I'm a dentist treating myself! CPAP Results... Advice please?

Thanks for all the info ChicagoGranny.

It seems a lot of information has become more readily available since I was on cpaptalk in 2010. I don't think it's common knowledge, however. It takes some looking to discover. And I don't think it hurts to bring things up and talk about them. I find these topics fascinating.

If it was indeed solely the shift to agriculture from hunter/gatherer that resulted in narrow arch development, then how does one account for children, today, living in third world countries commonly having wider, more healthy arches? I witnessed that first hand when I lived in Costa Rica in the early 1990s. Beautiful smiles without dark shadows at the corners of the mouth. They certainly aren't hunting/gathering. It's a curiosity to me, though it seems obvious agriculture was a huge contributor to the phenomenon. The last time I did a deep dive into the topic there was no definitive answer to the question. It seems we can sometimes only observe phenomenon but not always know every contributing factor--of which there are likely many--mandibular development being a dynamic and multifactorial organic system.

I do know that when the orthodontist was planning my sons' palate expansion he asked me if I wanted them to have just nice smiles, or Julia Roberts smiles. I didn't hesitate for a second. I said--give them Julia Roberts smiles if at all possible. I hoped to prevent them from developing OSA as adults. Neither of them were great sleepers as children. My oldest even had a polysomnogram at a very young age. That's a whole 'nother story.

Wow, I had no idea that bruxism had been directly linked to OSA. That's interesting. My children both had disturbing amounts of bruxism when small. It seems to have resolved with having palate expansion, so I'm grateful I had the forethought to insist on that for both of them. What disturbs me is that my dental hygienist says that she sees evidence of bruxism in most of the children she sees. That would imply that most of these children are already suffering from OSA… which I don't like to contemplate.

What I was saying is that I don't believe that tongue scalloping causes OSA, but perhaps I misread or misunderstood what the OP had said. Or perhaps I wasn't being clear. It happens. That tongue scalloping is present in the majority of OSA patients I have no argument with. That was known in 2010, though not widely accepted medical knowledge. I think it's fair to say it was considered "fringe" at the time--like so many things are when the ideas are first introduced.

I appreciate the updates to my knowledge and the filling in of gaps. Thanks again.

socknitster wrote: ↑

Sun Mar 15, 2020 7:18 pm

If it was indeed solely the shift to agriculture from hunter/gatherer that resulted in narrow arch development, then how does one account for children, today, living in third world countries commonly having wider, more healthy arches?

I won't comment on an anecdote that contradicts the peer-reviewed body of scientific evidence. If professionals have observed that Costa Ricans indeed have healthy jaw sizes, a scientific study would be in order.

socknitster wrote: ↑

Sun Mar 15, 2020 7:18 pm

What disturbs me is that my dental hygienist says that she sees evidence of bruxism in most of the children she sees. That would imply that most of these children are already suffering from OSA… which I don't like to contemplate.

I have long thought undiagnosed SDB was a problem in children, but it's sad to hear that your dental hygienist reports "most".

I love this discussion!

socknitster, sorry if I wasn't clear but a scalloped tongue does not cause OSA. Current theory is that it is a byproduct of bruxism and/or GERD resulting from OSA/SDB. GERD may cause the tongue to swell, and it presses against the dentition causing scalloping.

Back to ME (ha!) ... here's last night in the F30i mask, which I originally bought because I couldn't stop mouth breathing with the nasal pillows.


With the Bleep at these same settings (16 cmH2O minimum pressure, EPR at 3 cmH2O), every single metric was better except for leaks. For example:


My breathing is just way more erratic with the F30i... I'm not sure why.

I'm thinking of going back to the Bleep or P10 and getting the Knightsbridge dual band chinstrap to prevent mouth breathing.

nee wrote: ↑

Mon Mar 16, 2020 1:01 pm

Current theory is that it is a byproduct of bruxism and/or GERD resulting from OSA/SDB. GERD may cause the tongue to swell, and it presses against the dentition causing scalloping.

Interesting. That's new to me. The assumption had been that underdeveloped jaws led to crowding of a normal-sized tongue against the teeth.

nee wrote: ↑

Mon Mar 16, 2020 1:01 pm

16 cmH2O minimum pressure, EPR at 3 cmH2O

Are you using a foam cervical collar? I always think of that when pressures are that high. My doctor wanted me to switch to a BiPAP with pressure settings 24/18. Instead, I started using a cervical collar. With APAP pressure set at min 10/max 20, my actual pressure runs about 11 or 12 median and 14 max. Tolerable!

ChicagoGranny wrote: ↑

Mon Mar 16, 2020 1:21 pm

nee wrote: ↑

Mon Mar 16, 2020 1:01 pm

Current theory is that it is a byproduct of bruxism and/or GERD resulting from OSA/SDB. GERD may cause the tongue to swell, and it presses against the dentition causing scalloping.

