First Week CPAP results - help with results

[Miss Emerita]

You're do very well, and I see you didn't need to get up last night to pee! About sleeping on your back: do you think your chin drops down toward your chest while you sleep? If yes, you might try a pillow that provides neck support. (I have in mind pillows that are thicker across the bottom where your neck rests.) If no, I got nuttin!

I was just thinking about this. I feel like my chin does drop down. I wanted to try a different pillow. The one i'm using now is kind of bulkier and on the firmer side.

Sounds like a change is worth trying. When your chin tucks down toward your chest, it constricts your airway somewhat, making it easier for the relaxation of your airway tissues to create obstructive events.

[jwalsh126]

Bad news - I fell asleep with the wrong pillow (much thinner) and these were the results. Flex was off and pressure at 7. I woke up with chipmunk cheeks from sucking in air and had to blow it out my mouth. Appears I had a couple large leaks which caused a pressure spike to ramp up to 17+. The centrals did go down, but OAs were worst night so far. You can see I woke up at 6 and took the mask off and almost got up, but I went back to sleep with the original pillow I was using and seemed to get several decent hours.

I'm thinking of trying the same settings (FLex/EPR off and min pressure 7) with the original pillow. Or do you think I should change flex to the lowest level of 1? I'm hoping this night was just a fluke with the leak and bad pillow.

[Pugsy]

First thing...leaks don't cause pressure increases. Airway issuses/collapses cause pressure increases....the leak is the result of the airway issues causing the pressure increases. Leaks are a result of the higher pressure causing the mask to lose the seal.
All those OAs caused the pressure increase.

The experiment with Flex off was for 2 things...see if the centrals reduced and when Flex is off the overall pressure is increased slightly and see if that little bit more pressure helped with the obstructive stuff.

If you are more comfortable with using Flex...use Flex because we have to get comfortable and sleep first.

Try Flex at 1 if you are comfortable with it and lets try 8 cm minimum tonight.
Lets try dealing with the OAs and hyponeas and snores first...put the centrals on the back burner for now....hope they are arousal related and if we can reduced the obstructive stuff the arousals will reduce. If they don't we will cross that bridge later.

[jwalsh126]

Thank you for clarification! I want to try flex on 1 for now while we see if we can reduce the OAs and hypos to an acceptable level.

Tonight = pressure 8, Flex 1

Hopefully I can stick to these settings for a couple nights now to get several data points. Thanks again for all the help. I am 23 years old and this was all new to me, as my family members have never been tested. I am learning quickly and appreciate all the help I can get. Seeing my data so far makes me believe I am close to getting those levels down below 5.

[jwalsh126]

Lowest AHI to date! However I appeared to snore the most and my dry mouth is as dry as ever. I see there was a lot more mask leak tonight, but I like the fact that the AHI and OAs have reduced.
Question - As some users have already noted, do you think I would benefit from using some sort of cervical collar or memory foam pillow neck support to prevent chin tucking which may be collapsing my airway and causing these issues?

[Pugsy]

By all means give the cervical collar a try. I know some people it helps a lot and some it doesn't seem to help or they just can't stand it.
We just never know what is going to work for us or not without trying it.

I do want you to make a little change in OSCAR though so that the leak statistics aren't making leaks out to be worse than they are.
Go to Preferences/CPAP tab and on the right side change the red line leak threshold from 24 L/min to 70 L/min.
The 24 L/min default red line is a ResMed number and it doesn't work so great for Respironics machines because the leak is reported differently and the red line threshold for large leak territory.

You did have some very brief episodes of large leak (barely though and something I would just ignore if it didn't wake me up) but nothing that amounts to 19% of the entire night. The statistics is making it look like the leaks were worse than they were because it's using the wrong base line threshold.

