My snoring and flow limitation events and min pressure

[RRL]

I'm almost two weeks into my therapy. Although my AHI has hovered around 1.0, the snoring and flow limitation events have been significant - in fact, they have actually increased since I started using a chin strap. I mouth-breathe when I sleep, so using a chin strap is needed with the Wisp nasal mask. The Sleepyhead data shows many snores and FLs are followed by pressure increases, so it seems these events are significant enough to warrant minimum pressure adjustments.

My minimum is 8 cmH2O and max is 15. Last night I increased the minimum to 9 - the data doesn't seem to show much of a difference in terms of the snoring and flow limitations and subsequent pressure increases, so I am planning to increase the minimum pressure to 10 tonight. I've read various posts about snoring, pressure, masks etc. which has been helpful. I know it varies how long it takes for a person to notice improvements after starting therapy, so I am trying to be patient...I have not noticed any improvements yet, despite a low AHI.

So, I figured trying to address this snoring and FL business may help optimize my therapy. I've been hesitant to tinker with the Rx'd pressure range due to fear of 'getting in trouble' or having issues with insurance, but at this point I feel like I am being active in trying to improve my treatment efficacy my making data-informed tweaks. So, tonight I'll try increasing to a minimum of 10. I know increments of 0.5 have been suggested, but I feel like being more 'aggressive.' Please let me know if you have any comments, observations or suggestions. Thanks!

Here is Thursday night at 8 cmH20 minimum pressure:



Here is last night at 9 minimum pressure:



Edit: I've read of users experiencing a halt to their snoring when changing to pillows, but I've also seen users state that mask type does not impact snoring. In any case, I'm going to try to get an appointment to try on some new masks this week before the 30 days is over.

[Wulfman...]

Keep increasing your minimum till things get to looking better (fewer events) and improves your therapy.
Chances are, you'll need to get your minimum up to around 12 cm. and you'll see sub-1.0 AHIs and maybe less snoring and FLs.

Are you doing nasal cleansing before bedtime? Pressures mainly increase on snores and flow limitations, so if you have some nasal congestion, that can exacerbate both of those situations.


Den

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[palerider]

. I mouth-breathe when I sleep, so using a chin strap is needed with the Wisp nasal mask. The Sleepyhead data shows many snores and FLs are followed by pressure increases, so it seems these events are significant enough to warrant minimum pressure adjustments. ...
Edit: I've read of users experiencing a halt to their snoring when changing to pillows, but I've also seen users state that mask type does not impact snoring. In any case, I'm going to try to get an appointment to try on some new masks this week before the 30 days is over.

chin straps can push your chin back, narrowing your airway, and causing more flow limitations, and apneas.

some people have more luck with a cervical collar to help keep their jaw closed, though neither will stop mouth breathing, since you can easily breath with your jaw clenched, since teeth aren't airtight.

full face masks also can have the effect of pushing your jaw back, and thus can, for some people, have an effect on FL and apneas and snoring and such.

[RRL]

Keep increasing your minimum till things get to looking better (fewer events) and improves your therapy.
Chances are, you'll need to get your minimum up to around 12 cm. and you'll see sub-1.0 AHIs and maybe less snoring and FLs.

Are you doing nasal cleansing before bedtime? Pressures mainly increase on snores and flow limitations, so if you have some nasal congestion, that can exacerbate both of those situations.

Thanks for the advice, Wulfman..., I'm hoping an increase to 10 tonight will reduce the snoring, FLs, and pressure increases. I'm not doing any nasal cleansing before bedtime, but will explore options.

chin straps can push your chin back, narrowing your airway, and causing more flow limitations, and apneas.

some people have more luck with a cervical collar to help keep their jaw closed, though neither will stop mouth breathing, since you can easily breath with your jaw clenched, since teeth aren't airtight.

full face masks also can have the effect of pushing your jaw back, and thus can, for some people, have an effect on FL and apneas and snoring and such.

Thanks for the info, palerider. It makes sense that chin straps can push the chin back....I've been conscious of this fact when using the chin strap, adjusting it to minimize the chances of this happening, but it might still be pushing back some. Even though mouth-breathing will occur to an extent with either, I'll consider the cervical collar option as an alternative. I didn't know full face masks can also have an effect on FL, apneas and snoring for some people by pushing the jaw back, so I'll avoid them when exploring new masks.

[Holden4th]

Wouldn't mouth breathing show up as large leaks on your nightly data?

[palerider]

Wouldn't mouth breathing show up as large leaks on your nightly data?

not necessarily.

I use nasal pillows, and I can mouth breath, without any cpap air coming out my mouth... if I do it long enough, the machine records an obstrucive apnea. it all depends on what exactly is happening, and how much air is leaking.

[RRL]

Increasing my minimum pressure to 10 seemed to improve things. I had only 10 snoring events, which is the lowest I've had yet. Also, none of the snoring events led to a pressure increase, which happened with most of the numerous snoring events over the past two weeks. AHI was 0.50, which is the lowest I have seen so far. There were fewer FL events than usual. Although I've had nights with fewer FLs, those nights were typically characterized by frequent snoring events with subsequent pressure increases and more hypopneas and apneas.

