New User (Oscar Data now attached)

[Ograx]

The second test actually occurred before the first that is my bad posting them in wrong order.

So last night AHI hit 1.8 and leak rate was 14l with mouth tape that lasted for half night before it bursted out somewhat.

Bottom line I slept like crap and dont feel great and definitely swallowed alot of air. (Bloated)

Should I dial back the minimum pressure from the 6.6 it is at now back down to 4 and live with the 2.~ or so AHI I get at that reading and not have to deal with the large mouth leaks and mouth tape etc. or should I keep pressure or keep upping it and try to deal with the leaks.

Are the mouth leaks something the body can adapt to? (Ive been doing the tongue on mouth roof trick for last few days)

[Pugsy]

Don't decrease the 6.6 minimum pressure just yet.

Add in EPR and let's see what happens....It's the first thing we suggest for fighting the air in the belly issues.
Go full out... turn EPR on full time and set it to 3 and see what happens.

If the leaks didn't wake you up....14 L/min 90/95% number is well within the machine's ability to compensate for that leak no matter where it is from.

Getting decent sleep quality is going to be very important...without it we feel like crap no matter how low the numbers are.
Get the sleep first...then we worry about minor tweaking of the settings to optimize things.

[Ograx]

So turn on the EPR full time for tonight and what about the mouth tape? Try the EPR without tape for the night?

[Pugsy]

Mouth taping is to help with mouth opening leaks.
I don't see EPR making any difference but you never know. Your choice but if it were me I would tape just to see what happens..
Remember Science 101??? Keep your variables to a minimum if you can so you can best judge what caused a result.
Especially if you are waking often when the mouth pops open and air pressure enters the mouth and creates a tornado when it goes out the mouth and wakes you up.

Maybe try without tape later once you figure out if using EPR helps with the belly issues.
That's the main reason for using EPR right now....the bloated belly...aerophagia.

[Ograx]

So after reading up on the EPR setting I have a few more questions.

Some people this setting actually makes things worse for so what should I look out for?

[zonker]

So turn on the EPR full time for tonight and what about the mouth tape? Try the EPR without tape for the night?

btw, seeing how you are having trouble with the tape, may i suggest an alternative?

viewtopic/p1089718/viewtopic.php?f=1&t= ... s#p1086296

this doesn't work for everyone, but it sure works for me!

good luck.

[Ograx]

I have been trying to keep my tongue pressed yeah and I appreciate the tips. I’ll have to try and be more adamant about it as taping mouth shut for rest of my life kind of bothers me!

See how it goes tonight with the EPR setting on and I’ll post the sleep info after and let you guys know how night went. I realize this is a sometimes long proposal on getting it right but I’m thankful for all the advice and help.

[Ograx]

So using settings 6.6-20 with EPR full time 3 I was able to get 1.1 AHI and had very minimal aerophagia. Thanks for that tip Pugsy!

Two more questions.

What pressure should I be aiming for for my minimum? Going to try 7.0 tonight.

Is a small piece of nexcare tape on bridge of nose going to be able to help with nose bridge bruising or what are your tips for this?

[Pugsy]

I don't know that I would even increase that minimum if it were me. I would leave it alone for a while and let your body adapt to the new settings. There's certainly no critical urgent need to increase the minimum. I would gladly accept AHI of 1.1 especially if a little bit of that AHI was central index. We can't reduce the centrals/CAs with more minimum anyway.

As far as what to use to protect the bridge of the nose area....I have zero experience in that area. Sorry.
I can't stand anything on the bridge of my nose and for that reason simply chose to use masks that didn't touch that area.

I am of the opinion in general that if any mask bruises, causes skin abrasions, pain or discomfort....it's either fitted or sized incorrectly or simply the wrong mask for the person...and I would move on to another mask.

I do see moleskin offered as a barrier though...but if you want to try plain tape and it works...hey, use plain tape.

Some people just have what I call "paper skin".....very thin skin that is easily bruised or abraded. Sometimes even the mildest gentlest tape will tear the skin.

[Ograx]

Yeah I know I have thin skin on my nose. I do have another under the nose mask philips dreamwear that I want to transition into but wanted to get dialled in to a good machine setting first.

Maybe I’ll just keep the setting at 6.6 then.

The only AI I am getting are centrals but they have been steadily declining as well every night which I don’t quite understand.

Can they maybe be misclassified or is treating the obstructive ones helping with centrals?

Either way I’ll do another night or two and post data and see what you guys think.

I woke up 3 times last night but that is a lot better than 6-7 so have to say that I am seeing some improvements.

[Pugsy]

The only AI I am getting are centrals but they have been steadily declining as well every night which I don’t quite understand.

Can they maybe be misclassified or is treating the obstructive ones helping with centrals?

First of all a handful of centrals is quite normal and to be expected and not a big deal.
It's quite normal to have a central during sleep stage transitions...like awake to asleep. They are called sleep onset centrals.
The more wake ups we have during the night...more chances for falling back to sleep and sleep onset centrals happening.

It's also possible for some awake/semi awake breathing irregularities or pauses in breathing to cause the machine to flag that irregular breathing as some sort of apnea event. Commonly central false positive but I have personally seen false positive OAs and hyponeas on my own reports.

It is possible that as you get more used to this therapy and learn to sleep more soundly...less wake ups during the night...less chance for sleep onset centrals or false positive flagging to happen.....so that's why the centrals reduce.

And yes...treating the obstructive stuff itself will sometimes reduce the centrals...it goes like this..
OA happens...causes and arousal (may or may not remember being awake)...and during the arousal we hold our breath for maybe 10 seconds or so...machine flags it as a central but it's not real asleep central but instead related to irregular awake breathing.
So when we stop the OAs from happening....we stop the chances of the arousals from happening...and that stops the chances of false positive flagging or even real sleep onset central from happening.

It's why when we see someone with a high AHI that is composed of both a high number of centrals and OA/hyponea stuff....we try to deal with the obstructive stuff with more pressure first and once those are reduced to acceptable numbers we then worry about whatever number of centrals might be left to worry about.

[Ograx]

That’s the information I needed pugsy thank you for the crash course on it.
I was really hoping I wasn’t maybe looking at a mixed apnea situation.

[Ograx]

Ok so apparently I had a really bad night and now my data is saying I'm having a condition associated with heart failure?

Can you guys make sense of this and tell me what really is going on?

Don't feel that bad this mornign but this data makes it look like I was dieing.

[Pugsy]

Were you maybe awake or half awake when all that ugly happened at around 4 to 4:30 or so?

[Pugsy]

For future images...omit the snore graph so the other graphs can be enlarged at bit for easier viewing.
Not much going on with your snore graph so we don't really need to see it.