Help me prepare for Doctor

Hi all, I'd like your help to prepare for a doctor visit.

This may be the first time EVER that I get to talk to a sleep doctor. Yeah, one I never met "signed off" on my in-lab sleep report several years ago but this time I think I've got a referral which will get me face to face with one (if not, then a physician's assistant in that office). At minimum they will download my card and see I'm 100% compliant, send me away and charge the visit to my insurance... but I'm hoping to have better than that. I'd like to be prepared to engage the doctor in meaningful conversation about my CPAP therapy. Please help!

I'm doing great as far as AHI -- my monthly average is about .30 AHI -- mostly nights with zero to four events (and those are usually minimal hypopneas). My main trouble is leaks -- I know I'm opening my mouth, even with a chin strap, during portions of the night. But I'm also concerned about what my breath waveforms are looking like (even when not leaking) as it isn't looking very smooth.

I will mention to the doctor about a change of medicine, and that I'm doing really well weight-wise (now normal BMI) which was not the case when I was diagnosed.

What do you see, and what should I be prepared to talk about?

I'll attach a couple snapshots from SleepyHead of a recent typical night, one will be a one-minute closeup of the breathing.


--SleepyCPAP

What can help depending on if it's appropriate to you, is a soft cervical collar. It helps to keep your head off your chest, opens your airway better and keeps your mouth closed more. But even that (or chinstraps) won't keep your lips closed, so if that remains a problem after a collar trial, you might want to try a FF mask or taping.

Other than the leaks, I don't see many issues.
Have you considered a full face mask? At least you wouldn't lose your therapy air with one of those.


Den

.

Your leaks aren't that bad despite the % that SH is reporting over the red line.

SleepyHead defaults to the ResMed red line of 24 L/min so SH is calculating the % based on that number.
Your need to change the red line to something more in tune with what your machine is using which at your pressure and with your mask is more up around 80 to 90 L/min.
To change that value so the % of time in large leak is more accurate you need to go to Sleepyhead Preferences/CPAP tab and look in upper right corner to see where to adjust the "red line".

If those leaks aren't waking you up and you don't particularly want to use a full face mask I don't see the need to switch. Very little time is spent in large leak and the rest of the time your therapy pressure is quite able to do its job and very little is "lost".

From past experience dealing with how doctors think...if you want to discuss the breathing pattern try to target that first thing. Doctors don't typically put these reports that much under the microscope and will generally go with hours of use first...general average AHI second (if at all) and how you feel.
If me I would cut to the chase from from the start with something like
"I feel I am doing very well in terms of hours of sleep and AHI control but I am concerned about the breathing pattern I see and wonder what it means if it means anything and is there anything to change or needs to be changed....."
Get him to target your biggest concern first. "I want to discuss..... because it bugs me" type of starting point.

Thanks Julie, Den and Pugsy for your responses.

Den, I've got a full face mask "just in case" but my attempt at sleeping with it turned out even worse for leaks. I don't know if I could get it to work any better with my facial hair.

Julie, I've been curious about the neck collar. But it is mostly my lips that are the problem. I have used tape in the past, but it is harder with the TapPap (compared to SwiftFX).

Pugsy, I've put a higher number in the box for leaks and that was a great suggestion to customize the SleepyHead reports. I notice my machine flags leaks above 75. I didn't put that number in, because that is leak and vent combined -- I'm trying something around 50 as an experiment. Leading the conversation with my focus on the breathing/waveform is a great suggestion!

-- SleepyCPAP

Collar + tape?