Been a while

[Miss Emerita]

Hi Zonker! Great minds in sync, I see.

[Pugsy]

What is your primary sleeping position?
How much time on your side and how much time on your back?
Are you experiencing any nasal congestion?

[Jack o]

Zonker and Pugsy,

I got rid of the graph. Don't know how to change sequence but did 4 screenshots to show all.
I sleep on my back and left side. I have a deviated septum and have great difficulty with masks.
They are either too loose (leak) or too tight (press on my nose so can only breathe thru my mouth).
I go to sleep breathing thru my mouth and awake breathing thru both sometimes.
I am waiting for a SW (small wide nose piece) to replace the M Medium thinking that may be the problem need wide nostrils.
Maybe I am wrong but will try it - currently on back order.
Around 3/10/20 AHI went up so I switched from the old F30 to the F30i but it did not help - more comfortable but more leaking.
Both hamper nose breathing unless they are loose - then leak.
Thanks.

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[zonker]

Zonker and Pugsy,

and i now step aside. pugsy is one of the experts i alluded to.

you are in good hands!

[zonker]

Hi Zonker! Great minds in sync, I see.

my mother used to say that two heads are better than one, particularly if one is a cabbage head!

ME!! i mean *I* am the cabbage head!

[Jack o]

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4th - Could only post 3.

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[Pugsy]

We don't need or want all those graphs.
You can turn off (lower right corner of the last graph... click on that little a arrow and change from green to red) unwanted/unneeded graphs that are in the way...like the mask pressure graph because your regular pressure graph (with 2 lines) is much more useful than the mask pressure graph.
You can resize the graphs and you can move them around in order.
The main ones on the right side that I need to see...Events, flow rate, pressure , leak and flow limitation.
And of course the stuff on the left side minus the calendar and pie chart (which you are okay with how you are doing the left side).
I don't need all those other graphs and it's just more work for you taking screen shots and wasting band width posting them because we don't really look at them because they don't really tell use much. If we need or want one of the other graphs for some reason we can ask for it.

I don't know how much time you are spending on your back but I suspect more than you might think.
You need more pressure....see that pressure line flat lining at 13...it wants to go higher but it can't. You pretty much go from the minimum after the ramp is over to the maximum really quickly and it stays up there almost all the time.

I saw in your other thread that there was a mention of problems with aerophagia at some higher pressures. So I understand the limiting of the maximum but the fact is you are doing something that causes a need for more pressure.
The most common suspect is supine sleeping but maybe you are tucking your chin or something that is adding to the airway restriction.

Some options you can consider.
1....increasing the maximum pressure
2....make a concerted effort to stay on your side all the time and totally avoid sleeping on your back if at all possible. This isn't easy to to do....been there and done that myself because back sleeping hurts my back a lot but yet I sure seem to end up on my back a lot.
3....maybe use a cervical collar to keep the chin up and stop you from tucking your chin (if you are doing that) and then maybe you could get by with less pressure.

All this has to be tempered with any aerophagia issues you might have....we don't want to eliminate one problem to only have it replaced by another problem that makes you miserable.

[Jack o]

Pugsy,
Thank you very much for all the guidance. I have attached last nights’ picture and also the overview for this one time in case I forgot to tell you something of importance. I think there was less leaking last night with the lower strap a bit looser. The aerophagia is not as bad as it used to be months ago. I agree that something is different than in the past starting 3/10. When I used to have high set at 8.0, I was still averaging 5. I will push pressure up to 14 for tonight and see what happens. My neck has been hurting for a few weeks so maybe I am tucking my neck (thinking stress – investments dropping and corona – live in NJ, am 69 yrs., and have diabedes, plaque build-up, kidney disease but all functions are good so should not be an issue - hopefully). I would prefer not to wear a collar for now and see how trying to sleep on side and increasing pressure goes. Have moved most investments to money market – maybe the balance today. “Worry Wort” Thanks

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[Jack o]

Hopefully attached now.

[D.H.]

I suggest a min of 8 and a max of 20. You seem to be maxing out at 13. Therefore, allowing it to go higher might help.

If the higher pressure bothers you, or if the number of clear airway events goes up significantly, then you'll need to consider lowering the max.

[Jack o]

I increased pressure last night From: Low 6/High13 To: Low 8/High 15.
Surprisingly AHI increased From 6.8 To 9.6. Thought it would come down.
Did have 12 oz. wine at 7pm and none the night before.
Should I go down or up in pressure tonight?
From Nov. to mid Feb my high pressure was set at 8 and was getting an avg. AHI of 5.
I am thinking tonight to try either 9 or 20? Any suggestions?

[Pugsy]

Max of 15 is still not enough...see how the top pressure line pretty much stays pegged out at 15?

Might as well try 20 max and see what happens.

[Jack o]

Pugsy,

Thanks -
I just set at 20 for tonight and no wine.
Reading some other posts, I saw water chamber could be a concern so I just replaced it.
First time replacing chamber - over 2 yrs. old. Has had a burn mark in bottom for at least a while.
I don't know if that could be part of it.

[Pugsy]

I seriously doubt that your problem has anything to do with the water chamber.

Your problem has to do with the fact that for some reason now you need a lot more pressure to hold the airway open and prevent the airway from collapsing to the point of ending up with a flagged event.
More minimum might also help though it's not like you are going up and down a lot...you are going up and staying up and essentially creating a new minimum out of need so I don't really hold much hope for increasing the minimum to be the magic wand.

Your flow limitation graph is ugly....are you having much nasal congestion? Nasal congestion will cause the FL graph to be ugly and the pressure to go up but more pressure won't fix nasal congestion.
So if you are having some nasal congestion that has to be fixed separately.

[Jack o]

OK - I will set low at 10 and high at 20 - The 10 will help to know if there is even a small leak from the start.
I have a deviated septum and a certain amount of nasal decon. ongoing but no more than in past.
And masks have always hampered breathing thru the nose for me. (If too loose leak and too tight hamper nose breathing.) I breathe thru both.
So I have always breathed primarily thru the mouth during CPAP use. I have a thin high cheekbone face such that the more full the mask - the more it leaks. That is why I am using the F30 / F30i. I may need to look for a different mask. Maybe go back 2 masks ago to an F-20 with the 30 day cushion (F30 covers the mouth and is under the nose while F20 covers the nose and mouth). FX Quatro style mask (large face covering) are horrible for me with leaking. It is a nightmare looking for a new mask and I cannot even do that now with Dr. visits being over the phone in NJ. I had phone call with pulmonary Dr. yesterday. He had little to offer other than to increase pressure.

If the 20 does not work tonight I will see what happens at 8. I know that seems to make no sense but worth a one night try. Considering all this, an AHI of 8 to 10 is still better than not using CPAP. A few years ago my AHI without CPAP was 29 (severe). Who knows maybe it would be 50 now.