Updated Graph With Mouth Tape

[npolite]

Hi All,

I think I have found a mouth tape that doesn't rip my skin off (Niveus Gentle Strips). Last night I slept around 4 1/2 hours with the tape on but felt like I was suffocating. I didn't have a chin strap and think it might be needed. Leak rate looks good and while I had 6 CAs I don't think I can lower the pressure any further as I start getting Hypopneas.

https://imgur.com/a/bD5A7Pj

I have the humidity lowered to 1 as I found when I was waking up in the middle of the night and trying to get back to sleep that my nose was stuffy. This helped and I might need a setting of 2 to try at some point.

If at some point I try to go full mask, generally you need a high humidity level to keep you mouth from drying out, is that correct?

Thanks

[ozij]

Take the OSCAR green cursor, place it on the CA's (of which you have very little) and you'll see they seem to happen when your pressure goes down and flow limitations start happening. They could be waking you up.
(OK, let me be more careful: "I believe that if you take the OSCAR green cursor etc.")

That, to me, indicates you're letting the pressure go too low, definitely not too high. If anything, if this were my data, and I felt like I was choking I'd raise the minimum.

[npolite]

Here are the CAs that have been Zoomed in. It seems that the pressure is around 10-11. So do you think I need to bump up my min pressure to 11 and max to 13? I just recall having a lot of CAs last time I did this with a higher max pressure.

https://imgur.com/a/X5BO3xA

[ozij]

Here are the CAs that have been Zoomed in. It seems that the pressure is around 10-11

You didn't place the green vertical line on the CA's.

So do you think I need to bump up my min pressure to 11 and max to 13?

Whatever gave you the idea that this is what I think?
I said nothing with numbers, nor did I say anything about changing the max.

When did you feel like you were choking?
How long have you been sleeping with a taped mouth on these settings?

Here's what I see:
6 images, what happens before the CA

1 perturbed breathing, pressure at less than 10.5 change in pressure.
2 perturbed breathing, but pressure on its way down from 11
3 perturbed breathing, pressure at 10
4 perturbed breathing, pressure at 10
5 perturbed breathing, pressure at 11 on its way down
6 perturbed breathing, pressure at less than 10.5 on the far left and rising

Based on this single night - which may or may not be representative - I have two hypotheses, which don't exclude each other.
Your minimum pressure could be too low, letting your machine drop the pressure to where breathing is perturbed and the disturbance, or pressure change are disrupting your sleep. Conclusion: don't let the machine go there
Alternative: The pressure change itself is causing arousals.
Check that on you other data, use the green vertical line on the CA to help you see the pressure, and zoom a bit less.
Possible conclusion[s]:

• Use CPAP instead of APAP, start out at 10.6 because you're spending half the night at that pressure, or higher, anyway and its possible that pressure changes are causing arousals.
• Alternative: stay on APAP but raise only the minimum gradually and see how that affects your sleep

Don't make change in any setting until you've tested it for 4-5 nights, unless you feel it's very bad.

From a leas perspective, I don't see that you need a FFM.

[npolite]

Thanks for the reply. I am trying to understand OSCAR, I now see that the pressure is dropping before the CAs.

I will try a CPAP setting this weekend as I don't want to impact my work during the week in case things feel worse. Alternatively I will try to bump the pressure up but will need ramp up. I am not able to fall asleep if the pressure is 10 or above so will need to start it at 9 and ramp up after 45 minutes either way.

Thanks again and I'll report back

[ozij]

If you need the ramp, try to set it on Auto - in my experience it does a good job of identifying when I've fallen asleep, only raising the pressure when my breathing has become regular.
I set up auto ramp out of curiosity, wanted to see how it compares with my Polar watch about the time I fell asleep put at a tiny bit less than my therapy pressure, just for the experiment. Polar and ResMed agree - in other words, at least in my case, auto ramp is reliable.

There was no auto ramp 20 years ago when I started therapy, and the pressure, low though it was, made me so anxious that I would actually stay awake out of anxiety until ramp time ended... so I stopped using ramp entirely.

You can raise pressure in 0.2 increments, letting yourself get used to the change. Don't jump to a minimum of 10 of you find it so bothersome.

Good luck, and please come back to tell us how things are going.

[npolite]

Here is an update. I have been using the N30i and continued to use it but I know I am mouth breathing. Last night I woke up from it around 2:15 and decided to try the KT tape again.

I reviewed the graphs and zoomed into the CAs and don't see any decrease in pressure (or at least any major) around the time of the events
https://imgur.com/a/YPAX4Xi

My pressure range is 11.6-12.6 and OSCAR is telling me avg pressure of 12. Should I set it to 12? I have found that while the humidity setting at 2 is comfortable for when I fall asleep, when I wake up and try to fall back again it seems to be difficult to breathe. It could be related to my mouth breathing and being dehydrated though. If I usually set the humidity higher I really don't like it but I could try to get used to it if it will make things better. I just don't know.

