I'm a dentist treating myself! CPAP Results... Advice please?

[ChicagoGranny]

scalloping on tongue

Dr. Park has a couple of blogs on that subject -

https://doctorstevenpark.com/tongue-sca ... #more-3665

https://doctorstevenpark.com/sleep-apne ... #more-2890

[nee]

Night 5 of results...

Min: 11cmH2O
Max: 20cmH2O
EPR: 2cmH2O (turned it down from 3 to reduce open airway apneas).

Wearing mandibular advancement device, mouth tape, cervical collar. Woke up a few times during the night but went back to sleep quickly. Although I got 8 hours of sleep, I still had a hard time getting out of bed and I feel some anxiety this morning. Any advice?

1.13.2020 CPAP.jpg (680.79 KiB) Viewed 931 times

[palerider]

Let things go for another night or two. See what happens.

[Stephaniedp3]

scalloping on tongue

Dr. Park has a couple of blogs on that subject -

https://doctorstevenpark.com/tongue-sca ... #more-3665

https://doctorstevenpark.com/sleep-apne ... #more-2890

Sorry to derail the thread but wow! I’ve had my tongue like that for a long time!! I’ve always known I’ve had a small mouth.

[nee]

Let things go for another night or two. See what happens.

Thanks!

Night 6 results:

Min: 11cmH2O
Max: 20cmH2O
ERP: 2

Cervical collar, mouth tape, mandibular advancement device. Woke up a few times but fell back asleep quickly.

Noticing less central apneas, but those OA clusters persist. It looks like the machine is getting up to 15cmH2O to get me out of them, whereas before it would go up to 20cmH2O. Not sure if that's significant. Keep staying the course? Change something up?

1.14.2020 CPAP.jpg (688.29 KiB) Viewed 876 times

[Pugsy]

Most likely REM stage sleep when those clusters of OAs are happening.
The machine is increasing the pressure trying to hold the airway open and prevent the collapse (and it's probably preventing some but not all) and it just can't quite prevent enough of them so that they don't cluster together.

Two most common causes for when we see clusters like this....supine sleeping or REM stage sleep or maybe a combination of both.
Supine sleeping and REM stage sleep are known to worsen OSA and cause a need for more pressure to better hold the airway open.

To break up the clusters from whatever the reason....a little more minimum pressure.
Those clusters aren't horrible though and if it's just a random thing then there's probably not an urgent reason to do anything about them.
Now if you see 2 or 3 of such clusters every night....I would want to break them up if it was me.

[nee]

Thanks Pugsy - I'll bump it up from 11 cmH2O to 12 cmH2O minimum pressure and see how it goes tonight.

To be honest, I feel a strong sense of wanting to squash all events and make the flow limitations negligible. This problem has robbed me of living at my full potential all of these years. I just think to myself, if I wasn't so lethargic and had difficulty concentrating throughout college, would I have gotten better grades, gone to a better dental school, been less in debt? Had less anxiety and had been more outgoing? More driven? Made more progress at the gym relative to all the hours I put in?

I'm still in a good place and have no right to complain, but the frustration of no one having caught this or urged me to seek care is still there. I can only make each day better from now on, and I believe it starts with controlling this malady.

Sorry for the diary entry, just needed to vent haha.

[Pugsy]

I understand the need to vent.
Try not to dwell on the "what ifs".....it's not like you can change the past.
Best we can do is maybe change the future. Expend your energy on things you have some semblance of control over. Easy to say and not so easy to implement I know.....but try.

Bear in mind that squashing every single apnea and flow limitation may or may not fix your problem. Sometimes other things are going on that make it so I really good sleep (on paper) isn't maybe so great after all.
There's a lot more to feeling those good numbers than just getting them. Getting them is the easy part....feeling them is a whole different story.

[ChicagoGranny]

the frustration of no one having caught this or urged me to seek care is still there

Someone here used to post that a SDB screening should be part of every annual physical. I agree.

