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

[nee]

Here are the past two nights. Last night (second chart) I raised the minimum to 13 cmH2O from 12 cmH2O. Woke up in the middle of the night with the mask off so I turned it back down to 12 cmH2O and went back to sleep.

Mandibular advancement device, mouth tape, cervical collar as per usual.

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I have the Bleep mask coming in tomorrow so I'm pretty excited to use it!

[nee]

So, even though my AHI has been steadily going down, yesterday I had to nap right when I got home from a slow day of work before I went to the gym. Pretty frustrating. I really think it's due to my flow limits (I have been diagnosed with IFL/UARS).

Last night I bumped my minimum to 13 cmH2O from 12 cmH2O, and kept the EPR at 2 cmH2O.

My AHI doubled...!

I'm confused as to where to go from here...

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[Pugsy]

Did you wake up much last night? One of the clusters of flagged events coincides with flagged large leak. I am wondering if the leaks disturbed your sleep and you are having some false positive arousal flagging happening.

http://freecpapadvice.com/sleepyhead-free-software

Maybe you need to confirm that your flagged events you are trying to kill with more pressure are real asleep events that can be kill with more pressure. Watch all the videos above and examine each of the flagged events and don't limit them to just the centrals...false positives can happen in any category. Remember the machine only measures air flow...it doesn't have a clue if you are asleep or awake.

Finally....even if every one of those events were the real deal...sometimes we just have crappy nights and we don't know why and this is why we don't change settings based on just one ugly night. Sometimes it just happens....happens to everyone...even me.

[palerider]

So, even though my AHI has been steadily going down, yesterday I had to nap right when I got home from a slow day of work before I went to the gym. Pretty frustrating. I really think it's due to my flow limits (I have been diagnosed with IFL/UARS).

Last night I bumped my minimum to 13 cmH2O from 12 cmH2O, and kept the EPR at 2 cmH2O.

My AHI doubled...!

I'm confused as to where to go from here...


Screen Shot 2020-01-25 at 6.56.29 AM.png

Stay the course for a couple more nights, we all have bad nights, so you shouldn't make decisions on a single nights results.

[nee]

Did you wake up much last night? One of the clusters of flagged events coincides with flagged large leak. I am wondering if the leaks disturbed your sleep and you are having some false positive arousal flagging happening.

http://freecpapadvice.com/sleepyhead-free-software

Maybe you need to confirm that your flagged events you are trying to kill with more pressure are real asleep events that can be kill with more pressure. Watch all the videos above and examine each of the flagged events and don't limit them to just the centrals...false positives can happen in any category. Remember the machine only measures air flow...it doesn't have a clue if you are asleep or awake.

Finally....even if every one of those events were the real deal...sometimes we just have crappy nights and we don't know why and this is why we don't change settings based on just one ugly night. Sometimes it just happens....happens to everyone...even me.

Thank you, Pugsy. Just made my second cup of coffee. Time to watch those videos.

And yes I did wake up a couple of times last night. I have the Bleep mask coming in tonight which I'm looking forward to. It should help reduce leaks, so I'll bring the minimum pressure back down to 12 cmH2O rather than trying to go higher. A forum member was kind enough to send me an instructional video for the Bleep.

[Pugsy]

If you run into any problems with the Bleep don't hesitate to ask me or even call Stuart.
He welcomes phone calls and will even set up video chats directly with people to help them out.
This is his cell phone number....it's okay to post it because he has it posted on the Bleep website.
919-619-7170 if he doesn't answer just leave a message and your phone number and he will get back with you.

[nee]

Well, damn, the Bleep was terrible for me... but I'm committed to making it work and realize I probably won't get it perfect immediately.

Used witch hazel and everything stuck really well, didn't find it coming off in the middle of the night. Tried to make sure I heard four clicks with each nostril attachment but it's kind of hard to tell.