I would appreciate any feedback with the current set of graphs. I think I feel way worse today with the tape vs without.

Thanks

[ozij]

Here is an update. I have been using the N30i and continued to use it but I know I am mouth breathing. Last night I woke up from it around 2:15 and decided to try the KT tape again.

I reviewed the graphs and zoomed into the CAs and don't see any decrease in pressure (or at least any major) around the time of the events
[...]
My pressure range is 11.6-12.6 and OSCAR is telling me avg pressure of 12.

With your minimum a 11.6 and the maximum at 12.6 - what would call a major decrease in pressure?
The machine, and OSCAR don't give you an average, they give you the median, which means you spend half your time at or above that pressure half at or below.

I think I feel way worse today with the tape vs without.

People respond differently to leaks - I can only say that if I ever have leaks like that, I'm very miserable.
My solution is either taping or a Full Face Mask, sometimes one, sometimes the other. But no way can I get the sleep I need with such leaks.
Why are you focusing on your CA's?
Have you compared your flow limitations at higher or lower pressure?
Have you tried an FFM?
Do you want continue using the N30i and mouth leaking? Are you asking "how can I sleep better despite the mouth leak?"

[npolite]

With your minimum a 11.6 and the maximum at 12.6 - what would call a major decrease in pressure?
The machine, and OSCAR don't give you an average, they give you the median, which means you spend half your time at or above that pressure half at or below

The last posting you mentioned that I need to analyze the graphs before the CA occurs and see if there is a drop in pressure. I mentioned that I don't see it during these occurrences.


Why are you focusing on your CA's? I had seen comments that too many CAs indicate an issue with too high of a pressure
Have you compared your flow limitations at higher or lower pressure? I've been keeping this rate steady. Originally the NP had my setting at 5-15
Have you tried an FFM? I have tried a F30i and was miserable the day after I used it. I had a lot of leaks and extremely dry mouth. This was done with a larger range of pressure but I had the straps on so tight it almost hurt. I will give it another tray again and increase the humidity despite my nose only liking lower humidity levels.
Do you want continue using the N30i and mouth leaking? Are you asking "how can I sleep better despite the mouth leak?" I think I am at the point where I have exhausted all possibilities. I just think that CPAP doesn't work for me. I probably need to look at another sleep doctor practice as the one I went to get the device from just told me to leave the pressure settings at 5-15.

All of these issues started after I purchased a new mattress and end up now sleeping on my back. Before I could sleep on my stomach and side without any arm pain. I may have to revisit this and get a better more comfortable mattress since CPAP isn't working

[Nocibur]

I had seen comments that too many CAs indicate an issue with too high of a pressure

Only for TECSAns, and you're not a TECSAn.

I just think that CPAP doesn't work for me.

IMO it works fine (although IIWM I'd do a deep dive and work on those FLs a lot more).

I may have to revisit this and get a better more comfortable mattress since CPAP isn't working.

Wot?

[npolite]

IMO it works fine (although IIWM I'd do a deep dive and work on those FLs a lot more). -- What would I be looking for here to indicate I need higher/lower pressure?

Wot? -- With my old mattress I either didn't have any tiredness or it was very mild. If I sleep on my side or stomach I didn't have this issue. It was only after I purchased a new mattress that all of these issues started happening. With the new mattress I am no longer able to sleep on my side as I get pain in my arms after 20 minutes. If I stay too long on my side I lose bloodflow and my arms go numb. I now end up on my back which is where most of the SA occurs. I hope this makes sense.

[Nocibur]

What would I be looking for here to indicate I need higher/lower pressure?

I would look specifically at the waveforms to determine where/when/ how much additional pressure is needed.

For example, in your image:

1 - lfnQ4gv.png (114.01 KiB) Viewed 23956 times

the FLs are definitely causing an issue, but the true extent of the problem is not really reflected in the FL graph. You need to look at individual breaths and fix those that cause arousals.

[npolite]

So if a flow limit shows up does that mean I need additional pressure? What flow limit would show that I would need lower pressure?

In the example you show during the CA it does not show a significant flow limit, does that indicate adequate pressure?

[Nocibur]

So if a flow limit shows up does that mean I need additional pressure?

If they're causing arousals, definitely.

What flow limit would show that I would need lower pressure?

For your purposes, that is not a consideration.

In the example you show during the CA it does not show a significant flow limit, does that indicate adequate pressure?

It DOES show flow limitation and that the pressure is INadequate.

[pratzert]

What type of tape does one recommend?