[Treatment] CPAP to Bilevel advice

[kkjacks]

Maybe counterintuitive but the change helped! I did have tape failure in the middle of the night but it wasn't too disruptive to my sleep like the cheek-puffing was. I was awake at 4:10 so those last two events are awake breathing. I was wondering why my expiration time would be so much longer than inspiration? Here's what last night looked like...



           

[Sleeprider]

Well, it "seemed" counterintuitive to add pressure support to someone with centrals, but since we're using very-high trigger, it also sends a stronger signal to you to BREATHE! The other thing we accomplished was to reduce flow limits from .05 to .02, so it was definitely a move in the right direction all around. Sometime people like you make me look smarter than I am.

[kkjacks]

Ha! Don’t be too modest. I’ve been following your posts for a couple of months now and have a pretty good sense of how smart you are. As long as you have no concerns over the difference between insp time and exp time, I’ll continue with these settings for a few nights (along with fixing my mouth tape issue) and hope for more good nights. My sincere thanks for your help!

[TechieHippie]

Try pursing your lips some when you apply the tape. Also, It may not be intuitive, but mine stays on better when it's a little less sticky, so I stick it against my chin once.

Regarding your mouth filling with air... Are you able to relax your tongue up towards the top of your palate, with the tip of your tongue on the little nerve bundle behind the teeth? Swallowing can help get the back of the tongue up if it is able to. (Mine wasn't able without surgery, I was pretty severely tongue tied). See if you can find a placement for your tongue that you can relax into but doesn't allow any air into your mouth. It may take practice. There are myofunctional exercises that you can find online that can help also. One of them, for example, is to place one or two dental elastics or small round mints on the tongue, centered under the tip and/or halfway back, and then gently hold them to the roof of the mouth while doing something else for 15 minutes or so. If you try this, start with short times (it may cause neck or jaw pain if held too long) and then you can increase both the time and how far back you put the back one.

[Sleeprider]

Your I:E ratio is 1 to 1.88, so well within normal parameters.

[kkjacks]

TechieHippie I’m so glad you responded to this thread. It gives me the chance to thank you for the clever tip of lip pursing when applying mouth tape. I saw you recommend this in a post a few weeks ago, tried it and it worked so well my leak rate with the Airsense 11 dropped to almost nothing. Something so simple but so effective!

When I switched to the Autocurve VAuto a few days ago the tight seal did not serve me. The air causing the cheek puffing (what a weird sensation!) had nowhere to go so I had to keep releasing the tape. I think Sleeprider solved that for me with the increase in PS. It worked last night and I was able to get to sleep. I didn’t use the lip pursing method and in fact I cut a little hole in the tape hoping to avoid the cheek puffing  but it resulted in too many leaks so I’ll try it with a better seal tonight.

I have been playing around with tongue positioning but I’ll do more with it and try the mint exercises. sheesh - mint exercises! Who would have thought.

Sleeprider, thanks for the comment about the I/E ratio. Nice to be normal in something.

I’ll roll with this for a few more nights and hopefully I’m good to go! I can’t thank you enough for your help!

[TechieHippie]

I'm glad it helped! I've never tried it with mints. I've only used the elastics but we were talking about it on another thread and thought it would work. Let me know how it goes if you remember.

With a cheek puffing issue, can you breathe that air back in? That's what I do but honestly I have no idea how I do it ?

[kkjacks]

I’ll let you know about the mints.

I tried breathing the air back in to no success.

[kkjacks]

Good time for an update. I've had a week using Sleeprider's suggested settings with very good results. AHI has ranged from 3.89 to last night's excellent .45 with the majority of nights below 2, so I'm happy. The 3.89 night was an outlier with my old friend insomnia visiting. Mask issues have been my main issue but I tried my new N30 last night and loved it. Here's the best night and the worst night of the past week and a look at my 26 second OA last night. I sure can hold my breath.

           

[Sleeprider]

Looking good. I would be happy with those results and comfort. Kind of surprising how the Vauto works against centrals with that very-high trigger.