Need help, suspect UARS. Want to try APAP - need advice and guidance.

[Pugsy]

Were you thinking that the 95% pressure number meant that was where you were at in terms of pressure for 95% of the night or an overall average?
If so....wrong.

All it reflects is where you were at OR BELOW for 95% of the night. It's just a number and in fact just a number that is very easily skewed to the high side with a relatively short period of time at the higher number.

Same thing for a 95% number...at OR BELOW.
The or below part is real important but often people forget or don't know about the "or below' part of the definitiona.

[canyouhearmeaya]

Were you thinking that the 95% pressure number meant that was where you were at in terms of pressure for 95% of the night or an overall average?
If so....wrong.

All it reflects is where you were at OR BELOW for 95% of the night. It's just a number and in fact just a number that is very easily skewed to the high side with a relatively short period of time at the higher number.

Same thing for a 95% number...at OR BELOW.
The or below part is real important but often people forget or don't know about the "or below' part of the definitiona.

LOL. Clearly you've answered that before. Yes I thought it meant that was where I spent 95% of the night.. doh!

If I look at the pressure graph, it does seem that I spend most of the time at 8-9 if you took a mean.. Reckon it's worth cranking it up to 8 tonight, and seeing if that works any better?

[Pugsy]

Clearly you've answered that before.

Probably thousands of times.

If I look at the pressure graph, it does seem that I spend most of the time at 8-9 if you took a mean.. Reckon it's worth cranking it up to 8 tonight, and seeing if that works any better?

I don't know if you need more pressure or not but what you do need to do is quit changing settings willy nilly unless there is an obvious need.
Pick a setting and stick with it and don't change a damn thing for at least 2 weeks.
Keep a detailed log about your sleep quality and how you felt.
One of your main problems is your impatience and not giving anything much of a chance. There is a lot of truth to the "give the body time to adjust" thing.

Until you sleep soundly for the most part and thus eliminate the chance of SWJ messing with your data and what the machine might do...you are spinning your wheels.

[palerider]

Were you thinking that the 95% pressure number meant that was where you were at in terms of pressure for 95% of the night or an overall average?
If so....wrong.

All it reflects is where you were at OR BELOW for 95% of the night. It's just a number and in fact just a number that is very easily skewed to the high side with a relatively short period of time at the higher number.

Same thing for a 95% number...at OR BELOW.
The or below part is real important but often people forget or don't know about the "or below' part of the definitiona.

LOL. Clearly you've answered that before. Yes I thought it meant that was where I spent 95% of the night.. doh!

If I look at the pressure graph, it does seem that I spend most of the time at 8-9 if you took a mean.. Reckon it's worth cranking it up to 8 tonight, and seeing if that works any better?

Here's a thorough explanation of what those numbers actually mean:

http://adventures-in-hosehead-land.blog ... de-to.html

[ChicagoGranny]

my mouth was BONE dry this morning.. How do I explain that? I 100% know full well the CPAP caused it

CPAP can't cause dry mouth.

Now, some part of your CPAP therapy could cause dry mouth. One possibility is your tape was leaking air, and indeed, air was "rushing" through your nasal passages and out through the leaking tape over your lips.

Also chicago, any comments on pressures based on last nights data?

Some people love EPR, and some don't like it. Your pressures are relatively low. How do you like EPR of 3?

[canyouhearmeaya]

my mouth was BONE dry this morning.. How do I explain that? I 100% know full well the CPAP caused it

CPAP can't cause dry mouth.

Now, some part of your CPAP therapy could cause dry mouth. One possibility is your tape was leaking air, and indeed, air was "rushing" through your nasal passages and out through the leaking tape over your lips.

Also chicago, any comments on pressures based on last nights data?

Some people love EPR, and some don't like it. Your pressures are relatively low. How do you like EPR of 3?

Turns out the tape still allows air through, so it was leaking out of my mouth even with it taped. Still happened quite a few times last night also, will have to try different tape and see if I can stop that happening as it keeps waking me up through the night.

I guess my question would be, why would anyone NOT use EPR? What's the disadvantage? It just seemed to me to make breathing/exhaling easier with the machine.

Could having EPR on 3 reduce the quality/effectiveness of my therapy?

[ChicagoGranny]

Could having EPR on 3 reduce the quality/effectiveness of my therapy?

Since your therapy is going well, let's not go here at the moment. If you like EPR 3, continue to use it.

[palerider]

I guess my question would be, why would anyone NOT use EPR? What's the disadvantage? It just seemed to me to make breathing/exhaling easier with the machine.

There are a couple reasons not to use EPR... primarily, because the user doesn't want it... it's mainly for comfort, if it doesn't do any good for someone, they may just not want it. It can cause mask movement because the mask inflates and deflates a little as the pressure changes.

For some people, EPR can cause an increase in central apneas to the point where they're worth doing something about.. (A small number of centrals an hour are insignificant).

Could having EPR on 3 reduce the quality/effectiveness of my therapy?

Since EPR results in a pressure drop, it can reduce the effectiveness of therapy if pressure is too low. for instance:

assume someone needs 9cm pressure to alleviate events.. they've got their pressure set at 10.. all is good, then they decide to turn EPR to 3... that drops the pressure between inhales to 7... now their throat closes up, and they have events.

The answer, of course, is simple, just raise the set pressure so that the epr dropped pressure is high enough.

[Pugsy]

I like EPR...feels more natural to me so I am more comfortable and for me more comfortable equals I sleep better and anything that helps me sleep better or longer is fair game.

