07-26-2018, 02:32 PM
Help, one step forward, two steps back
Hello All:
I am hoping that some of you knowledgeable people can help me get back on track. First some background.
I started APAP late in December, 2017 following two home sleep studies, one without my oral appliance and one with (I was trying to get approved for a new oral appliance). AHI without appliance was 47 with appliance 16. So started my cpap journey.
My first mask was the Swift FX for her - I developed significant nasal, ear and sinus congestion. After trials of other masks including full face (I am very slender - bmi of 19 - with a very narrow chin) I switched to Resmed N20. I can make this mask work, but need to tape my mouth and splint my nares open using a plastic intra-nasal breathe aid (I have a slightly deviated septum - ENT said that it could be straightened, but I would not have any more nasal capacity.). I also found that I need to use Flonase daily - usually just before bed to keep my nose as free of congestion as possible + set humidity level at 5 - summer and 7 - winter. The pressure from the nasal cushion pushes on the plastic splint and causes quite a bit of soreness.
I have trialed a number of full face masks from an on-line supplier and have not been able to make anything really fit my face so until recently stuck with the N20 despite the soreness and inability to control mask leaks as well as I would like.
I have been using Sleepyhead to attempt to improve my therapy. I have increased pressure from initial prescription of 8 - 14 to the current 11 - 15 with some trial at 16 and 17. Of great concern for me has been my flow limitation graph. It has been rather wild looking. Interesting to me is that I was on a trip overseas (elevations ranging from near sea level to 5000 ft - I live at about 800 ft), and my flow limitation graph was better than I have ever had. See screenshot.
When we returned I wasn't able to achieve this sort of result.
I decided to try a nasal pillow mask and chose the P10 as that seemed to be minimalist and less area to seal.
With some initial trial, I have been able to use this mask and get some decent (for me) flow limitation graphs. Although my breath wave shapes look very jagged.
I continued to have variable results and couldn't maintain the better flow limitation graph and in the meantime consulted with a new sleep dentist (he makes his own custom face masks) and began reading more about flow limitations. The article referenced on your site by Dr. Barry Krakow really sounds like he is talking about me!
I starting experimenting with EPAP as I hadn't been using it. I first set it to 1.
And then to EPAP of 2.
Expanded view:
And then to 3:
After reading more regarding flow limitations, I realized that my machine was set to regular apap mode, not the apap for her mode. So tried the for her mode for 1 night (after a good week of sleep), and it was a disaster. I felt like I had run a marathon and my chest was so tired (from trying to breathe all night - I think).
Since then, I haven't been able to get back to what was decent sleep for me even by back tracking on my EPAP. So am not sure where to turn next. I also can't seem to post more than these 5 images - so apologies. I will try to follow up with disaster night and last night.
Any help appreciated!
sleepless badger
I am hoping that some of you knowledgeable people can help me get back on track. First some background.
I started APAP late in December, 2017 following two home sleep studies, one without my oral appliance and one with (I was trying to get approved for a new oral appliance). AHI without appliance was 47 with appliance 16. So started my cpap journey.
My first mask was the Swift FX for her - I developed significant nasal, ear and sinus congestion. After trials of other masks including full face (I am very slender - bmi of 19 - with a very narrow chin) I switched to Resmed N20. I can make this mask work, but need to tape my mouth and splint my nares open using a plastic intra-nasal breathe aid (I have a slightly deviated septum - ENT said that it could be straightened, but I would not have any more nasal capacity.). I also found that I need to use Flonase daily - usually just before bed to keep my nose as free of congestion as possible + set humidity level at 5 - summer and 7 - winter. The pressure from the nasal cushion pushes on the plastic splint and causes quite a bit of soreness.
I have trialed a number of full face masks from an on-line supplier and have not been able to make anything really fit my face so until recently stuck with the N20 despite the soreness and inability to control mask leaks as well as I would like.
I have been using Sleepyhead to attempt to improve my therapy. I have increased pressure from initial prescription of 8 - 14 to the current 11 - 15 with some trial at 16 and 17. Of great concern for me has been my flow limitation graph. It has been rather wild looking. Interesting to me is that I was on a trip overseas (elevations ranging from near sea level to 5000 ft - I live at about 800 ft), and my flow limitation graph was better than I have ever had. See screenshot.
When we returned I wasn't able to achieve this sort of result.
I decided to try a nasal pillow mask and chose the P10 as that seemed to be minimalist and less area to seal.
With some initial trial, I have been able to use this mask and get some decent (for me) flow limitation graphs. Although my breath wave shapes look very jagged.
I continued to have variable results and couldn't maintain the better flow limitation graph and in the meantime consulted with a new sleep dentist (he makes his own custom face masks) and began reading more about flow limitations. The article referenced on your site by Dr. Barry Krakow really sounds like he is talking about me!
I starting experimenting with EPAP as I hadn't been using it. I first set it to 1.
And then to EPAP of 2.
Expanded view:
And then to 3:
After reading more regarding flow limitations, I realized that my machine was set to regular apap mode, not the apap for her mode. So tried the for her mode for 1 night (after a good week of sleep), and it was a disaster. I felt like I had run a marathon and my chest was so tired (from trying to breathe all night - I think).
Since then, I haven't been able to get back to what was decent sleep for me even by back tracking on my EPAP. So am not sure where to turn next. I also can't seem to post more than these 5 images - so apologies. I will try to follow up with disaster night and last night.
Any help appreciated!
sleepless badger
