Hitting Max Pressure With Controlled AHI Question

[Franko39]

Hi everyone,

Thanks again for the help and tips. I've slept on it for a few more nights, so to speak. The changes made were upping my pressure from 6.0-10.6 to 7.0-11.2.

Attached are the last two nights of data. The Sept 1st night seems to be achieving that "flatter curve" that one of you had mentioned earlier, with a nice low AHI as well.

How do these flow limitations look now? There's still some there, but I'm not sure how bad these are, relatively speaking.

TIA!

[robysue1]

How do these flow limitations look now? There's still some there, but I'm not sure how bad these are, relatively speaking.

How are you feeling these days?

That's really the critical question with data that looks like this. If you are feeling pretty good---as in you wake up feeling ready to face the day and you have enough energy to get through your day, then the best thing you can do is just not worry about those remaining flow limitations.

Here's the thing: Not everything that Resmed scores as a "flow limitation" can be fixed by increasing the pressure. Sometimes flow limitations can be caused by nasal congestion. Or a deviated septum. Or, occasionally, the airway can counterintuitively become more unstable at higher pressures and part of that increased instability can show up as "flow limitations" that don't get better, and can get worse, as the pressure increases.

In other words, if you feel good, it's reasonable to assume that the flow limitations are not necessarily indications that you need more pressure to manage your OSA.

[Franko39]

How do these flow limitations look now? There's still some there, but I'm not sure how bad these are, relatively speaking.

How are you feeling these days?

That's really the critical question with data that looks like this. If you are feeling pretty good---as in you wake up feeling ready to face the day and you have enough energy to get through your day, then the best thing you can do is just not worry about those remaining flow limitations.

Here's the thing: Not everything that Resmed scores as a "flow limitation" can be fixed by increasing the pressure. Sometimes flow limitations can be caused by nasal congestion. Or a deviated septum. Or, occasionally, the airway can counterintuitively become more unstable at higher pressures and part of that increased instability can show up as "flow limitations" that don't get better, and can get worse, as the pressure increases.

In other words, if you feel good, it's reasonable to assume that the flow limitations are not necessarily indications that you need more pressure to manage your OSA.

I don't feel much different in these last few days (with the pressure tweaks made) than I did when I was on the 6.0-10.6 pressure range. I'd say that I feel like it's an improvement overall for my energy level on CPAP therapy, vs. off of it. However, I still get fatigue towards the end of the day even with the CPAP. I've only been on therapy successfully (keeping the mask on all night, having fixed the leaks, etc) for a couple months now, so perhaps things will improve with some more time.

[robysue1]

I don't feel much different in these last few days (with the pressure tweaks made) than I did when I was on the 6.0-10.6 pressure range. I'd say that I feel like it's an improvement overall for my energy level on CPAP therapy, vs. off of it. However, I still get fatigue towards the end of the day even with the CPAP. I've only been on therapy successfully (keeping the mask on all night, having fixed the leaks, etc) for a couple months now, so perhaps things will improve with some more time.

More questions:

1) Do you have a regular sleep schedule? As in do you go to bed at roughly the same time each night and get up at roughly the same time each morning? If you do have a regular sleep schedule, what does it look like?

2) How long does it take you to fall asleep at the beginning of the night? Do you remember waking up frequently during the night? If so, how many times do you typically wake up and how long does it take you to get back to sleep after a random wake-up in the middle of the night?

3) When you say you get fatigued towards the end of the day, do you mean a couple of hours before bedtime? (That's kind of common even for people without sleep apnea.) Or do you mean during the late afternoon? (It's also kind of common for people to get tired and/or sleepy during the afternoon, particularly after lunch, even if they don't have any sleep problems, including both insomnia and OSA.)

[Franko39]

I don't feel much different in these last few days (with the pressure tweaks made) than I did when I was on the 6.0-10.6 pressure range. I'd say that I feel like it's an improvement overall for my energy level on CPAP therapy, vs. off of it. However, I still get fatigue towards the end of the day even with the CPAP. I've only been on therapy successfully (keeping the mask on all night, having fixed the leaks, etc) for a couple months now, so perhaps things will improve with some more time.

More questions:

1) Do you have a regular sleep schedule? As in do you go to bed at roughly the same time each night and get up at roughly the same time each morning? If you do have a regular sleep schedule, what does it look like?

2) How long does it take you to fall asleep at the beginning of the night? Do you remember waking up frequently during the night? If so, how many times do you typically wake up and how long does it take you to get back to sleep after a random wake-up in the middle of the night?

