New-ish CPAPer, got more CA's and chipmunk cheeks

[Some_Guy]

Hi all,
I appreciate what I've been able to learn by reading these forums. I have a question/situation that has been touched on, but I was hoping folks might be able to provide more suggestions or information.

I was diagnosed with mild sleep apnea (AHI = ~8 on a home sleep study), with mostly obstructive events. And the doc suggested that a lot of other "smaller" events where evident but not getting flagged by the system. I've had my Resmed Airsense 10 for 3 weeks or so, and have pretty much used it nightly except for a few trips that I didn't take it on. Nose pillows. Started off with auto setting, 5-15. Ramp. Auto climate. EPR=on and I believe set to 3. I've since fiddled with the settings a bit, such as pushing the max down to 10 and skipping the ramp (seems fairly pointless, with 5 as my starting point). I've also fiddled with pushing the min to 6 but am not sure how much it matters for me.

One problem has plagued me all along -- I often find myself with air filling my mouth and eventually pushing its way out through my teeth after filling my cheeks (the Dizzy Gillespie/chipmunk effect). I generally fall asleep fine, and then at some point find myself slowly gaining consciousness as I notice this effect happening. I'm under the impression it's probably been going for a while, at least sometimes, because my mouth is often very dry. So usually at that point I take the thing off and sleep the rest of the night without it. I'm averaging ~3-5 hours per night with the sleep snorkel. When I try to power through, I tend to end up with a lot of chipmunk events and not a lot of sleep.

Possibly related: my AHI is now usually pretty high (8-19) and is now composed almost entirely of Central events. Obstructive events are way down, near zero.

My theory is that the thing is doing a bang-up job on my obstructive apnea but for whatever reason, the air pressure is causing me to stop trying to breathe. At that point, the machine ramps up, but the air just goes into my mouth. I was noticing high pressures when I'd wake up, so pushed the max down from 15 to 10 and it may have helped slightly. But this is all pretty variable -- occasionally I have a night with only around 3 AHI, but that's rare.

I'd be glad for any thoughts on this. Is it just a matter of me adjusting to the thing? Are there settings to mess with? I saw the sleep tech last week, but mostly just talked about mask comfort/seal and she wasn't too interested in the chipmunk effect. I won't see the tech for a few more weeks, or the doc for another month or so. Having found a couple threads on here with similar problems and some suggested solutions, I tried upping the humidity last night (to 7, from "auto") and ended up with water in the hose. I also tried pushing the ERP down to 2, and it seemed fine at bedtime but pretty hard to breathe in the middle of the night when I was trying to get back to sleep after a chipmunk wake-up.

I have Sleepyhead, but haven't yet worked out the technological complexities of getting my charts on here for y'all to look at. But I can/will, particularly if that seems relevant. I was figuring that the basic patterns, just described, might trigger some suggestions at least. I'd be glad to find a way to make this thing work... But then again, I've got an appointment for an oral appliance coming up, so maybe that'll prove to work better for me. (Snorkel vs mouth-full-of-plastic -- I'm not sure what sounds worse...)

Thanks!

[Julie]

The higher the EPR, the higher your AHI will be, so if you can lower the EPR your AHI should follow. I personally would raise the low setting of 5 by a couple for a few days as it's very low, and your AHI is high, even with the EPR factor.

[LSAT]

The higher the EPR, the higher your AHI will be, so if you can lower the EPR your AHI should follow. I personally would raise the low setting of 5 by a couple for a few days as it's very low, and your AHI is high, even with the EPR factor.

Actually Julie, I found this not to be true in my case....I have been using EPR 2 for as long as I have had my Autoset. My AHI ranges from 1.5-2.5. My long term average is 1.9. I very rarely get an AHI below 1.0 so I decided to try lowering my EPR. I dropped it to 1 and for the next week I averaged in the upper 2s. I moved the EPR back to 2 and my AHI is back to where it was. Maybe it's just me, but the lower EPR did nothing to improve my AHI.

[Julie]

Ok, I thought it was most likely the way it worked... seemed to happen to various people, but if it's not automatic, then it isn't.

[RubySnooze]

Some_Guy,

Total newbie here, but I also get those chipmunk cheeks and have found a couple things:

1) After I used the CPAP for awhile, chipmunk cheeks stopped happening. Just went away entirely. Several months later, I switched from a full face mask to nasal pillows, and the chipmunks returned. Hoping they decide to quietly leave, as they did before.

2) Somewhere on this forum, a more knowledgeable person recommends sleeping with your tongue up against the roof of your mouth. Or at least the tip of your tongue up against your front teeth. Sorry I can't remember more on that, but maybe it will come up if you do a search.

Good luck!

[Guest]

Thanks all.

Yeah, RubySnooze I did find some discussion of the tongue strategy. I confess I had a bit of trouble imagining myself actually being able to train my tongue to do any particular thing while I'm sleeping. But maybe I'll try to think about that tonight if/when I wake up with the strangely discomforting sensation of a mouth full of over-pressured air. I'm glad to hear that the chipmunk thing eventually went away for you.

And thanks Julie on the pressure and EPR recs. I will try bumping up the low pressure a little, and will try again on the EPR=2. (Given the abundant adjustability of the autosense, I'm a little surprised that the EPR only has three levels. Or four I guess, if you count "off".)

[Some_Guy]

Oh, didn't realize I was signed out, or that it'd let me respond without signing in... That last post was me, in case that wasn't obvious.

[OSAHell]

Hy Some_Guy,

Did a big part of your events in your PSG report where hypopnea?

Sorry, can't really help for the "chipmunk thing". This link might be of interest to you if you're thinking to go the oral appliance route, particulary the OP's yesterday UPDATE post! The problem I see with oral appliances is that there's no easy way to know if it actually treat your apnea efficiently... Unless maybe if you sleep with an oximeter every night.

viewtopic/t73370/Finished-first-week-of-cpap.html

You also should fill in your equipment profile, it come really handy to many of us.

[OSAHell]

Forgot to put this in my last post...

If you wonder why I ask you about hypopnea, it's because I was experiencing pretty much the same thing as you about CAs events when I started CPAP. Had very little OA events on CPAP/APAP at ANY pressure but a truck load of CAs, I even tried a fixed pressure of 4 at some point... a bit better but basically the same thing. My average AHI under CPAP was pretty much the same as my Dx AHI, which seem to be your case from my understanding. The first "report" the sleep doc gave me was 1 page with text and some numbers (time, desat, etc.) but for apnea it only says: "All events are obstructive" and even specified "Zero central apnea event", Dx "Moderate Obstructuve Sleep Apnea". When I finaly put my hand on the full PSG report and start looking at the event's breakdown and numbers I made some interesting discoveries... You can take a look at the following thread where I have a post on the first page (the longer one) that tell my little story about my "PSG revelation" on hypopneas and others things... In my particular case, I just need an other kind of machine to treat my apnea problem.

viewtopic.php?f=1&t=106359