If my using EPR allowed a few more events to slip past the defenses than I wanted to see...I would just increase the minimum pressure a bit to compensate for it. If my machine would give me 4 cm EPR...I would be using that.

Now someone else might not like how EPR feels for whatever reason...that's okay too.
Use whatever feels good so you don't have to fight anything or have mental stress or whatever.

The name of the game...good quality sleep so anything that you can do to help it out...do it.

Yes, sometimes EPR can cause centrals but that is really rare and if it happens there are ways to deal with it.

[canyouhearmeaya]

Well, fewer centrals last night, not sure why but that's good. Hopefully as my body adjusts to CPAP they will reduce. My biggest issue right now is the mouth leaking. The problem is the tape is coming a little loose in the night, and then I'm attempting to mouth breathe at times for some reason causing the air to leak, which then wakes me up, rinse and repeat.

Do leaks look a bit high in general? Any other data that stands out to address? Thanks

Edit: GRR, board is messing up and won't allow me to attach the image, giving a HTTP error. Will have to post later.

[Pugsy]

You can use imgur.com for hosting your report images. That's what we have done for years since it's just recently got the ability to do attachments here at the forum.

[canyouhearmeaya]

There we go! Couldn't even get an img tag embed to work earlier, must have just been a funny 5 minutes!

[Pugsy]

Quit worrying about the centrals. Some are probably SWJ from when you woke up briefly and even if they were all the real deal there's not enough of them to worry about. Some central flagging is entirely normal...as in sleep onset central....and when you have a wake up and go back to sleep..there's another likely chance for another sleep onset central to get flagged.

So how many times do you think you woke up last night? Any known special reason for the times you did wake up?
How do you feel this morning?

[canyouhearmeaya]

Quit worrying about the centrals. Some are probably SWJ from when you woke up briefly and even if they were all the real deal there's not enough of them to worry about. Some central flagging is entirely normal...as in sleep onset central....and when you have a wake up and go back to sleep..there's another likely chance for another sleep onset central to get flagged.

So how many times do you think you woke up last night? Any known special reason for the times you did wake up?
How do you feel this morning?

I'm not worried about them, just good to see them go down. Ultimate aim is as little disruption as possible, right? (On the basis that equates to best quality sleep, which is the real goal lol!)

Over the last 3 nights, the times I recall waking up were due to mouth leaks. How many times I don't know, as it's those half concious wakings where you go straight back to sleep.. However I certainly feel it was happening quite a few times, maybe 10 or so. (Although I can't accurately say in honest, could be 5, could be 50. That's the problem with sleep disruption, at least for me, I'm always in such a hazey half asleep state that I can't accurately recall.)

How do I feel? Hard to say. I certainly don't feel anything drastic yet, but it's been 3 nights - and equally I might still need to adjust my pressures etc yet. I don't feel worse, so that's a positive.

I really need to find a solution to stop the mouth leaking, as right now that seems to be the most obvious disruption. I do have a chin strap, which I've never actually used as it didn't feel all that comfy but I might give that a go tonight. I've spent the last month working on tongue posture, learning to correctly keep my tongue on the roof of my mouth which I'd never known was normal until a month ago, however it would seem that isn't happening all night yet, hence the leakage. Hopefully it's something my subconcious will engrain over time and resolve the issue.

I feel like currently I have 3 options to play with to see how therapy varies:
- Min/Max Pressures
- EPR (Currently on 3, so could try 2,1,0)
- Humidity (Currently manually set to 5, as felt 'auto' was too high. May even try nudging this down to 3 just to see if it feels any better/worse.)

I've still been waking up 'groggy', have yet to wake up feeling 'refreshed' per say.

I must admit, part of me really wants to try cranking up the min pressure from 7 to 8 tonight, just to see how that goes. I feel super confident with the machine now, I can breathe so easily with it. I really do think that last machine I had was faulty, and it was so obviously uncomfortable to breathe, I was perplexed as to how ANYONE could 'get used' to that. Where as this machine out of the box, felt good to breathe with. At no point have I felt remotely like I was struggling to exhale/suffocating. It's good, because although I don't necessarily feel any benefit from therapy yet, I feel no hesitation with the machine. The fact that I can breathe easy with it too, also makes the noise bareable! I don't think this one is any quieter, but I think the fact I can breathe comfortabley and relax allows me to not notice the noise, whereas last time around where I was constantly in a state of discomfort, my senses were noticing every stimulus.

With the last machine I couldn't even imagine ever getting used to it. This one, after 1 night I was at total ease with it. Doesn't seem remotely weird at all now, it's like my mind and body is in harmony with it lol! Ofc it could be argued that it's psychological, and no one can prove either way, but I have to say i'm VERY inclined to say it isn't. The difference in ease of breathing with the last machine and this one is night and day. The ONLY other factor I consider that could have changed it is tongue posture.. Which, could actually be a very feasible answer, as tongue posture has so much influence on breathing and the airways. Either way, I'm happy, as I can finally give this CPAP business a real crack, without feeling like I'm being dragged through hell!!

[Pugsy]

Whatever you do...make one change only at a time and be prepared to stick with that change for 1 week before changing anything else unless the results are just disastrous for some reason or other.

Keep a detailed log of how you feel you slept...hours slept...number of wake ups (approx) and how you feel in general.
Along with documentation of any extra stuff you might be doing for leak control. You need to be able to look back at the log and make accurate comparisons and don't rely on your memory.

My suggestion...work on leak control and minimizing those wake ups first because without the leak control being optimized it's really futile to go changing all that other stuff.
If the leaks didn't wake you up...I wouldn't worry about them..for the most part they are well within the machine's ability to compensate.