CPAPtalk.com

Here's overall progress...





Day 17 I fell asleep reading and went the whole night without using the machine (just forgot/fell asleep).

leptic wrote: Have done a few nights at 8 cmH2O - probably time to bump up to 9 (or go right to 10?)

I'd say 10 or 11...

palerider wrote:

leptic wrote: Have done a few nights at 8 cmH2O - probably time to bump up to 9 (or go right to 10?)

I'd say 10 or 11...

Thanks

I think you are more than likely going to end up needing at least 10 minimum but going from 8 to 10 in one jump may or may not be all that comfortable for you. It hurts nothing to take your time and work up slowly and who knows...might get lucky and end up not needing as much as I think you will.
While 10 isn't horribly high..when a person has been using 8 for a while that 2 cm jump could maybe be a bit uncomfortable initially.

When I was in your shoes and my 8 cm minimum wasn't getting the job done (I was seeing AHI of around with some dense OA clustering very similar to yours...I went up slowly. It wasn't so much that 10 was all that horrible in terms of comfort but it was a bit disconcerting initially while awake and made for falling asleep a bit prolonged.
Now didn't increase it 0.5 for a week and then another 0.5 for another week...I would just try 2 or 3 days and then move up. Overall I think it took less than 2 weeks to get to 10 where I finally was seeing the clustering breaking up like I wanted...plus while going up slowly it gave me a clear cut answer to "what if I used a little bit lower" You might make the jump to 10 and see a big difference (you also may not) and then wonder "what if I was at 9 minimum".

Up to you to decide which way you want to go. There's pros and cons to both ways.
Given that I think that you tend to be more like me and want more immediate results...I wouldn't drag my feet moving up because in the back of my mind there's always the thought "I can always come down"
But that's just me....if you try 10 immediately and it feels good ...there's more chance of seeing a rather dramatic improvement with it and I myself tend to prefer dramatic if at all possible. But again that is me and that doesn't mean it is the "right" way for someone else to approach things.

What's nice is that the CA numbers are coming down and mainly seem to be showing up when you are having OAs and that points to the OA maybe causing an arousal and the CA being related to the arousal and not the pressure...and that's a good thing. Reduce the OAs and the centrals will more than likely reduce a little more also. They are already reduced by a lot and now in numbers where they don't warrant much more than a second glance.

Pugsy wrote:I think you are more than likely going to end up needing at least 10 minimum but going from 8 to 10 in one jump may or may not be all that comfortable for you. It hurts nothing to take your time and work up slowly and who knows...might get lucky and end up not needing as much as I think you will.
While 10 isn't horribly high..when a person has been using 8 for a while that 2 cm jump could maybe be a bit uncomfortable initially.

you're probably right, it's only that he's having higher than 11 pressures normally with the apap that's why I suggested such a big jump without much concern, since it's less than he's having normally... admittedly, it is more than he's probably used to while awake, and that might make a perceptive difference

I just hate seeing people having higher than needed AHIs for longer periods, that's my excuse for rushing it a bit

Pugsy wrote:I think you are more than likely going to end up needing at least 10 minimum but going from 8 to 10 in one jump may or may not be all that comfortable for you. It hurts nothing to take your time and work up slowly and who knows...might get lucky and end up not needing as much as I think you will.
While 10 isn't horribly high..when a person has been using 8 for a while that 2 cm jump could maybe be a bit uncomfortable initially.

When I was in your shoes and my 8 cm minimum wasn't getting the job done (I was seeing AHI of around with some dense OA clustering very similar to yours...I went up slowly. It wasn't so much that 10 was all that horrible in terms of comfort but it was a bit disconcerting initially while awake and made for falling asleep a bit prolonged.
Now didn't increase it 0.5 for a week and then another 0.5 for another week...I would just try 2 or 3 days and then move up. Overall I think it took less than 2 weeks to get to 10 where I finally was seeing the clustering breaking up like I wanted...plus while going up slowly it gave me a clear cut answer to "what if I used a little bit lower" You might make the jump to 10 and see a big difference (you also may not) and then wonder "what if I was at 9 minimum".

