AHI spike with Ultimate Chin Strap

[Bodhi]

I have an unusual situation that I can't understand. I've been blessed with terrific AHI and minimal leaks until a couple of weeks ago. Then, while the AHI remained in the 0.0 to 0.4 range, the 95% leak rate spiked to the 9 to 16 L/min range, very unusual. My leaks ALWAYS come from between my lips--not a seal problem with the nasal mask. I attributed it to pollen and stuffy nose. Here is a typical example:

May 27:



I wouldn't have cared, but the leaks were sometimes waking me up causing poor sleeping. I changed to new nasal pillows to no effect.

Then, I changed to the Ultimate Chin Strap thinking that would stop the leaks. It did, but AHI spiked:

28 May example of leaks and events:





On the 29th I again wore the Ultimate Chin Strap until around 2:15 a.m. when I switched to the Pap Cap.

The results of the before/after:



Here is what I'd like you to consider: Why, since the Ultimate virtually eliminates leaks, do I have so many apnea events with it?
Has anyone else experienced this? What would be the most likely cause(s)?


Last night with Pap Cap (no image):
AHI: 0.0
Leaks: 16.8

Thanks in advance for all suggestions.

[McSleepy]

Maybe the Ultimate Chin Strap (UCS) pulls your lower jaw towards the back of your head, while the Pap-Cap (PC) does not; or the PC allows your jaw to slide forward, opening your airways, while the UCS does not. I have found that a small jaw displacement can make a significant difference as far as allowing the soft tissue in your larynx to collapse and block your airways. Since your machine has auto-titrating capability, have you tried allowing the pressure to go higher to compensate?
McSleepy

[Bodhi]

Here is a screenshot of the pressure with the UC and the PC. I have reset the top pressure to 10 -- that night it got to 9.3 twice.


I think your analysis makes sense regarding chin movement. Something is causing obstructions, for sure. I have tried tape a couple of times, but both times my AHI went up so I discontinued that approach. The Mirage Liberty hybrid also caused a spike in AHI, so I discontinued that approach also. I wonder if the buildup of pressure in my mouth when my lips can't seep air (tape, Ultimate, liberty) is enough to close something down.

[McSleepy]

In the absence of better ideas, you could try raising your pressure range (to something like 7/12cm) wearing the UCS and look at the data the next morning. I, personally, do not believe in the ability of today's CPAP machines to accurately auto-adjust pressure and I would recommend you establish a fixed pressure that works for you. Then again, I use bi-level pressures and I can make that happen easily (i.e., the fine balance between comfort and efficacy). But your pressures are quite low and you should be able to tolerate an increase, especially for a night, to test a hypothesis.

In your case, I do not believe that the the release of pressure through the mouth, per se, is what is "helping" the breathing. There would need to be a constant, high-volume pressure release for that. It does appear that the way you hold your jaw, affected by the different "setups", might be the deciding factor here. I have been fighting something like that recently. In my early years of CPAP, I would open my mouth occasionally and suffer the consequences, which caused me to learn (not consciously) to keep it shut - to the point where I'd have major apneas that would wake me up completely (nose obstructions). Then my body learned to slide my lower jaw forward to keep the soft tissue taut, but recently that caused some TMJ problems... I made a chin strap myself last week and I'm sleeping with it now, and the TMJ inflammation has all but disappeared. I also raised the pressure a bit to anticipate an increase in AHI. I'll report back in my other thread (viewtopic.php?f=1&t=64186) when I have some more conclusive results.

Our bodies do much more than we are aware of; we just need to have our consciousness learn to know and work with the unconscious. The good thing is we now have data to help with that. Let us know how this turns out.

McSleepy

[howkim]

I looked at my data last night. I've had no significant change in AHI, but a MAJOR (good) one in my leak rate since starting to use the Ultimate Chinstrap.