[Treatment] Understanding rise in AHI

[Expat31]

Certainly progress on the leak situation.

Some things to do now:-

1. Turn off ramp, or if you really feel you need it, do a “starter” setting of say 30 minutes until you get used to it.
   
2. EPR on full Time, ramp only is useless.
   
3. Set EPR to 3 for the moment, but we have to watch for central apnea increase, and adjust down.
   
4. Set minimum pressure to 7cms. In my opinion   well calibrated minimum pressure is  the most important adjustment of them all. It is the first line of defence, and catches many events before they can develop.
   
5. Leak. Get a tape that covers the corners of your mouth. They are the weak points. Often people have problems with them getting loose after a few hours, due to movement and movement and saliva seeping through. LL in his video advised “pursing” your lips. I don't agree. A better seal is by folding your lips “inwards” (can't think of a better verb) so that they are invisible when looking in the mirror. Sounds a bit ridiculous, but I think it is a better seal. Too difficult for saliva to pass through.
   
6. Choice of tape. My opinion is to avoid the complicated crossed types, those with central holes, Simple is best. Some tapes can be a pain to remove. I learnt  something the other day from Deborah in her post. Milk of Magnesia Dors the trick.
   

A lot of things to work through. Normally I don't think it is a good idea to make lots of changes in one go, as if something makes thing goes a bit wrong, you don't know which adjustment is the cause.

Maybe do the lot, but examine your charts carefully for changes. You can always row back.

It's a complicated business to start with, but it's worthwhile the effort.

[PedroT]

I woke up shocked at my AHI number last night. I thought I must have only slept for 30 minutes and but I realized slept over 5 hours without waking up. Felt very nice.

Didn't realize how much I was droolling in my sleep considering how wet my mouth tape was. I now I am waking up minimal dry mouth. This has been something that has been bothering me for many years.

Think I woke up because of rainout. Would have liked to sleep more. Do you guys have any tips on dealing with it?
I have a heated hose, with some cover I got from my vendor, and my temp of 27 degrees Celsius and humidity of 6 has been fine for the last weeks until today.
I also do live in a cold climate (Canada).

No changes from last night, just kept using the mouth tape. Not sure if I want to try the soft cervical collar but should I still consider it even though my AHI is super low (probably the lowest AHI I've had in the four months I've owned the machine )

[Expat31]

Glad things went well last night.

Looks like cleaning up the leaks cleaned up your graphs also, especially centrals. On the night of 25th December, you had quite a lot. 

There seem to be improvements across the board.

I see you have not changed your settings. Best leave them alone at the moment. Keep them in reserve. 

“If it ain't broke, don't fix it”

If you can avoid collars, all well and good. I find mouth tape and an excellent Breveda pillows mask a good combination. The latter is super quiet, as has a diffuser. No constant air noise compared with other masks.

Keep up the good work!

[Expat31]

Sorry, forgot about rain-out. Y0two possible solutions I know of, a hose holder with a dip in the hose to collect water so it drains back, or a hose insulation sleeve, available on Amazon, very reasonably priced. I use the latter only.

[PedroT]

AHI went up again after the previous success.

Haven't changed anything from the previous night.

Only change was in my pre-sleep routine:
         - Yesterday I didn't take a shower before sleeping because of the late night out. Today I did and I also found out that left nostril was completely blocked when I woke up the first time. Was not blocked when I went to sleep. Wonder if its the fan blowing in my face + shower combo that causes my nose to be blocked.

Not sure what to make of the events at the last two hours of my sleep. Trying to understand why my events can so variable from day to day. Feel less rested today compared to yesterday even with more sleep.

Edit: I'll mention diet too. Last time I had a sub <1 AHI on Dec 3, I remember eating a decent meal before bed. I have been intermittant fasting with a fasting a window of 16 hours+ for the last two months. Helps with the weight loss but it is just a coincidence that the Dec 3 and the night from the two days I had a decent meal two hours before bed? I've read intermittant fasting can cause some sleeping issues. I'll post the December 3 graph also as reference (I also wasn't wearing any mouth tape then). Two nights ago, I also had a big meal two hours before bed with a sub <1 AHI.

[SarcasticDave94]

According to your OSCAR settings, EPR 3 is basically OFF, as it's set to Ramp only. But Ramp is off too, good keep Ramp off.

Turn EPR to full time 3 and Min pressure to 7.

Your leaks are still robbing you of good therapy.

Your AHI numbers will go up or down, even per night. This indicates nothing more than every night is different. One night means little overall, but you can use it to signify the beginning of trends only, as one night by itself is not a trend.

Last pointer, zero events isn't the goal. Instead, low events with consistency is your end goal. Under AHI 5 is medically treated not cured, however you want a bit under AHI 5 consistently to feel your best. Again zero isn't necessary, as it'll cost you stressing over it and likely ruin your comfort.

[Expat31]

Thanks for your graphs.

I would like to go back to the first two lines of my first reply:-

Leaks, leaks, leaks.

I think your enemy n°1
                         ------------------------------------------------------------------------+
You leaks are however back. 

Assuming you did tape as in the previous night, I can only guess that this reocccurance is related to you having a blocked nostril, and somehow during sleep your head was pushing against the pillow and displacing your pillows mask, so that air escaped. 

A guess I admit, but can't see any other logical solution, unless your tape was not fix properly.

I would really recommend that counter productive to make any changes unless this done. Changing settings at this stage will just confuse the situation, and be distracting from the underlying problem.

In a leaking environment that you have, the algorithm is incapable to record anything correctly, except the leaks. The results are consequently distorted and I suggest useless for analysis purposes.

Therefore, please keep laser focused on leaks only, at this stage.

Once achieved, settings can move to the top of the list.

I cannot comment on big meals at the end of the day, except in general terms it most likely will disturb sleep.

From what I understand, the body's metabolism changes in the digestion process. I am not sure how, you may have to look that up. Also any alcohol can also make a difference.

Personally is is an big "No No" for me, but we are all different. 

I have no medical training, my comments and opinions are based solely on my own experience.

Sincere apologies for the forthrightness in my comments.

Best wishes.

[PedroT]

Thanks for the advice everyone.

I will stick to just less anxious about this stuff and keep at it