[Treatment] Just started treatement

[prettybadapnea]

Hi all,

I just started treatment a week ago.

Tried a full face mask, then a nasal mask, then nasal pillows (which I used the last 2 nights). At my titration study they used a nasal mask and my AHI was 1. So far at home I only got it to 1.09 for one night, the rest of the nights have been higher.

I was getting some leaks at home with the nasal mask (which corresponded to events) which is why I went to the nasal pillows.

I feel more energized, and I want to optimize things so I am getting the best treatment possible and have as much energy as possible.

Attached is my OSCAR chart from the last few nights. One thing I do wonder about is the tidal volume, I have a deviated septum and I wonder if that is causing it and if there is a solutions.

Would love to hear all of your thoughts on how to optimize this.

[Jay51]

Welcome to ApneaBoard.  Your charts look pretty good IMO.  You are close to bumping into your max pressure of 12.  You may want to raise that to 13.  Flow limitations look good.  Tidal volume doesn't look too terribly bad IMO.  A few CA's, but not terrible.  

Leaks can be reduced though to help therapy.   Mask Primer

Your question about whether a deviated septum could be causing your lower than normal tidal volume.  It could, but most likely not having a huge effect on it.  I had a septoplasty (and turbinate reduction) 2 weeks ago and I am breathing better through my nose (both nostrils). I plan on doing a review on the surgeries in a few months for Apneaboard.   But don't just take my word for it.  Type in "septoplasty" in the SEARCH at the top of the main page and it will bring up many threads about this topic.  You can do your own research on it also.  And others who have a deviated septum may want to post here also.  

Here is an article from Lucid about nasal breathing during sleep:  The Nose Is Weirder Than We Thought     
Basically it states that a person alternates between the left and right nostril during sleep to breathe.  Before therapy, I would wake up in the night and couldn't breath at all through my left nostril.  From all the research that I have done, it seems the degree of improvement a person gets here is dependent on the degree of deviation in the septum.  Mine was pretty severely deviated.  

One experiment I tried that convinced me to get the septoplasty was buying some of those nasal dialators (the silicone ones that were thimble shaped, and the more rigid metal ones).  My breathing improved in my left nostril.  

[prettybadapnea]

Thank you for the link to the mask fitting primer! Played with the nasal pillows a bit, backed the pressure from the straps off a whole bunch, and last night got myself an AHI of 0 

The strange thing is that when I zoom in, my breaths look really shallow and at points my tidal volume is at 150. For the record I'm a 5ft 11" male.

Is that a potential issue?

See attached OSCAR charts.

[Jay51]

Congratulations on the 0 AHI.  Your tidal volume at 340 median for the entire night seems low for being 5'11.  Anything in your medical history besides the deviated septum that you think could be possibly contributing to this?  Any lung or heart issues?  Etc.? 

Also, how do you feel after a night of sleep like this?

[prettybadapnea]

Nothing in my medical history that I know of.

Any thoughts on what the next step might be?

As to how I feel, I started treatment a week ago and feel 10 years younger.

[Jay51]

Double congratulations on feeling ten years younger.  Can you bottle some of that and send it my way?  

If you are doing this well, a change may not be necessary IMO.  A good plan would be to show these lower than normal tidal volume numbers on these exact OSCAR charts to your (PCP or Sleep DR. or even RT if you use a DME).  They may have some suggestions.  

If you ever lose this good feeling from sleep, it might be time to further investigate your tidal volume.  There are more advanced machines that can improve tidal volume (and also possibly a septoplasty in the future), but that is your call.  

One cheap experiment might be getting one of more of those nasal dialators and trying them in your nose as see if your tidal volume improves significantly.  Amazon has them and many others.  It should give a clue as to how much the deviated septum is bothering you.  I tried this same experiment and decided on the surgery.  The dialator "pried" open my left nostril and gave more space in it to breathe.