This problem has robbed me of living at my full potential all of these years. I just think to myself, if I wasn't so lethargic and had difficulty concentrating throughout college, would I have gotten better grades, gone to a better dental school, been less in debt? Had less anxiety and had been more outgoing? More driven? Made more progress at the gym relative to all the hours I put in?

You could have been so financially successful that money for exotic sports cars and cocaine was chump change to you. Then, at age 37, on the North San Marcos Road, at 3:00 a.m., you missed a curve in one of your Lamborghinis and died in a fiery crash.

[palerider]

Thanks Pugsy - I'll bump it up from 11 cmH2O to 12 cmH2O minimum pressure and see how it goes tonight.

To be honest, I feel a strong sense of wanting to squash all events and make the flow limitations negligible.

You're on the right track, but you can never make anything (especially breathing) perfect.

So, you want to minimize events and FLs, because FLs are a sign that you're working harder to breathe, and that will disturb your sleep. That's part of the reason that all the auto machines raise pressure when they detect FLs.

[nee]

Thanks Pugsy - I'll bump it up from 11 cmH2O to 12 cmH2O minimum pressure and see how it goes tonight.

To be honest, I feel a strong sense of wanting to squash all events and make the flow limitations negligible.

You're on the right track, but you can never make anything (especially breathing) perfect.

So, you want to minimize events and FLs, because FLs are a sign that you're working harder to breathe, and that will disturb your sleep. That's part of the reason that all the auto machines raise pressure when they detect FLs.

Makes sense, thank you.

Got a quick question... is it normal to not feel like no air is being blown with the AirSense P10 nasal pillow? At 11cmH2O, breathing just feels "normal." I feel like, as I start slowly withdrawing it away from my nostrils I feel the pressure WAY more, but once it's snug on my nostrils it feels like not much.

[Pugsy]

is it normal to not feel like no air is being blown with the AirSense P10 nasal pillow? At 11cmH2O, breathing just feels "normal." I feel like, as I start slowly withdrawing it away from my nostrils I feel the pressure WAY more, but once it's snug on my nostrils it feels like not much.

Yep, entirely normal. I will let PR explain the physics behind it....I can't put it into words very well.

[palerider]

Thanks Pugsy - I'll bump it up from 11 cmH2O to 12 cmH2O minimum pressure and see how it goes tonight.

To be honest, I feel a strong sense of wanting to squash all events and make the flow limitations negligible.

You're on the right track, but you can never make anything (especially breathing) perfect.

So, you want to minimize events and FLs, because FLs are a sign that you're working harder to breathe, and that will disturb your sleep. That's part of the reason that all the auto machines raise pressure when they detect FLs.

Makes sense, thank you.

Got a quick question... is it normal to not feel like no air is being blown with the AirSense P10 nasal pillow? At 11cmH2O, breathing just feels "normal." I feel like, as I start slowly withdrawing it away from my nostrils I feel the pressure WAY more, but once it's snug on my nostrils it feels like not much.

You have to put your hand right up next to the vent mesh, it's very diffused, but it's venting as much as the masks that are blowing those hard streams.

When you pull it from your nose, you're creating a huge leak, so the machine ramps up the airflow to try and maintain pressure.

Trust the data from your machine, the "mask pressure" trace is actual measured pressure (compensated for pressure drops due to airflow resistance in the patient circuit. things like tubing diameter, length, type of mask, presence of humidifier and antibacterial filter.)

[zonker]

Got a quick question... is it normal to not feel like no air is being blown with the AirSense P10 nasal pillow? At 11cmH2O, breathing just feels "normal." I feel like, as I start slowly withdrawing it away from my nostrils I feel the pressure WAY more, but once it's snug on my nostrils it feels like not much.

perfectly normal. i remember the first time it happened to me. i actually had to touch the bottom of my nose to insure the p10 was there!

[Stephaniedp3]

I have a different mask but yes even after a month of wear I still find myself quadruple checking my mask.