3) When you say you get fatigued towards the end of the day, do you mean a couple of hours before bedtime? (That's kind of common even for people without sleep apnea.) Or do you mean during the late afternoon? (It's also kind of common for people to get tired and/or sleepy during the afternoon, particularly after lunch, even if they don't have any sleep problems, including both insomnia and OSA.)

Sorry, I missed this post.

1) I tend to sleep late, so I guess that's the regular schedule for me. Unfortunately due to my work (shift work, so both mornings and later afternoon shifts), my wake-up schedule is more variable. I also have young kids who tend to come sleep in our bed and disturb our sleep, so that interferes with my sleep. My usual sleep schedule is something like - get to bed and fall asleep between 1AM-2AM, am woken up a couple times per night from the kids in bed or dry mouth from the CPAP, then wake up between 8-9:30AM each morning.

2) I can usually fall asleep fairly quickly, within 15-30 minutes, each night. I do wake up a couple times a night for the reasons noted above - usually fall asleep again fairly quickly afterwards.

3) I'd say the fatigue kicks in around 7-8pm. That's new for me - I feel like the CPAP changed my fatigue profile. I used to have the fatigue kick in around the mid-afternoon, then go away. Now, it kicks in later in the evening. I've always been a night owl (perhaps some kind of coping mechanism for the OSA/fatigue), but it seems this need fatigue profile is more typical/normal, with CPAP use.

[Franko39]

Hi everyone,

Thank you again for your assistance. It's been nearly a full year since I started the CPAP journey, and I think I've gotten the hang of it, more or less. The last few months have been more fine-tuning and optimization.

- I can sleep through the night with the mask on now (most nights anyway).
- Leaks are no longer a regular issue, since switching to the F30i mask (still happens occasionally, due to my tossing and turning).
- The last thing I was trying to resolve was the flow limitations. I've heard mixed things, including that my figures weren't too bad. I tried upping the pressure and upping EPR a bit. Not sure if it made a big difference, but I decided to just leave things be, as it sounds like my flow limits aren't terrible.

Overall, I think I may feel a difference now, on nights where I'm able to use the CPAP for a full night without interruption. Hard to say for sure - I've heard that it takes some time to see improvements, so I'll keep at it.

The only issue I now have is that my mouth tends to open a bit at night as I'm asleep, and the blast of air coming in from the CPAP makes my lips really, really dry. I've been waking up once or twice each night due to how dry my lips are - not sure if there's a good fix for this or not.

I've posted some recent OSCAR data representing my typical nights - any insights/comments would be appreciated!

Franko

[robysue1]

1) I tend to sleep late, so I guess that's the regular schedule for me. Unfortunately due to my work (shift work, so both mornings and later afternoon shifts), my wake-up schedule is more variable. I also have young kids who tend to come sleep in our bed and disturb our sleep, so that interferes with my sleep. My usual sleep schedule is something like - get to bed and fall asleep between 1AM-2AM, am woken up a couple times per night from the kids in bed or dry mouth from the CPAP, then wake up between 8-9:30AM each morning.

2) I can usually fall asleep fairly quickly, within 15-30 minutes, each night. I do wake up a couple times a night for the reasons noted above - usually fall asleep again fairly quickly afterwards.

So there are a whole bunch of unavoidable life-issues that keep you from getting a full, uninterrupted night's sleep with the machine on most nights. CPAP can't fix the shift work or the kids coming into the bed and disturbing your sleep on a regular basis.

All of those things might be enough to explain the continued fatigue that kicks in around 7-8pm, which is also after "arsenic hour" as my hubby used to call the time when we and the kids all arrived home cranky because we were both starving for something to eat and tired and we still had to cook supper ....

In other words, having young kids and a full time job is enough to leave one feeling tired and fatigued in the evening, particularly if your sleep is regularly interrupted by the kids and you have a schedule that switches every few days due to shift work.

As for the dry mouth waking you up: There are somethings that you can try for that---more in my next post.

[robysue1]

- I can sleep through the night with the mask on now (most nights anyway).

Your previous post indicated that there were some life issues (young kids + shift work) that interfere with getting a full, uninterrupted night's sleep.

- Leaks are no longer a regular issue, since switching to the F30i mask (still happens occasionally, due to my tossing and turning).

If the data you post is typical, your leaks are well controlled and you don't need to worry about them unless they are waking you up. If you do wake up from a leak but have learned how to fix the leak and get back to sleep in about 10 minutes, then you don't even nee to worry too much about the leaks that wake you up if they're not happening all night long almost every single night.