Woke up with extremely dry mouth a couple of times (despite the mouth tape, so I'm not sure where I went wrong.) At a certain point I also woke up with the hose completely detached from the nostril area + air vent ... not sure how I managed that!

I think I also had a leak where my mustache meets my nose, so I went and trimmed my hairs early in the morning before replacing the Bleep and going back to sleep (results in second photo).

I went and did the filter trick as well because the air was annoying - that helped!

First results:

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Early AM results with 2 new Bleeps attached:

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RERA?

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[nee]

Wondering if these are RERAs. My RDI is ~12 according to my high resolution pulse oximetry results from back in July, so these are what I'm trying to squash.

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[Pugsy]

To be a RERA there has to be a reduction in air flow enough to cause an arousal and you have to be asleep first.
If your machine didn't flag a RERA then we assume that the arousal was just a spontaneous arousal. We have to assume it because in reality the machine doesn't have anyway to really know if we are asleep or not.
When it flags RERAs it is actually saying that the breathing looks like it is respiratory related...it's not the gospel. It's making an educated guess based on the algorithm program into it for evaluating breathing air flow reductions.

Most arousals are going to be spontaneous and not respiratory related if you aren't seeing many flagged RERAs.

Too many spontaneous arousals are bad though because they mean that the sleep quality isn't ideal.
Unfortunately we don't always know what the cause of spontaneous arousals might be and sometimes even when we know the cause it isn't always easy to fix.

Your second half of the night with the second set of port attachments....something still wasn't clicked in or attached totally correct. It was still leaking from somewhere. If your mouth wasn't taped...that would be the first suspect but if the tape was for sure secure then the only thing left to leak is something in the mask attachment.

Here's a routine that I go through each night to confirm no leaks.
1...attach ports to nose...then I put a finger over both port openings to block them and try to breathe...if I can't breathe easily...no leaks.
2..then I attach the frame to the ports and then I put the end of the hose in the palm of my hand to seal it...and then I tray to breathe again. This step is where I might find I don't have the ports clicked in or something like that...if I can breathe then I know there's a leak somewhere. If you can move any air...there's something not attached correctly.

[ChicagoGranny]

Just made my second cup of coffee.

Decaf? If not, it may be part of your problem.

[nee]

Just made my second cup of coffee.

Decaf? If not, it may be part of your problem.

Hah! Never decaf. I always finish my last cup by 1 pm and go to sleep at 10-11 pm, so I think it's fine.

Update on the Bleep... I used the Resmed filter which helped with the ventilation that was bothering me, but I was getting noise/leakage where the vent swivel meets the tube. Got in touch with Stuart who is going to send me a couple of things to alleviate the issue. What a great guy. The lack of flexibility on the tube is hard to deal with, so I'm going to try switching it to the P10 tubing.

[ChicagoGranny]

so I think it's fine

The operative word is "think". Humans are very poor judges of their sleep quality.

[nee]

so I think it's fine

The operative word is "think". Humans are very poor judges of their sleep quality.

Well I just googled some things, and if we go by the half-life of caffeine (5 hours) I should have 25% of the caffeine remaining in my body by the time I go to sleep.

Wait, what?

I'm going to start quitting.

[ChicagoGranny]

I'm going to start quitting.

You probably know to taper because cold turkey causes nasty headaches in some people.

One of my granddaughters was telling me about a friend of hers who complained about headaches on Saturday mornings when she slept in. It turned out to be caffeine withdrawal - on workdays, she was in the habit of drinking three or four cups of coffee throughout the morning.

[nee]

Decent results last night with the Bleep!

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It's interesting how the flow limit, leak rate, and apneas correlate with each other.

My current theory is that my tongue falls back and I start mouth breathing (flow limit), and some of the air escapes from my mouth tape (I have tested that with sufficient pressure air leaks out due to my facial hair)...eventually the tongue falls back more and I end up with an apnea event. After which the tongue goes back to where it should be, I nose breathe, and the leak rate goes down to 0.