johnnygz - Therapy Thread

[johnnygz]

As expected (?), my sleep was a lot more consistent with the cervical collar (It's from a brand called Nimood I think, on Amazon). I would even through away some of the events because I was probably awake at the beginning and the end of the these sessions. I'm happy with the OSCAR output! Still feeling a bit fatigued, but I would attribute that to the total time asleep and some struggles to get back to sleep. I'm sure time will help

I think my next steps are:

1. Mess around with my mask fit and potentially try a new one, I've found that I've over tightened it to try and reduce leaks and that is reducing the ease of breathing. I do like the mask though, just seems to resist a bit with the nose flaps (at least, that's what it feels like). I think the firmer, lower pillow will also help on my side.
   
2. Barely adjust my pressure range since it seems to be consistently in the middle of my range and my events are almost non-existent.
   
3. Practice! I just don't stay asleep long enough and then when I fully wake up I have a hard time falling asleep with the mask and collar back on. I think if I could routinely get 7-8 hours of sleep I'd be stoked. It's definitely an adjustment getting used to sleeping with so much... accessorizing lol.
   

Thanks everyone for the help!

[johnnygz]

Sadly a bit of a regression last night, consistently under 5 hours of sleep with the mask on. AHI went back up to pre cervical collar numbers, but the events seem to be a bit more spread out so not sure if it's positional anymore. Potentially, the addition of the collar made me sleep more consistently which now opens me up to more H/OA/CA events?? 

Will try to tighten the collar a bit tonight, maybe I was getting my chin under it. Also swapped to the L sized face mask and seems to have alleviated some of the exhaling issues and discomfort.

[johnnygz]

Pretty consistent with the night before. Cervical collar seems to be doing its job pretty well! Excluding the first ~30 minutes or so of the chart, where I was awake and tossing/turning, I had no OAs last night and just a handful of H/RERAs and a couple CAs. Pretty happy with the progress, will continue to bump up my pressure settings to try and remove the Hs because I woke up this morning absolutely exhausted and took of my mask and slept for at least another hour (potentially because I went to bed so late).

[johnnygz]

I had a feeling that the increases in pressure in response to my flow limits were waking me up so I tested a night in CPAP mode at a constant 13cmH20. The constant pressure was fine, pretty similar to the 10-12cmH20 range I was using. I still got quite a few hypopneas and RERAs. Did not sleep as long as I wanted to, unfortunately. The only thing consistent in my therapy so far is that my flow limits seem meh and increasing the pressure up to 13cmH20 has thus far all but completely eliminated my OAs, while keeping the Hs and RERAs high enough to disturb my sleep.

I can't do anything but keep at it, but potentially looking into buying a BiPAP to see if I can sleep more consistently.

[johnnygz]

Bringing this thread back from the dead. Updated equipment and move to BiPAP.

General things, started this journey a while back. Have gotten a bit better at sleeping with BiPAP and use a Knightsbridge chinstrap to combat my pretty brutal jaw drop (SCC and mouth tape do not work as well). I've had mild sleep apnea and got a second turbinate reduction in January so my nasal breathing is a lot better. 

I honestly didn't feel too bad and didn't really have many symptoms before I started CPAP but did the sleep study because of my nasal issues and a desire to optimize my sleep (All my wearables were saying I had sh**ty deep sleep amounts). Currently I don't feel very different than before so I'm questioning the need for continued CPAP. I run about 20 miles, a week, I lift 3-4 days a week, I'm 6'2" 215 lbs (188 cm and 100kg) so big, but not overweight/fat (13% bf), blood pressure is usually 115-120/60.

Should I retest my sleep study?? Are there hidden issues that mild sleep apnea could cause?? Honestly, the chin strap is probably the worst part of sleeping at the moment but there are no better options to keep my jaw shut sadly.

EDIT: My flow limits are still bad, as you can see in OSCAR, despite generally clear nasal pathways and very high pressures with BiPAP. Not sure if they are causing issues or just something that is there.

[johnnygz]

Hey all,

I'm back after trying a lot of different things with regards to my xPAP therapy. I even went in for a sleep endoscopy which clearly showed I have lateral wall collapse on my side and full concentric collapse of my upper palate on my back. There was evidence that MAD would not help but pressure did help stent my airway open so CPAP should be working.

My issue continues to be FLs. I have attached my most recent night (4 hours) of sleep and you can see 95% rate my FL is 0.28. It's fairly constant, so I don't think its positional but maybe someone can see better. My flow rate waveforms are pretty clearly flow limited. I've moved my PS up to 8 (I have pressure set constant 11 EPAP and 19 IPAP) and it has decreased my FLs as I increase PS. I do not appear to have any induced CAs.

I'm already sleeping with a Knightsbridge chinstrap which has done a TON to keep my leaks non-existent, but if my flow limits look like they are positional I assume switching to a collar and mouth tape may be more effective? Should I continue to increase my PS? Seems like consensus here is that anything over 6 or so is too high but if I drop down that low my FL get incredibly bad. I've attached a night with a PS of 6 and the FLs are almost constant throughout the night which makes me think its not positional.

I generally feel no difference using BiPAP and sleeping without it, it does not help at all or make me feel different at all. Constantly fatigued is the best way to describe it (and my sleep doctor also thinks it contribute to low testosterone because my body can never really rest so a vicious cycle lol) So I'm really trying to make this work before I look into surgery.

Hopefully someone has some insight for me! Thank you!

[johnnygz]

Well, this has turned into my personal journal so might as well use it to keep my thoughts in order lmao. I went back to CPAP mode based on some guidance and to see how impactful the BiPAP really was. And my 95% FL is pretty much the same. FLs for EPR 3 and 14 fixed pressure is probably a bit more consistent than BiPAP but not all that different. I guess I'll stay at 14 pressure for a couple more nights and then keep going up since PS 8 was not effective in reducing FL. 

Another option that was mentioned to me was EERS but I know nothing about that so I guess I'll have to look into that as well, along will using a SCC (I've finally gotten used to the Knightsbridge cap and swapping sounds miserable).

[johnnygz]

I'm pretty close to giving up on xPAP at this point. I might try ASV just for sh*ts and giggles but nothing seems to be working consistently for me. I've tried three nights all with a chin strap, mouth tape, and a SCC. One was not bad, I just woke up like 3-4 times and the other 2 nights were just sh*t. No amount of PS seems to be making my FLs better, I've ensured no positional apneas with a low pillow and a SCC, I have very minimal leakage. At this point surgery seems to be the only option.