Up to you to decide which way you want to go. There's pros and cons to both ways.
Given that I think that you tend to be more like me and want more immediate results...I wouldn't drag my feet moving up because in the back of my mind there's always the thought "I can always come down"
But that's just me....if you try 10 immediately and it feels good ...there's more chance of seeing a rather dramatic improvement with it and I myself tend to prefer dramatic if at all possible. But again that is me and that doesn't mean it is the "right" way for someone else to approach things.

What's nice is that the CA numbers are coming down and mainly seem to be showing up when you are having OAs and that points to the OA maybe causing an arousal and the CA being related to the arousal and not the pressure...and that's a good thing. Reduce the OAs and the centrals will more than likely reduce a little more also. They are already reduced by a lot and now in numbers where they don't warrant much more than a second glance.

Thanks Pugsy,

I also wanted to mention an experience I've had since I've started paying more attention to my sleep/breathing. It happens fairly regularly that I have some foggy awareness at the end of certain apneas. This usually happens when I have been definitely asleep, but then I have just the slightest awareness that I've come to the end of something like a very long sigh. It was more pronounced with flex mode on, but I got the feeling the machine was gently nudging me with little puffs of air and this is what was causing me to wake ever so slightly. The feeling of the sigh was not unpleasant - I say I felt like it was long because of the impression that my lungs were really at the end of their capacity (not forcing it, just relaxedly letting the last little bit of air out). Looking back I think I've experienced this before I was diagnosed and in some cases the sigh might have been accompanied by vocalization (kind of a long groan).

The other 'audible' sign that my wife told me about back in the days when we slept in the same room was clicking. This drove my wife crazy - I did use an iPhone snore monitoring app to record some of this, and there's a definite click. In retrospect it really sounds like the airway is repeatedly blocking and unblocking, with a wet little 'click' each time it re-opens. During the recordings I made it happens every breath for long intervals... I should try this again with the CPAP.

The final bit of advice I wanted to solicit was on how I might train myself to breathe through my nose. I have always been a mouth breather (my dentist could tell when I was a kid) and this was an issue with my snoring as well, since my wife felt the problem might be solved if I'd just breathe through my nose. I have made an effort, and was able to achieve long intervals at night when I was indeed nose breathing. However, I seem to be dependent on the feeling of cooler, 'fresh' air inhaled through the mouth (I am sure this is purely psychological). Because the nasal passages provide so much 'buffering' to changes in pressure, temperature, etc. I think this would help in tolerating the CPAP (I'd still be ok using a face mask, which I find very comfortable). I think the humidifier would generally be good but the feeling of warm moist air going into my mouth feels rather stale. It's a lot better with my nose (which does not mind warmth and humidity at all), but when initially getting to bed I feel I can only get enough air with my mouth. Someone will surely say the key is 'just force yourself' and I'm happy to do that. If there are any additional methods that helps I am all ears though.

Thanks again!

Breaking a life long mouth breathing habit is going to be a tough one to break since yours wasn't because the nose was plugged up but was just because you liked to take big gulps of fresh cool air. You have to start with daytime breathing though...keeping the mouth shut.
I never breathe through my mouth during normal breathing (exercise induced need to mouth breathe is totally different). So you would have to make an effort during the day for sure while you have control over how you breathe. Keep the tongue in the roof of the mouth most of the time and hope that eventually the habit changes and the mouth stays closed (for the most part) during the night. Is still mouth breathe some during the night...usually when I end up on my back and gravity lets the chin fall down. It's never for very long though because back sleeping will end up waking me up because the back hurts like hell and it doesn't take all that long.

Are you using the heated hose or regular hose?
And what temperature is your bedtime usually kept at during the night?

