Mitreal - Therapy Thread

[Mitreal]

Hello all. I am a new member of the CPAP club and here for some advice from the experienced. 

Some history: I have known for years that I have had sleep apnea, but I hadn't taken it seriously.  I also suffer from clenching and grinding. Over the past few years I have experienced increased sleepiness, head cloud, irritation, TMJ/facial muscle tension among other symptoms.  Thankfully, I was referred for a sleep study at the top university by a dental hospital professor I met a few months ago. I had a sleep study done.  I was diagnosed with mild to moderate sleep apnea. The professor advised that I be fitted with a MAD, but the oral medicine prof that referred me advice against it (for now) and referred me back for CPAP treatment. 

I have been on therapy for 2 weeks now. Strangely, the therapy seems to have been getting worse.  When I started the AHI was around 1 or 2.  Now it's 5-10.  I know that I have occasional mouth leak. After reading a lot of threads here,, I have been attempting the tongue trick. It seems to have been working. I do have a peculiar issue. I have nostrils that collapse quite easily, even with moderate inhalation. I have noticed that when I sleep on my side, that the nasal mask collapses the nostril it pinches. More seriously, when the air leaks through my mouth, the pressure inside the mask immediately collapses both nostrils until my mouth closes. I also have a tendency to drape my arm across my face when I sleep so I worry I am covering the CO2 holes in the mask at times.

I have a suspicion that my numbers are getting worse because I am getting used to setup and experiences deeper sleep recently, but I am not certain. I think this is possible as I feel slighly more rested with the higher numbers. I am here to ask for some help to figure this out. I want this treatment to work, but I don't want to have to wait 2 to 3 months for feedback. I have downloaded OSCAR but I am waiting for a card reader. In the meantime, I will checkout the OSCAR guide to posting and continue to read other posts.  I am considering getting the p30i mask due to the nasal cushion shape and exhaust hole position. On the other hand, I am worried it may be a waste if I can't get a handle on the mouth leak. 

 I am glad this forum exists.  I am looking forward to the guidance and suggestions coming my way, learning and gaining hold over this disorder. Thanks in advance.
 
I do have an initial question: I have noticed that some OSCAR charts that are posed list an RDI instead of an AHI even though the same machine seems to be being used. Why is that?

[Crimson Nape]

Hi Mitreal!  -  

Since there are several therapy threads on the board, I have modified your thread name to reflect your username. The new thread title is, Mitreal - Therapy Thread.  Pretty catchy, huh?

Now to your question; In OSCAR's preferences options, you can select either an AHI or RDI reporting.  This option is listed in File ⇾ Preferences ⇾ CPAP ⇾ General CPAP and Related Settings.

- Red

[Mitreal]

Hi Mitreal!  -  

Since there are several therapy threads on the board, I have modified your thread name to reflect your username. The new thread title is, Mitreal - Therapy Thread.  Pretty catchy, huh?

Now to your question; In OSCAR's preferences options, you can select either an AHI or RDI reporting.  This option is listed in File ⇾ Preferences ⇾ CPAP ⇾ General CPAP and Related Settings.

- Red

Thanks.  That leads me to wonder "what is the significance of changing the setting?"

The card reader will be arriving tomorrow. I am at a bit of a loss on what to post once I figure out OSCAR because myair is reporting very different AHIs. The last one was higher than my sleep study's. This worries me after being privy to the information that resmed sets the flag for the events at 20% more than the recommend amount.

Should I post OSCAR information from a good day and bad day?

[Crimson Nape]

Since you are not using an advanced CPAP (ASV or ST models), leave everything the way OSCAR starts.  This will mean that you leave the view to the default Standard view and leave all Daily graphs in the order they are presented.  OSCAR is set up to show the most important variables in descending order.  To take a screenshot, press the F12 key (Mac: Fn+F12).  This will collapse the calendar if it is open and remove the right sidebar if it is open too.  Sometimes the user's monitor size may require resizing the graph heights, so we can see the 6 more important ones, but we will worry about that later.

