Setting Pressure While Difficult to Exhale

[atgg11]

           

Hello,
 
I use a nose pillow mask assisted by a chin strap. After a long adjustment period to the treatment, I started feeling more energetic and less tired during the day. However, I still tend to fall asleep at my desk and require 1-3 30-minute naps during the day.
 
Some of this might be due to waking up multiple times during the night to urinate or because of intense dreams. Strong insights from these dreams often leave me so bothered that I follow the sleep hygiene recommendation to go sit on the sofa until I feel tired again. I then return to bed and hope to fall asleep, resuming my treatment.
 
 
Approximately 45% of the nights my AHI is below 5, and 46% are below 10. However, I sometimes wake up feeling unable to properly exhale against the tube’s air current, which also makes falling asleep difficult. The machine is set at a 15-minute delay (soft start) and standard 2.
 
 
I’ve experimented a bit with the pressure range, but I'm not confident in my adjustments. Attached are a few screenshots with the hope they can provide additional information to anyone who might be able to help make my life easier.
 
Thank you greatly in advance for your assistance.
 
Best regards,

Amos

[Narcil]

not super familiar with lowenstein machines but i can give it a try.

You have many flow limits and some hypopneas remaining so i think more pressure would help. i would set the minimum to 6 or 7cm with a corresponding increase in max pressure to 9-10. raising the min pressure would also help you take full advantage of softpap since the machine cannot go under 4cm, you aren't getting any benefit from it until it increases pressure.

[SarcasticDave94]

This also appears to have the clustering of Positional Apnea. If your chin tucks towards your chest, it will close off your airway.

[Sleeprider]

Take a look at the wiki on optimizing the Lowenstein PrismaLine devices https://www.apneaboard.com/wiki/index.ph...timization

[atgg11]

Thank you for this unexpected analysis. How can the possible effect of the chin trap on the breathing path be minimized, please?
 
 
Thank you very much once again. My heartfelt appreciation for the response.
I am on my way to study the information behind the link.

[atgg11]

I feel welcome to the Apnea Board.
This is a thoughtful website, full of goodwill, and with an impressive body of technical- physiological knowledge, much experience and common sense. It is truly inspiring.
I am moved by the rapid and practical response to my request for advice. The support I feel goes beyond the immediate need to improve my situation. It makes me hopeful for the future of humanity, knowing that there are people who care and are ready to lend a helping hand.
I not only feel grateful but also sense a growing desire in me to increase my own contributions in any possible way.
 
 
I shall immediately adjust the range of the pressure and am looking forward to tonight’s sleep. I will share any feedback here to hopefully add to someone’s knowledge.

[Deborah K.]

Are you using ramp on your machine? If so, it would be good to turn it off or at least use it for only a few minutes. Since you are waking up often for bathroom breaks, ramp kicks on again after each break, and you get virtually no therapy during ramp each time you return to bed.

[atgg11]

Wise tip. Thank you very much for being so attentive to my individual situation

[Deborah K.]

While your flow limits are your biggest problem, you might want to address your Positional Apnea.  PA shows on your Oscar chart where apneas are clustered together.  Yours are not terrible, but still worth fixing.  PA happens when your chin is tipped down toward your chest. It's kind of like a kink in a hose that hinders water flow.  In your case, the kink is hindering airflow.  Some people can correct this by sleeping on a flatter pillow.  If that doesn't work, most solve it by wearing a soft cervical collar.  If properly fitted, the collar holds the neck straighter and solves the PA.  

I used collars but then tried something else that also worked for me and is more comfortable.  I bought a child-size pillow (these are smaller and flatter than regular pillows) that has a raised front and back edge.  For me the higher raised edge keeps my head tipped slightly back and completely solves positional apnea.  I think a travel pillow with a raised edge would probably work too.

Anyway, those are my thoughts on Positional Apnea.  

Best of luck with improving your therapy and comfort!  

[atgg11]

I am glad to report that after adjusting the pressure range (6cm-10cm) and disabling the softpap/ramp, my flow limitation has gone from an average of 30% the week before to 0.00 over the last three nights. This progress is very encouraging, and I am extremely grateful for the existence of this website.
 
To address Positional Apnea, I am now experimenting with new sleeping positions. However, I am unsure where Positional Apnea appears on the Oscar chart.
 
Nevertheless, thank you all very much for your support so far.
 
Best regards,
Amos