VS2 snores don't seem to trigger pressure increases....we don't know why or what they really are. We are never really told their impact on things and if using Respironics Encore software they aren't ever really shown. They are just ignored.
viewtopic.php?f=1&t=155478&p=1182872#p1182872 scroll up to the top and read what RobySue wrote.

So....couple more nights at these settings and if the AHI stays the same...then another 1 cm increase in the minimum.....assuming you slept decently. If you have a troubled night and know you didn't sleep well then we ignore those nights because of high potential for false positives muddying up the waters.

And by all means....try a cervical collar if you wish. Might keep you from having to use higher pressures. It comes with it's own baggage though. Some people don't find them very comfortable and they don't sleep so great with them. Others do just fine with them.

I have no idea if a special pillow just under the neck would keep the chin from tucking but again worth trying. Anything is fair game to try.

[jwalsh126]

Thanks Pugsy - I made the changes in OSCAR that you requested.

About the sleep - I feel good and rested, but I still wake up with dry mouth and am wondering if this should go away once we find the ideal pressure. Is this because I am still mouth breathing with the full face mask since my airway is still becoming obstructed, just a lesser number of times?

[Pugsy]

Dry mouth....

Primary causes....mouth breathing, medication side effects, other health conditions.

Don't expect it to improve once we figure out an ideal pressure unless some of the mouth breathing is related to gasping for extra breaths due to the apnea events or airway issues which might be making the mouth breathing worse. Not impossible but not a given either.
I thought I was a mouth breather at night despite my nose functioning clearly during the day and at night. I was continually waking up (pre cpap therapy) with dry mouth and sore throat from probably gasping for air and massive snores. Come to find out once I was on cpap therapy those episodes of dry mouth and sore throat (probably from snoring that would rattle the windows) went away.
I do occasionally still wake up with a bit of dry mouth and I know it's from mouth breathing because I will wake up on my back and I will be mouth breathing. It takes very little mouth breathing to dry out the mouth. It doesn't always mean that someone is doing massive prolonged amounts of mouth breathing. So sometimes I might see evidence of mouth breathing for 10 or 15 minutes and the mouth will be massively dry.

Using a full face mask doesn't necessarily stop the mouth breathing though. All it does is lessen the chance of someone losing precious therapy pressure out the mouth. Some people just get dry mouth easier than others. Maybe a hydration issue or maybe they are also taking meds which can make the mouth dry out more quickly from just a little mouth breathing.
Using a full face mask even with maximum humidity being delivered isn't always a fix either. These humidifiers weren't designed to hydrate the oral cavity....they were designed to hydrate the nasal cavity with is much smaller than the oral cavity. For some people who get dry mouth easy...the humidifier can't always fix it even at maximum humidity.

You could try increasing the humidity setting and it might help. It might not help. For some people more humidity actually increases nasal congestion which in turn will increase the mouth breathing which of course increases the dry mouth.
For some people more humidity actually decreases nasal congestion which in turn could decrease mouth breathing and in turn decrease the mouth dryness.
Everyone is different in what their nasal mucosa might need in terms of humidity. In general though most people tend to need more humidity than less. That's why most cpap prescriptions included heated humidity now. Years ago humidifiers weren't commonly dispensed and in some parts of the world they still aren't.

You could try increasing the humidity setting and see if it helps with the dry mouth or not. For some people it works...for some people it doesn't but it never hurts to try anything in an effort to increase our comfort. If you find it does increase nasal congestion then back off.

There's a reason so many full face mask users supplement there routine with mouth hydrating products at bedtime.....sometimes even with maximum humidity being delivered it simply isn't enough added moisture.
And they are routinely getting AHI numbers below 1.0 so we can't really blame gasping for air as the possible cause.

You might be like I was and once we get an optimal pressure figured out for you that the dry mouth will reduce...if your dry mouth was a result of gasping for hour from the apnea events.
I can't promise it though but it isn't impossible.
In the meantime it hurts nothing to experiment with increasing the humidity being delivered....you might get lucky and find it works well for you.

