Please help newbie making 2nd attempt!

Thanks pugsy and cardsfan once again. And also thank you to Jpires56 for the encouragement. The first time I tried therapy was about 6-7 years ago - I had a loud machine, a claustrophobic and uncomfortable mask, and very little instruction or training despite going through a standard sleep test. Not surprisingly, I lasted about three days and tossed the whole kit into the closet in anger. To be fair, I didn't go back the sleep therapists and try to work through the problems. I was angry, and obviously not committed to the process.

With the problem continuing, I finally capitulated and decided to try it again 7 years later. This time, I was given a quiet machine, a much more comfortable nasal pillow mask, and better training. And I found this forum, which has been a huge help. All of this helped to get me off to a better start than I had imagined was possible. Jpires56, I agree with you 100% - taking the time to find ways to make sleeping more comfortable with all this stuff is very important. On my fifth night, I used a CPAP pillow that has cutouts to allow side-sleeping (my preferred position), and has a velcro loop for the hose that helps keep it out of the way. This made a big difference in my comfort! Thanks for your ideas!

While I have only been doing this for about ten days (!), I have noticed that I have more energy during the day, I don't wake up 2-3 times per night to go to the bathroom, and the occasional reflux that I suffered from seems to have lessened. I am very thankful

I did end up tweaking up the pressure to 11 last night (now 11/16), and it seemed to continue to pay off. Probably makes sense to keep it here for a few days and make sure it's consistent?

Wow, so glad you will be getting some REAL sleep. I'd leave it there for now for a week, just to give your body a chance to recover.

I wouldn't be afraid to raise the minimum to 11.5 or even 12 in a week or so, just to see what happens. If the added pressure causes problems like swallowing air or waking you up, then I'd lower it back.

For more comfort items:
http://www.snugglehose.com
http://www.padacheek.com
CozyHoze Boss

Our host https://www.cpap.com has these comfort items.

I have the same pillow, but mine doesn't have the velcro loop.

Thanks! I'll stop the tweaking for a few nights

I wanted to provide an update after getting such good advice. Over the past week, I've had a good run, with my AHI mostly between 1.2 and 3.0 and Obstructive mostly between 0.5 and 1.2. My pressure remains at 11/16, with a 95% pressure of about 13, and a median pressure of about 11.8. During this period, I've been sleeping fairly well, with the help of a good CPAP pillow that makes side sleeping much more comfortable. After feeling a burst of energy the first week, I've normalized a bit and now mainly see myself as less apt to fall asleep during the day or while driving. More notable has been the disappearance of any need to get up and urinate at night, and the apparent disappearance of some periodic reflux.

So I am trying to figure out where to go from here. I'd love to see AHI < 1.0, but I am not sure how I'd respond to bumping the pressure up to 12 - I do find myself flapping my lips sometimes w the pressure at 11, and I am a little worried about a propensity to "tongue thrust", as my teeth have been a little sensitive. Any thoughts? Thanks as always.

I've pasted in my last three SH reports below:

RichCee wrote:I'd love to see AHI < 1.0,

Why?

I don't mean to be rude or flippant but what do you expect to gain if you get it below 1.0?

Also...remove the CA index from your AHI evaluation because you can't do anything about the CA index anyway with your machine and it doesn't need to have anything done about it anyway.

AHI of 2.19 of which 1.64 is CA....so that leaves 0.55 for OA/Hyponea which is the obstructive stuff and that's what we can treat with this machine. We don't treat centrals/CAs with your machine.

AHI of 1.27 of which 0.63 is CA...so that leaves 0.64 for OA/Hyponea

AHI of 1.97...of which 0.92 is CA so that leaves 1.05 for OA/Hyponea which is the "worse" night in terms of obstructive sleep apnea...and it's far from being "bad" of the 3 nights you shared.

Great point Pugsy, thanks - I was not thinking of AHI in that more tightly defined manner. I guess what I was really trying to do was just optimize the settings as best I can - I am absolutely not dissatisfied with where I am and consider myself lucky to have gotten there (with help) fairly quickly!

When I got to an apap setting that seemed to work well, I still had mostly centrals. I also woke up with air blowing out my lips the higher the pressure went. I started lowering my upper pressure to see what would happen. I found that I did better overall with less change in pressure. You could try lowering your max. pressure. I eventually got to a straight cpap setting instead of apap.

Cardsfan, am I correct in assuming that a straight CPAP just blows at a constant air pressure rather than auto adjusting? And that once the pressure range is narrowed done, some people just do better with a constant flow that doesn't jump around?

Yes. According to wulfman. I tried it and it worked for me.

RichCee wrote: some people just do better with a constant flow that doesn't jump around?

Yes, fixed pressure or even a teeny tiny apap range seems to be a better choice for some people.
I think it probably is worth trying as long as you don't happen to be someone who sees some rather marked pressure changes during the night. If you happen to be like me and need a LOT more pressure during REM sleep than using a fixed pressure doesn't work out so great because for me that would mean using around 18 cm all night long vs using apap range of 10 to 20 and the bulk of the night when not in REM I get by with 10 to 12 cm.

If you are doing well...sleeping soundly and feeling decent using apap range there probably is no urgent need to change to fixed pressures but if you aren't sleeping so great and aren't feel so great during the day then changing to fixed pressure is something to try in an effort to improve things. It works well for some but not for everyone though.

Wildly changing pressures never seemed to bother me which is good...I sure wouldn't want to use 18 all night just to deal with REM sleep stage.

I liked a tight range when I used apap, and unfortunately was sensitive to epr greater than 1. An epr of 2 made me giddy after a week or so, and I tried it several times and had to go back to 1 every time. Maybe try a lower epr just to experiment?

I would try 12 min. 15 max. For a few days

Thanks for the advice! I have a different question -- the last two nights I have used a night guard mouth piece to help with clenching of teeth at night. It has made it difficult for me to keep my mouth shut (I use a nasal pillow mask) and I think I probably spent some time breathing through the mouth or at least letting air escape through the mouth. My AHI, however, showed the lowest levels ever for me - well below 1.0 versus more typical figures in the 2.0-3.0 range. I am trying to figure out if that reading is being affected by the suspected air escape via mouth? Or if somehow using a mouth guard has actually helped reduce OAs? I am including my last SleepyHead report below, thanks for any insight!

If you are mouth leaking it sure isn't very much because the leak line really looks pretty darn good.
Not all mouth breathing/leaking will result in massive leaks to the point that the data is questionable or therapy is affected.
Unless it is waking you up...the leak is well controlled and well within the machine's ability to compensate for it.

I had a chance to actually test known awake mouth breathing once. I woke up and was mouth breathing gently...no massive tornado noise or exit of air pressure out the mouth and since it happened when I woke up naturally and ready to get up for the day I decided it was a good time to check out what this mouth breathing looked like on the leak graph so I kept doing it gently for about 20 minutes.
Below is the report I got and I circled the known awake time gentle mouth breathing at the end of the night. As you can see it barely registered and was no where near bad enough to affect the machine's ability to compensate for it. Look at the end of the night where I have it circled in red.