Franko39 - Therapy Assistance

[Franko39]

Hi everyone,

Thanks again for the helpful tips for a beginner. It's been a good 8 months of therapy and I think I've finally started to get a handle on things. My leak rates have lowered a lot (thanks to the F30i mask) and I'm able to sleep through the night with the CPAP on most nights. Most nights on therapy, I'm hitting an AHI score between 2-3.

In reviewing my OSCAR data, I'm seeing a trend that I am hitting the ceiling of my pressure range (6-10.6) for a 2-4 hours/night on average. Would you recommended increasing the max pressure as such?

I've heard mixed things about pushing too hard on the pressure due to CAs, etc. Since my AHI is pretty good as-is and I'm sleeping well, I'm not sure how necessary it is to further raise the max pressure to reduce the time spent where the machine is "capping out". TIA!

[Jay51]

Congratulations on your therapy.  The only 2 negatives that come to mind with increasing pressure is 1.  more CA's; and 2.  possibly more aerophagia.  But in almost every case, raising pressure improves therapy when hitting the max every night.  

You can experiment with a bit higher pressure(s).  You can always come back down in pressure if the increasing pressure experiment fails.

[Franko39]

Hi everyone,

Thank you again for your assistance. It's been nearly a full year since I started the CPAP journey, and I think I've gotten the hang of it, more or less. The last few months have been more fine-tuning and optimization. 

- I can sleep through the night with the mask on now (most nights anyway).
- Leaks are no longer a regular issue, since switching to the F30i mask (still happens occasionally, due to my tossing and turning).
- The last thing I was trying to resolve was the flow limitations. I've heard mixed things, including that my figures weren't too bad. I tried upping the pressure and upping EPR a bit. Not sure if it made a big difference, but I decided to just leave things be, as it sounds like my flow limits aren't terrible.

Overall, I think I may feel a difference now, on nights where I'm able to use the CPAP for a full night without interruption. Hard to say for sure - I've heard that it takes some time to see improvements, so I'll keep at it.

The only issue I now have is that my mouth tends to open a bit at night as I'm asleep, and the blast of air coming in from the CPAP makes my lips really, really dry. I've been waking up once or twice each night due to how dry my lips are - not sure if there's a good fix for this or not.

I've posted some recent OSCAR data representing my typical nights - any insights/comments would be appreciated!

Franko

[Jay51]

Thank you for the update.  All 3 charts look ok IMO.  Around .07 95th percentile flow limitations.  If you are satisfied with this, then that is fine.

Here are some tips on reducing mask leaks:  

• Mask leak solutions                  Mask Primer
  

[Franko39]

Thank you for the update.  All 3 charts look ok IMO.  Around .07 95th percentile flow limitations.  If you are satisfied with this, then that is fine.

Here are some tips on reducing mask leaks:  

• Mask leak solutions                  Mask Primer
  

Thanks for the feedback!

Would those flow limitations be something that you'd personally address, if you had those numbers with your own therapy?

The leaks aren't too worrisome for me, as they don't occur that frequently. I'd say a bigger concern is my dry lips (inner lips especially) due to the mask. This has been more of a problem lately, since I changed my nighttime mouth guard to a bulkier one that tends to push my lips open a bit more (didn't realize this was an issue until after I received the mouthguard from my dentist). Any suggestions or tips on dealing with the dryness of the lips?

[Jay51]

In regards to your .07 95th percentile flow limitations:  it should be up to you based on how you feel in the morning after sleeping.  The only major tweak I can see is trying EPR 2 full time vs. EPR 1 full time that you have now.  If it gets worse (more CA's and worse feeling in the morning after EPR 2 full time), then switch back to EPR 1 full time and you are probably optimized on this particular machine about as best as you can be IMO.

[Franko39]

In regards to your .07 95th percentile flow limitations:  it should be up to you based on how you feel in the morning after sleeping.  The only major tweak I can see is trying EPR 2 full time vs. EPR 1 full time that you have now.  If it gets worse (more CA's and worse feeling in the morning after EPR 2 full time), then switch back to EPR 1 full time and you are probably optimized on this particular machine about as best as you can be IMO.

Thanks for the suggestion - I did try something along these lines a couple months back, on similar advice from other board members re: the flow limitations. I went to EPR 3 full time and had a rough time - my AHI score shot up with a significant uptick in CAs, so I backed off to EPR 1 again.

I'll try a night at EPR 2 and see if see if this middle ground setting may be just right for me.

[SeePak]

Franko and Jay

I have had identical issues controling CA events, EPR made it worse, but i can still get a boat load of CA events even without EPR.

I think there are a lot of other people on here with similar stories.

I am beginning to think this is mostly intolerance to CO2 which causes large breaths and then stoppage of breathing.

I am doing breathwork exercises to LOWER my intolerance to CO2 and will share results once i see improvement that can be objectively reached.