So what if I snore a little?

sgass · Post by **sgass** » Wed Feb 20, 2008 8:01 pm

Hello all, great forum!

I was titrated on Monday night, and the tech warned me that those who write the prescriptions will probably call me in for another round because she wasn't able to eliminate the signal on the snore track. She'd started me off at a relatively high pressure (I forgot to ask), and didn't see any respiratory events, but kept cranking it up until she got to 15 because there was still some indication that I was snoring.

I have a feeling that those who write the prescriptions want to be sure that all traces of snoring have been eradicated, just to be sure I'm not motivated to ask any questions. But is there any real reason to boost the pressure beyond what's necessary to eliminate the apneas? If there aren't any apneas, but I still manage to make a snoring sound, is there a valid reason to increase the pressure?

Thanks!
Steve

GeneS · Post by **GeneS** » Wed Feb 20, 2008 8:13 pm

Were you breathing thru your mouth during your test? If you were your cpap was not working so it is meaningless to adjust pressures to solve a problem caused by mouth breathing. You need to find a way to seal your mouth before you can find the optimum setting. If you were not mouth breathing or leaking you will likely need to raise your pressure to improve results. If you have a data capable machine and software you can figure it out.
GeneS

Wulfman · Post by **Wulfman** » Wed Feb 20, 2008 8:17 pm

I think that's what they did with me. They got up to 16 and still had "some events". My sleep doctor wrote my prescription for 18 cm.
I got a data-capable REMstar Pro 2 and the Encore Pro software. I TRIED 18 for less than an hour and then reset my machine to 10 cm. I still had LOTS of snoring but very low AHI numbers for about a year. I ultimately decided to bump it up to 11 and 12 which got rid of my snoring. I also came up with my own procedure to get my nasal passages clearer and since then, my snoring has been almost non-existent.
If a person is using an APAP/Auto, the snoring will keep driving up pressures. I had read about that characteristic of Autos, so that's one of the reasons I opted for a data-capable CPAP for my first machine. I had been told that I was a "1st class" snorer, so no sense in spending the extra money at that time for the Auto. I also wanted to see how this therapy was going to work for me before spending extra money on technology I might not need. I eventually spent some extra money for the Autos, but really haven't needed their features. Doing just fine on straight pressure.

Den

sgass · Post by **sgass** » Wed Feb 20, 2008 10:01 pm

Oh yes, I am a mouth breather. When I lie down, at least. So I told her to go straight for the full-face mask (a Quattro) and for whatever reason my nasal passages slammed shut entirely when it was on -- that's something I'll have to work on later. Otherwise the leak rate was excellent, and I assume I got the full benefit of the therapy. Or is it simply less effective when mouth breathing is involved?

And thanks Wulfman, that's an excellent tidbit about APAPs. I intend to end up with a data-capable unit in any event, and have figured that an APAP would be my best investment if I end up spending my own money, so I'll have to consider that carefully if I don't luck out with the provider.

I guess my real concern here is that those who write the prescriptions are going to bring me in for another night just so they can collect an extra 5 grand, and then prescribe a much higher pressure than I actually need. I'll find a way to properly adjust the pressure later on, so mostly I'm just offended by what seems to be borderline malpractice. Of course this all presumes that the tech is right and they call me in again, but if they do I want to have my arguments prepared. Is there any medically valid reason to increase the pressure beyond that which is necessary to control apneic events?

Thanks.
Steve

GeneS · Post by **GeneS** » Wed Feb 20, 2008 10:25 pm

sgass
When you breath in thru your mouth with a nasal cpap your lungs and airway pressure go negative(below atmospheric) or air would not flow thru your mouth (0 pressure) to your lungs. Cpap stands for continuous positive airway pressure so cpap is not working at all when your airway pressure goes negative. Then if you close your mouth and breath thru your mask your lung and airway pressure jumps up. it will be a little below your set pressure when you inhale and a little above your set pressure when you exhale. I would think the constant jumps and drops between negative and set pressure would also be disturbing to your sleep and body.

I tend to harp on mouth breathing because it is important to cpap treatment and often misunderstood and I went years breathing thru my mouth with nasal cpap before I finally sat down did the math and figured it out.

ozij · Post by **ozij** » Thu Feb 21, 2008 12:42 am

Gene, the math changes when the mask is full face - in a full face mask the positive pressure is still there when you open your mouth.

Steve - the tech may have been inexperienced (or not, see the bi-level info). What you should be concerned about is your blood oxygen level when you snore. If you still snore, and your O2 level is fine - that's one thing. It its not, that's a total other story.

