depressed second week

[andy5805]

still 100% compliant

after an amazing first week, I've found the issue I had prior to the machine has transferred to the machine - snoring myself awake - it only happens on my way into sleep, but happens a few times, and if panic takes hold, that's that, the night has gone to hell. Last night was a bit like that for me

I know why it happens. My mouth wants to open despite great nose breathing through the mask. When it does, violent snoring immediately occurs that I only notice going half way into sleep, and not when I'm into full sleep.

My uvula and tongue are very close, despite having tonsils out. I'll be zoning out into peaceful sleep then a violent wretch accompanied with a roar jerks me into misery. If I ignore it enough times and win the psychological battle I have a chance, if like last night panic grabs me, I have no chance.

Kept the mask on and managed to find that ointment to seal, wondering if my settings are wrong and I need to increase pressure

current EPAP min 6 max 7.1, IPAP min 10, max 12, PS 4, max 5

Events - hypoapnea just over half, CA , 1/4 RERA whatever that is 1/8 and flow limt 1/8


Should I increase pressure to stop snoring? Help anyone?

[zoocrewphoto]

It sounds like the snoring is caused by your mouth being open. If so, changing the pressure won't help. You either need to master keeping your mouth closed, or use a full face, hybrid, or total face mask to eliminate the problem.

I'm sure several people will post tips for keeping your mouth closed. I know some use chin straps. Some have mastered keeping their tongue in place. I can't even try because of my need to breathe through my mouth. I'm very happy with my full face mask.

[robysue]

Andy,

Your signature indicate you are already using a full face mask---one that covers both your mouth and nose. Is that correct? Hence we can't simply say the problem is "mouth breathing with a nasal mask, so you need a full face mask."

So---What position are you lying in when this happens? If you're on your back, maybe changing the position you go to sleep in will help.

And finally, you gave us the break down between the type of events, but you didn't actually tell us the AHI. And we need that before making any kind of suggestions about whether your pressures might need to be changed.

[Pugsy]

The pie chart breakdown doesn't really help us all that much.
We need the breakdown of events shown above the pie chart.

[McSleepy]

One thing that I've found helps me keep my jaws firmly closed is a flexible mouth guard in combination with a chin strap. The latter I made myself from 2" elastic band and some cloth pads, while for the former I use the cheap silicone dental trays for teeth whitening ($4 for 3 from Amazon, shipped). Those are moldable so you can fit them to your teeth (I use lesser heat so that they stay thicker and I don't bite through them). I prefer fitting them to my lower jaw because it displaces my jaws less and I don't wake up with an underbite.
Keeping your mouth closed wbile sleeping is ultimately a habit that you'll need some time to form. The important thing is to remember that, one way or another, you will find a solution, so your snoring simply cannot win the war - it might win a battle or two, but you will prevail in the end.
McSleepy

[DoriC]

You haven't listed your machine correctly. Is it the one Pugsy has in her profile? Bipap?

[Pugsy]

You haven't listed your machine correctly. Is it the one Pugsy has in her profile? Bipap?

Yes, Andy has the PR System One 60 Series BiPap Auto model 760 like I have.
I think Andy had trouble figuring out which one to choose.

[kteague]

I am not familiar with that machine, but does it have a ramp? Too low of a pressure, whether ramp or actual treatment pressure, can cause one to open their mouth to be able to breathe when an obstruction happens upon dozing off. What effort will be best to address your problem will depend on the cause - low pressure or relaxed jaw. Or both.

[andy5805]

Thanks for all the helpful comments

I try and sleep on side.

AHI was a low average - 1.43 - but clustered between 1 and 5 all between 1.10 and 3.30 so that two hours I think is what left me exhausted on Thursday- after that I had perhaps 3-4 hours and went to work. with me the killer is always snoring to get to sleep jerking me awake - if I actually get to sleep I've won, it's the getting there that I have the issue with and the snoring caused by tongue base and uvula - how I hate that uvula - it's a part of me completely committed to driving me crazy. Against me, not for me. Obviously depending on stress levels/tiredness, panic builds each and every time I snore awake thinking will I have enough in me to survive the motorways/work etc. Most of the time I ignore it and eventually I'm asleep for a fragmented night, some nights I lose, like Wednesday as the panic starts to grip me.

The machine has helped - though when I've gone exclusively nose breathing with the hybrid mask my mouth has still wanted in. Again my nose clears itself when I get to sleep on the machine, but it rasps and hums sometimes on the way. I think my airway is thin, and that the damned uvula is up to it's devilry in reverse and flapping the other way to create that noise. I can't have it cut off, I can't afford the time off work, already had the tonsil operation.

Thing is- and I'm blessed - nothing can take last week away from me, I could read all day on forums how CPAP/Bipap works and think "it's for them" until last week. So no matter how bad I get, I have that memory and something to work towards. Some people don't ever have that road of Damascus experience to drive them, last week for me was as if I was 10 years younger.

Slept ok ish tonight though bloodied my nose on the sideways deep sleep, and still full time on the machine.

