I'm not getting enough sleep now.

robysue wrote:

avi123 wrote: In your case if you can't fall back a sleep why not stop the APAP, remove the mask, and use a chinstrap to help you sleep the rest of the night? Try it out. The chinstrap should stop your tongue falling into your throat and wake you up.

Avi,

There is no way that an external strap of cloth designed to keep your mouth closed is going to do anything to prevent your tongue from falling back into the upper airway. Chin straps are designed to prevent mouth leaks; they are not "stand alone" devices for treating OSA.

If there is NO WAY then please check this:

Treatment of Severe Obstructive Sleep Apnea Syndrome with a Chinstrap

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2556917/

One only case written up... does not mean anything much and should not be recommended on its own to others without a lot of follow-up by doctors, labs, etc. etc.

avi123 wrote:

robysue wrote:

avi123 wrote: In your case if you can't fall back a sleep why not stop the APAP, remove the mask, and use a chinstrap to help you sleep the rest of the night? Try it out. The chinstrap should stop your tongue falling into your throat and wake you up.

Avi,

There is no way that an external strap of cloth designed to keep your mouth closed is going to do anything to prevent your tongue from falling back into the upper airway. Chin straps are designed to prevent mouth leaks; they are not "stand alone" devices for treating OSA.

If there is NO WAY then please check this:

Treatment of Severe Obstructive Sleep Apnea Syndrome with a Chinstrap

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2556917/

This is a case study of ONE person, not a controlled study that dates back to 2007. Chinstraps are not designed to be used, but in this one case it "worked." Whether a chinstrap will work for large numbers of people with OSA is a whole different question. The paper concludes with this statement:

The use of CPAP might have improved upper airway muscle tone and/or edema, thus leading to an improvement in the second PSG. However, our patient had not used CPAP for 2 months prior to the second study done with the chinstrap. Thus we doubt that residual CPAP effects stabilized the upper airway. It should also be noted that the endoscopic exam was performed in a nonblinded fashion. Thus, any case series evaluating chinstrap efficacy should utilize blinded endoscopic exams.

In sum, this case report indicates that a simple and inexpensive chinstrap deserves further investigation as a modality for the treatment of OSAS.

Deserves further investigation should NOT be misinterpreted as: Try this if you want to just give up on PAP therapy.

Moreover, one article that cites the above article is is a study that failed to reproduce the results in the case study and is less than favorable towards the idea that a chinstrap by itself might be of use in treating OSA:

The efficacy of a chinstrap in treating sleep disordered breathing and snoring. (Aug 2014) This paper's abstract states:

STUDY OBJECTIVES: A previously published case report suggested that a chinstrap alone might improve obstructive sleep apnea (OSA). We conducted this study to determine whether a chinstrap was a feasible alternative to continuous positive airway pressure (CPAP) in patients with OSA.

METHODS: 26 adult patients with OSA (apnea-hypopnea index [AHI] > 5/h on diagnostic polysomnogram [PSG]) underwent a modified split-night PSG, using only a chinstrap for the first 2 hours of sleep, followed by CPAP titration for the remainder of the night. Improvements in AHI, arterial oxygen saturation (SpO2), and snoring with chinstrap use were compared to results with optimal CPAP pressures.
RESULTS:

There was no significant difference between the diagnostic PSG and the chinstrap portion of the split-night PSG in the following parameters: general AHI (median [IQR] 16.0/h [9.7-26.0] vs. 25.9/h [10.7-42.7]), SpO2 nadir (84.0% [80.5-87.5] vs. 87.0 [84.0-88.5]), AHI in REM sleep (26.7/h [16.8-43.7] vs. 42.4/h [21.3-57.7]), AHI in supine sleep (24.9/h [11.9-51.5] vs. 29.8/h [11.7-55.5]), snoring index (253.2/h [147.5-353.1] vs. 180.0/h [9.8-393.3]) or subjective snoring scale (3.0 [0.8-3.0] vs. 2.5 [0.4-3.0]). The AHI and SpO2 nadir in the 13 patients with mild OSA also did not improve with chinstrap use (9.6/h [8.1-12.2] vs. 10.6/h [6.8-35.4] and 87.0% [83.0-90.0] vs. 88.0% [87.0-89.0]). All these parameters showed significant improvement with optimal CPAP titration (p < 0.05).

CONCLUSIONS: A chinstrap alone is not an effective treatment for OSA. It does not improve sleep disordered breathing, even in mild OSA, nor does it improve the AHI in REM sleep or supine sleep. It is also ineffective in improving snoring.

Temazepam? How long have you been using it?

Julie wrote:One only case written up... does not mean anything much and should not be recommended on its own to others without a lot of follow-up by doctors, labs, etc. etc.

Question:

Do you assume that robysue needs your help?

How old are you? The older you are, the less sleep you are gonna get. It's just a fact of life. I'm 70 and my Doc says 5 to 6 hours is about normal for someone my age.

Noctuary, could find out if a chinstrap (like the one I use) works for him. It does work for me when I don't use my APAP. As a matter of fact I can find lots of solid data on it. Just Google Snoring and Chinstraps.

avi123 wrote:

Julie wrote:One only case written up... does not mean anything much and should not be recommended on its own to others without a lot of follow-up by doctors, labs, etc. etc.

Question:

Do you assume that robysue needs your help?

