djam's therapy thread

[djams]

Uh oh. I posted my 100 this morning. I must have lost it. I've never seen Mr Smily.

Nah - that's OK. You'll find a myAir screenshot from me in this thread somewhere. It's the "Congratulations! You've earned a silver badge for..." any number of reasons. They make it easy to share these on FB - do that instead.

[babydinosnoreless]

I took PR advise and deleted mine before more saw it.

[djams]

Copying this post from the Bleep DreamPort thread here so that it's part of the "official record".

Well. Yesterday evening I got the best reward yet from using the DreamPort. My wife told me that she feels much better in the mornings "since you've started using that new mask. You don't wake me up so much".

I know that everyone hasn't followed my posts from the beginning - but this *IS* the reason that I made my initial visit to the sleep doctor. My snoring had gotten to the point that it prompted my wife to set up camp in a spare bedroom.

So this is a huge development. The initial goal of getting her moved back into our room happened pretty quickly. 04/24 I will have been at this for one year.

Hard to describe how happy I am about this. I didn't even call her out for calling it a mask.

[zonker]

Well. Yesterday evening I got the best reward yet from using the DreamPort. My wife told me that she feels much better in the mornings "since you've started using that new mask. You don't wake me up so much".

snoopy-dance.gif

[djams]

I've been using the Bleep DreamPort, and it's been allowing me to drop my min pressure. When I switched from FFM to nasal masks, I was able to reduce my min pressure from 12cm to 9cm. In conjunction with this I turned EPR off, as it didn't even remotely bother me with my min at 9cm. Once I started using the bleep, I've been able to lower my min pressure to 7cm and still maintain very low AHI. The drop in min pressure (along with knowing that my mask *isn't* leaking), has allowed me to come up with a mouth taping / beard trimming system that prevents me from mouth leaking the majority of the time.(4 strips of strategically placed tape).

I tried dropping my min pressure to 6cm, but I guess I found it uncomfortable because it was taking me much longer to fall asleep. AHI was fine - 0.0 to 0.5. But I changed it back to 7cm due to the falling asleep time. Then last night I remembered that Pugsy suggested that I add in some EPR, so I gave that a try. Decided to go straight to the full 3cm, putting my EPAP at 4cm. I was anticipating a somewhat elevated AHI. But it came in right on my average. The differences I see from "normal" in the chart below are 1) Pressure line is a more active than usual, 2) Both of these OA's are completely legit - not associated with an arousal. The vast majority of my events these days are all post-arousal.

EPR 3 was kind of unsettling when I first turned the machine on. But once I got settled in, ahh, nice - now I remember why I like it. But I'm certain I could adjust to 6cm min if I work my way down slowly.

So, after all that rambling. My question is: from a therapy point of view, is there any benefit to 6cm min with EPR OFF compared to 7cm min with EPR/3 as long as my AHI remains acceptable? For some reason, I'm uneasy about having my EPAP at 4cm. Thoughts?

[palerider]

, I'm uneasy about having my EPAP at 4cm. Thoughts?

There are two problems with an EPAP of 4...

1) Some people feel they're suffocating, not getting enough air.
2) It doesn't provide enough pressure to keep most people from having apneas.

If you're not having either of those problems... don't worry.

[Pugsy]

I use 7 minimum with EPR of 3...so I have 7/4. I like the way it feels. I am sure I wouldn't like straight 4 cm all by itself but with IPAP being 7 I find it quite nice. My AHI is nice and low most nights and when it's not it's 99% because of SWJ due to crappy sleep from back pain so I just shrug my shoulders and move on.

If you are happy with your AHI...and you are happy with the way it feels when you first mask up and turn the machine on and are comfortable...and you sleep good and feel good...use whatever you feel works for you.

My primary goal...good quality sleep as best I can and best chance I can get of feeling decent during the day. Numbers be damned and sometimes graphs be damned.

I did briefly try 6 with EPR at 2...I sort of started to feel a bit stifled...not quite enough air moving for comfort. I knew what it was and I knew I could probably get used to it but then I figured why should I??? So I didn't really work at trying to get used to 6/4....I am quite happy with 7/4 all the way around...comfort, therapy effectiveness, etc.

[Jas_williams]

Below are som concerns

Once you drop below 7 min with 3 EPR the amount of EPR becomes variable eg the minimum pressure the machine can give is 4 on exhale so when you start if your minimum is 6 with EPR 3 in actual real terms your actual pressures are 6/4 which is an EPR of 2 you dot get the full EPR of 3 until the min pressure is raised to 7.

Also some users feel suffocated at such low pressures

The pressure line changes can cause arrousals in some users.


If it was my graph I woul leave my minimum at 7 or 8

[Jay Aitchsee]

So, after all that rambling. My question is: from a therapy point of view, is there any benefit to 6cm min with EPR OFF compared to 7cm min with EPR/3 as long as my AHI remains acceptable?

