Sleep PA changing pressure, wants sleep study. Can advice from here hurt my Medicare?

[midwestguy]

Wow.  And when I google motoprolol one of the first things I see is to tell your doctor if you have sleep apnea.

It shouldn't be a surprise. He's seen my chart. I've mentioned it.

[midwestguy]

Bruxism mouthguards can also worsen apnea. Especially if it is holding your jaw in a specific position which if you are using both upper and lower guard like it sounds is probably more likely.

Once positional is treated or if you are having trouble doing so it might be worth a trial without the guards to see if they make any difference on cpap data.

My mouth guards are separate and free-floating -- my jaw is free to move.
The only reason I have two is that the grinding is very severe. The upper
one has grooves in it. So the lower one was added.

I could leave them out, but the grinding (and I suspect clenching) would
keep me awake!

[Geer1]

Just figured I would mention it since you didn't have it noted. I have bruxism myself but am more of a clencher. Funny enough I just saw a specialist about it today, they want to start me on a hard acrylic mouth guard and then if I fail that (I failed an over the counter soft guard already) they will try botox.

I assume your level of apnea plays a role in your bruxism and grinding (since bruxism is primarily a symptom of arousal in people predisposed to it).

[midwestguy]

Well, so much for consistency. An AHI of 0.98 on the 18th, 11.28 on the 19th.
Graph for the 19th attached.

Lots of possible reasons for the bad AHI last night:

-- Many bathroom visits (diuretic works well)

-- Anxiety over the upcoming TEE procedure at the hospital on Friday

-- Cervical collar may have softened and been compressed by my chin

-- Frustration over loss of something under the bed

-- EPR set to 1 from 3

I was going to return some other cervical collars. Since the one may have
failed, the others are worth another look.

cathyf: Smart Start is off.

Tell me what zooms might be interesting.

Thanks,

Harv

[Dormeo]

Your EPR was at 1 for both of these nights. Your flow limitations are so heavy that I would recommend you return it to 3. Is that feasible? I hope you can find a comfortable and effective cervical collar.

[midwestguy]

Your EPR was at 1 for both of these nights.  Your flow limitations are so heavy that I would recommend you return it to 3.  Is that feasible?  I hope you can find a comfortable and effective cervical collar.

Hi Dormeo,

You read my mind. 'What's the easiest change to make for tonight?' And it's exactly changing the EPR back to 3.
I was going to return the other collars I bought. Maybe there's a better one in the batch. That'll be
Saturday's little project.

Thanks for your suggestion and good wishes!

Best,

Harv

[Geer1]

I just noticed your ventilation numbers and they confirm that you have to be mouth breathing, I just don't get how there is never any leak for someone mouth breathing the majority of the night. For your information your tidal volume of 140 correlates approximately with a 45 lb person and your minute ventilation of 2.25 is half of what is usually considered the lower end of normal (4-6). If that was all the air you were getting you would probably be dead so I think its safe to assume you are mouth breathing to make up the remainder of air.

I recommend trying a full face mask to see what happens. I personally like the Resmed F20.

[midwestguy]

I just noticed your ventilation numbers and they confirm that you have to be mouth breathing, I just don't get how there is never any leak for someone mouth breathing the majority of the night. For your information your tidal volume of 140 correlates approximately with a 45 lb person and your minute ventilation of 2.25 is half of what is usually considered the lower end of normal (4-6). If that was all the air you were getting you would probably be dead so I think its safe to assume you are mouth breathing to make up the remainder of air.  

I recommend trying a full face mask to see what happens. I personally like the Resmed F20.

If leak is defined as “mask leak,” the zero would make sense.
A simpler and cheaper alternative to changing masks might be taping my mouth shut.
Do DMEs give loaners to try?

[Geer1]

Mouth leaks are common, leak reported doesn't differentiate where the leak is located it just determines it based on machine flow rate, your breathing and normal mask vent rate. What isn't common is someone being able to take partial breaths in through nose and not lose air out of their open mouth which appears to be something you have mastered unless there is something even stranger going on and your machine isn't operating or recording properly.

Taping your mouth shut is an option but since it appears you mouth breath most of the night I would be ready to rip the tape off when you wake up feeling like you are suffocating (not guaranteed to happen but not unlikely if data is correct).

As for masks I am in Canada and things are different here, most places discontinued loaners with covid.

[midwestguy]

Mouth leaks are common, leak reported doesn't differentiate where the leak is located it just determines it based on machine flow rate, your breathing and normal mask vent rate. What isn't common is someone being able to take partial breaths in through nose and not lose air out of their open mouth which appears to be something you have mastered unless there is something even stranger going on and your machine isn't operating or recording properly.

Taping your mouth shut is an option but since it appears you mouth breath most of the night I would be ready to rip the tape off when you wake up feeling like you are suffocating (not guaranteed to happen but not unlikely if data is correct).

As for masks I am in Canada and things are different here, most places discontinued loaners with covid.

Ugh. Another complication. Added to the list.

Thanks for spotting that.

As for trying to go without mouth guards, I’d wind up biting my lip 
or tongue.

Thanks, Geer1.

Harv