Pugsy wrote:Breaking a life long mouth breathing habit is going to be a tough one to break since yours wasn't because the nose was plugged up but was just because you liked to take big gulps of fresh cool air. You have to start with daytime breathing though...keeping the mouth shut.
I never breathe through my mouth during normal breathing (exercise induced need to mouth breathe is totally different). So you would have to make an effort during the day for sure while you have control over how you breathe. Keep the tongue in the roof of the mouth most of the time and hope that eventually the habit changes and the mouth stays closed (for the most part) during the night. Is still mouth breathe some during the night...usually when I end up on my back and gravity lets the chin fall down. It's never for very long though because back sleeping will end up waking me up because the back hurts like hell and it doesn't take all that long.

Are you using the heated hose or regular hose?
And what temperature is your bedtime usually kept at during the night?

Shortly after getting the machine, I sought 'cooler' air by turning both the hose heating and humidification down to zero (off). I later turned humidification back on to '1', and more recently bumped it up to '3'. I suppose I should be tracking this as well - not sure if SleepyHead logs these settings...

When the heated hose is used...you have to go into the clinical setup menu to alter the humidity...and the choices are 1, 2 or 3...70, 80 or 90% humidity

Then when the heated hose is used the little dial that you can change on the fly without being in the clinical setup menu only affects the hose air temp.
It's 4 degrees per setting starting at ambient room temperature.
So the setting of 1 with the heated hose attached ...adds 4 degrees to the ambient room temperature.
So you can use a hose air temp of 1 with a humidity setting of 3 (90%) if you want to. That's what I do in the summer...keep the hose air temp as cool as I can get it and still get the humidity I want. In the summer I can do it without rain out happening but in the winter the bedroom temp is much colder and the cooler air doesn't feel so good and I would get rain out...so in the winter I warm up the hose air.

So that "cooler air" thing you like really depends on the starting point ambient bedroom air temp.
I was thinking maybe you could lower the hose air temp to get rid of the warm muggy feeling you don't like but if you were already using the lowest setting (and I don't think it will allow you to turn off the hose air heat totally) then that idea probably won't work so great.

Pugsy wrote:When the heated hose is used...you have to go into the clinical setup menu to alter the humidity...and the choices are 1, 2 or 3...70, 80 or 90% humidity

Then when the heated hose is used the little dial that you can change on the fly without being in the clinical setup menu only affects the hose air temp.
It's 4 degrees per setting starting at ambient room temperature.
So the setting of 1 with the heated hose attached ...adds 4 degrees to the ambient room temperature.
So you can use a hose air temp of 1 with a humidity setting of 3 (90%) if you want to. That's what I do in the summer...keep the hose air temp as cool as I can get it and still get the humidity I want. In the summer I can do it without rain out happening but in the winter the bedroom temp is much colder and the cooler air doesn't feel so good and I would get rain out...so in the winter I warm up the hose air.

So that "cooler air" thing you like really depends on the starting point ambient bedroom air temp.
I was thinking maybe you could lower the hose air temp to get rid of the warm muggy feeling you don't like but if you were already using the lowest setting (and I don't think it will allow you to turn off the hose air heat totally) then that idea probably won't work so great.

Great info thanks again!

Ugh - raised pressure to 10 cmH2O, but result was 17.70 AHI indicated. I didn't find the pressure too bad, but noticed that it led to more mask leaks. The mask leaks end up producing a kind of droning/farting sound that is just enough to rouse me into semi-wakefulness the whole night. The leak noise, plus diminished efficacy of the mask, probably make the AHI readout suspect.



You can see the leak period at 1:30... I was 20% awake during most of this period - not enough to fix it. Got up at 2am to go pee, and collapsed on bed without putting mask back on (not really a conscious decision). Later I woke briefly and realized the mask was off, and put back on.

I tried tightening the mask, loosening the mask, etc. but the air keeps farting around the edges (see signature for mask type). At best I can pull off a kind of groovin' saxiphone solo effect with it, but mostly it sounds like flatulence.