If increasing the humidity causes condensation/rain out in the hose or mask...then we deal with it with heated hose or hose cozy or something....if you find that more humidity does help with the dry mouth.

Everything we do comes with potential baggage and when that baggage is a problem then we try to figure out some way to make it less of a problem.

When I first started therapy and thought I was a mouth breather everyone was telling me I just had to get a full face mask.
Well back then most of the full face masks covered the nasal bridge area and I learned early on that any sort of pressure caused immediate nasal congestion which in turn would increase mouth breathing and for me was a serious detriment to even sleeping.. I just can't sleep if my nose is congested. I had a choice between 2 evils which were both pretty bad. Use a full face mask and mouth breath but no sleep because of the congestion or use a nasal pillow mask which didn't cause congestion and I could at least sleep with it and deal with mouth breathing negatives as loss of therapy pressure. I chose nasal pillows because I could at least sleep with them and then worry about reducing the mouth breathing later. Without sleep this therapy isn't really therapy. We simply have to sleep.
I still mouth breathe a little every now and then. I really don't care. It's rarely for very long and I don't normally wake up with it and it rarely goes horribly deep into large leak territory. I made a compromise...I allow some rare episodes of mouth breathing as a trade off for sleeping decently. It simply isn't worth it to me to try to use a full face mask just to fix a problem that might be for 15 minutes once or twice a week.

Now people who have chronic nasal congestion issues (which I don't) from allergies or whatever and they just have to use a full face mask....then we deal with the issues that might come with using a full face mask. We always have options....sometimes not particularly attractive options but we do have options.

[jwalsh126]

Not sure what to think of this. Here are the last 3 nights with the same settings (min pressure 8; Flex 1). The only thing I am consciously aware of is the fact that I notice more leaking from the mask. One of these nights I completely slept through the night, but the others I did not.

Side Note - I am going to try getting a memory foam pillow just for comfort reasons for my neck since I am a back sleeper

[Pugsy]

Feel up to increasing the minimum to 9?

[jwalsh126]

Yes, I think it's worth a shot. Do you think there is a chance something other than pressure is causing some of these problems?

[Pugsy]

Yes, I think it's worth a shot. Do you think there is a chance something other than pressure is causing some of these problems?

There's always a chance for just about anything.

What I do is look to fix what is obviously needing fixing right now and then see what's left over that might need fixing.

Right now you need more minimum.

[jwalsh126]

I agree with the minimum pressure. Thanks Pugsy! Will switch to 9 and leave flex at 1 for now. So we are trying to adjust pressure to fix the OAs, hypos, and snoring first. Then we will have to address any issues with centrals (if they remain) later? That's the impression I get from all of this.

Sorry 1 more question - Notice anything noteworthy with the rate of leaks? Overall mask fit seems very good (96%+).

[Pugsy]

So we are trying to adjust pressure to fix the OAs, hypos, and snoring first. Then we will have to address any issues with centrals (if they remain) later? That's the impression I get from all of this.

Correct

anything noteworthy with the rate of leaks? Overall mask fit seems very good (96%+).

The episodes of large leak are very brief and don't amount to much. As long as they don't wake me up I shrug my shoulders and don't give them a second thought. Masks move around...we lose the seal...we mouth breathe a little....as long as not massively prolonged or wake us up...I don't worry about it.

[jwalsh126]

3-day update - Hey, I am seeing positive results in reducing the AHI. Last night I had a hiccup with a leak at one point and I woke up with the chubby air cheeks again, but went to the bathroom and reset the machine and all was fine. I'm starting to see more "periodic breathing." Is that bad? Or is it a good sign due to the reduced apneas, I am just having some episodes of periodic breathing.

Let me know what you think of these results and if I need more sample sizes at the current settings (min pressure 9; Flex 1). Thank you all (especially Pugsy) for the help with this process. It has been a tremendous boost of reassurance.