Interesting. That's new to me. The assumption had been that underdeveloped jaws led to crowding of a normal-sized tongue against the teeth.

nee wrote: ↑

Mon Mar 16, 2020 1:01 pm

16 cmH2O minimum pressure, EPR at 3 cmH2O

Are you using a foam cervical collar? I always think of that when pressures are that high. My doctor wanted me to switch to a BiPAP with pressure settings 24/18. Instead, I started using a cervical collar. With APAP pressure set at min 10/max 20, my actual pressure runs about 11 or 12 median and 14 max. Tolerable!

The GERD thing was new to me as well. That theory makes sense, as does the theory that underdeveloped jaws lead to crowding of a normal-sized tongue against the teeth. I don't think the two are mutually exclusive!

I'll try the foam cervical collar tonight. To be honest I've been trying to minimize accessories all over my head and was hoping the F30i by itself would solve things, hahah.

Nee,


Just pointing out. In this graph

the leaking with the Bleep was not high enough to worry about no need to add even more things to your sleep such as chin straps etc.

Maybe you should try a full face mask like the ResMed AirTouch F20 I switch to it just recently and love this mask.

Jas_williams wrote: ↑

Tue Mar 17, 2020 1:45 am

Nee,
Just pointing out. In this graph the leaking with the Bleep was not high enough to worry about no need to add even more things to your sleep such as chin straps etc.

Yeah, it's just that some nights it's like that, while other nights there's a lot of leaking. I'd rather eliminate the inconsistency.

squid13 wrote: ↑

Tue Mar 17, 2020 7:00 am

Maybe you should try a full face mask like the ResMed AirFit™ F30 I switch to it just recently and love this mask.

That's what I've been using for the past couple of weeks, now. (The F30i). Here's last night with the F30i + a foam cervical collar:


Flow limits went down as compared to no cervical collar, but I'm still puzzled as to why my breathing is all over the place, with the pressure needing to go up to 20 cmH2O despite no major leaks. With the Bleep everything looked pretty great compared to this at the same pressures. I got 8 hours of sleep, still felt tired, so I slept in until 11 am... ahhh...

nee wrote: ↑

Tue Mar 17, 2020 12:04 pm

With the Bleep everything looked pretty great compared to this at the same pressures.

I have noticed that, with the P10 when compared with a full face mask. (F20 and F30i)
It took a little more pressure to get similar results. Volume of mask? Or some other reason?
I do not think I am alone in this observation, from reading past posts on here.

Just an observation.

JPB

I edited my post, wrong mask what I use now is the ResMed AirTouch F20.

My flow rates look like this with the F30i, for the full night.

Is this expiratory snoring?

And a 39-second CA from a couple of nights ago.


Zoomed out view of that whole night. No obstructive apneas! Way less flow limits than usual. Thoughts?

The flow rate looks like the cardiac echo thing.
Ballistocardiographic artifacts
viewtopic.php?f=1&t=176864&p=1321125&hi ... c#p1321125
lots of past discussion about it
search.php?keywords=ballistocardiographic


The central look like an awake/arousal breathing irregularity flagged by mistake. It doesn't look like asleep breathing just prior to the central.

Pugsy wrote: ↑

Mon Mar 23, 2020 6:27 am

The flow rate looks like the cardiac echo thing.
Ballistocardiographic artifacts
viewtopic.php?f=1&t=176864&p=1321125&hi ... c#p1321125
lots of past discussion about it
search.php?keywords=ballistocardiographic


The central look like an awake/arousal breathing irregularity flagged by mistake. It doesn't look like asleep breathing just prior to the central.

Thank you Pugsy.

So last night, I put a piece of tape over each nostril and poked a 3x3mm hole into each one, then put in my mandibular advancement device, and then put my F30i FFM on.

Why? Because I'm sure I have palatal prolapse. Going back to my first days of using Oscar, I couldn't find any obstructive apneas occurring in inhalation. They've all been on exhalation. My girlfriend has also told me that I'll start breathing out, stop for 10-20 seconds, and then breathe out completely.

So, by making it more difficult to exhale, my hypothesis is that the pressure would keep my palate from flopping upwards. I dropped from 17 cmH2O to 8 cmH2O because higher and higher pressures have not eliminated the clusters, even with a neck brace on. The higher pressures might be counterproductive as they cause leakage, and they might not be needed to keep the palate from prolapsing, especially with the nostril tape on adding additional pressure against exhalation.

Results from last night:


Close-up of expiratory apneas (palatal prolapse):


I'm still having the exhalation apneas. I purchased the Theravent nostril strips and will use those tonight and start adjusting the pressure. I have hope that this will eliminate my problem.

Sources:

https://doctorstevenpark.com/2things

https://doctorstevenpark.com/expiratory ... ral-apneas

viewtopic/t106596/Successful-AHI-reduct ... =theravent (the thread that gave me this idea)