Help! CANNOT ADAPT

[Jack o]

10 days with CPAP – a horror – swallowing lots air with both full face and nasal with chin strap. Mouth breather big time. Continuous leaks – high cheek bones – no mask fits well – when moving from back to side and side to back leaks start all over- right , left, top and bottom. CPAP prescribed pressure is 14. When able to sleep for 2-3 hrs – wake up filled with air/gas and cannot sleep again for 2-3 hours both full mask and nasal - I have mild sleep apnea (16 episodes per hr.) Next: plan to try dental device? Tried dental 5 years ago and found claustrophobic hooking the top of mouth to the bottom? I am pre – diabetic, and take lipitor and BP medicine (under control), have low blood oxygen hemoglobin 17.4.



Any suggestions --- CPAP, Dental or other ???? Jack O

[Pugsy]

What brand and model machine are you using? Wonder if you could get by with less pressure which would maybe lessen the air swallowing or maybe a bilevel pressure machine which is normally the next step when aerophagia is a significant problem.

Aerophagia is the air swallowing thing.
wiki/index.php/Aerophagia

If your machine is a ResMed machine using EPR we can make it work sort of like a bilevel machine but 3 cm reduction may not be enough relief.

[Jack o]

Using a ResMed s9 series and Resmed masks and a Forma.

[49er]

10 days with CPAP – a horror – swallowing lots air with both full face and nasal with chin strap. Mouth breather big time. Continuous leaks – high cheek bones – no mask fits well – when moving from back to side and side to back leaks start all over- right , left, top and bottom. CPAP prescribed pressure is 14. When able to sleep for 2-3 hrs – wake up filled with air/gas and cannot sleep again for 2-3 hours both full mask and nasal - I have mild sleep apnea (16 episodes per hr.) Next: plan to try dental device? Tried dental 5 years ago and found claustrophobic hooking the top of mouth to the bottom? I am pre – diabetic, and take lipitor and BP medicine (under control), have low blood oxygen hemoglobin 17.4.



Any suggestions --- CPAP, Dental or other ???? Jack O

Hi Jack,

If you're interested in pursuing dental appliances, here is a copy of summary I posted of a study whose URL has disappeared. You also might want to visit http://www.apneasupport.org/sleep-apnea ... n-f20.html and look for posts by SleepDent. By the way, he also likes the TAP appliance alot that was used in the study. But since your apnea is right at the beginning of the moderate range, you might have more options.

Best of luck to you.

I just found what looks like a great study comparing the success rate of fixed dental appliance with ones that are adjustable which turns out to be the TAP appliance. Not sure what the fixed one was. A successful outcome was considered to be an AHI of 5 or below.

Unfortunately, I tried to repost the table of results but the formatting was lost when I pasted the information in this post. But the highlights were that for mild apnea (average AHI of 9.6), the success rate for the TAP was 73.4% and 63.8 for the fixed.

The success rate for moderate apnea was lower than I expect which was 52.2% for the TAP. I had previously thought that was around 60%. But interestingly, according to the table for people with AHIs of 20-29, the success rate does end up near 60%.

For the fixed appliance, it is 35%.

For severe apnea, the success rate for the TAP is 44.62% which actually was higher than I initially thought. But again, certain AHI ranges in the severe category had a higher success rate at 60%. These turned out to be from 35 to 44.

For the fixed appliance, it is 37.8. which is higher than it is for the moderate range

[Pugsy]

Which model S9 ResMed...name is on the machine up by the LCD screen.

Are you using EPR which is the exhale relief feature available on the S9....1, 2 or 3 cm reduction of pressure during exhale.
Sometimes that 3 cm reduction allows for enough relief that a person can significantly reduce the aerophagia issues.

Model name is important because some of the models have data where a person can evaluate their therapy along with a pressure reduction to see if there is a point where the OSA is adequately controlled without introducing the air swallowing thing.

If you aren't using EPR...turn it on and use it at the highest reduction which is 3 cm and see if that helps.
If you are already using 3 EPR then never mind what I just said.

[Todzo]

10 days with CPAP – a horror – swallowing lots air with both full face and nasal with chin strap. Mouth breather big time. Continuous leaks – high cheek bones – no mask fits well – when moving from back to side and side to back leaks start all over- right , left, top and bottom. CPAP prescribed pressure is 14. When able to sleep for 2-3 hrs – wake up filled with air/gas and cannot sleep again for 2-3 hours both full mask and nasal - I have mild sleep apnea (16 episodes per hr.) Next: plan to try dental device? Tried dental 5 years ago and found claustrophobic hooking the top of mouth to the bottom? I am pre – diabetic, and take lipitor and BP medicine (under control), have low blood oxygen hemoglobin 17.4.

Any suggestions --- CPAP, Dental or other ???? Jack O

Hi Jack O,

Probably your best hope is to spend quality time with the machine during the day. Part of it laying on your bed getting used to all of your regular sleeping positions and moving too them. Part of it with minor distraction such as listening to music, on the computer, reading a book, watching light TV.

Keep in mind that you are developing new breathing reflexes. The machine makes it easier to inhale so you will tend to inhale too much. It resists your exhale which tends to throw that part of the cycle off. With all of the daytime awake resources you should be able to calm things down and become at ease with the machine. Indeed, you need to learn to breath very gently – you are going to be asleep after all.

