Clear Airway Events

[Brucpap]

Agreed, I am going to try 8-11 tonight.

Again I woke up once or twice with my jaw slacked and cheeks puffed out like a blow fish (tape held it shut).

Should I try a chinstrap or soft collar? Or stay course and see how things progress for a couple weeks.

[Brucpap]

CA events are gone now.

Looks like it's mostly hypopnea now. 

My mouth tape gave way and I woke up with a leak out of my mouth around ~5:30am, maybe that's why there was so many hypopneas?

I feel better than normal today, but not as good as the last two days.

[Sleeprider]

As you adapt to the therapy, it's fine to bring back more EPR to see if you have just moved beyond it. I'd like you to include flow limits in your charts so we can see what is going on. I suspect you had a pretty good increase in FL between 3:20 and 3:50. The pattern of low flow limits through much of the night with periodic or occasional significant increase is typical of a positional issue that restricts airflow. Just be aware you may be chin-tucking during these periods. It's not worth wearing a collar for this, but see what you can do to avoid it.

[Brucpap]

Thanks for all the help.

Please see flow limit chart below.

[Sleeprider]

See that? i knew about the flow limits without even seeing them.

[Brucpap]

Nice catch! thanks. I agree, I think there is a positional component.

Two more things:

1. My jaw is slacking and my mouth tape isn't holding, so I am waking up with air leaking out of my mouth.  I think it might be worthwhile to try a chin strap or soft collar to keep my jaw from lowering, thoughts?
   
2. It seems I consistently wake up at the 54 min-60 min mark in a mild panic and rip off my mask, any thoughts on this? Maybe I am entering a deeper sleep and have a big apnea event? Maybe 02 levels are really dropping?
   

Appreciate all your help.

[Sleeprider]

A soft collar often provides enough pressure on the jaw to keep your mouth closed. I don't like chin straps because the tend to pull back, making apnea worse. It's kind of like a reverse mandibular advancement and this can make "positional" apnea worse. If you can find a strap or device that pulls up, not back, it's fine.

If you zoom in on your flow rate to where you can visualize the individual waves, you will see the flow limitation as flattened or downward sloping tops on the inspiration wave. I can see the top of your flow rate looks chopped off like a cut lawn compared to the shaggy expiration waves. That tells me you have a substantial flow limit, even at times that it is not being marked on the graph. While you're looking at the zoomed chart, take a look at the moments before you awaken in a panic. Your chart shows a steadily declining tidal volume approaching that arousal, so it's plausible you were just under-ventilated and had a shot of adrenaline. I think we need to increase minimum pressure to 9.0 to help with that restriction, and it might also help to increase EPR to 3, but keep a close eye on CA events.

[Brucpap]

Thanks, I will try 9.0-11.0 and EPR 3 tonight and report back.

If CA's go up significantly I will drop back down to EPR 2.

[Brucpap]

Last night I used a double sided mouth guard to help keep my jaw from dropping, but it felt like I didn't sleep very well even though my AHI looks really good. I was tossing & turning. I only got about 4 hours on the machine and ended up ripping it off and sleeping 2 more hours.

I think I will leave the settings as is tonight and try the soft collar if it arrives today.

[Sleeprider]

We can see some issues between 00:45 and 01:30 that would cause sleep disruption. Overall, the period of unstable respiration, flow limitation and leaks was improved considerably from previous charts.