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zenman72 wrote:I haven't slept much at all in days.

Any idea why? That concerns me more than your leak numbers now (if you stay below 0.4 L/s) unless the leaks themselves are disruptive.

Pugsy wrote:

zenman72 wrote:I haven't slept much at all in days.

Any idea why? That concerns me more than your leak numbers now (if you stay below 0.4 L/s) unless the leaks themselves are disruptive.

I just assume it is because of the higher apneas, but I am also having other issues this week like alot of gas and getting up to pee alot, which I don't generally get. Perhaps I have a little bit of a bug affecting me. I also think the lack of sleep has gotten me into some kind of insomnia state.

I was able to get a little sleep last night, which is very relieving to me today. Last night leak was .38 and AHI 14.3

zenman72 wrote:Last night leak was .38 and AHI 14.3

What were your pressure range settings? and what was the 95% pressure number showing on the machine?

The AHI number for sure will cause disruptive sleep. I have an idea you can try if you are willing but I need the pressure ranges and your 95% pressure number from last night if it is still available on your machine (it resets to zero at 12 noon).

Pugsy wrote:

zenman72 wrote:Last night leak was .38 and AHI 14.3

What were your pressure range settings? and what was the 95% pressure number showing on the machine?

The AHI number for sure will cause disruptive sleep. I have an idea you can try if you are willing but I need the pressure ranges and your 95% pressure number from last night if it is still available on your machine (it resets to zero at 12 noon).

The number for pressure from last night was 13.8. I was assuming this was average pressure but I defer to your expertise if you say that it is the 95% rate. The pressure rate was 8 to 20 in my first sleep session, I got up for a while and changed it to 12 to 20. The AHI/press/leak readings did not change much from the end of the first sleep session to the 2nd one.

Despite the numbers not changing much, I feel like the 2nd sleep session was the best I've had in about 4 or 5 days and has given me enough energy to feel like part of society today.

I'm all ears if you have an idea and really appreciate your kindness and feedback

The pressure number showing on the S8 LCD screen is a 95% number.. This means that for 95% of the night you were at OR BELOW this number. It isn't an average like you would normally be thinking of. There is an average available but only with the software.

I forgot to ask...are you using EPR or if you have already told me I have forgotten. If you are using EPR at what setting?

How about an experiment with a small range on APAP mode? That way you will lessen the chance that the wide changes in pressures make keeping a good seal more difficult.
If you are starting the night out at 8 cm and fit the mask to 8 cm but you end up spending a good bit of time up around 12 to 14 cm the adjustments for 8 cm aren't going to work so great at the higher pressures.
Plus I am thinking that you probably need more minimum pressure anyway.

Remember this is all assuming that AHI is obstructive in nature. We have zero way to evaluate centrals with the S8 machine.
What we do is see if the AHI reduces with more pressure (this would lead us to believe that the events are obstructive in nature) but if the AHI increases with more pressure then we may be looking at higher pressures causing centrals and we get to have a different discussion.

As long as your leak number stays around 0.40 or below..let's live with it for now but if it gets around 0.50 L/sec we have to wonder a bit as to how valid any AHI number is.

So how about trying 11.6 cm minimum and 15 cm maximum? So fit your mask to 11.6 cm and let's hope with the higher minimum the event precursors that are warning signs of impending collapse of the airway are better controlled and maybe the pressure won't need or want to go to that 13.8 or higher and maybe trigger leaks which might trigger more pressure which triggers more leaks...and so on.
If you are using EPR...or not...don't change it though...just let me know so I know for future ideas.

See what the AHI, leak and pressure numbers are tomorrow morning.

Pugsy wrote:The pressure number showing on the S8 LCD screen is a 95% number.. This means that for 95% of the night you were at OR BELOW this number. It isn't an average like you would normally be thinking of. There is an average available but only with the software.

I forgot to ask...are you using EPR or if you have already told me I have forgotten. If you are using EPR at what setting?

How about an experiment with a small range on APAP mode? That way you will lessen the chance that the wide changes in pressures make keeping a good seal more difficult.
If you are starting the night out at 8 cm and fit the mask to 8 cm but you end up spending a good bit of time up around 12 to 14 cm the adjustments for 8 cm aren't going to work so great at the higher pressures.
Plus I am thinking that you probably need more minimum pressure anyway.

Remember this is all assuming that AHI is obstructive in nature. We have zero way to evaluate centrals with the S8 machine.
What we do is see if the AHI reduces with more pressure (this would lead us to believe that the events are obstructive in nature) but if the AHI increases with more pressure then we may be looking at higher pressures causing centrals and we get to have a different discussion.

