CPAP- Need Evaluation and Advice

[Lucid]

Hi, Connieliles  If the p30i is hurting the inside of your nostrils, you may have it adjusted too tight, or need a different cushion size.  Too tight can be as problematic as too lose when it comes to mask leaks, in general.

The problem I had with the p30i initially was that the lower edges of the pillows were pressing into my upper lip, just below my nose.  Both the pressure and the occlusion of pores were harming my skin.  I tried protective tape and creams, but the only thing that worked was to tape a strip of fabric just under my nose for padding.  I use strips of micro terry cut from the soles of light-weight running socks.  It has to be very thin in order not to displace the pillows.  Other wicking knit fabric might work, as well.

Here are some links that might help, in case you haven't already seen them: 

http://www.apneaboard.com/wiki/index.php/Mask_Primer
 
How to achieve the perfect mask fit - GUARANTEED! | Apnea Board

[Connieliles]

Seeking advice.  This is as good as it gets for me.  Currently using soft cervical collar, mouth taping with a small horizontal slit, Bleep  Eclipse.  Terrible, terrible  aerophagia.  I am also concerned with the continued flow limits. When I look at the individual breaths, many appear to me to be flow limited, even if it is not showing on the graph. Afternoon sleepiness is better, but still present. I am finally have some dreaming, which I assume is an improvement. Any suggestions for improvement?
Thanks in advance!!

[Sleeprider]

Connieliles, Let's make your therapy better. The soft cervical collar is working to prevent the clusters of apnea. Now to help with aerophagia, take EPR from 2 to 3. No other changes for now, but we will try to further reduce pressure induced aerophagia, the increase in EPR should help. We will be reducing your maximum pressure from 12 to 11 and lower in small steps to be able to observe the effect and try to pick the best compromise between comfort and efficacy. Hang in there, and start with ERP 3.

[Connieliles]

    A better night,  aerophagia still present - slightly better.

[Sleeprider]

Looks better with improved tidal volume and 95% flow limit dropping from 0.12 to 0.06. Next step, everything the same but maximum pressure at 10.0.

[Connieliles]

       

Results with pressure at 10.  I have a slit in the horizontal tape, so still some leaks even with the bleep eclipse. Still afternoon sleepiness.  Aerophagia is some better.
Still wearing soft collar.

[Sleeprider]

The best looking results were on 2/19, and I can't explain why we see more hypopnea on 2/26 with very similar pressure and EPR. The increased EPR clearly improved flow limits and stabilized pressure. The difference between 8-12 and 8-10 pressure should still produce good results. I think it's your choice dependent on comfort. It does not appear a lower overall pressure would be advised at this point. With EPR 3, your EPAP pressure is still lower and that is probably the biggest factor in reducing aerophagia.