's too low for you.

This was suggested by palerider almost a week ago - you haven't done it.

Hasn't done anything I suggested...

While I am grateful for your free advice, the snark really isn't necessary. My goal was the post was reducing leaks which were waking me up and causing major fatigue the next day. Fixing up min/max was secondary - AHIs are generally less than 3 for me.

Your advice was to change min/max to 8.4 and 20. Which was helpful, but not directly focused on the problem I was trying to solve. That said, I raised min to 6/12 in conjunction with mouth taping - not ideal from a scientific method perspective (changing multiple variables). Plus: baby steps as I learn the ropes. A night of good sleep is worth more to me than drastic changes since AHIs were low. I didn't to change to 20 because leaks were an issue and higher flow felt like it could lead to more leaks. Plus there's a differing opinion from ozij about whether 20 is the right approach in this case.

In any case, I am grateful for your advice. In the 7 nights since you gave it I've taken it (partially). And once I solve the main mouth leak problem, I'll experiment with it in due time. Cheers

[vintage]

vintage?

the link is broken on your dropbox files and we can't see your previous oscar charts.

maybe try imgur.com? it's free and very, very solid.

I took palerider's advice and have used Imgur for the latest images. Initial couple of post's images are broken. If you want to see them I'll replace the dropbox hosted images with Imgur ones but I didn't think it was necessary.

What do you think?

[vintage]

though would love any insights from reading the Oscar tea leaves (or a pointer on where I can learn to do so!)

Your min pressure should be more like 8.4, it's too low for you.

This was suggested by palerider almost a week ago - you haven't done it.

I can't see the images Zonker responded to, but I can see two of three recent images in which you spent 95% at the time in pressure lower than 12, i.e. for 95% of the time you did not even hit the present max.

Upping the pressure for those other 5% may cause more leaks - and it's leaks you're complaining about. I suggest you start with upping your min, see how that affects your sleep and your results, and if you're not sleeping well, go ahead and give the higher max a try.

In the 7 nights since this was given, I raised min to 6 in conjunction with raising max to 12 and figuring out which combination of three mouth tapes and a chinstrap would help solve the main problem: mouth leak (not high AHIs).

Baby steps, friend!

[vintage]

Another thought....sometimes when the minimum is increased a bit and more optimal in actually preventing the airway collapse the machine may not even need to go as high as it is wanting to go now.

I keep remembering a woman from some years back who was using essentially a wide open range of 5 to 20 and she was spending a LOT of time at pressures over 16 cm and her pressure graph was all over the place because she needed a lot more than the 5 minimum. So she worked her way up to 9 cm minimum and once there things settled down and she never ever even hit 13 cm max. Go figure that one.

While a lot of us do leave the range more wide open because the machine will only go to where it thinks it needs to go....sometimes where it wants to go creates more problems than it fixes so when that happens we limit where the machine might want to go. Increasing leak problems is certainly a problem that qualifies for a reason to limit the max especially if the time the machine wants to go higher is really not all that much anyway.

Your minimum pressure is your most critical setting when using a range of pressures unless you are hitting the maximum pretty much all night long and then if you did that we would have a different discussion.

That's super helpful context for why raising Min is important. Instead of magic incantations ("raise min to x and max to y") I much prefer to understand the why and build my mental model of how this works.

Thanks Pugsy!

[vintage]

Quick update: used a strip of 1" Medvance Soft Silicone Tape over my mouth. It's easy to peel without ripping my face, but doesn't prevent leaks for me. So threw a strip of 2" 3M Micropore Surgical tape over it to hold it down. Put a chinstrap on for good measure.

Results were great with respect to both mouth leak and AHIs:



Feel pretty awesome this morning despite being asleep for less than 7 hours (according to my sleep tracker)!