[CPAP] Newbie looking for help/opinions please!

[buckrogers76]

Do you have to keep your mouth closed when putting your tongue on the roof of your mouth as with an open mouth i breathe through my mouth instead!

[Gideon]

Place your tongue on the roof of your mouth and breath.  Mouth or Nose?

FWIW my sleep clinic "issued" me a FFM and now I regularly use P10 Pillows without issue.  I am also a "Mouth Breather, or was.  Masks are very personal so every chance you get try a new one.  You have a good FFM which I do recommend for anytime you are stuffed, but I find the pillows work most of the time even then.  Ask your DME when you can get a new mask.  Go in and try several then, with your machine under pressure.  Walk out with a new style or a backup for your still very usable FFM.  You should be able to do this every 3 months, and replace the mask cushions more often (1 month)

Hi Fred

I will discuss with the nurses when i check in with them next! oh and the tongue on roof of mouth test , when i breathe in its through the nose!

My wife however assures me that prior to starting CPAP i used to breath at night exclusively through my mouth!

Regards

Buck

Me too, Prior to CPAP a complete Mouth breather.  Practice the tongue on the roof of the mouth trick, it works.  I find that a nasal mask or pillows will frequently "splint" me into nose breathing.  I think that over time we can get you into a more comfortable mask.

Regardless, keep this one because you know it works.

Fred

[Gideon]

Do you have to keep your mouth closed when putting your tongue on the roof of your mouth as with an open mouth i breathe through my mouth instead!

work on the position.  I keep mine toward the back

[Sleeprider]

To add to Fred's comments, we are seeing a good reduction in event rates and a transition of your events from predominately obstructive, to more hypopnea. This is where bilevel therapy comes in. You are at an EPAP pressure that adequately treats OA, but it will take pressure support to treat the residual hypopnea. To understand where we are coming from, read the titration protocol for BiPAP or VPAP: https://www.resmed.com/us/dam/documents/...lo_eng.pdf (page 35) or http://incenter.medical.philips.com/docl...%3d9792335 (pp 11-12).

Pressure support treats hypopnea, and in cases where high pressure is required to treat obstructive apnea, PS provides a lot more comfort. Finally VPAP/BiPAP is capable of higher pressure overall. I'm sorry that your situation has taken you to such high pressures, but I think you can find more comfort with bilevel. It still would make sense to check with your doctor and understand if there is some anatomical source for your high level of obstruction and airway resistance. If you have access to a friend in the U.S., a Dreamstation BiPAP Auto can be obtained on Amazon between $720 and $800 (price varies), and Suppier #2 has some very good prices on bilevel machines and they ship internationally; otherwise you will have to see what the medical system in U.K. will do for you.

[buckrogers76]

To add to Fred's comments, we are seeing a good reduction in event rates and a transition of your events from predominately obstructive, to more hypopnea.  This is where bilevel therapy comes in.  You are at an EPAP pressure that adequately treats OA, but it will take pressure support to treat the residual hypopnea.  To understand where we are coming from, read the titration protocol for BiPAP or VPAP: https://www.resmed.com/us/dam/documents/...lo_eng.pdf (page 35) or http://incenter.medical.philips.com/docl...%3d9792335 (pp 11-12).

Pressure support treats hypopnea, and in cases where high pressure is required to treat obstructive apnea, PS provides a lot more comfort.  Finally VPAP/BiPAP is capable of higher pressure overall.  I'm sorry that your situation has taken you to such high pressures, but I think you can find more comfort with bilevel.  It still would make sense to check with your doctor and understand if there is some anatomical source for your high level of obstruction and airway resistance.  If you have access to a friend in the U.S., a Dreamstation BiPAP Auto can be obtained on Amazon between $720 and $800 (price varies), and Suppier #2 has some very good prices on bilevel machines and they ship internationally; otherwise you will have to see what the medical system in U.K. will do for you.

Thanks Sleeprider!

I seem to recall seeing someone about my sleep apnea situation a few years ago and he said my airway is naturally narrow and it's rather crowded in there! This was before going through the recent sleep study and subsequent diagnosis in Wales!
Regards

Buck

[quiescence at last]

yes. so, as SR says - the EPAP is increased to correct as much as possible the OA, and the EPR is increased to help correct the hypopnea.  

so, my action if this were my data is -
keep EPR at either 2 or 3 to battle the hypopnea, and have the EPAP minimum pressure to about 13. so, my minimum pressure would be 13 plus EPR.
>  Option 1: with EPR set at 2, the min pressure would be 15.
>  Option 2: with EPR set at 3, the min pressure would be 16.
In either case, I would put max pressure at 20, but see how it works out (tempted to set my max pressure as min pressure plus 2. so pressure 15-17 or 16-18.)

good luck with your adjustments.

QAL

[buckrogers76]

yes. so, as SR says - the EPAP is increased to correct as much as possible the OA, and the EPR is increased to help correct the hypopnea.  

so, my action if this were my data is -
keep EPR at either 2 or 3 to battle the hypopnea, and have the EPAP minimum pressure to about 13. so, my minimum pressure would be 13 plus EPR.
>  Option 1: with EPR set at 2, the min pressure would be 15.
>  Option 2: with EPR set at 3, the min pressure would be 16.
In either case, I would put max pressure at 20, but see how it works out (tempted to set my max pressure as min pressure plus 2. so pressure 15-17 or 16-18.)

good luck with your adjustments.

