Chin Tucking as cause of apnea

[ejbpesca]

scowell wrote:

What mask are you using?

I use a ResMed F20 full face large although I measure for medium.  The large is to accommodate mouth breathing.  Any facial movement causes a leak, I toss and turn causing leaks.  I have to wear it very tight to pass a mask test on my AirSense 10.

My natural sleep position is on my side chin tucked, I think rolling to my back sets off thick clusters of apneas, not sure why.

I roll due to pain developing from remaining on my side after a period of time.

I've tried a half dozen FF masks, F20 one seems to leak the least, but there are more to try.  Thanks for your the name of yours.

Skin oil seems to cause leaks but the worst cause is any facial movement and body movement which I cannot avoid.  I try to remove oil by washing masks and face but even with a clean face, it returns in the night to slick up the silicone.

[scowell]

ejbpesca, sounds like my same program... sorry about your leaks.  Not familiar with the mask you have, but it is a popular one.  I also have pain and roll around, arms go to sleep, toss and turn all night.  Supine (on the back) is the worst for OA's.

You're already mouth-breathing to bypass the palate and tongue... is the problem that you don't mouth-breathe sometimes?  I'm on my first week with the FF mask, still learning about this.  As I've mentioned, some nights it's *much* worse, tongue swelling?  Perhaps after a night of OA's, the tongue is swollen?  ENT tomorrow, we'll discuss.

There are boil-to-fit masks now... a soft liner is recommended.  Are you watching any of the YouTube folks?  I find lots of ideas and help there as well.  The Bleep is guaranteed to not leak... I just couldn't handle it, the holes are too small, I need big air.

Have you tried nasal mask with mouth taping?  Is your OA tongue-jaw related?  You tuck your chin... have you tried the straps?  I bought some tongue-suckers, I'll report back on them, arriving tomorrow.

[ejbpesca]

Thank you for the replies scowell.  My helper UnicornRider may have given up on me or is too busy with more serious cases..or who knows?  

I looked online for the nearest sleep therapist I am willing to pay well outside of insurance to look at my case.  I get zero help from my DME and doctor.  The closest one to come up is 700 miles away.

Do you know of an online pay service for help with CPAP/BPAP therapy?  I have gotten GREAT help here and from another forum but I would like to be directly in touch with a professional who can examine my OSCARs, diagnosis, conditions etc., and maybe lead me to some better therapy.  I get decent therapy once in a while and oh what a difference.  I know immediately upon waking that the therapy worked.  I can't seem to replicate that though.  Sooo many variables.

I want a BPAP and may spring for one out of pocket.  I guess my current prescription is all that is needed to buy it.  Yet it is possible that the cause of my Flow Limitations is anatomical and not treatable except by surgery which is not an option.

Maybe this forum has a listing of online pay as you go Sleep therapists.  I don't like the Lucky Lankey or whoever's $99 a month subcription offer.  I would pay him per task/visit though.  He is quite a character.  He has no contact email or I would make him an offer.  He seems very knowledgable.

I guess there is not a pay section to ApneaBoard or is there?

I've learned way more in the past month or so than in 15 years of therapy, from ApneaBoard.  I guess I would like to never have had to dive so deep into it all but being retired and stuck at home most of the time I have the time and it is very interesting.  OSCAR is an amazing application of software, but I feel it could use a trimming down for average users or at least have levels of reports that start simple and then go deeper if the user chooses.  

I taught adults to use the first microcomputers, 35 years ago.  Judging from my peer's current state with computers, they still are very challenged. I can't image them attempting to use OSCAR, nor willing to spend the hours of study necessary to do so.  Maybe an OSCAR Lite?  Or how about AI mixed with OSCAR to give advice?  Maybe someday.  My Air is too little, but I have not seen it in a while.  Sleep HQ blocked me because two machines got registered and I can't get in to remove the old machine. 

Thanks for sharing your situation.  I feel not so alone as I am. 

I am going to try to replicate tonight's sleep with last night's.  If I do it will be a small miracle.  Chin up. hehe, or down.

[UnicornRider]

I have not forgotten you, I thought I had sent out a reply earlier but I must have been distracted by life and was looking at a preview instead of the posted reply, when I closed out.

I hope I have led you deep enough into this world of OSCAR and *PAP that you would find plenty of learning to keep you occupied for awhile. With your technical background and time on your hands, I was hoping to inspire you to carry on so that you could start assisting people, especially Apple folks with importing Wellue products into OSCAR. In addition to understanding the relationship between our sleep environment and AHI scores.  