What to post; You may wish to take an average bad day and an average good day. Extremes are going to happen, and we just live with those. We are looking to strike a good medium.

Please see the links in my signature for how to post an image here and additional information.
- Red

[Mitreal]

Crimson Nape What to post; You may wish to take an average bad day and an average good day.  Extremes are going to happen, and we just live with those.  We are looking to strike a good medium.

Please see the links in my signature for how to post an image here and additional information.
- Red

Thanks for the input. I decided to post 3 nights. I am not sure exactly what I am looking at, but it seems that things look quite different from day to day. I have included my first night, worst night and most recent night. I have experienced a few nights similar to each of these at.the 2-week point. Wile preparing the images, I noticed that the myair app and OSCAR give different AHI numbers: Myair 4.5, OSCAR 3.11.

Looking forward to learning what is going on

[Crimson Nape]

OK! Consider turning the ramp off, EPR to 3 set to Full time, Minimum pressure at 11, and maximum pressure 13. Also, try to avoid sleeping on your back. This position increases OAs and Hypopneas.

The EPR should aid in reducing your flow limits. Using a minimum pressure of 11, combined with the EPR of 3 will result in an EPAP pressure of 8 to 11 and the IPAP pressure will be 11 to 13.

Your thoughts?
- Red

[staceyburke]

You are having 2 obviously problems. First positional apnea and the other are high flow limits.

Positional apnea is when you sleep in a position that cuts off your own airway. It is also known as chin tucking where your chin drops down to your sternum cutting off your airway.

No pressure changes can help positional apnea, you have to stop getting into that position. Sometimes sleeping on your back is the problem but if it is not that simple you will need to use a collar. I have a link on collars - please take a look at it.

Flow limits are helped using EPR. TO DO THAT you need to make a couple of changes.

First set your machine to EPR FULL TIME (it is on ramp now)

EPR 3
Min 7

[Mitreal]

Ok.  Thanks for the help. I will turn the ramp off, set EPR full time to 3, and I'll set the min to 7 for a night. Tomorrow I will try setting it to 11. 

I will read up on the collars. I know that there was some positional data in my sleep study, saying supine was worse than my side. I remember that I couldn't fall asleep easily during the study as I could not get into my preferred position. I like to fall asleep on my side, but I am not actually on my side. I tend to be on a 45 degree angle. Somewhere between stomach and side.  The bed was small and up against a wall. This didn't allow me to be in that position easily and is likely not reflected in the results. When I have time I will post my sleep study.

Thanks for the help

[Mitreal]

After changing the settings and sleeping with a flat pillow, I kept waking up last night. I think I will give these settings a few more days before the switch and wait to look at the results to avoid discouragement. I woke a few times with the sensation that there was something wrong because it was so easy to breathe. I guess I was already getting used to the former settings. I have always slept with a high pillow. After the positional apnea comments, I tried using a flat pillow. It is going to take a while to get used to that. It is a weird sensation. The flatter position also caused me to wake wrapped in CPAP tubing a few times. I think I am going to pick up the p30i sooner than later. to avoid that again. 

I did a quick translation of my sleep study. and noticed something I missed the first time. There is a note that I had an open mouth 3 times. I will do my best to learn to check for this with the data and rectify it.  If I can't, I will test a FFM later.  I get one mask/year.  I'll just hold off until Jan.

Curious: What in the OSCAR screens pointed you to the positional apnea conclusion?

[Expat31]

I was just like you, kept sleeping on my back, and had terrible positional sleep apneas (shown by bunches or "cluster" events of breathing flow patterns in the graph), and had of course rotten nights.

My body had a mind of its own, just couldn't train it.

It took me months to find the solution after trying all types of pillows, collars etc.

For me the only solution was was a velcro chest support with 3 tennis balls tucked in the lining. It is sort of a belt about 10cms/4" wide made out of a firm elastic material. Bought it on Amazon (France) but probably available elsewhere. It makes back sleeping totally impossible. Total cost (including tennis balls, if I remember correctly, around €25).

For me it changed my life.