New APAP user (UARS) some questions

[apapnovice]

Hi,

I received my APAP machine about a week ago for treatment of my UARS. It's a loan machine for a trial period of a few weeks. Not really feeling hugely different yet. I just wanted to run a few things past people.

First, here's three of the nights so far:

https://imgur.com/a/2CLpYMG

Q 1: Obviously from an AHI perspective my sleep looks tremendous, but that's not surprising given that I don't have sleep apnea. I notice that the flow limit. jumps before the pressure increases significantly, several times a night - could this still be a sign of arousals/increased resistance? My understanding is that the APAP machine adapts to the patients needs, however does that not mean that the disturbance has occurred before the machine can help out? I am, thankfully, finding the pressure on the machine very easy to cope with (not surprising as it is so low anyway!) If I upped the minimum pressure to 5, 6 or maybe even 7 (given that that's as high as it seems to go), might I avoid these instances and potentially have more consistent, better quality sleep?

Q 2: My mouth fell open several times the first couple of nights, I closed it and promptly fell back asleep. I've not noticed this happening the last couple of nights, is it possible that I've learned to keep my mouth shut because of the machine?

Q 3: I'm finding the nasal pillows are making my nostrils slightly raw and sore, I don't think I've got the straps to tight. Does anyone have a solution for this?

Thanks in advance for your help!

[slowriter]

Q 1: Obviously from an AHI perspective my sleep looks tremendous, but that's not surprising given that I don't have sleep apnea. I notice that the flow limit. jumps before the pressure increases significantly, several times a night - could this still be a sign of arousals/increased resistance? My understanding is that the APAP machine adapts to the patients needs, however does that not mean that the disturbance has occurred before the machine can help out? I am, thankfully, finding the pressure on the machine very easy to cope with (not surprising as it is so low anyway!) If I upped the minimum pressure to 5, 6 or maybe even 7 (given that that's as high as it seems to go), might I avoid these instances and potentially have more consistent, better quality sleep?

Q 2: My mouth fell open several times the first couple of nights, I closed it and promptly fell back asleep. I've not noticed this happening the last couple of nights, is it possible that I've learned to keep my mouth shut because of the machine?

The increases in pressure also correspond to those periods of high leaks. It looks to me like, for a lot of the night, each of the three nights, you're mouth breathing. You need to resolve this first.

And on your first question, with UARS, you generally want to raise the min pressure higher than you would with OSA, precisely because the algorithm will be less optimized for that.

[Pugsy]

For the nasal soreness....if you have something like Lansinoh lanolin ointment/cream available in the UK that is what we normally recommend people use. Liberally during the day and a tiny bit at night. It's what breast feeding moms use on their nipples to help with chaffing and soreness. Won't hurt you or your mask since it won't hurt babies either.
The nostrils are pretty much virgin territory and just not used to having anything up against the skin.
Be very careful though....it is very easy to get nasal pillows too tight. They shouldn't be going into the nostrils at all. They should rest gently against the nostril opening. The only thing that is actually inside the nostril is the tiny tip of the inner cone of the nasal pillow and it shouldn't be touching inside the nostril at all.

Be careful with the sizing of the nasal pillow....too small and it might try to crawl up inside the nose and that's not good at all.

Very minor tenderness can be expected but real pain or blisters or broken skin or raw skin.....improper fitting and either too tight or wrong size nasal pillow. Anything more than minor tenderness...something is wrong but the Lansinoh will help it heal faster.

[Miss Emerita]

Welcome! You have a fairly "busy" flow limitations graph. FLs occur when your airway somewhat limits your breathing, usually due to the relaxation of the tissues lining the airway. They can cause you to work harder to inhale, and that in turn can mess with your sleep.

EPR (expiratory pressure relief) can be effective in reducing FLs. To get the full benefit of your EPR setting of 3, you need to reset your minimum to at least 7. The lowest pressure the machine delivers is 4, so with a minimum of 7, you'll always be getting EPR of 3.

If your leaks are bothering you, then they're a problem, but you're not up in large-leak territory, so for now I'd worry about leaks only if they are disturbing your sleep.

Keep us posted, would you?

[apapnovice]

Q 1: Obviously from an AHI perspective my sleep looks tremendous, but that's not surprising given that I don't have sleep apnea. I notice that the flow limit. jumps before the pressure increases significantly, several times a night - could this still be a sign of arousals/increased resistance? My understanding is that the APAP machine adapts to the patients needs, however does that not mean that the disturbance has occurred before the machine can help out? I am, thankfully, finding the pressure on the machine very easy to cope with (not surprising as it is so low anyway!) If I upped the minimum pressure to 5, 6 or maybe even 7 (given that that's as high as it seems to go), might I avoid these instances and potentially have more consistent, better quality sleep?

Q 2: My mouth fell open several times the first couple of nights, I closed it and promptly fell back asleep. I've not noticed this happening the last couple of nights, is it possible that I've learned to keep my mouth shut because of the machine?

The increases in pressure also correspond to those periods of high leaks. It looks to me like, for a lot of the night, each of the three nights, you're mouth breathing. You need to resolve this first.

And on your first question, with UARS, you generally want to raise the min pressure higher than you would with OSA, precisely because the algorithm will be less optimized for that.

I assume this is just my lips and tongue relaxing and opening during REM sleep? There seems to be a corresponding amount of leaks/changes in pressure in line with the typical amount of REM sleep cycles.

How can I resolve this? I have a face mask as well, but I can't get it not to leak. Also, when breathing through mouth with it on, my cheeks inflate massively.

