Frustrated

So sorry mask decided to act up last night. If it isn't one thing its another...always something sometimes.

Let's hope tonight things go better.

Well, still had clusters... not as bad, but still too many. I guess repeat tonight at same pressure and see what happens?? I'm starting to get that tiredness again and I'm not happy about that. Pressure was 15 - 20cm. I can't recall now Pugsy if that was the min you said or was it 16 because my median is always over 16cm?

John - I can't remember if you have a lot of trouble breathing through your nose? Have you thought about trying a nasal mask or pillows to see if getting the pap directly into your nose would be better therapy than w/full face mask? It really worked for me...

Randy, I have a deviated septum and my nasal passages always feel plugged so I don't think it would work too well. Plus I am a mouth breather and I know I would then be facing the issues with keeping my mouth closed.

I truly don't mind the face mask, but if I read what you are saying is it would deliver more pressure to the air passage way that it needs to keep open? I would think the pressure via the nose or via the mouth would be the same though otherwise why would they offer the FFM?

You could try a hybrid mask.... nasal pillows and mouth covering. Worth a try.....

Perrybucsdad wrote:Randy, I have a deviated septum and my nasal passages always feel plugged so I don't think it would work too well. Plus I am a mouth breather and I know I would then be facing the issues with keeping my mouth closed.

I truly don't mind the face mask, but if I read what you are saying is it would deliver more pressure to the air passage way that it needs to keep open? I would think the pressure via the nose or via the mouth would be the same though otherwise why would they offer the FFM?

John - I can't explain why but I was using a FFM (Mirage Quattro) at 14 cm pressure and my AHI was good (less than 5) but I was snoring A LOT. Off the charts loud on the ResScan reports with corresponding OAs. I tried apap 14-20 cm which helped a lot, but I found I spent the night up around 18.6-19.8 cm most of the time.

I had read a few posts here and there about nasal masks being more effective for some people and started trying out nasal masks. I went back to 14 cm straight cpap (my prescription) to try it and found that my snore graph became almost nonexistent. The lower pressure was taking care of the snoring; I can only conclude because it was coming directly into my nose and not being diffused from further away like with the FFM. My AHI is now down to 0.2-1.0 most of the time for the 2 weeks I've been using nasal mask full time, and I don't need the higher pressures.

I also have a deviated septum and congestion issues, but if I do the nasal irrigation daily I can breathe well through my nose most of the time. A few nights I've had to use the FFM and results were just as before. I found that I don't need anything to keep my mouth closed; the pressure seems to do it on its own.

Hmmmm.... very interesting Randy.

Also, good thought by Emilia on the hybrid... I hadn't thought of that. What are the benefits of the hybrid?? Does it deliver more concentrated pressure into the nose, but also allow the mouth?? I might have to try one of the try out masks to see how that may work. That would be great if that solved it.

15 cm minimum is better but as you can see not quite optimal. You may need the 16 minimum.
At this point if it were me I would probably do the 16. You're in this far. Might as well plunge the rest of the way in.

Get several days with the 15 or 16 min and max at 20 and be prepared to present your case for BiLevel.

You may not need 20 often but the BiLevel will be hugely more comfortable and allow the 25 ceiling to be available..just in case. I think it will ease your mind and I know you will like BiLevel as far as comfort.

Well, I tried something last night just to see what would happen. I set the unit to straight CPAP mode, and set the pressure to 18cm. AHI was 7.1... how disappointing. I honestly don't get this.

Perrybucsdad wrote: CPAP mode, and set the pressure to 18cm. AHI was 7.1... how disappointing. I honestly don't get this.

I can understand your frustrations. Curious..were there clusters again? Some periods of the night where nothing happened and some periods of the night where it all went to hell? How much of an impact do you think sleeping position plays? Were you on your back at all?

Huge clusters plus regular centrals. I will post a graph later, don't have it with me right now.

Here is the latest graph. This was all at 18cm.

No idea if I was on my back, but even if I was, I would think 18cm would be more than enough pressure to keep my airway open. I see the flow limitations so something was going on but why didn't the pressure keep the airway open.

You killed all the obstructives with the 18 cm of pressure and only had some centrals until that last hour.
Now what happened during that last hour? Were you restless? Partly awake?
Something different was going on during that last hour.

The centrals? No amount of pressure will prevent those.

I feel your pain, I really do. I have been all over the board with my pressure and my numbers and I really understand your frustration. I usually have an AHI around 6 or so. Typically centrals make up about 3 to 3.5 of that number and my obstructives are 1.5 to 2. My hypopneas are usually low, but when they get into the 2+ range my AHI just heads up along with them. Four or five months ago I decided to reel in my 30+ second obstructive apneas. I eventually went from a cm of 10 to 17. But what was odd is that the higher the pressure the longer the apnea... my highest was 84 seconds. When the length of your apneas are so long and the red line is so high that the number box won't fit on the screen. Or... more than a dozen obstructive apneas one right after the other for almost 8 minutes straight. Same REM issue except mine is every 90 minutes or so.

I have also experimented with the height of my bed pillows to see what impact that would have. I usually sleep on my back which is only making things worse. In my purely non-professional and non-medical opinion, it seems that my lower jaw will fall back when I am on my back and have a low pillow. I have tried this when I am awake and the blockage is pretty impressive to the point where I might as well go to the garage and get my compressor. So I prop my head up a little more and it seems to help a little. I've lowered my pressure to 12cm and last night my AHI was 2.5, but that was an anomally; it'll be back up tonight.

I'm not sure what this means to you, other than to keep plugging away and don't give up. Finding a good doctor that can make sense of it would be the best solution... "I" need to do that someday. Maybe try a straight CPAP at your titrated pressure instead of APAP. Fortunately I'm not tired and don't have a problem falling asleep during the day, so I'll just keep trying to work the numbers the best I can. My only advice is to not let your numbers dictate how you feel or what you can do... high = bad day, low = good day. Try not to get frustrated and keep on your therapy, no matter where your numbers are because they will be a whole lot worse without xPAP.

John

Pugsy wrote:You killed all the obstructives with the 18 cm of pressure and only had some centrals until that last hour.
Now what happened during that last hour? Were you restless? Partly awake?
Something different was going on during that last hour.

The centrals? No amount of pressure will prevent those.

Pugsy - what if he stays with straight cpap but starts decreasing from 18cm (to 17.8, 17.6 etc) to see if the centrals go away?