I'm going to continue with this new minimum pressure level and see if the improvements continue. If at my 'treatment efficacy' follow-up appt. next month my doctor happens to notice that I changed the minimum pressure and responds negatively, I plan to provide before and after screenshots to show him why I did it and that it has helped.

The Wisp continues to be generally comfortable with minimal leaks, but it has caused some middle nose irritation and some on the sides of the nares. I tend to experience flares of dermatitis around my nose even without a mask touching the face, so I figure it makes some sense to try nasal pillows - though I know they can have their own irritation issues. I was hoping to try the AirFit P10 pillows, but I got the impression they only carry PR masks/pillows like the Nuance or Dreamwear since the manikin was wearing Dreamwear. I guess it doesn't hurt to make an appointment and try some new masks, as long as I can return to the Wisp if they don't work out. Thanks for all of your assistance!

[OkyDoky]

but it has caused some middle nose irritation and some on the sides of the nares.

Try Lansoinoh for the mask irritation. It can be found in the baby area of most stores. It is used by breast feeding mothers and new mask users . It usually doesn't take long before it's no longer needed.

[Julie]

And just in case you haven't been made aware of it, sleeping on your back causes many more events, so whatever you can do to change that if it applies would be a good idea.

[RRL]

Thank you for the suggestions! Last night I continued with 10 cmH2O min. pressure and AHI remained low at 0.58. FLs were still lower and snoring events relatively minimal. Only one pressure increase due to FL and none due to snoring events. Moving from 8 to 10 has definitely decreased the snoring events, FLs, pressure increases and AHI. I plan to try 10.5 tonight to see if I can further decrease the numbers.

As an example of the improvement, below are two nights with AHI below 1.0. First is minimum pressure 8 and second is 10.

[Wulfman...]

Lookin' good!

If you want to eventually eliminate those pressure spikes/probes (if they're disrupting to sleep), setting the minimum and maximum to the same pressure or going to straight CPAP mode will do it.


Den

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[RRL]

Thanks! I was wondering about the constant spikes/probes....will definitely consider your suggestions. I'll wait until after I see the doctor for my first follow-up to make any more changes to minimize the chances of him noticing my 'tinkering' with the Rx.

[palerider]

Thanks! I was wondering about the constant spikes/probes....will definitely consider your suggestions. I'll wait until after I see the doctor for my first follow-up to make any more changes to minimize the chances of him noticing my 'tinkering' with the Rx.

first, remember your doctor works for you, if he doesn't like what you're doing, fine one who likes having patients involved in their care.

second, those spikes, while they look huge on the zoomed scale of the pressure graph, are insignificant. though if you want to be sure, zoom in one some of them, (arrow keys or mouse clicking, right click to zoom out) and look at your breathing pattern around them, in most cases, there's no change.

[RRL]

Good point about the doctor. I was thinking (if he noticed the changes) he would be pleased that a patient was compliant and trying to optimize their treatment, but I guess he could be very 'by the book' and have the 'I'm the doctor;not you' attitude. If he does have that response, I agree it makes sense to find one who likes having patients involved in their care. It's not like I'm doubling my dose of medications or making drastic changes here, and what I've done was based on my therapy data and has helped - so I don't see it like I was acting recklessly or putting myself at risk.

I get what you mean about the pressure spikes being insignificant. My (very limited) understanding is that this machine consistently creates these spikes in APAP mode to 'check' for any issues that need to be addressed. Is this accurate? If not, please share your knowledge about this topic so that I understand it properly. Thank you for your comments!

[Wulfman...]

Good point about the doctor. I was thinking (if he noticed the changes) he would be pleased that a patient was compliant and trying to optimize their treatment, but I guess he could be very 'by the book' and have the 'I'm the doctor;not you' attitude. If he does have that response, I agree it makes sense to find one who likes having patients involved in their care. It's not like I'm doubling my dose of medications or making drastic changes here, and what I've done was based on my therapy data and has helped - so I don't see it like I was acting recklessly or putting myself at risk.

I get what you mean about the pressure spikes being insignificant. My (very limited) understanding is that this machine consistently creates these spikes in APAP mode to 'check' for any issues that need to be addressed. Is this accurate? If not, please share your knowledge about this topic so that I understand it properly. Thank you for your comments!

Well, I said "IF" (they're disrupting to your sleep). Some people think they're insignificant and to others they MAY be. You have to decide for yourself. I never tolerated the pressure probes very well. That's one reason I chose to use straight pressure.
But, to me they're like somebody poking you while you're sound asleep......asking......"you OK?"......"you OK?"......"you OK?"......
It's one of the things about Respironics machines that I've disliked. And, they've been doing that since they developed their APAPs. All of my 10 yr. old APAPs do that, too. At best, it's annoying. At worst it could be disrupting.

And, about your doctor. Always be sure to take copies of your reports to substantiate your reasoning for your changing your settings. They DO work for YOU.


Den

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