Follow up after two months

[cbombzzz]

Hello all,

I initially posted questions regarding my high AHI numbers back in early April of this year. I experimented with settings on the CPAP machine but nothing has seemed to improve my AHI numbers. when I have the pressure setting above 9.0 I get very gassy and bloated. 
[attachment=6638]

the gaps in the dates were when I was not at home and using a travel machine without a data card.

I'm not sure what to try now. My AHI numbers are still bouncing around. 

Are the Clear Aways, Obstructive, and Hypopnea numbers good or bad? What am I looking for here? Is the machine doing it's job?

Some mornings I feel fine despite a higher AHI, but often times I still feel pretty tired. 

I appreciate any advice you can give me.

cbombzzz

[JesseLee]

I just want to note that previously you had tried higher pressures, but experienced an increase in central apnea. Some other members in your previous thread had mentioned a different mode of therapy (S/T or ASV). You ended on the last thread with a fixed pressure of 9.

[cbombzzz]

I must have everyone stumped

[Walla Walla]

Your CA's seem to be settled down. I'd increase the minimum to 10cm and give it a week to see how that looks.

[cbombzzz]

thank you for the reply. 

any pressure over 9.0 i get really gassy and bloated. i also wake up with an extremely dry mouth quite often. does this have anything to do with the mask or leak rate?

i use the humidifier at a setting of 2, higher than that and i get rainout.

i appreciate your advice.

[cbombzzz]

I'm curious if there is a better way to ask questions or if I've offended someone here?

[Walla Walla]

No not offended. One of the first things you can try is increasing EPR 1cm at a time to see if it helps to prevent swallowing air. If you've had a problem with Clear events in the past you'll want to keep an eye on that. If the EPR starts causing a large increase in Clear events you'll want to reduce your EPR back down. You'll just have to test it and see how it goes.

[JesseLee]

Hello cbombzzz,

Gee whiz man, I apologize. I most certainly was not ignoring you and on behalf everyone else, I'm very sure they were not either. Sincere apologies to you sir.

You have come to the right place for advice.

Mask choice and leaks are some of the most problematic issues to find a solution for and there is no solid answer to your question because that is very unique to you. If your wrestling with leaks, mask choice is a very probable cause, but before you dish out money on another mask, ask your DME to let you use one of their trial or demo masks if they have them. A good DME will have this service. The leaks are also resolved by mask adjustments and pillow sizing a lot of times. Try the next size larger on your pillows, you may be surprised.

For dry mouth, it is typically caused by mouth breathing. A soft cervical collar has shown to be very effective. Chin straps are another option. This too, is a personal choice.

If you are mouth breathing, which i suspect, you likely will resolve dry mouth and leaks at the same time. My first suggestion is to try the soft collar. It can solve/prevent positional obstructive apnea as well. This is also an economical option.

[cbombzzz]

Are the Clear Aways, Obstructive, and Hypopnea numbers good or bad? What am I looking for here? Is the machine doing it's job?


cbombzzz

[JesseLee]

You have next to no clear airway (central) apnea, which is excellent. You are experiencing mostly obstructive apnea and hypopnea and those are resolved with increased pressure and EPR respectively. Following Walla Walla's advice will help to resolve those and hopefully there will be no emergence of central apnea.

Your numbers are not terrible. According to the last 3 charts you are at AHI of 4-5 which is the high end of treated. Based on Walla2's advice, the numbers should come down.

On another note, the aerophagia may may also be helped by a collar as well by keeping the airway alignment correct. No guarantees there, but i hope to address the higher pressure issues.
I got a tip the other day that by repositioning the pillow under the shoulders, head, and neck will help sometimes if your a back sleeper vs just having the pillow under the head and neck. Seems worthy of a try.