Increase Pressure?

My AHI is down but my leak rate is still not good. I am waiting for my mouth tape to come in the mail,
I guess I won't be able to troubleshoot any further until I can rule out if it's mouth leaks or mask leaks.
I also moved the pressure range back to 8-10 because I notice the higher pressure (10-15) wakes me up
when it breaks my natural lip seal. I also stopped wearing my nose strips which seems to help the leak
rate but still have issues with leak.

First night of mouth tape. It looks like my leak rate went way down. So in terms of flow rate and pressure and AHI, I'm still having events, what's the next step in order to attack those issues?

Pugsy wrote: ↑

Sat Jan 13, 2024 9:38 pm

jonesresidence wrote: ↑

Sat Jan 13, 2024 9:32 pm

try and keep leaks under control....any recommendations on how to approach that issue?

How to try to fix the leaks better depends on what is causing them.

2 main culprits when using a nasal mask
1...mouth opening/breathing leaks letting the air out the mouth and that means it isn't going down the airway in full force.
2...simply mask moving around from either being too loose or wrong size cushion or whatever.

If it is mouth breathing leaks there are several options but first you have to try to determine if it for sure is mouth breathing.
The only way to know for sure is to tape your mouth shut and not have that tape come loose.

If the leak line is perfect with tape then you know you were opening your mouth too much and there are various options available besides just taping the mouth.

If the leak line is still ugly with tape eliminating potential mouth leaks....then you know that mask moving around is the cause of the leaks. When that happens you have to figure out what is causing the movement and fix it.

jonesresidence wrote: ↑

Tue Jan 23, 2024 8:42 am

So in terms of flow rate and pressure and AHI, I'm still having events, what's the next step in order to attack those issues?

Increase that max pressure setting. You are pretty much pegging out at the current max of 10.
Turn on EPR and set it to 3 full time. This may help with the FLs.
The minimum pressure setting should probably be up around at least 9 cm.
Your machine is already pretty much setting a new minimum anyway...it's going up to almost 10 and staying there all night anyway.

Ok, I upped the pressure range to 9min-12max, EPR Full time Level 3. What are your thoughts on this result?

So how did you sleep last night and how do you feel today (which part of that remains to be seen as the day progresses)?

I really wish people wouldn't just plop down a report without the back story of how they slept or feel. The "best looking" report doesn't mean jack squat if they slept horribly and feel like dog crap.

Subjective feelings matter immensely. It isn't always about the numbers.

On paper alone...an acceptable report when just going by the numbers and looks of the report.
I see one break in therapy where you were awake and turned the machine off and then back on. Why?
Were there other awakenings where you didn't turn the machine off???
I would bet my last dollar that the little cluster of centrals right before you turned the machine off were arousal/awake flagged events. My bigger question is why the awakening?

Finally...it's one night only and one night does not a trend make.
Keep these settings for at least a week and closely monitor how you sleep and feel.

Let me share a little story with you that highlights why subjective feelings matter so much no matter what the "report" says.
Back when I first started therapy and I was about 3 or 4 months into therapy I woke up and felt amazing and that amazing feeling lasted all day long. I felt like superwoman. Slept great (or much better considering my arthritis issues) and felt on top of the world.
Back then I didn't look at the data the very first thing each morning because I didn't want to create any self creating prophecy and let the data cloud how I might feel. So I never looked at the data until the evening once I had a chance to experience the day without report data clouding my perception of how I felt.

But I just "knew" in my heart of hearts that I just had to have had one of those miracle AHI 0.0 nights.
Wrong....once I checked the data I had an AHI of 9.4. WTF....yep 9.4 and back then we didn't have central flagging nor did we have any way to look up close at the flow rate either.

I don't know the why but I will tell you right now that I would gladly take a nightly AHI of 9.4 if I could have that same superwoman day any day of the week. Numbers (good or bad) don't mean squat until we know if we met any of our subjective goals with those numbers.

Remember our goals...it's not a math test...it's sleep better and feel better. AHI of 0.0 doesn't mean much if the night's sleep quality was in the toilet and we feel like total dog poo the next day....and it happens all the time.
Case in point the people who come here with sub 1.0 AHI numbers and they are wondering why they still feel like crap.

Sorry for the report plop. My goal is to get the report looking decent and then assess how I feel, in other words, I've done my due diligence to mitigate what the machine is trying to tell me, and then go from there. Maybe that's the wrong approach. I want to give it some time with the new settings, I think I feel a little more alert in terms of how I normally feel in the morning. But hard to say without going the distance. I had an appointment with a sleep tech or DME specialist the other day and he said if I'm under 5, i don't have to worry about anything, and If I still feel tired, then I can safely assume that the cause is not due to anything sleep related and that I should consult my primary care physician to figure out what else may be causing it. He said these machines are straight forward and not complicated, it's just air. I asked if he had ever heard of OSCAR and he said no. I don't get why my health care provider is on such a different page than this online forum community. Are they just trying to make it simple for the patient to understand and restrict all the data down to one simple AHI number?