Ask them about your pulse ox. ask for a trial with a pulse ox. at home,

By the way - if they discover you need high pressure - (edited to add: 15 or above), you might be eligible for a bi-level machine - and that might actually be very good. Maybe the tech was thinking of a bi-level titration, which is different from the fixed one. I wouldn't pass up on the chance for that - bi-levels add a lot to therapy comfort, and are different machines as far as insurance is concerned too.

O.

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CPAPopedia Keywords Contained In This Post (Click For Definition): Titration, Bi-Level Machine

GeneS · Post by **GeneS** » Thu Feb 21, 2008 8:14 am

ozij
I agree that with a full face mask the math is different. I wasnt sure whether a full face mask was used for the whole test. With a full face mask the air you breath in thru your mouth starts at cpap pressure rather than atmospheric pressure.
GeneS

Wulfman · Post by **Wulfman** » Thu Feb 21, 2008 9:53 am

sgass,

I just wanted to point out that even if a person were to purchase an Auto/APAP, they can still be run in single-pressure (CPAP) mode......if a person's sleep characteristics (snoring for one) caused the pressures to change too dramatically. That's what I do.....I run mine in CPAP mode.

Den

sgass · Post by **sgass** » Thu Feb 21, 2008 9:57 am

Ah, thank you ozij. I feel better now. She didn't say anything about O2, and spoke as if BiPAP was undesirable. So yes, I think she probably needs some more experience. And in general I'd feel a lot better if there was some tangible evidence that a doctor was actually involved in the process.

Now I can only hope that it won't actually be 2-3 weeks until the next step -- I wasn't aware of just how bad I feel until I experienced real sleep.

Thanks!
Steve

Gerald · Post by **Gerald** » Thu Feb 21, 2008 10:04 am

Sgass..........

Keep in mind that the main purpose of CPCP therapy is to maintain 93% or higher blood oxygen levels all night....every night.

If we have a few "snores"...so what? The purpose of CPAP is not to reduce snores......it's to keep us from suffocating. "Snores" are just a symptom of the "suffocation process".

So...whatever....or however we do it....is really an individual thing. All of us are a little different.....and it takes "different strokes for different folks" to get the job done.

Sufficient O2 is the actual goal that all of us seek.

Gerald

Guest · Post by **Guest** » Thu Feb 21, 2008 2:25 pm

As I've said before, I just don't understand why all the people with "mouth breathing" problems, instead of trying giant rubberbands around their heads or taping their mouths shut like a hostage or other silly things, don't instead merely use a full-face mask. Open your mouth all you want, "mouth breathe" all you want, it doesn't matter. Take nice huge high-capacity mouth breaths. And it's particularly excellent when you have a cold.

Full-face masks just don't "get their due" in the industry, it seems. 90% of what I see is about nasal masks, and given the problems with "mouth breathing" and usage with a cold or sinus problems, problems which full-face masks eliminate entirely, I do wonder why full-face masks aren't mentioned more often and aren't more popular... in fact, I wonder why they're not the industry DEFAULT, with nasal interfaces only being a second-line alternative for clastrophobic people.

Go figure....

neverbetter · Post by **neverbetter** » Thu Feb 21, 2008 3:10 pm

I agree. when the hybrid came out I didn't have to worry about taping my mouth shut any more.

Wulfman · Post by **Wulfman** » Thu Feb 21, 2008 4:47 pm

Anonymous wrote:As I've said before, I just don't understand why all the people with "mouth breathing" problems, instead of trying giant rubberbands around their heads or taping their mouths shut like a hostage or other silly things, don't instead merely use a full-face mask. Open your mouth all you want, "mouth breathe" all you want, it doesn't matter. Take nice huge high-capacity mouth breaths. And it's particularly excellent when you have a cold.

Full-face masks just don't "get their due" in the industry, it seems. 90% of what I see is about nasal masks, and given the problems with "mouth breathing" and usage with a cold or sinus problems, problems which full-face masks eliminate entirely, I do wonder why full-face masks aren't mentioned more often and aren't more popular... in fact, I wonder why they're not the industry DEFAULT, with nasal interfaces only being a second-line alternative for clastrophobic people.

Go figure....

Being the mouth-breather I was, I never even considered anything other than a full face mask. I would feel more claustrophobic having everything all taped/strapped shut. I DO get claustrophobic in tight, cramped spaces, but I've never really had that problem with a full face mask in that regard.

Den

OutaSync · Post by **OutaSync** » Thu Feb 21, 2008 4:58 pm

If they would make a full face mask that would fit all faces (especially small, thin faces) , there wouldn't be a problem. You would think they would put more effort in to that. Go figure.

roster · Post by **roster** » Thu Feb 21, 2008 5:02 pm

neverbetter wrote:I agree. when the hybrid came out I didn't have to worry about taping my mouth shut any more.

Ditto.