Still snoring. Any thoughts?

[lisamcrn]

Hello.  Appreciate any thoughts to my current Sleepyhead data. 

I'm still snoring and have been trying to use a chin strap.  I'm still struggling with keeping my masks on for the entire night.  I'm switching between the FP Eson NM and Brevida NP.  I have a few small leaks with that will be working on trying to make a mask liner after this.  I also use the FP Brevida.  I really like both products, but get irritated with them. 

Thanks!

[Sleeprider]

Raise minimum pressure to 8.5 and see if OA is reduced. As far as your Sleepyhead graphs go, please do not cut off the left pane that shows the CPAP and efficacy summary. My signature shows how to organize these graphics. I recommend ignoring the VS2 snore chart and perhaps event turning it off in preferences.

[lisamcrn]

Thanks Sleeprider.  I've also fixed my graphs to include the rest of the data.

Another thought that just hit me when Sleeprider recommended increasing the lower pressure.  My first night my machine was set on CPAP mode at 10.  I felt so horrible the next day after wearing my first nasal mask, my director at work was trying to be helpful and called the RT down from his meeting to talk with me.  He changed my machine to APAP 8-10.  That really doesn't make sense if I needed CPAP at 10.  But, that it didn't even cross my mind is rather sad-  nurses do not make good patients.

[Cranberry Ray]

lisa, I love using my AirFit P10 nasal pillows but have a hard time keeping my mouth closed which looks like it could be your issue too. Besides using a chin strap I also use a piece of medical 2" paper tape (the gentle kind from Nexcare). I know it's not for everybody but it works for me. Being a nurse you may have access to some at work and might be worth a try. Aside  from the leaks your numbers don't look bad for just starting out.

Hang in there, it will get better.

[Mosquitobait]

Thanks Sleeprider.  I've also fixed my graphs to include the rest of the data.

Another thought that just hit me when Sleeprider recommended increasing the lower pressure.  My first night my machine was set on CPAP mode at 10.  I felt so horrible the next day after wearing my first nasal mask, my director at work was trying to be helpful and called the RT down from his meeting to talk with me.  He changed my machine to APAP 8-10.  That really doesn't make sense if I needed CPAP at 10.  But, that it didn't even cross my mind is rather sad-  nurses do not make good patients.

Remember, you have a ramp option.  Set it so that it doesn't maximize before you fall asleep.  If you set it for 8, you will still be getting therapy, but eventually full therapy.   I cannot stand a pressure of 10 when I'm awake, but 9 is doable and I will fall asleep with 9.
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[AshSF]

Lisa. You are hardly snoring. The vs graph will show one reading for every 2 minute interval. The reading shows the no of breaths on which some snoring was detected. Assuming you take more than 10 breaths a minute, it's basically a few snores in a night. I wouldn't worry about the snoring part. For example, Counting snores on your 21 feb graph, I see < 15 snores for the whole night.

Also, you can snore with your mouth shut as well. So don't blame an open mouth automatically.

You can confirm both these things by using a overnight audio/video recording app on any smartphone.

The range of 8-10cm is practically useless on a respironics machine due to its hunt n peck algorithm. I would suggest you move to a constant pressure of 10 or a bit lower.

Also, you might find that your pressure needs are different on a nasal pillow mask.

[MitchS]

Hello Lisa. Like you, I had a hard time with snoring and mask leaks. I was unable to to get my leaks under control using a Full Face Mask so I changed to a P10 pillow mask. It has worked great for me. I did have to solve the mouth breathing, however.

At first I started using just a chin strap. It stopped most of the mouth leaks and helped with the snoring. My leak rates, however, were hovering just below large leak levels and I still had a problem with snoring. I just recently started using a 2.5 inch wide, stretchy woman's headband under my chin strap. I position it with what is the top of the band when wearing it just under my nose, with the top of the band passing just under my ears to the back of my neck. Since I started using this combo my leaks are usually at or just above zero most of the night with the few that crop up occasionally under 24cm. This has allowed me to successfully use the pillow mask which, even with the chin strap and headband, is far more comfortable than the FFMs I was trying to use.

In order to address the snoring I ran Auto Trial on my machine and set my fixed CPAP pressure at the 90% pressure the machine settled on while in Auto Trial. I was still having several snoring events a night, some of which were several seconds long. I started increasing my CPAP .5cm every two weeks until the snoring was virtually stopped. When I finally got the snoring to a level I thought was acceptable my pressure was 2.5cm higher than my prescribed pressure. I still have 3 or 4 snoring events some nights but most nights I don't snore at all. The pressure increase had the added benefit of further controlling the few obstructive events I was having. Like AshSF said, sometimes you just have to decide when to leave well enough alone.

Mosquitobait's suggestion that you use the ramp mode if it makes you more comfortable is a good point. Your DreamStation has a SmartRamp mode. By using SmartRamp, your machine would keep your pressure at the minimum ramp pressure by using an auto titrating algorithm to raise the pressure if you start having events. SmartRamp will terminate and change to therapy mode when the SmartRamp pressure reaches the minimum therapy mode or the ramp time expires, whichever occurs first. SmartRamp may allow you to stay comfortable while raising your minimum pressure to control your OA as Sleeprider has suggested.