I get more out of consulting with a stranger on this forum than I do with my health care provider. It's disappointing being that health care costs so much.

Break in therapy is due to bathroom break. Happens nightly.

I don't recall any other awakenings.

I sure do appreciate your help and willingness to dialog back and forth regarding my reports. It's great to have this resource.

Pugsy wrote: ↑

Wed Jan 24, 2024 7:57 am

Let me share a little story with you that highlights why subjective feelings matter so much no matter what the "report" says.
Back when I first started therapy and I was about 3 or 4 months into therapy I woke up and felt amazing and that amazing feeling lasted all day long. I felt like superwoman. Slept great (or much better considering my arthritis issues) and felt on top of the world.
Back then I didn't look at the data the very first thing each morning because I didn't want to create any self creating prophecy and let the data cloud how I might feel. So I never looked at the data until the evening once I had a chance to experience the day without report data clouding my perception of how I felt.

But I just "knew" in my heart of hearts that I just had to have had one of those miracle AHI 0.0 nights.
Wrong....once I checked the data I had an AHI of 9.4. WTF....yep 9.4 and back then we didn't have central flagging nor did we have any way to look up close at the flow rate either.

I don't know the why but I will tell you right now that I would gladly take a nightly AHI of 9.4 if I could have that same superwoman day any day of the week. Numbers (good or bad) don't mean squat until we know if we met any of our subjective goals with those numbers.

Remember our goals...it's not a math test...it's sleep better and feel better. AHI of 0.0 doesn't mean much if the night's sleep quality was in the toilet and we feel like total dog poo the next day....and it happens all the time.
Case in point the people who come here with sub 1.0 AHI numbers and they are wondering why they still feel like crap.

Yes, this makes perfect sense and I like the idea of not looking at the report in the morning so as to not fool yourself into thinking you feel good. Yeah I agree, at the end of the day, it's all about how you feel. For me, that's TBD.

jonesresidence wrote: ↑

Wed Jan 24, 2024 8:33 am

Break in therapy is due to bathroom break. Happens nightly.

Are you male and of an age where the nightly bathroom breaks is from the old prostate? I apologize if you mentioned this before but I don't remember and don't have time to go back over the entire thread.

jonesresidence wrote: ↑

Wed Jan 24, 2024 8:33 am

I don't get why my health care provider is on such a different page than this online forum community. Are they just trying to make it simple for the patient to understand and restrict all the data down to one simple AHI number?

I don't know the answer but to be honest the first thing that comes to my mind is simply laziness. They don't think they need to expand on their comprehension of the data shown so they don't take the time to learn....and actually think outside the box.
And I don't buy into the "less than 5 AHI being the end of the goals" either. Bet my last dollar that they don't use cpap and yet they still tout cpap as a fix for all sleep problems and it simply isn't the miracle fix for all sleep problems.

Getting good sleep and feeling decent has a lot more involved with it than just reducing/eliminating obstructive apnea events. People who don't have OSA messing with things have problems with sleep all the time. That's why there is a multi billion dollar sleep industry thriving.
It is a very complicated process this restorative sleep thing and a lot of the time it takes a lot of work to tease out potential solutions.

Give the new settings at least a week and lets see what you report. Your nightly bathroom trips (if from the prostate) aren't something the machine can fix.
If at the end of a couple of weeks you still think you need to see more improvement in something then lets use SleepHQ and be able to zoom in on the flow rate and check for arousals even if you don't remember but the one bathroom arousal.
We can have arousals messing with our sleep that we don't remember. I see them every night because I am 71 years old and have some pain management issues related to arthritis. Night before last I could only get a little over 5 hours of very fragmented sleep (and I remembered a lot of arousals from pain so I know that I had more arousals than I remembered because we always have arousals that we don't remember). I didn't feel so great yesterday either. I didn't bother to look at the data yesterday because I already knew what it would tell me. Always, always my AHI is either very low or chocked full of arousal related flagged events to the tune of at least 75% of my AHI being the false positive arousal related event flags.
Plus I always have evidence of multiple arousals even without a flag. It is what it is.

So last night I took a sleep aid to help me sort of sleep through the pain a little better and I got a little over 8 hours of "sleep" but I remember probably at least a half a dozen awakenings when I had to change position because of discomfort.
I would rather not take a sleep aid but I have to get some more sleep and the night before last (AHI was less than 1 if I remember right) was the 3rd night in a row that I didn't. Now I know the problem...it started when the rain and freezing rain moved in because rain/storms and cold are a know factor in making my arthritis pain worse. In fact I can usually predict rain or cold or change in weather simply by what it does to my sleep quality.
Those old folks who said they could predict the weather because their "rheumatism" tells them are speaking the truth.

Getting old isn't for sissies and despite our desire to have cpap and a low AHI mean we feel like superwoman/superman...it just isn't going to happen very often.

I don't know how much the nightly pee breaks are a problem for you. But anything that causes wake ups is going to mess with sleep quality will in turn impact our overall sleep quality. We end up not getting the regular progression of sleep stages that is needed for the restorative powers of sleep to work their magic.