I would recommend an hour a day for the next couple of weeks – until you have better nights. Start about half each kind of time (in bed, light distraction). If you can do more time – great!

I am not sure what you mean by “ low blood oxygen hemoglobin 17.4”. Blood oxygen (SpO2 measured by fingertip oximeter) would be considered low around 90%. Hemoglobin (Hgb) would be in the normal range for an adult at 14 to 18 gm/dL so the number you mentioned would be in the high normal range. I think that either number being low would affect your breathing reflexes and make CPAP a bit harder to get used to.

May we find good answers!

Todzo

[Jack o]

Model is "Elite". To be honest I have not read thru the book and don't know if it has EPR. I need to read. Thanks.

I agree - need to learn machine in day hours. My Nephrologist is the one that sent me to the sleep apnea doctor due to low oxygen in blood combined with high protein in urine. I think the high # 17.4 means oxygen is on the low side. The doctors in this area use 17 not 18 as the end of the high limit of the range (blood test results show 17 max in range. The nephroligist also sent me to a Hemotologist before and he had no concern with the 17 and also told me that there were 2 different ranges being used. Maybe my 16 episodes per hr. is OK and I should stop thinking too much.

[STL Mark]

Assuming you have good insurance I would work with the sleep doctor and DME's respiratory therapist to find out what can be done temporarily to keep you compliant. Once compliance was no longer an issue and your body had adjusted the pressures could be returned to the normal therapy settings.

[Pugsy]

The book you have probably doesn't have all this information in it.
So read this
http://www.apneuvereniging.nl/forum/pdf ... manual.pdf
Your EPR may or may not be turned on
and Sleep Quality may be set to "Usage"....set it to "On" to be able to utilize the data that the S9 Elite gathers.
You can use SleepyHead or ResScan.

[this-sucks]

like said sleep docs the place you got it from usually has sleep therapist to help you

leaks how do you sleep on back on side roll around i sleep on my back if you put a rose on me i would look dead

side and movers have more troubles with leaks

and it sounds like you need bi-pap bi-level only a few can take the constant pressure machines

air gas etc like said get used to it let it do the breathing like life support it does the work

look at forums the mouth and other non medical prescribed stuff is bad i have heard jaw dislocation etc from those gimmicks

if your mild check into surgery or pills mild has more options then us severe ones

good luck it gets better

[robysue]

Jack o,

Looking for some clarification here.

You write:

My Nephrologist is the one that sent me to the sleep apnea doctor due to low oxygen in blood combined with high protein in urine. I think the high # 17.4 means oxygen is on the low side. The doctors in this area use 17 not 18 as the end of the high limit of the range (blood test results show 17 max in range. The nephroligist also sent me to a Hemotologist before and he had no concern with the 17 and also told me that there were 2 different ranges being used. Maybe my 16 episodes per hr. is OK and I should stop thinking too much.

It sounds like you're confusing results from two different tests. Are the 17.4, the 17, and the 18 referring to results from a blood test or a urine test that the nephrologist ordered that's the case, then they do not directly have anything to do with the AHI.

An AHI = 16 means that in every hour of sleep there is an average of 16 times that you stop breathing or almost stop breathing for at least 10 seconds. That works out to be an average of a breathing problem a bit less than every 4 minutes or so.

An AHI = 16 is just above the cut-off between mild and moderate sleep apnea because the severity of sleep apnea is only measured by the number of times you stop breathing. But that's not always a good indication of the real impact the apnea has on the particular sufferer. Some people have pretty significant O2 desats even though their apnea is on the mild side. You may be one of them since your nephrologist sent you for the sleep test because some other test had already showed you have low oxygen in your blood.

And if your low oxygen levels are due to your OSA, then no, 16 events per hour is NOT ok and you definitely need to figure out a way of dealing with the problem.

[kaiasgram]

Jack o, you mention having tried a nasal mask -- do you mean nasal as in over the nose, or nasal pillows which go just under and slightly inside the nostrils? If you haven't tried a nasal pillow mask, it would be worth a shot. Less leaking, less "stuff" on your face, no pressure on the bridge of the nose, and can usually withstand a bit more tossing and turning during sleep. That doesn't solve the mouth breathing , but there are ways to work on that too.

A lot of the issues you're mentioning are things you can work on and we can help you with. Pugsy and robysue have pointed you in the right direction(s). Be patient, it's too early after 10 days to conclude that you cannot adapt.

And welcome to the forum.

[Jack o]

Clarification on the 17,17.6,18 numbers-

These refer to blood tests. Hemglobin is 17.6 and Hematocrit is 53.6. The Nephrologist believes these just out of range readings which mean low oxygen in the blood could be attributable to sleep apnea. That is the reason she sent me for the test as well as the high protein in the urine for many years. (I had no other symptoms, sleep fine and not tired). She believes sleep apnea could be the cause. The sleep study said I do have sleep apnea with 16 episodes per hour..

[Jack o]

I tried nasal pillow but kept sneezing and had to take off. Maybe just a 1 time thing and worth another try.. Thank you all.
Will read up and work on Resmed over the weekend - during the day when wide awake.

[Jack o]

Is Provent a viable alternative?