I'd rather find a solution whilst keeping the nasal pillows.
Note: pillows weren't so sore last night.

[zonker]

I assume this is just my lips and tongue relaxing and opening during REM sleep? There seems to be a corresponding amount of leaks/changes in pressure in line with the typical amount of REM sleep cycles.

How can I resolve this? I have a face mask as well, but I can't get it not to leak. Also, when breathing through mouth with it on, my cheeks inflate massively.

I'd rather find a solution whilst keeping the nasal pillows.
Note: pillows weren't so sore last night.

may i suggest this method?

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

i have used jay's method successfully for a number of years. i've modified it a bit to fit my face and head but it's basically the same.

i also use a firm foam cervical collar to keep my jaw up.

i'm also a p10 user and this has allowed me to continue to be one.

good luck!!

[slowriter]

may i suggest this method?

i also use a firm foam cervical collar to keep my jaw up.

That's what I use as well; works well, without need for mouth tape.

Other option is a strap like the Knightsbridge.

[zonker]

may i suggest this method?

i also use a firm foam cervical collar to keep my jaw up.

That's what I use as well; works well, without need for mouth tape.

Other option is a strap like the Knightsbridge.

yup. each us uses what works best for ourselves. i have tried a chin strap and didn't like it.

a lot of experimentation to see what works best.

[Miss Emerita]

If you want to try tape, I'd suggest starting with a box of Somnifix strips. They hold well and are gentle on the skin. Be sure to dry and then purse your lips before you stick the strip on. If that helps you, then you can try cheaper alternatives, like 3M micropore tape.

A collar or chin strap may be all you need if the only problem is that your jaw drops. But even if your jaw isn't dropping, you may still need help keeping your lips from parting.

[musculus]

Hi,

I received my APAP machine about a week ago for treatment of my UARS. It's a loan machine for a trial period of a few weeks. Not really feeling hugely different yet. I just wanted to run a few things past people.

First, here's three of the nights so far:

https://imgur.com/a/2CLpYMG

Q 1: Obviously from an AHI perspective my sleep looks tremendous, but that's not surprising given that I don't have sleep apnea. I notice that the flow limit. jumps before the pressure increases significantly, several times a night - could this still be a sign of arousals/increased resistance? My understanding is that the APAP machine adapts to the patients needs, however does that not mean that the disturbance has occurred before the machine can help out? I am, thankfully, finding the pressure on the machine very easy to cope with (not surprising as it is so low anyway!) If I upped the minimum pressure to 5, 6 or maybe even 7 (given that that's as high as it seems to go), might I avoid these instances and potentially have more consistent, better quality sleep?

Would be helpful to zoom in to those FL events, especially at later REM sleep episode (when FLs are happening). Good idea to increase min to 6-7.

Q 2: My mouth fell open several times the first couple of nights, I closed it and promptly fell back asleep. I've not noticed this happening the last couple of nights, is it possible that I've learned to keep my mouth shut because of the machine?

Q 3: I'm finding the nasal pillows are making my nostrils slightly raw and sore, I don't think I've got the straps to tight. Does anyone have a solution for this?

sometimes the residue on new gear cab be very irritating to the skin..

Thanks in advance for your help!

[Lightweaver]

EPR (expiratory pressure relief) can be effective in reducing FLs. To get the full benefit of your EPR setting of 3, you need to reset your minimum to at least 7. The lowest pressure the machine delivers is 4, so with a minimum of 7, you'll always be getting EPR of 3.

Does EPAP (on Vauto) affect flow limitations at all? If a patient only has fls and no real apneas, is there any reason to raise EPAP past 4?

[slowriter]

EPR (expiratory pressure relief) can be effective in reducing FLs. To get the full benefit of your EPR setting of 3, you need to reset your minimum to at least 7. The lowest pressure the machine delivers is 4, so with a minimum of 7, you'll always be getting EPR of 3.

Does EPAP (on Vauto) affect flow limitations at all? If a patient only has fls and no real apneas, is there any reason to raise EPAP past 4?

PS/EPR addresses FL.

If you find min EPAP of 4 comfortable and you get no events, I can't see any reason to raise it.

[Miss Emerita]

My own exhale pressure is 5; I don't need anything higher to address obstructive events. My pressure support is 4.8, yielding inhale pressure of 9.8; that boost has done a great job on FLs.

One piece of terminology that can be a little confusing: EPR is subtracted from (inhale) pressure, and pressure support is added to (exhale) pressure. So EPR of 3 with a pressure setting of 7 translates to an inhale pressure of 7 and an exhale pressure of 4. On a bi-level machine, PS of 3 and a pressure setting of 7 would translate to an inhale pressure of 10 and an exhale pressure of 7.

[Lightweaver]

My own exhale pressure is 5; I don't need anything higher to address obstructive events. My pressure support is 4.8, yielding inhale pressure of 9.8; that boost has done a great job on FLs.

One piece of terminology that can be a little confusing: EPR is subtracted from (inhale) pressure, and pressure support is added to (exhale) pressure. So EPR of 3 with a pressure setting of 7 translates to an inhale pressure of 7 and an exhale pressure of 4. On a bi-level machine, PS of 3 and a pressure setting of 7 would translate to an inhale pressure of 10 and an exhale pressure of 7.

I'm curious, how did you settle on 4.8 precisely? Why not 5?

[Miss Emerita]

I was going up very slowly from 3, .2 cm at a time, and when I got to 5, the centrals and the aerophagia just wouldn't settle down. So I backed off to 4.8, where both are OK. Shorter answer: trial and error!