I have no doubt that a part of your AHI is going to be from arousals/awakenings (you may or may not remember)...I think of them as false positives. They are a symptom of any poor sleep rather than the cause of poor sleep.

Lets see how things go after your body gets used to the new settings and some time is needed.
Let me share another story of mine.
Back when I made the change to bilevel (just because I prefer more difference between inhale and exhale and I could do it) I had no idea what settings to try. So I tried 3 or 4 variations and then picked the best (on paper anyway) result and decided to try it for 6 weeks without changing anything no matter the results. At the beginning of the experiment I had "okay" results in terms of AHI anyway...ran 3 to 4 AHI with some nights a little less and some nights a little more.
I kept those settings for a full 6 weeks without changing anything and I gradually saw that the nights with less AHI started showing up more often and by the end of the 6 weeks my consistent AHI was cut in half.
There is a lot of truth in the "give it some time" adage.

Yeah, I’m guessing laziness as well, I realize that more and more across the board with any sort of service we get in the marketplace that the people working there just want you in and out like a cow or sheep being herded.
Not all the time, but generally speaking it feels that way.

I know that we all need to make money in this crazy world but I question the relationship between healthcare and corporate shareholders. In theory, the more cures you find, the more money you make…but it also so happens to be,
the longer you can sustain a problem, the longer you can make money off of it by treating symptoms with “band-aids”. That’s the business model of like 99% of the OTC market. Like all things, there seems to be a good and a bad.
I notice this in the consumer product market as well with quality of goods. Ever notice things are not built to last? That’s because companies realized that if you build something well, you won’t see your customer again for a long time.
So instead, let’s make our products not last so the consumer is back in the store sooner and ready to buy again... Now with that said, do I think that’s the case with how sleep issues are being treated by the healthcare industry?
Maybe, maybe not, hard to know for sure. Mask replacements, machine replacements, tubing, cleaning supplies, filters, the whole 9 yards...

Like you say, sleep issues are complicated and my sleep issues may not even be related to OSA. It could just be that our understanding of sleep issues is not that advanced yet and we need more time to research and learn.
Or maybe there is a little bit of both going on. And it's also possible that perfect sleep every night is a pipe dream…as with everything, nothing is perfect.

I have heard of SleepHQ and I do have a free account with them. I thought you can zoom in on flow rate in Oscar as well?
Regards to nightly bathroom trips, I’m 42 M and have been doing that since I was a kid. So not sure what to make of that or how to change it without dehydrating myself.
Sorry about your arthritis pain, I’m not there yet, I’m sure it’s no fun. I have heard that CBD can help with arthritis pain. Something to maybe look into, it’s anecdotal at this point but some folks find relief.
Here is something from the Arthritis Foundation: https://www.arthritis.org/health-wellne ... ritis-pain

The next step is to give it some time on these new settings. I find that using the mouth tape is working but is painful to remove in the morning. Feels like it's tearing my skin and chapping my lips.

Again, thanks for your time and input on all this stuff. It’s appreciated!

jonesresidence wrote: ↑

Fri Jan 26, 2024 2:24 pm

I thought you can zoom in on flow rate in Oscar as well?

YOU can zoom in on the flow rate in OSCAR but I can't. I can only do it if you sent me all your data and I loaded all those files in my OSCAR software but that's a lot of work for both of us and I don't have the time or energy especially now that SleepHQ is available.

I can zoom in on the flow rate when SleepHQ is used.

YOU can zoom in and take LOTS of screenshots and post them though. LOTS of work for YOU.
YOU can also study hard and learn to spot awake vs asleep breathing yourself.

jonesresidence wrote: ↑

Fri Jan 26, 2024 2:24 pm

I find that using the mouth tape is working but is painful to remove in the morning. Feels like it's tearing my skin and chapping my lips.

Some tape is easier and gentler to remove than other tapes. Hard to straddle that fine line between having it stick well enough to not come off during the night and not pulling off a layer of skin the next morning.

You might try something we used to suggest a long time ago for sensitive skin.
Take some Phillips Milk of Magnesia and apply it to where the tape goes on lips and around lips...let it dry thoroughly and then apply the tape. The milk of magnesia acts like a barrier so removing the tape should be less painful.

I'll give that a try, also do you have a recommendation for a Pulse Oximeter? Do you think it's worth picking one up to see that kind of data?

jonesresidence wrote: ↑

Sat Jan 27, 2024 8:03 pm

I'll give that a try, also do you have a recommendation for a Pulse Oximeter? Do you think it's worth picking one up to see that kind of data?

How bad is the itch (curiosity about your O2 levels) you want to scratch with one of those overnight recording pulse oximeters? Do you plan to use if often or just to scratch the itch and probably won't use it more than 2 or 3 times and then put it in the drawer to forget you even have it?

If you don't plan to use it often....get the cheapest you can find that will do what you want.

Make sure it is OSCAR compatible (there's a compatibility list in OSCAR website).
You want to make sure your times sync up just in case something off or weird shows up.

As to "is it worth it"? Depends on just how bad that itch is.

Do you think it's helpful?