Alarming results on oscar

[Lucy84]

Hi,
I changed to the setting you suggested, can you tell me if this looks any better?

Thanks

[Sleeprider]

Lucy, sorry to be late in responding. We were dealing with a passing Hurricane yesterday. The changes you made, resulted in reducing the periodic breathing by 50% as well as a reduced CA event rate of more than 50%. OA is nearly unchanged. You did not comment on comfort, and I really want to also take that into account moving forward, so your personal feedback on how changes feel is important. You are clearly affected by fluctuations of pressure and the use of EPR. I recommend we try reducing EPR from 2 to 1 and leave all other settings the same. We want to see how you respond to even more steady pressure without the inhale/exhale transitions.

[Lucy84]

Hi, Im sorry to hear about the hurricane and i hope that you and yours are all safe. I made the changes you suggested and my results are looking great! over the weekend i was getting an ahi of about 3.5 and my CSR was zero both nights. I have included screenshots of monday night and sunday night so you can see how great it was. Comfort wise its great, I havent been getting up in the night for the past few so I think Im sleeping better.

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last night

[Sleeprider]

I'm glad to hear your results and comfort are much improved. The trade-off for using less EPR to reduce CA events and periodic breathing is a higher flow limitation, and that is evident in your current results. The types of events you are having now, hypopnea and obstructive apnea, may respond to a higher pressure. I'm reluctant to advise a change in pressure, but let's try a maximum pressure of 10 and see if that helps reduce events further. I'd rather you be comfortable than to pursue a low AHI, so again, please advise on both comfort and results if you try a max pressure of 10-cm.

[Lucy84]

Hi,
I changed the pressure to 10 but I think it was too much for me, I started swallowing a lot of air again and waking up with a stomach full of air again. I also started opening my mouth for some reason and getting a lot of leaks. I changed the max back down to nine and the air swallowing has stopped but im still opening my mouth at night and getting leaks a lot. before changing the settings I was having zero leaks. Ill include screenshots of a night with the higher pressure verses the lower pressure.

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pressure returned to 9

[Dormeo]

I looked at some of your earlier charts, and they showed leaks, though perhaps you were having zero leaks more recently.

I can't quite see where your dotted red line is on your leak chart. You might want to check that it's set to Leak Rate Upper Threshold.

Even on the leakier night, for much of your "Large Leak" time, your machine was probably compensating for the leakage. So to my mind, the real question is whether the leaks are waking you up. Could you let us know?

About mouth leaks:

1. Tongue position. Try putting the tip of your tongue behind your upper front teeth. Then position the main part of your tongue up against your upper palate. Finally, give a little suck or swallow to create a bit of suction. You should now be able to open your mouth while breathing entirely through your nose. Practice this during the day, and see if you can get it grooved in deeply enough to help while you are asleep at night. For some people, this is really all it takes to avoid mouth leaks.

2. Collar. If your jaw tends to drop down during the night, pulling your mouth open, then a soft cervical collar, or a firmer snore collar, can be a big boon. More here:
http://www.apneaboard.com/wiki/index.php...cal_Collar

3. Although chin straps tend to pull the jaw back, which is not helpful, the Knightsbridge Dual Band strap has a design that pulls the jaw straight up, which makes it a possible alternative to a cervical collar.

4. Tape. Some people (including me) rely on tape to keep the lips from opening. (I can't rely entirely on the tongue thing.) When the lips open, all too often that eventually leads to a noisy and disruptive mouth leak. To see whether tape would be feasible for you, I recommend that you invest in a box of Somnifix strips. They are very gentle on the skin but hold very well. Be sure to curl your lips inward per instructions before placing the strip. If these work for you, then you can experiment with lower-cost options.

Note about tape: Some people avoid it, for two reasons. (1) If you suddenly need to vomit in the night, the tape could lead to your aspirating some vomitus, which would be bad. However, you can sacrifice one strip to see for yourself how well you can pull you mouth open in an emergency using only your jaw muscles. (2) If there is a power failure and your machine goes off while you're sleeping, you won't be able to do the natural thing and open your mouth to breathe. As for that, out of an abundance of caution, I've put a circuit alarm in a plug on the same circuit as my machine. It will wake me up immediately if I lose power to the machine.

[Lucy84]

hi,
If you look at the first chart I uploaded you can see that I had zero large leaks and it was like that since I switched to a nasal pillow but since changing the settings it has caused me to start opening my mouth at night and I wake up with a mouth like a desert several times in the night, its pretty horrible. I hoped I would adjust but it doesnt look like Im going to. Ive tried a chin strap but I cant wear it because I have TMJ disorder. Ill get some mouth tapes and give those a try. do you think there are any settings that could be adjusted to help though as it wasnt a problem before?

[Dormeo]

Yes, do try mouth tape. Also, there's a product in the U.S. called Xylimelts; if they don't sell them in the U.K., maybe you could find something similar. They are small discs that stick to your teeth or gums during the night and help you produce more saliva.

You could try increasing your EPR to 2. This will lower your average pressure for the night, since you'll be having less pressure when you exhale. It's *possible* this would help some with the leaks. With an EPR of 2, you may see fewer hypopneas and flow limitations; you may also see more CAs.

[Lucy84]

Thanks, I'll give that a try tonight. Could you explain EPR to me? I don't really know what it is.
Thanks

[Dormeo]

It drops your pressure by 1, 2, or 3 each time you exhale. So if your pressure at a particular time is 7 and your EPR is 2, for example, you’ll have a pressure of 7 when you inhale and 5 when you exhale. For the whole in/out of that one breath, your average pressure is 6.