I'm not sure why you felt like you needed to say this, but it looks like you got this backwards, since Julie posted her comment first.

avi123 wrote:

Julie wrote:One only case written up... does not mean anything much and should not be recommended on its own to others without a lot of follow-up by doctors, labs, etc. etc.

Question:

Do you assume that robysue needs your help?

Avi,

Julie saw your post before I did. She wrote a short, but relevant comment. I wrote a longer, but relevant comment. We're not "ganging up" on you. Rather we both saw a post that we thought needed to be questioned. Julie took the time to follow your link to the paper and read enough to get the main important thing out of it: The paper you link to is a case study. And she posted that.

I spent a bit more time poking around following the links for papers which cited the paper you linked to. I was looking for whether any follow-up studies on this idea had been done. And lo, and behold, one of the papers that cites the one you talked about just happens to be a follow up study published in 2014 that refutes the idea that a chin strap by itself can be used to manage/treat OSA.

I narrowed the pressure range from 8-20 to 8-13. I slept five and a half hours; I'm tired. Not the fatigue though, just tired.


The last time you used your ResMed AutoSet...
was last night (on Thursday, May 07, 2015)
You had an AHI of 0.69, which is considered pretty darn good
You machine was on for 5 hours, 46 minutes and 2 seconds.
You had no major mask leaks (maximum was 20.40 L/min).
Your pressure was under 12.9cmH2O for 95% of the time.

Looks pretty damn good!

Now, can you work up to 7 to 8 hours of sleep?

your pressure curve shows that the machine wanted to raise the pressure above 13 cm but was not allowed to. You should try setting the max pressure at 14 cm

Noctuary wrote:I narrowed the pressure range from 8-20 to 8-13. I slept five and a half hours; I'm tired. Not the fatigue though, just tired.

This night looks a whole lot better---much less variation in the Flow Rate and no really obvious "wakes"---although it does look like you may have a bit more restless between 3:00 and 4:30. But if you don't remember waking up during that time, that's a huge step forward.

One thing to note in passing: You were in bed for 5:46 and you said you slept for 5 1/2 hours, or 5:30. That means that on this night your self-reported sleep efficiency is 5.5/5.75 = 95.6%, which is "excellent". Yes, you're still tired---most likely because you got only 5.5 hours of sleep. But you may be feeling better than you have on other nights where you've only gotten only about 5-5.5 hours of sleep simply because you were NOT lying in bed for a couple of hours stressing out over the fact that you were awake.

Question: Do you think the lowering the max pressure is the main reason you didn't wake up in the middle of the night and find yourself unable to get back to sleep?

And an observation: You are hitting the max pressure of 13 and staying there for some pretty extended times. But (and this is an important but) you report sleeping better (no hour long wakes) AND your AHI numbers are better than they were when the machine was allowed to go higher. The AHI is down because the number of CAs scored is way down, and the number of CAs scored is way down most likely because there are no extended wakes where you were trying unsuccessfully to get back to sleep. In light of the overall better sleep, you need to NOT get worried about sitting at your max pressure setting for most of the night. A lot of people around here tend to look at pressure curves like yours and insist that the max pressure needs to be raised. It doesn't need to be increased as long as you are sleeping better with the pressure sitting at 13 than you were when the pressure was allowed to max out at 15.

More about Chin Straps:

http://www.cpaphelpdesk.com/cpap-chin-strap.html

IMO, a chinstrap like the one I use acts like an oral appliance. It does:

Stabilize the lower jaw and tongue and Increase the muscle tone of the tongue.

In the study mentioned in above post by robysue they have not even described the kind of chinstrap used.

Warning !

• Please, please keep this mind - if your doctor just writes a prescription that states “CPAP Chinstrap”, you will most likely only get the type of chin strap the Home Medical Equipment company gets at the lowest wholesale price. Basically the cheapest one. It might not really meet your needs. So spend a few minutes on this website and familiarize yourself with the various types of CPAP Chin Straps. Watch the video reviews. This way you know their strengths and weaknesses upfront and thus you can make an informed decision

SleepDisturbed wrote:Looks pretty damn good!

Now, can you work up to 7 to 8 hours of sleep?

To Noctuary:

While the long term goal should be to work up to 7 or 8 hours of sleep, please be aware that that probably won't happen overnight.

This is the first night in a long time that you didn't have a long wake lasting 1-2 (or more) hours. You need to consolidate what you've accomplished before trying to get 7-8 hours of sleep.

What I mean by that is this: You need to see if you can continue getting 5.5 hours of sleep in a roughly 6 hour time in bed window for a few more days. Once you are consistently getting 5.5 hours of sleep in a 6 hour time in bed window, then try moving the bedtime back by 15 minutes and see if the sleep increases to 5.75 hours. If you have no trouble getting 5.75 hours of sleep in a 6.25 hour time in bed window for several days, move the bedtime back by another 15 minutes and repeat.

The idea is to try to keep the actual sleep time pretty close to the time in bed window. In other words, you want to encourage your body to stay asleep the whole time you are in bed. Yes, it's a slow process, but in general you may find that you will feel better with a higher sleep efficiency and a bit less sleep than a lower sleep efficiency and more time asleep. To make myself clearer: What I'm saying is that you may find that you will feel better if you get 6.5 hours of sleep in a 7 hour time in bed window than you do if you need to spend 8.5 hours in bed to get 7 hours of sleep. Sleep efficiency computations for these two scenarios:

• SE = 6.5/7 = 92.8%
  SE = 7/8.5 = 82.3%