Not giving up yet...

leptic wrote:Ugh - raised pressure to 10 cmH2O, but result was 17.70 AHI indicated. I didn't find the pressure too bad, but noticed that it led to more mask leaks. ...
I tried tightening the mask, loosening the mask, etc. but the air keeps farting around the edges (see signature for mask type). At best I can pull off a kind of groovin' saxiphone solo effect with it, but mostly it sounds like flatulence.

Not giving up yet...

I don't think that the higher pressure was the cause, you were having leaks when the machine dropped the pressure, and after you put the mask back on, the leak situation was ok even at higher pressures... buuuut, maybe it just looks that way.

to tame the leaks, so they're not disturbing, look into mask liners, they vary from the simple (an outline of something like t-shirt material that fits between face and mask) to the very detailed and custom (from padacheek.com)

one advantage of the padacheek ones, they're quality made and sold to be washed and reused while most of the 'cheaper liners' are sold by greedy companies that want you to use 'em one day and buy another. "but they're only a dollar each!" which adds up... of course, most of those greedy companies don't mention that you can wash and reuse theirs too...

If you want to try making your own mask liner, here is a link to the pattern I used to make mine: http://montfordhouse.com/cpap/diy-cotton-mask-liner.pdf

I made them out of an old, well used tee shirt. They will stretch out when you use them. I made several of them, and after I used one, I would put it in a mesh bag until laundry day. We would throw the bag in with the whites and wash them. My wife would then take them out of the bag and iron them flat. They can be laundered and reused many times. The pattern will fit most medium and small masks. If you use the large mask, you can enlarge the pattern as necessary.

Thanks Palerider, Okie,

I will look into the liners.

Yesterday was an interesting day, and I'm hoping it signifies and impending breakthrough. For one thing, I felt pretty good throughout the day despite pretty poor sleep quality the night before. By the end of the day, I'd say I felt unusually good. This might be partly due to the LCHF diet I've been following, and I had a level of energy after dinner that I have not seen in years. I also went to yet another school event for my kids, and was able again to walk by a bunch of carb-laden treats that usually exert a heroin-like addictive temptation. I've also been exercising more, which I think has only been possible thanks to cutting down carbs and avoiding those damn insulin spikes (which I'm now realizing I was really sensitive to). I've also found my alcohol cravings have greatly diminished (as in "no, you don't have to have two glasses of wine with dinner, in fact no wine is ok most nights").

After kids' bedtime, I actually had energy to really do stuff for the first time in ages. It was a good thing, because of a number of work and other deadlines that had piled up. I ended up doing something I very rarely do, and worked (very effectively, which is a welcome change) way past midnight.

The result was that I went to bed at around 3:30am, and while I was obviously tired it was kind of a pleasant, satisfied exhaustion that was accompanied by some nice (and long absent) feelings of achievement. While it's probably pointless to read too much into such an anomalous night, one thing that struck me was that I actually slept through my alarm which normally goes off at 6am. In fact I woke from a sound sleep, the likes of which I haven't experienced in a long time. I also slept virtually the whole night on my back, which I try to avoid by often end up doing if really exhausted. I am wondering if the usual advice to avoid sleeping on one's back has the same importance for someone who's using CPAP to keep their airway open? I kind of prefer it, and think it helped keep the mask in place.

Here's the chart - the long quiet interval from 4:30 to 7am was a real treat!! Even though I went to bed at 3:30am, I feel like I got more useful sleep than on a typical night. Maybe it helped being really exhausted when going to bed.



Hard to know if it's the CPAP at 10 cmH2O, the low-carb diet, reduced alcohol consumption, or the fact that I've been exercising again, but I've had some glimmers of hope that I could be on the road to feeling a lot better. Thanks again to all for the advice and support, particularly Pugsy!!

PS I'm also coming, I think, to the tail-end of my SSRI withdrawal after titrating down and stopping Cipralex with my doctor's approval (goodbye brain zaps!) Have not taken Concerta in a couple of weeks... Finally adjusting after this change may also account for some of the improved state.