Help please for a new Resmed user.

[Partner]

Got four posts, but the forum is still telling me "I'm sorry, brand new members are not allowed to post images until they have 4 posts."    ? ? ?

[Partner]

Here are the charts for last night - I hope they are useful for you:

Complete night:

   

30 minute view of OAs
   

2 minute view of OAs
   

[Crimson Nape]

Got four posts, but the forum is still telling me "I'm sorry, brand new members are not allowed to post images until they have 4 posts."    ? ? ?

Those are 4 U.S. posts but being in France, you have 4 metric posts and you know there is a conversion factor. Seriously, it takes the server a little while to recognized that you have obtained the required number. Wait a little while and try again.

[Partner]

[OpalRose]

We'll give the humidifier a try    

Your suggestion of teaching Mrs Partner to lightly suck her tongue between her molars made me think of teaching Granny to suck eggs . . .   (sorry).

Next post should be the charts . . .

I had to laugh at that, but seriously...it really works.  I was lucky and found that method very easy to use.  

I also used this exercise before starting Cpap to help strengthen the muscles in the throat area and help maintain control of the tongue:

With mouth closed and tongue at roof of mouth behind front teeth, slide the tip of tongue slowly from front to back, keeping the tip of tongue to roof of mouth.  Hold for a count of 8, then slide
tongue slowly forward again.  Hold for a count of 8.   Do 6 sets a few times a day.


You can do it anytime, and no one knows you are doing it.  

[Partner]

We'll give it a try - thanks for your help.

I must have been too slow posting the charts, because they've appeared in post No. 12.  Or maybe it's a time-zone thing  

[mesenteria]

I call myself a tapist.  I haven't managed to master the tongue-suck technique, and I have gone to the next quickest control for mouth breathing or leaking, and that was to tape vs. the collar.  So far, so good.

It's not for everyone, and not really recommended.  All I ever do is say that I have done it since Night #2, and that it has worked well ever since.  Your nickel, your choice.

But what I wanted to address mostly is the cheempunk syndrome....sorry...chipmunk syndrome.    If you are taping effectively, and are a slack-mouthed sleeper (wow, THERE'S a hefty label for ya!), your cheeks will puff as much as mine under even minor pressures delivered via PAP regimens.  However, you mentioned that your tape has let you down at times, and that's as bad as any RERA or full arousal...it interrupts your sleep pattern.  I don't know what you're using, but I have found the 3M Corp's Nexcare white 2.5cm wide 'water resistant' tape to work very well.  At any pharmacy worth visiting, and probably at Wally's as well, it comes in a white plastic spool, usually with a tub-like enclosure to slip over the flanges of the spool.  I take pains to press mine into place everywhere on its surface once applied, and that works very well.  

I believe, to address aerophagia, that if it happens, it's probably going to happen while sleeping supine...on your back.  At least, that's when I am more likely to experience it.  It happens that many of the unwanted events related to apneas take place when sleeping supine.

As a tip, in case it's news to you, sleeping in the 'recovery' position, curled up fairly tightly on one's LEFT side, will help to express 'pressure' from either end of the alimentary tract.  Just ask the nurses at the endoscopy clinic.  I get a thumbs up for that one.  The point is, while you are hoping to deal with the bloatedness at zero-dark thirty, and would rather not head to the toilet, if you turn over on your left side, knees drawn up quite a ways, you'll soon find yourself back asleep (while your partner will be wide awake and fuming).

[Sleeprider]

Here are the charts for last night - I hope they are useful for you:

Complete night:



30 minute view of OAs


2 minute view of OAs

Partner, this chart helps a lot.  Your wife is using a fixed CPAP pressure of 5.8 cm (almost 6.0) with EPR (exhale pressure relief) of 1 CPAP mode.  This results in an inhale pressure of 5.8 and exhale pressure 4.8.  What stands out for me is the Flow Limitation which is persistently high and is the reason her pressure would rise using autoset pressure.  I know there is a lot of concern here for high pressure causing leaks, but I really think your wife will be more comfortable with a pressure setting of 7.0 with EPR 3.  This will result in a higher inhale pressure of 7.0, but lower exhale pressure of 4.0.  This difference in pressure between inhale and exhale is called "Pressure Support" in bilevel, and it can have a very therapeutic effect on flow limitation, which is caused by a restriction in the upper airway.  If you can set the machine in either Autoset mode Autoset mode with minimum and maximum pressure at 7.0, or in CPAP mode with pressure at 7.0, and set the EPR to 3 in Comfort Settings, then your wife will have pressure of 7.0/4.0.  This should be more comfortable, will treat hypopnea, and should not significantly increase leaks. This should also help a lot with the problem between 06:15 to 07:15 where she is inhaling through the nose, but exhaling by mouth. 

The AHI is pretty acceptable at her current pressure, but increasing EPR is going to improve comfort, should reduce the hypopnea and may help her relieve the flow limits which can be very disruptive to sleep. Here is a link to a Wiki article that discusses why bilevel pressure is beneficial for upper airway resistance syndrome, which appears to describe your wife's problem best http://www.apneaboard.com/wiki/index.php...ome_(UARS)

[Partner]

Thank-you for your advice Sleeprider  

The machine was set up in June at 5 min 15 max in APAP, but this caused so much air loss through her lips that she couldn't sleep.

The pressure was dropped to 5 min 8 max in APAP in July, which improved things, although she still had a lot of hypopnea and central apneas (which she didn't have in the sleep test).  In both cases the technician set the EPR at 1cm during the ramp.

When on a pressure of 8, there seemed to be even more flow limits than she has now on 6.

I've included the charts from 10/07/2019 as an example:

10 July, complete:
   
10 July, 10 minute:
   

It seems that she has less problems with lower pressure; which is counter-intuitive (?).

I'm pretty sure that most of her apneas/hypopneas now occur when she sleeps on her back, so we are currently working on this problem and reducing the leaks (which I presume reduce the efficacity of the machine ?).

A little bonus question if I may: last week I tried out the machine to see what it felt like (and was agreably surprised !). However when I held my breath for 15 seconds, it was flagged up on Oscar (and Resscan) as an OA.  Can we trust the distinction between OA and CA made by these machines ?

[sheepless]

regarding the bonus question: I just held my breath. the way that feels like the 'default' method is to close my throat; it's easier than holding my breath with throat open. chances are you closed your throat and if so, it properly identified it as oa.