[robysue]

Right now it looks like you are running in Auto Bipap mode. Does the machine detect VS snores when this problem is happening? If it does, then the machine should be increasing the EPAP pressure automatically if EPAP is not already at your max allowable EPAP setting. So is that happening?

I bring this up for two reasons:

1) If your machine is already increasing the EPAP from 6 to 7, then you know you're going to need to increase either the max EPAP setting or increase the min EPAP by more than 1 cm.

2) If your machine is NOT detecting VS snores, then you know you can't "fix" the problem by giving the machine more room to increase the pressure----you'll have to increase the min EPAP if you want more pressure.

Your overall AHI is low enough where pressure-induced centrals don't seem to be a real concern. So sure, if you want to bump up the pressure a bit to see if that helps, it's worth a try.

[andy5805]

Right now it looks like you are running in Auto Bipap mode. Does the machine detect VS snores when this problem is happening? If it does, then the machine should be increasing the EPAP pressure automatically if EPAP is not already at your max allowable EPAP setting. So is that happening?

I bring this up for two reasons:

1) If your machine is already increasing the EPAP from 6 to 7, then you know you're going to need to increase either the max EPAP setting or increase the min EPAP by more than 1 cm.

2) If your machine is NOT detecting VS snores, then you know you can't "fix" the problem by giving the machine more room to increase the pressure----you'll have to increase the min EPAP if you want more pressure.

Your overall AHI is low enough where pressure-induced centrals don't seem to be a real concern. So sure, if you want to bump up the pressure a bit to see if that helps, it's worth a try.

Hi Sue

can't believe how technical this is ! this is why I failed last time, and this is why , helped by great advice by you, Pugsy, others on board, I will succeed this time.

my miracle first week went like this

IPAP 5cm, PS( min) 4 PS (max) 5 , EPAP 12

I haven't touched PS, I think that's ok

But then I either got more stressed, or my nose became more congested - probably both, or I just had a week where I wanted to be a mouth breather, so the snores hit the roof and kept waking me up.

I had a bad night previously this week so for my hell night I was on IPAP 6, and clearly , that didn't work.

so exhausted, last night, I moved it again IPAP to 7, (and also EPAP to 14 to allow range) - now last night was rough as anything but I feel ok. I slept so hard on my side the pillow drew blood from my immediate inner nose. I also experienced the usual snort arousals going under, and fears that it might lead to more hell BUT I was so exhausted I managed to ignore them, went under, and rested. There was ONE massive jolt awake (don't usually get these asleep) but then I drifed out again.

and now I have a weekend, thank goodness. I wonder if it is worth sticking with these settings another night, not jumping the gun in fear that if it happened when I was exhausted, this time it'll wake me up. IPAP leak, normally at 30, was off the scale at 110ish average. The machine is detecting Vsnores of 5, I'm just not sure it's effective in stopping them.

[Pugsy]

Hi Andy,

EPAP is the lower number...so 5 or 6 or 7 cm this is exhale pressure...always lower than inhale with your machine
IPAP is the higher number...so 12 or 14....inhale pressure

I just sent you a private message suggesting 1 cm increase in EPAP...but I didn't realize that you used 7 EPAP last night and made the other change to IPAP.
I would leave things at last night's settings for a few nights to give your body a chance to adjust.

To everyone else...I have seen a report with the snores in question. AHI is super great. The snores normally are not of the magnitude (at least on paper) that we would normally worry about them but since they are disturbing sleep and creating a problem then we want to try to limit their appearance. A little more EPAP to help better hold the airway open and thus hopefully prevent the snores from materializing in the first place no matter what position a person ends up sleeping (just in case that is a factor) because trying to force sleeping position sometimes creates more of a problem than a slight increase in pressure might. In this case the pressures used are low and we have room to increase the pressure just a little.

[andy5805]

Thanks all for your help ! - it is very much appreciated.

bit zonked today after night before last, I do know which way round they are and what they stand for but for some reason I got mixed up transcribing it from the application, perhaps this is how I copy stuff at work!!!? !

Going to eliminate stress from this weekend not get involved in massive DIY projects, because afterall, I've done approx. 2 weeks "full time" on the machine and it can only get better. I bet there are a fair few of you on here that don't even consciously realise when you're doing the mask. I think that's sort of state of mind i'd like for the future, just a complete matter of fact approach to the situation

All the best
Andy

[Foggy1]

Andy, I also tend to mouth breath, though I don't do it consistently. I tried the Mirage Liberty, but haven't been able to get accustomed to it. I really want to be able to wear it, because I need a full face mask at times. I admire your persistence. You've inspired me to try the Liberty again.

[andy5805]

Andy, I also tend to mouth breath, though I don't do it consistently. I tried the Mirage Liberty, but haven't been able to get accustomed to it. I really want to be able to wear it, because I need a full face mask at times. I admire your persistence. You've inspired me to try the Liberty again.

good luck foggy - I had a week last week where it made all the sense in the world to be on the mask - I knew it was better sleep than I'd had in years.

So despite my issues with compliance, I now know it's about settings, stress management, that sort of thing, and that one day soon I'll get back what I was shown a glimpse of last week. When I do- what a new life i'll have!