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Diagnosed with mixed mild sleep apnea after in clinic sleep study in March of 2022. Info: imgur.com/a/3Zsa0wH
Was prescribed a cpap. Settled for a Resvent ibreeze as this was during the recall and didnt want to wait for a Resmed.
I no longer suffer from RLS and i have learned to sleep on my side.
Fast foward to now and my central apneas appear well controlled with my cpap as i havent had 1 flagged ever(odd i know, based on extreme amount during study). Yet, i have zero symptom resolution and never wake feeling refreshed. I have experimented with varying pressures and IPR settings, but I appear to struggle with flow limitations. Of which i dont understand how to interpret. I have to use a chin strap/mouth tape to keep from mouthbreathing/blowfishing at any pressure. Above 12cmH20 constant/minimum and i have to use polident to secure my lips, which isnt always effective.
Current settings:
min:10
max:13
IPR: 3
I have attached my most recent sleep and provided a link to closeups on a couple FLs. imgur.com/a/kwkbLox
Included also data from my apple watch in case something is pertinent.
Thank you for any insight.
Your minimum pressure plus IPR 3 is not sufficient enough to keep your airway open as evidenced by the prevalent obstructive events so you'll want to consider raising the minimum to compensate for the pressure drop of IPR. Effectively you're attempting to treat your sleep disordered breathing with 10cmH20 - IPR3 = 7cmH20 and it's not working.
Considering you're having issues taming leaks 12cmH20 and above have you considered trialing a full face mask and/or constant pressure?
If you can tolerate it, I'd recommend turning off IPR tonight to see if the pressure increase tames your obstructive events. When it works, we can then compensate for IPR by raising your minimum and maximum pressures and transitioning to a full face mask or coming up with a better mouth taping regimen.
Just two comments to your sleep study: 1) You were awake a lot during that study. 2) Your RDI is drastically lower for the side sleeping you did versus the time you slept on your back, so I would encourage you to consistently sleep on your side. Oh, just reading that you have learned to sleep on your side, so that's good. Stay the course.
The standard protocol is to up your pressure until all OAs and hypopneas are resolved. From there, we can up pressure further to eliminate FL, or, more preferably, increase pressure support or a derivative of it (IPR, EPR, etc.) to eliminate the remaining FL. So, with that said, I second to do what gainer suggested. Alternatively, should you read this in time, you could keep your IPR settings and up the pressure. Whatever way you decide to go, just make sure you're not changing too much too quickly; even small incremental changes of 0.2cm can have a sizeable effect on therapy results.
Went back to a constant pressure of 12 with 0 IPR 3 nights ago. This was the setting i used for the majority of my therapy.
I utilize polident, medical tape on mouth, and a respironics deluxe chin strap to eliminate mouth breathing/blowfishing. First 2 nights were unsuccessful with massive dry mouth and slobbering. 3rd night mouth stayed shut. Will attach details for that sleep.
Pretty clear i need to experiment with higher pressures which isn't really doable with nasal pillows.
I have a F20(silicone) in my possession and I have an appt with my DME tomorrow to discuss other FFM options. Will bring home something new and likely purchase mask liners for both in an attempt to seal better. Worst case i will need to shave and simply not look in the mirror any longer.
I have performed the tongue sticking to the roof of my mouth exercises for awhile now. At night I actively try to keep it there. But I have always struggled with keeping my mouth shut/blowfishing from the start of my therapy.
Polident, mouth tape, and a chin strap help but it’s 50/50 as to whether my mouth will open during the night. The unsuccessful nights will always cause frequent awakenings/bathroom trips and a much worse intensity of symptoms the next day.
I haven’t tried a higher pressure than 12, but I anticipate similar results. Keeping my pressures low while ineffective, eliminate any mouth opening issues.
I trialed a soft cervical collar also. Didn’t help.