I have had a flurry of 0.00 AHI scores since the one at the end of December. By focusing on my leak rate, pillow, mask and other variables that I have control over, I was able to consistently get low scores. But with UARS, low scores do not always convert over to restorative sleep. So I am building a packet to present to my sleep doctor here in a couple of weeks, I am not sure where this will lead me, I suspect we will gently start increasing pressure minimum, at the same time I may lower my pressure support. I only have a few cmH2O room left on this machine before I reach the max output, then I will have to move to the exotic machines.

 I am going to leave you with one of my 0.00 AHI OSCAR Reports to analyze, we will see how well my efforts have paid off. This particular night was so miserable I was amazed to see I had scored a low AHI, much less a 0.00 AHI. It felt as the pressure was totally out of time with my breath, maybe my heart just was not into it that night.

   


 I think it is important to maintain PMA (Positive Mental Attitude), I failed that particular night.

[TechieHippie]

UnicornRider, I'm confused, I must be missing something (I know very little about the VAuto and am only used to CPAP data)....looking at that graph, the flow rate only has no data after 10:30 , wouldn't that mean you turned off the machine or had no support from the machine after the first small section, and therefore no way for the machine to judge AHI?

I don't think OSCAR will calculate AHI from your oxygen graph. It would seem that you got no support from your machine, and AHI is actually unknown, not zero, but maybe I am reading it wrong.

You did have some deep oxygen drops and lots of variability. I don't know how to extract AHI from an oxygen graph, but I have stared at a lot of oxygen graphs; I know what to look at for my own treatment. That dip to 73 alone would make me feel pretty awful the next few days. Your median oxygen of 92 means you spent most of your time either under 90 or between 90-94, which is not ideal. How much time under 90% (from the oxygen monitor report) did you have? Hours? I feel pretty out of it if I have more than a few minutes under 90 and more than about 25-35% of time between 90 and 94. (That said, I don't have COPD; my dad did, and the ranges are different for people with COPD).

I agree about a positive mental attitude, but when you can't maintain it, you might want to see it as a symptom from your body, not a failure of your intentions. This graphs feels to me like you aren't getting the therapy you need and doesn't surprise me that you felt miserable - there is a reason.

I say this with kindness and no judgment!

Lisa

[scowell]

(snip)
 I am going to leave you with one of my 0.00 AHI OSCAR Reports to analyze, we will see how well my efforts have paid off. 

 
Your machine did not record.  The AHI is invalid.  Your O2Ring etc recorded the whole time... it's like you had two 15min sessions of PAP, mostly the machine wasn't even on.  See the duration of 19min?  No wonder you had a bad night... jeez.

[UnicornRider]

Hi Techie,

We've been chasing circles on this forum today. I left you a note on another thread just now.

Everything you say is true.

This last couple of years have been very challenging, I have been on *PAP for over 10 years, but after going through chemo and radiation therapy during the pandemic, I found I was in an ever increasing AHI. Raising pressure and EPR to keep it under control resulted in my sleep doctor putting me on the ResMed AirCurve 10 VAuto. It is a very versatile machine with several Modes of operation and special features that offer tuning and tweaking to meet the needs of the client. That machine is well respected on this and other forums.

It has not been easy to get to the pressures I am at today, I had some serious compliance issues. It seems as though you have to keep the mask on your face to meet compliance.   

I will be getting supplemental O2 here shortly from my PCP. 

Thanks for your concern, I feel no animosity in your post.

When I said my heart was not into it that night, my pulse graph would be indicative of that.

[scowell]

(snip)
It has not been easy to get to the pressures I am at today, I had some serious compliance issues. It seems as though you have to keep the mask on your face to meet compliance.   

Yes!  If you don't use the machine you're not compliant.  Is this just drama?

[UnicornRider]

 
Your machine did not record.  The AHI is invalid.  Your O2Ring etc recorded the whole time... it's like you had two 15min sessions of PAP, mostly the machine wasn't even on.  See the duration of 19min?  No wonder you had a bad night... jeez.

My AirCurve 10 VAuto did record. The AHI is valid. My Checkme O2 Max recorded the entire night. I did have two ~15 min sessions of *PAP. I normally fall asleep within two minutes, that night the pressure in the mask was not right, I gave it two tries.

As a Texan, I would think you could recognize the international finger symbol of the Bird, that my heart sent out to be recorded on the pulse graph. If you look closely, you will notice that finger is pointed directly at the Flow Rate graph.

[TechieHippie]

I gotcha I think. I'm a little humor impaired.

Thanks for the comments on the other thread. Good luck with the supplemental oxygen and improving your health.