- The last thing I was trying to resolve was the flow limitations. I've heard mixed things, including that my figures weren't too bad. I tried upping the pressure and upping EPR a bit. Not sure if it made a big difference, but I decided to just leave things be, as it sounds like my flow limits aren't terrible.

Sometimes chilling about about trying to fix the last little thing we're seeing in the data is the better choice. In other words, deciding to just leave things be for now is reasonable.

Overall, I think I may feel a difference now, on nights where I'm able to use the CPAP for a full night without interruption. Hard to say for sure - I've heard that it takes some time to see improvements, so I'll keep at it.

Keep in mind that as long as your kids are young and they're interrupting your sleep by crawling into your bed, you're going to have some fatigue issues: It's part of parenting young children. As the kids grow and become less needy at night, you will have more nights where you will be able to use the CPAP all night long without interruption.

The only issue I now have is that my mouth tends to open a bit at night as I'm asleep, and the blast of air coming in from the CPAP makes my lips really, really dry. I've been waking up once or twice each night due to how dry my lips are - not sure if there's a good fix for this or not.

There are a few things worth considering.

First if this is happening often enough for your lips to actually get chapped, you will need to do something to protect the lips.

If this happens almost every night, you could consider taping in an effort to prevent the mouth from opening. If you don't want to tape, then I would suggest the following:

1) Slather on a lip balm before you go to bed each night. And keep some lip balm on the night stand next to the CPAP. When you wake up and the lips feel dry, slather on some additional lip balm before going back to sleep.

2) Keep yourself well hydrated both during the day and at night. You may want to keep some water on the night stand as well. Sometimes drinking a bit of water helps the lips feel less dry. Do this before you slather on the next coat of lip balm.

Finally I'll add this: Some lip balms seem to last a lot longer than others do. Back when I was starting out, I had a really bad problem with the exhaust flow from my Swift FX mask chapping my lips. I found Badger Balm (not cheap) to be one of the most long-lasting lip balms that I tried. Now? I can pretty much use whatever kind of balm I want. But I still need to slather on a pretty decent coat before I go to sleep and if I wake up and the lips feel even slightly dry, I'll put more balm on before going back to sleep.

[Franko39]

Thank you again for your tips and the detailed post! I'll likely just leave the flow limitations be for the time being, as you had suggested.

There are a few things worth considering.

First if this is happening often enough for your lips to actually get chapped, you will need to do something to protect the lips.

If this happens almost every night, you could consider taping in an effort to prevent the mouth from opening. If you don't want to tape, then I would suggest the following:

1) Slather on a lip balm before you go to bed each night. And keep some lip balm on the night stand next to the CPAP. When you wake up and the lips feel dry, slather on some additional lip balm before going back to sleep.

2) Keep yourself well hydrated both during the day and at night. You may want to keep some water on the night stand as well. Sometimes drinking a bit of water helps the lips feel less dry. Do this before you slather on the next coat of lip balm.

Finally I'll add this: Some lip balms seem to last a lot longer than others do. Back when I was starting out, I had a really bad problem with the exhaust flow from my Swift FX mask chapping my lips. I found Badger Balm (not cheap) to be one of the most long-lasting lip balms that I tried. Now? I can pretty much use whatever kind of balm I want. But I still need to slather on a pretty decent coat before I go to sleep and if I wake up and the lips feel even slightly dry, I'll put more balm on before going back to sleep.

My apologies - for clarity, it's more of my inner lips getting dry that's the issue. The external lips aren't a bother for me. The internal lip dryness is what has been waking me up once or twice a night. When I wake up, my inner lips feel like completely devoid of moisture and I have to lick my gums and the inside of my lips thoroughly to make the feeling going away (I usually fall back asleep after this, but it's still a bother).

I think part of this issue may be because I recently changed my mouthguard to a bulkier one, so it's harder to fully close my lips over the new mouthguard. Unfortunately, I don't have insurance and am not keen on paying out of pocket for a new mouthguard, if able to avoid it.

I've tried taping in the past when using nasal pillows - found it uncomfortable and I'd wake up and tear off the tape while half-asleep still. I switched to a full face mask partly to avoid having to tape. So, I'd rather not have to tape, if I can help it!

I'm considering trying biotene for dry mouth - perhaps rubbing some of that into my inner lips/gums before bedtime. If you have any other suggestions for the inner lip dryness, that would again be much appreciated.

[Miss Emerita]

I wonder whether Xylimelts might help you. They are small discs that stick to your gums or teeth and stimulate salivation throughout the night.

[Franko39]

I wonder whether Xylimelts might help you. They are small discs that stick to your gums or teeth and stimulate salivation throughout the night.

I'll gladly give it a shot - thanks for the tip!