Need Some Advice

Pugsy · Post by **Pugsy** » Mon Jan 06, 2020 9:18 pm

Try 1 cm more minimum EPAP. It doesn't surprise me that the AHI and snores are higher than I would like to see.

Don't worry about the timed breath thing. I am more interested in patient triggered breaths and your are more than acceptable at 96%.
I am very happy with that statistic.

No other changes just yet....but you need more EPAP for sure and probably more than 1 cm but let's go up slow.

Work on the leaks also....some of the snores might be mask leak noise fooling the machine.

Are you having to add water to the water chamber? Meaning is it using much water? It should be at the setting of 5 and if it isn't using any at all we have a problem with the humidifier.

Pugsy · Post by **Pugsy** » Mon Jan 06, 2020 9:32 pm

I am actually very happy about last night.
I was hoping we might get lucky and not need as much EPAP but it wasn't meant to be.
I was prepared to actually change things fairly quickly based on what I saw. No sense in using less EPAP. I don't see time actually being our friend here. Now if the AHI was a lot lower...yeah maybe give it some time.

Keep me posted about the headache situation. I am really glad to hear it is reduced.

Maiden72 · Post by **Maiden72** » Tue Jan 07, 2020 11:18 am

Pugsy,
I couldn't get to sleep last night. I finally took some melatonin and got to sleep about 2:30. But i know it wasn't good sleep as i woke up with the mask leaking. Top strap keeps slipping down. Might be moving it in my sleep. If i tighten it down, it pushes up against nose too much and can't breathe. I went to bed before reading post to raise the epap. With my sinus issues, i have trouble getting air in my nose. Causes me to have difficulty getting to sleep. Thus, why i had the pressure support so high. I will move epap up 1. I could barely feel pressure last night. Really need to try different mask. Even with humidifier at 5, I don't need to add water as i rarely get enough hours of sleep. Insomnia issues, so i dont try sleeping until i am really tired. Water reservoir still had a little bit in it this morning.

Pugsy · Post by **Pugsy** » Tue Jan 07, 2020 11:31 am

What masks do you have in your possession right now that you can switch to?

Which one is more comfortable and easier to manage in terms of leak control or mask movement control?

Maiden72 · Post by **Maiden72** » Tue Jan 07, 2020 11:49 am

Right now i have resmed f30 ff which is what i am using. I have a respironics amara view too. Both leak under nose. I tried resmed airtouch f20 ff, but i felt like too much deadspace and didn't feel like the pressure was optimized so I traded to the f30. Thst was 7 months ago. I do probably need one that goes over bridge of nose, just worry about pressure not being enough. I really also think it might be good to invest in one of those pressure gauges to test this used machine.

Pugsy · Post by **Pugsy** » Tue Jan 07, 2020 12:02 pm

The chances of the machine not delivering the pressure it says is delivering are pretty slim but you can either buy one of those manometers or make a homemade one to check it out. It might be worth it for peace of mind.

The over the nose full face masks can potentially create their own problems with nasal congestion if you happen to be one of those people who find that any sort of pressure up on that nasal bridge area actually causes congestion. I happen to be one of those people myself so I have first had experience in that area. Take your fingers and press gently on the sides of the nose up where the nasal turbinates are....the area where eyeglasses usually rest.
If you find you get congested fairly quickly then you know that you are also one of those people.

I don't use a full face mask at all....never have other than trying one every now and then to just see what it is like...so I am not much help in offering ideas for managing leaks with a full face mask.

Have you ever tried a mask liner? In your situation for right now unless the leaks are waking you up they would be at the bottom of my to do list.