QAL

Hi quiescence

Have a look at my charts for last night and then have a look at my charts from when i had the EPR set higher. My Hypoapnea score is lower now than when my EPR was higher. What do you think , as my numbers have fallen again I'm tempted not to mess with the settings and spoil it.

My biggest issue now is mask leak! it's not mask leak from how I've got it on but more from when i sleep on my side as the mask gets slightly dislodged and causes the leaks. As soon as i move to turn over it stops!

Regards

Buck






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[DeepBreathing]

I think it's important to understand how EPR works on a Resmed Autoset, and the difference between an Autoset and a bilevel machine.

On a bilevel, EPAP (exhalation positive airway pressure) is the pressure the machine provides when you're exhaling. This is what splints your airway against collapse. As you breathe in, the machine adds additional pressure, called pressure support (PS) to achieve IPAP (inhalation PAP). Note that PS is added to EPAP to achieve IPAP.

These terms are not really applicable to CPAP or APAP. The machine provides a pressure, which is just called "pressure". If you have EPR set, when the machine detects that you're starting to exhale, it reduces pressure by the amount of EPR. It is actually the reverse of pressure support on a bilevel machine. As the name suggests - exhalation pressure relief - EPR lowers the pressure. This is equivalent to lowering your EPAP (exhalation positive airway pressure). So if you need a certain EPAP to overcome obstructive events, increasing EPR will actually lower the EPAP below the required level and your obstructives - and obstructive hypopneas - will go up. (EPR does not "fight" hypopneas).

In an earlier post you mentioned problems with your eyes. Some of the full face masks will leak up the side of your nose, blowing air into your eyes. This can be irritating and - if carried to extremes - can cause a severe irritation called "dry eye". I've had this occur with both the Quattro Air and Simplus. To overcome it I take some fabric (pyjama fabric works well) and fold it into a strip about 100mm long by 25mm wide and 3 or 4 layers thick. I lay that over the bridge of my nose and drape it down, then carefully fit the mask so that it sits on the fabric. It's easier to do than it sounds. This forms a fairly efficient seal, stops your eyes getting irritated and also avoids the mask rubbing on your nose and causing a pressure sore. The size and number of layers will vary depending on the shape of your nose.

[buckrogers76]

I think it's important to understand how EPR works on a Resmed Autoset, and the difference between an Autoset and a bilevel machine.

On a bilevel, EPAP (exhalation positive airway pressure) is the pressure the machine provides when you're exhaling. This is what splints your airway against collapse. As you breathe in, the machine adds additional pressure, called pressure support (PS) to achieve IPAP (inhalation PAP). Note that PS is added to EPAP to achieve IPAP.

These terms are not really applicable to CPAP or APAP. The machine provides a pressure, which is just called "pressure".  If you have EPR set, when the machine detects that you're starting to exhale, it reduces pressure by the amount of EPR. It is actually the reverse of pressure support on a bilevel machine. As the name suggests - exhalation pressure relief - EPR lowers the pressure. This is equivalent to lowering your EPAP (exhalation positive airway pressure). So if you need a certain EPAP to overcome obstructive events, increasing EPR will actually lower the EPAP below the required level and your obstructives - and obstructive hypopneas - will go up. (EPR does not "fight" hypopneas).

In an earlier post you mentioned problems with your eyes. Some of the full face masks will leak up the side of your nose, blowing air into your eyes. This can be irritating and - if carried to extremes - can cause a severe irritation called "dry eye". I've had this occur with both the Quattro Air and Simplus.  To overcome it I take some fabric (pyjama fabric works well) and fold it into a strip about 100mm long by 25mm wide and 3 or 4 layers thick. I lay that over the bridge of my nose and drape it down, then carefully fit the mask so that it sits on the fabric. It's easier to do than it sounds. This forms a fairly efficient seal, stops your eyes getting irritated and also avoids the mask rubbing on your nose and causing a pressure sore. The size and number of layers will vary depending on the shape of your nose.

Hi Deepbreathing

Thanks for the detailed response and advice. Talking of pressure sore's, i have one that has just appeared on one side of my nose. It's red but not sore as yet! I will try the material strip thing and was also thinking of adapting my head position on my pillow. I'm still trying to sleep with the mask on the same way as without when you really sink your head fully into the pillow. Last nights leak stats were the worst in a while so i need to revisit mask fit/position/tighness etc to get it right.

I'm happy with my overall score which is still going down , but I'm thinking now of switching off EPR tonight as its set on 1 at the mo. I think i will leave everything else alone and see what transpires!

On another point i heard somewhere that everybody actually get apnea's every hour , so if thats true i'm not that far off being at normal levels all be it aided by a machine.

Regards

Buck

[JeffT]

A "normal" AHI is 5 or less. In other words, if you did a sleep study, and you scored 5 or less, then that would be considered normal and no treatment would be required.