No, whatever works for you is appropriate (comfort, measured results, restorative sleep).
Notice that your EPAP is only at 4 when your machine is not calling for higher pressure. When flow limitations are detected, IPAP and EPAP increase.

[djams]

I really appreciate all of the replies! Thanks.

In my last post, I didn't even state WHY I'm messing around with near perfection. I'm hoping to get to the point where I can sleep without taping my mouth. Pretty big omission.

The second night below. I can clearly see the detrimental effects of this change. Over the last 2 nights I've had 5 OA's. One of the OA's last night woke me up, it's at a time when I looked at the clock. Looking back, the last OA's that I had were on 03-13 and I had 2 that night. I can see benefits as well - so far two nearly perfect leak lines, and no waking up with chipmunk cheeks. I'm a really heavy sleeper, but for some reason a mouth leak will wake me up in an instant. I could provide examples where a mouth leak of 3L causes a little arousal in my flow chart.

I'm going to keep all of the great advice in mind, and ride this out for a spell. See where the numbers go, and how I feel. Honestly, hard to believe that I could feel much better than I do right now. With the EPR at 3 though, it feels like I'm just exhaling normally - and maybe (big maybe) I'll one day sleep without taping. I'm still wearing the scunci every night over my tape. It really helps on the nights where my tape fails. Which I'm finding is a signal to trim my beard.I have to keep it nice and short.

EDIT: adding the chart. oops

[Jay Aitchsee]

In my last post, I didn't even state WHY I'm messing around with near perfection. I'm hoping to get to the point where I can sleep without taping my mouth.

I understand that, I've done the same. Using EPR not only feels good, it lowers the overall effective pressure, helping to keep mouth leaks at bay. I, too, have used 7 with an EPAP of 3 to do just that. I've found that limiting IPAP max is also helpful. Currently, I'm finding auto 6-8, EPR3, effective. Of course, everybody's MMV.

[djams]

In my last post, I didn't even state WHY I'm messing around with near perfection. I'm hoping to get to the point where I can sleep without taping my mouth.

I understand that, I've done the same. Using EPR not only feels good, it lowers the overall effective pressure, helping to keep mouth leaks at bay. I, too, have used 7 with an EPAP of 3 to do just that. I've found that limiting IPAP max is also helpful. Currently, I'm finding auto 6-8, EPR3, effective. Of course, everybody's MMV.

Thanks Jay. I hadn't even considered limiting IPAP max (blasphemy!!!!). Another idea for my bag of tricks. Appreciate it.

[Jay Aitchsee]

You know, those OA's might not be real. Could be inhaling through the mouth for more than 10 seconds. As a mouth breather, you may occasionally do this. When inhaling through the mouth while wearing a nasal interface for more than 10 seconds, the machine detects no flow and scores an apnea. Problem is, I know of no way to tell for sure by examining the flow whether they are real or not. Zooming in could show some preceding mouth exhales and one could guess that OA's following could be mouth inhales, but it is not definitive. Also, one might expect to find some Flow Limitations and hypopneas preceding an OA, but again, not necessarily. So, ???
Something else to think about.

[zonker]

I really appreciate all of the replies! Thanks.

In my last post, I didn't even state WHY I'm messing around with near perfection. I'm hoping to get to the point where I can sleep without taping my mouth. Pretty big omission.

well, i'm going to follow this more keenly, then. i, too, tried sleeping without anything over my mouth. i was just wondering if my mouth had been properly trained to the point where i wouldn't need anything.

alas, for me, it wasn't to be. for one thing, i discovered that the scunci rig across my mouth helped press the p10 a bit more against my nostrils thus cutting down leaks.

for another thing, i found that my bottom lip would still slide down and cause me to wake up. so, will continue with it for the present.

hope you have good luck in trying to get rid of the taping.

[djams]

You know, those OA's might not be real. Could be inhaling through the mouth for more than 10 seconds. As a mouth breather, you may occasionally do this. When inhaling through the mouth while wearing a nasal interface for more than 10 seconds, the machine detects no flow and scores an apnea. Problem is, I know of no way to tell for sure by examining the flow whether they are real or not. Zooming in could show some preceding mouth exhales and one could guess that OA's following could be mouth inhales, but it is not definitive. Also, one might expect to find some Flow Limitations and hypopneas preceding an OA, but again, not necessarily. So, ???
Something else to think about.

I'm still taping in the recent screenshots. So hopefully not trying to mouth breathe. That sounds stressful.

It's very unusual for me to have an obstructive apnea without a FL - I'm not sure I've ever seen one without the other in my charts.

You bring up interesting thoughts here, and I'll keep then in mind. Here is an OA from last night, the one that woke me up. There's a little-bitty FL going on, so I included that too.