1 year and still tired!

[Scott C.]

O.K. here is last nights chart with min. pressure at 10. and Flex at 1. Best AHI yet. BUT, I woke up alot with dry mouth, worst night ever! This seems to go hand in hand with raising the min. pressure. More pressure more dry mouth. DreamStation says mask fit 98%. I Have been using a cervical collar. But thinking about mouth taping. Also the 95% pressure has gone up to 12.30. is this to be expected with raising the min. pressure? 
 I Still don't feel rested at all. Not sure where to go from here.   .    Just to recap on June 19th min pressure was 4 now June 26 it is 10. Flex was 3 now 1. Was this to fast? Thanks for your thoughts...

[DavePaulson]

Your CA,s improved from last night, they seem to occur when you have mask leakage. When I started it took me months to "learn" not to mouth breath, I'm glad I stuck it out and didn't go the full face mask route. You could look at getting a full though. I would do another night at this pressure and try everything to control the mouth breathing. If you search for the term mouth breathing in the forum post titles you will find lots posts.

[Sleeprider]

your latest results show some promise that these are effective settings, but the leaks need to be dealt with. I can't advise on taping, but if that is what it takes, then it really depends on whether you feel comfortable with it. An exercise to try to learn about controlling air pressure is to sip water from a straw while using CPAP pressure. You will be amazed at how mastering this technique can help you control leaks once you have mastered it. Many of us can speak without losing control of air pressure. Learning the control, can sometimes translate into improvement during sleep.

[Scott C.]

your latest results show some promise that these are effective settings, but the leaks need to be dealt with.  I can't advise on taping, but if that is what it takes, then it really depends on whether you feel comfortable with it.  An exercise to try to learn about controlling air pressure is to sip water from a straw while using CPAP pressure.   You will be amazed at how mastering this technique can help you control leaks once you have mastered it.  Many of us can speak without losing control of air pressure.  Learning the control, can sometimes translate into improvement during sleep.

" sleeprider" Let me get this straight. Are you saying while wearing the Dreamwear nasal mask to sip water through a straw? If not could you be more specific?

Sounds like a really good tip. Thanks!

[robysue]

 Just to recap on June 19th min pressure was 4 now June 26 it is 10. Flex was 3 now 1. Was this to fast? Thanks for your thoughts...

In my humble opinion, that was way too fast.

Increasing the min pressure from 4 to 10 is a HUGE change. Changing Flex at the same time from 3 to 1 is another big change. My guess is that smaller changes would be less disruptive to your sleep. How did you do that pressure increase?

O.K. here is last nights chart with min. pressure at 10. and Flex at 1. Best AHI yet. BUT, I woke up alot with dry mouth, worst night ever!

There is not point in chasing a low AHI if the sleep is bad for other reasons. How did you feel this morning and during the day? My guess is pretty lousy.

This seems to go hand in hand with raising the min. pressure. More pressure more dry mouth. DreamStation says mask fit 98%. I Have been using a cervical collar. But thinking about mouth taping. Also the 95% pressure has gone up to 12.30. is this to be expected with raising the min. pressure?

Mathematically speaking, it's quite reasonable to see an increase in the 95% pressure level as you increase the minimum pressure setting: You are much more likely to REACH a pressure of 12.3cm if you start at 10cm than you are to reach 12.3cm if you start at 4 or 6cm.

More minimum pressure being associated with more dry mouth is also not unusual: More minimum pressure means there's more air blowing around your upper airway even if you don't have any official Large Leaks. (The DreamStation "mask fit" stat indicates how much time you were not in Large Leak territory: A Mask Fit of 98% means that you had Large Leaks for about 2% of the night.) So while your leak line is quite acceptable in terms of the efficacy of therapy, there's enough small leaks going on to explain the dry mouth.

I Still don't feel rested at all. Not sure where to go from here. .

You may need to look at the whole problem differently: Rather than focusing on how good/bad the AHI, CAI, and leak data are, focus on what makes you most comfortable while using the machine for a while and what leads to you feeling more rested in the morning and what leads you to feeling less rested in the morning.

Rather than continuing to frequently tweak the pressure and Flex settings in a quest to magically feel better, I think you need to just pick the pressure setting and Flex setting based on How do you feel? I know you don't feel good on any of the settings you've used. So for the pressure setting, you need to pick the one that made you feel the least lousy. Stick with 10-15 if you don't feel any worse now than you have in the past year.as

For Flex, pick the setting that makes it easiest for your to fall asleep. In other words, if Flex = 1 feels better than Flex = 3, then stick with it. But if Flex = 3 was more comfortable, then go back to Flex =3.

If the cervical collar is causing discomfort, ditch it ---even if there's an uptick in leaks.

In other words, rather than working on perfecting your CPAP data, work on what actually makes you feel better in the morning.

