Need Help Optimizing Therapy

A lot of good discussion here, but is donewithbeingtired getting appropriate help?

ChicagoGranny wrote:

Captain_Midnight wrote: the FFM pushes the mandible toward the windpipe, and tends to close the flow.

Try this little experiment. Breath in comfortably; and, while doing so, push back on your chin (mandible).

I have heard this before and I have tried it before. I just tried it again sitting here. No matter how hard I push, my mandible will not budge.

Now if you came into my bedroom and pushed on my chin while I was asleep .....

maybe it's already back... most people have play in the joint of their mandible and can move it forward and backward, it's not a fixed joint.

ChicagoGranny wrote:

"Selfie"?

Or......

Dirty Mary Callahan: Uh uh. I know what you're thinking. "Did she fire fifteen shots or only fourteen?" Well to tell you the truth in all this excitement I kinda lost track myself. But being this is a 9mm semi-auto with enough power to blow your ugly head clean off, you've gotta ask yourself one question: "Do I feel lucky?" Well, do ya, punk?


Den

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Wulfman... wrote:Dirty Mary Callahan: Uh uh. I know what you're thinking. "Did she fire fifteen shots or only fourteen?" Well to tell you the truth in all this excitement I kinda lost track myself. But being this is a 9mm semi-auto with enough power to blow your ugly head clean off, you've gotta ask yourself one question: "Do I feel lucky?" Well, do ya, punk?

I think Den's in love... gramps better watch out!

palerider wrote:I think Den's in love... gramps better watch out!

Gramps knows that I like Den a lot.

palerider wrote:maybe it's already back... most people have play in the joint of their mandible and can move it forward and backward, it's not a fixed joint.

I have a normal overbite. My MAD is not capable of moving my mandible but a small amount forward before it becomes intolerably uncomfortable.

We will have some visitors tomorrow and I will see who can push their mandible backwards.

ChicagoGranny wrote:

palerider wrote:I think Den's in love... gramps better watch out!

Gramps knows that I like Den a lot.

Well, I like BOTH of you......a lot.


Den

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ChicagoGranny wrote:We will have some visitors tomorrow and I will see who can push their mandible backwards.

or forwards.

FFM's push on your lower jaw. Some people, including some of the sleep techs on binarysleep.com, say FFM's push the jaw back for some people and makes their sleep apnea worse.

It makes sense to me. It's well known that for some people, an oral device that pulls the jaw forward improves their apnea. MMA surgery has moving the jaw forward as its main purpose. Why wouldn't pushing the jaw backwards make it worse on some people? An FFM is sort of like a dental device that makes your apnea worse for some people.

As for pushing your mandible back, there's quite a bit of flexibility in mine. If I squeeze my teeth together, my lower teeth move back and rest behind my upper teeth. If I relax a bit, my jaw moves forward, and my front teeth meet. I can even stick my lower teeth out in front of my upper teeth a bit and still be a bit relaxed.

If you find a FFM makes your AHI numbers worse, it's probably a real effect. You may be able to fix it with a little more pressure. Find what works best for you.

ChicagoGranny wrote:push their mandible backwards

Gramps and I agreed when we masked up and got in the bed we would see if our masks (Innomed Hybrid is our usual) would push our mandible back. We both agreed it could if the straps were over tightened. But both of us have found a loose headgear works well. We also both wear soft spinal collars and think maybe that helps.

But this I am still concerned about:

ChicagoGranny wrote:A lot of good discussion here, but is donewithbeingtired getting appropriate help?

Her/his thread has been hijacked by regulars that are not helping her/him.

OK I am back with a few more nights of data. Have had a cold, so its not been the best for using the machine, but hey you get what you get.

I have been playing with the apap range with mixed results. Not really sure what is causing the spikes in the AHI. Maybe sleeping on my back? Maybe REM?

I don't feel any different so far.

Also how good is the machine at catching the increased apneas and hypopneas and adjusting pressure to "head them off"? Or does it lag enough that it never really catches up? So once I get a good level established is it better to run in cpap mode rather than apap?

Anyhow, here's the data, appreciate the next level of interpretation.

donewithbeingtired wrote:OK I am back with a few more nights of data. Have had a cold, so its not been the best for using the machine, but hey you get what you get.

I have been playing with the apap range with mixed results. Not really sure what is causing the spikes in the AHI. Maybe sleeping on my back? Maybe REM?

I don't feel any different so far.

Also how good is the machine at catching the increased apneas and hypopneas and adjusting pressure to "head them off"? Or does it lag enough that it never really catches up? So once I get a good level established is it better to run in cpap mode rather than apap?

Anyhow, here's the data, appreciate the next level of interpretation.

In order to "head off" apneas, there needs to be snores or flow limitations preceding them for the machine to trigger pressure increases. If there are none, it won't happen and they'll go ahead and occur. That's also why having an adequate minimum pressure or fixed pressure (if CPAP mode is desired) to prevent the vast majority of events to begin with. Even with a range of pressures, we often used to advise having the minimum pressure set to where a CPAP pressure would need to be. Then if any additional pressure may be required, it MAY (possibly) increase if the triggers are there.

Personally, I don't do well with ranges of pressures (as the pressure changes disturb my sleep), so I'm a little biased in that regard. But, some people do well and like the ranges.


Den

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Thx Den. I have been trying to figure out that minimum cpap pressure to prevent the apneas, then maybe leave a range in there above that to handle anything that is atypical? Not sure if the pressure changes bothering me, but I do know that I am still tossing and turning a lot, switching between left side and right side. I also think I am getting bugged by mask noises and outflows at some point. Wonder if that is when the pressure cranks up with more apneas?

Appreciate any other advise here...I am still feeling like this is a pretty big mess and not making a lot of progress. Just know I need more pressure at times, higher than the 10cm Rx, but still too many variables and moving parts to seem to be making improvements.

You have ramp turned on starting from a pressure of 4.0 and continuing for 45 minutes until you reach therapy pressure. The ramp cycles every time the machine is stopped. I think you would be much more comfortable starting the ramp at a higher pressure, and having it complete in 10 minutes or less. Many users do not use ramp at all, and 4.0 is a very low pressure and amount of air to be receiving. When you are just starting the night your respiration rate and volume tends to be relatively high anyway until you settle in. Please consider changing ramp.

I would use a minimum pressure of 10 cm and not change the maximum pressure. Wulfman is correct that the obstructive events are getting through, and the cure is more pressure. Without flow limitations or snores, the pressure will not rise, and it does not rise when an apnea or hypopnea is in progress.