As long as your leak number stays around 0.40 or below..let's live with it for now but if it gets around 0.50 L/sec we have to wonder a bit as to how valid any AHI number is.

So how about trying 11.6 cm minimum and 15 cm maximum? So fit your mask to 11.6 cm and let's hope with the higher minimum the event precursors that are warning signs of impending collapse of the airway are better controlled and maybe the pressure won't need or want to go to that 13.8 or higher and maybe trigger leaks which might trigger more pressure which triggers more leaks...and so on.
If you are using EPR...or not...don't change it though...just let me know so I know for future ideas.

See what the AHI, leak and pressure numbers are tomorrow morning.

I'm not sure what EPR is so its safe to say I assume I'm not using it I'll go with your suggestion and use the 11.6 to 15 range and we'll see what we get.

EPR is ResMed exhale relief. It reduces the pressure by 1 cm per setting while exhaling.
It's a setting available in the clinical setup menu. Next time you go in there you might poke around to see if you can find it and make a mental note.
We can talk about it later if we need to.

zenman72 wrote:I'm not sure what EPR is so its safe to say I assume I'm not using it

Even though you may not know what it is, it may be turned on.

The only way to know for sure is to check the setting.

I tried last night with the settings Pugsy suggested and got some better sleep and better numbers. 6.4 AHI on .32 leak.

Not numbers to be satisfied with long term I guess but at least I finally got some sleep. I should also note that I have covered my mouth the last couple of nights to prevent mouth breathing, which I think has helped.

zenman72 wrote:I tried last night with the settings Pugsy suggested and got some better sleep and better numbers. 6.4 AHI on .32 leak.

Give those same settings 2 or 3 more nights to see if they seem stable.
Then increase the minimum to 12.2 or 12.4 and let's see what happens. Leave the max at 15.
Also, what was the 95% number shown for pressure?
That .32 leak...we will gladly take that. Right now most important thing is better sleep and feel a little better.

zenman72 wrote:I never used to be able to talk, and taking a breath through my mouth took alot of effort. That has changed and it seems I can talk much more easily. I have also been having difficulties sleeping again after a couple of years of doing well.

Wondering if other people can talk/breath easily or if I should look for other causes for recent issues.

There's a "valve" between your nose and your throat. Once your brain learns how, you can close this valve off and keep the pressure out of your throat, lungs, and mouth when you want to talk or sip water or just want to breathe through your mouth.

To see this valve in action, close your mouth and blow air into it like you're blowing up a balloon. Even though there's pressure in your lungs, throat, and mouth, no air comes out your nose because the valve is closed.

By the way, does anyone know of the medical terminology for this "valve?" Surely the doctors have a high dollar word for it.

archangle wrote:By the way, does anyone know of the medical terminology for this "valve?" Surely the doctors have a high dollar word for it.

Are you thinking of the epiglottis?
The epiglottis is actually a flap of connective tissue that is made of elastic cartilage at the base of the tongue. It points upward except when solids and liquids pass from the oral cavity into the esophagus. When you swallow, this position is changed so that it covers the opening of the trachea in the throat by folding down over the glottis to prevent food from passing into the lungs through the trachea. So it temporarily blocks off the air passageway as food goes down the esophagus it doesn't go down into the lungs. After you finish swallowing, it then reopens the trachea to allow breathing.

http://en.wikipedia.org/wiki/Epiglottis
The epiglottis guards the entrance of the glottis, the opening between the vocal folds. It is normally pointed upward while one is breathing with its underside functioning as part of the pharynx, but while one is swallowing, elevation of the hyoid bone draws the larynx upward; as a result, the epiglottis folds down to a more horizontal position, with its superior side functioning as part of the pharynx. In this manner it prevents food from going into the trachea and instead directs it to the esophagus, which is posterior.

The epiglottis is one of nine cartilaginous structures that make up the larynx (voice box). While one is breathing, it lies completely within the pharynx. When one is swallowing it serves as part of the anterior of the larynx

Last night was better again. Press 13.0 leak .16 AHI 4.9

Slept better. Still feel somewhat tired but it is a world different (better) than I felt 4 or 5 days ago.

Good job...crossing fingers that this will continue going in the right direction.

Pugsy wrote:

archangle wrote:By the way, does anyone know of the medical terminology for this "valve?" Surely the doctors have a high dollar word for it.

Are you thinking of the epiglottis?

The epiglottis is between the mouth and the lungs, not between the mouth and nose.

I think it's actually the soft palate that closes off the airflow into your nose.