Maiden72 · Post by **Maiden72** » Tue Jan 07, 2020 12:14 pm

If I press up on bridge of nose, where glasses would sit, it does not constrict. It does consrict if i press lower which is where this current mask pushes. I really need to look into the sinus surgery. Septoplasty and turbinate reduction. Also suggested throat surgery, but i don't think i want to do that. I will research masks in the meantime. Thanks a bunch. I really appreciate your help

Okie bipap · Post by **Okie bipap** » Tue Jan 07, 2020 12:56 pm

Speaking from experience, I recommend the septoplasty and turbinate reduction. Stay away from any throat surgery. I had UPPP surgery at the same time as I had a septoplasty and turbinate reduction. This was about twenty three years ago. The recovery from the septoplasty and turbinate reduction was very easy. The throat surgery was painful and affected my ability to eat spicy foods (think Mexican) for several years. It relieved the symptoms of my sleep apnea for several years, but I am now on a bi-level machine. My nephew had the same surgey about the same time as I did, and he went on a CPAP machine as soon as he healed up. The effectiveness of this kind of surgery is iffy at best. The doctors consider a 50% reduction in your apnea as a successful surgery.

Maiden72 · Post by **Maiden72** » Tue Jan 07, 2020 3:28 pm

Thanks okie. I was told a friend that the same things you mentioned about the throat surgery. He reccomended that I get the sinus surgery ent dr suggested. I just want to be able to breathe again. I expect to still be on bipap even if i get the sinus surgery. I am hoping that it could improve my therapy.

Okie bipap · Post by **Okie bipap** » Tue Jan 07, 2020 5:25 pm

After the surgery, I could breathe better with the splints installed than I could before the surgery. When they first removed the splints, I almost hyperventilated. I had never been able to move that much air through my nose in my entire life.

Maiden72 · Post by **Maiden72** » Wed Jan 08, 2020 9:08 pm

Since lowering my epap to 11 and pressure support to 4, i have more episodes and snoring but i feel better. Stll leaking but leak rates are less. No more headaches. So, my question now is, is ahi 5 to 7 ok? Up from 1 to 2.
Most are ha and fl. A couple of oa and ca, but nothing alarming me there. Oscar didn't hsve report last night. I will kerp these settings for now, look into a new mask and mask liners. So, at this point it is lower pressure is higher ahi, but i feel better. So, i guess that is what i have go accept for now. I can post oscar or encore in a few days

Pugsy · Post by **Pugsy** » Wed Jan 08, 2020 9:18 pm

No, I am not happy with AHI of anything above actually 3..... or a large number of snores or flow limitations but I want to go about fighting them slowly.

Need more minimum EPAP. Keep everything else the same. Try 1 cm more minimum EPAP which I guess makes it 12... if you can.
Glad the headaches are gone...they very well could have been related to the high PS. Causing some sort of imbalance in the gas exchange and/or low oxygen.

We have essentially dumbed down the ASV so that it behaves like a regular auto bilevel machine and I think that's fine because it's all you need.
What we need to find is the minimum EPAP setting that prevents the airway from collapsing. So need to do some more experimenting in the minimum EPAP setting.

Keep all other settings the same.

Maiden72 · Post by **Maiden72** » Wed Jan 08, 2020 9:28 pm

Ok. I will up the epap to 12 tonight

palerider · Post by **palerider** » Wed Jan 08, 2020 11:50 pm

Maiden72 wrote: ↑
Wed Jan 08, 2020 9:08 pm
Since lowering my epap to 11 and pressure support to 4, i have more episodes and snoring but i feel better. Stll leaking but leak rates are less. No more headaches. So, my question now is, is ahi 5 to 7 ok?

Would you like me to sit by your bedside and poke you with a sharp stick every 8-12 minutes?
That's what an AHI of 5-7 is like.

Maiden72 · Post by **Maiden72** » Thu Jan 09, 2020 5:30 pm

Not a good night. I woke up in the middle of the night and one of my straps was totally undone and appears from encore, that it was for over an hour. I suspect that I was having issues and ripped it off. I noticed before I fell asleep I was having some issues with exhaling with EPAP. Usually within 1 hour or 2 of falling asleep my nose becomes clogged and then I start having leaks or pulling at my mask. I think I am going to change my flex from 1 to 2. My sinuses are always bad, but worse in the winter. Really feel absolutely horrible today. Just tired and run down. This has been such a struggle with me. I really need to get in touch with the ear, nose and throat surgeon. I am just scared to death of the medical bills and if this is covered and deductibles. Encore is sufficient for my reports. Oscar not working for this machine. The reports only show half an hour or so with Oscar.

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