Keep track of how much time you actually think you are asleep when you are in bed. In other words, your usage is excellent, but are you waking up a lot during the night? And if you are waking up, how long does it take you to get back to sleep?

[ajack]

Just to clarify my thinking, roby and I welcome input.
AFAIK, If you were titrated overnight for cpap, you would come home and start using the fixed titrated pressure. AFAIK they don't use a gradual increase. I understand the max and 95% are two commonly used settings, when switching from auto to fixed pressure. Although the minimum had been raised, the 95% and max had a smaller change of about 3cm over the 6 days. I would guess in a titrated lab setting, it would have been titrated to around it's current level and started at a fixed pressure from day one.

AFAIK Increased pressure doesn't increase flow to the user. A bit more from the mask vent, but in general, It's leaks that increase flow through the nose and mouth

Have I got the wrong end of the stick with this?
While sleep quality is a major factor.

[Sleeprider]

your latest results show some promise that these are effective settings, but the leaks need to be dealt with.  I can't advise on taping, but if that is what it takes, then it really depends on whether you feel comfortable with it.  An exercise to try to learn about controlling air pressure is to sip water from a straw while using CPAP pressure.   You will be amazed at how mastering this technique can help you control leaks once you have mastered it.  Many of us can speak without losing control of air pressure.  Learning the control, can sometimes translate into improvement during sleep.

" sleeprider" Let me get this straight. Are you saying while wearing the Dreamwear nasal mask to sip water through a straw? If not could you be more specific?

Sounds like a really good tip. Thanks!

Scott, it is an exercise to help you learn how air pressure control can work.  Sipping water while under pressure (no need to be in bed) teaches you to isolate the pressure using your tongue and breath control.  Learning to speak simple sentences while not letting air rush from your mouth is another.  Other exercises are to alternately breath in through the nose and out through the mouth and vice versa. It is possible to do these things and even yawn without air rushing from your throat.  These exercises train you to control pressure, and for some people it translates to controlling leaks in sleep. Be patient because the first attempts will likely result in some weird noises and possibly discomfort...practice makes perfect.  Once you get it, you can respond to your wife or others without removing the mask, or grab a quick sip of water bedside to resolve a dry mouth without breaking therapy.

I agree with Robysue, be sure to give any changes time to settle in.

[robysue]

Have I got the wrong end of the stick with this?
While sleep quality is a major factor.

Yes, we all start off with a huge jump from "no pressure" to "some (or lots) of pressure".  And lots and lots of people then immediately report serious problems with "I can't get to sleep with this thing on my nose," "I can't stay asleep with this thing on my nose," and "This thing is ruining my sleep which wasn't too awful before I started CPAP."  And what do we tell them? Keep using it long enough to get used to the added pressure.

It's true that some people have no problems adjusting to major pressure increases.  But others have trouble adjusting to even minor ones.  And those adjustment problems usually manifest themselves as trouble getting to sleep, trouble staying asleep, and not waking up refreshed due to lots of spontaneous arousals.  All of which mean their sleep quality got worse after the pressure change. And hence the advice to "go slow" and "give yourself enough time with the new settings to get used to them."  
 
In other words, if you are someone who can handle a big jump OR multiple jumps a day or two apart without it adversely affecting your sleep quality, then sure, increase the pressure by 3cm every 2 days until you find the pressure you think you need.  But the OP is having problems sleeping with the machine. His data is not great, but it is far from awful. Hence the need to go slow: He needs to feel that he can successfully get to sleep each night and wake up without serious dry mouth problems during the night and in the morning before increasing the min pressure again and again and again.

[Scott C.]

"robysue" thanks for the input! Glad to know my numbera are not awful. Sleep quality about the same as I have been having over the last year. Not much of an issue falling asleep. But the really dry mouth is new. Settings were the same last night. Except I did try tape to see if it improved  the leak data on last nights chart.  Just in case I need a new mask. Dreamstation says mask fit 100% last night

"ajack" what is AFAIK? the pressure doesn't really bother me as much as I thought it would. Have not had an ah-ha moment in over a year so I am willing to try any and all suggestions. Including taping. Which by the way as far as I know it stayed on all night. Sleepyhead said I had an acceptable amount of large leaks.

"sleeprider"  I will try those exercises . Does the leak data warrant a mask change? 

Everyone thank you for your patience with this newbie to the board. 

Here is last nights chart same settings 10 min. pressure and Flex 1  Plus the mouth taping. (really weird feeling with the tape, the collar and the mask) and still woke up with dry mouth several times.

I dropped the snore graph because apparently I don't snore.

Oh if anyone has good tips on re-traing your mouth to stay shut please pass it on.

[Scott C.]

Almost forgot, tried setting the dreamstation humidifier to a higher number 4` to help with the dry mouth but did not notice any difference. But going through the menu I realized the humidifier is set to adaptive instead of fixed. Does it have to be on fixed for me to change the heat settings?