Warnick13 Therapy Help

[OpalRose]

The 95% FL dropped from .12 to .04, so that's a positive. Everything else stayed almost the same.

So yes, go ahead and raise the minimum to 10.4cm. Give it a couple days.

Be sure to tell us how you feel with any changes.

[Warnick13]

Thanks! Will make the change and keep you posted. I had a minor headache this morning but I can't say if it was from the increase in pressure.

[Warnick13]

Morning, 

I've attached my last two nights at the 10.4 cm minimum pressure.  I can't say that I feel any better or any worse; snoring seems to be improving, if I am reading the data right.  I am experiencing slight headaches in the morning - is this normal until I get used to a higher min pressure?  I am struggling with mask comfort/fit.  The cushion is only a few weeks old; I replaced headgear before last night.  Issue seems to be a bridge of nose, as it either feels too tight or too loose so I am trying to make adjustments to find the right fit.  Leakage from last night was much better than the previous night.  I do use a CPAP pillow, which I think has helped.

One thing I have noticed is that over the past week, my AHI scores have increased.  I used to be running around 0.08 to 1.2, now I'm up into the 3-5's.  Is this indicative of anything or just normal?

[OpalRose]

The very first chart you posted shows an AHI of 2.84.  What pressures were you using when you were seeing AHI of .08-1.2?

What I notice is with trying increased pressures, we were able to bring down FL, but at the same time increased CA's.  This is probably going to be a balancing act to find a good pressure range and still be able to keep FL down.  

So, with no benefit seen using a higher pressure, dial it back to where you felt most comfortable, possibly 9cm.  At the same time, you may want to try EPR of 2 instead
of 3.

In addition, even though your leak rate is low enough, the leak graph shows a lot of movement.  Unfortunately, finding the right mask fit can be a challenge.  

Have you read though the Mask Primer?

[Warnick13]

The pressures when I had lower AHIs were running in the 7.0-9.66 range. I did do a lot of fiddling with the mask last night, trying to get it comfortable over the night. Most nights (pre pressure increase) the mask was good with no problems with comfort.
I will dial back to 9 and readjust the EPR to 2; and read thru the Mask primer. I really appreciate your help!

[robbob2112]

In my opinion I would keep the pressures and concentrate on the leaks.

   If the increased pressure helps with the snoring or eliminates it that is worth keeping.  Snoring is a clear sign of OA.  Eliminating the snoring is going to let you and your wife both sleep more soundly.  Treatment emergent CA are pretty normal and tend to go away on their own.  

      As an airtouch F20 user I can tell you the right fit can be a pain.  The cushion should hit you just below the brige of the nose and just below the lower lip.  If you hold it in place at the top and it hits closer to your chin you may want to try the next smaller size.  
   
And one trick I have learned since I had cataract surgery the last two weeks, I use mouth tape to tape the bottom of the mask to my chin to keep it from riding up to my scalp.  The  F20 was riding up and blowing air into my eye corner.  For the tape look on amazon for "Cover-roll stretch",  it has the right amount of sticky to work and also not tear skin the next day.  I do the same think on the F&P Evora mask (like the F30 only they have a large and it doesn't pinch my nose.)
  
  For the straps, if you wash them in very hot water when they loosen up they will shrink back when they dry.  That way you really only need replace it once a year or when they just give out.

It is also possible to wash the airtouch mask if you don't squeeze the cushion over much and let it dry out at least a few days before use.  I trade off like this every few weeks and get around 3 months from each mask.  I do wipe it down with a cpap wipe daily.  Cpap wipes verse baby wipes.  The cpap wipes have a stronger antibacterial on them than a baby wipes.  Opinions vary but that is my take on it.


Don't chase a zero AHI, the only thing that is important is how you feel the next day.  

And, it may take a week or 3 before you wake up and think "I feel pretty good".  I tend to wake up and decide how I feel I slept, then go look at Oscar to see the number and I record how I feel on the notes tab.


Last tidbit, where in Colorado do you live?  Have you ever thought about an O2ring or other oxygen monitoring device?  My wife and I both use them and also supplemental oxygen at night only.

[Sleeprider]

As pressure came up we started to see clusters of events and leaks. I think the problem may be mainly positional. You certainly needed higher pressure than your original minimum of 5.0. I'm inclined to get you back to pressure of 9.0 and for you to look at the positional apnea article here and see if you can devise some ways to avoid chin-tucking or sleeping positions that cause poor cervical alignment. https://www.apneaboard.com/wiki/index.ph...onal_Apnea

[Warnick13]

Thanks for the suggested reading.  I am a side sleeper and purchased a CPAP pillow with the notches to accommodate the mask but clearly it’s not working as well as I thought.  If I take the pressure back up to 9, what should I set the EPR at? 
Could the mask movement be attributed to its position - eg its not overhead with a “hose buddy”, it’s draped over my side essentially

[Sleeprider]

Higher EPR tends to reduce flow limits, so keep EPR 3. That should help with RERA and hypopnea events. Increasing minimum pressure, increases EPAP, which should help prevent OA events. You don't have a serious problem with AHI, but the clusters of OA events do suggest positional issues, and I have found the "so-called" CPAP pillows are too firm and tall and cause more problems than they solve. Treat yourself to a good quality down pillow. You'll sleep better and it can be a tool to prevent these problems.

[OpalRose]

Since we're lowering the pressure to 9, then set the EPR to 2 instead of 3.

One note about Cpap pillows... I tried one years ago and it didn't work out for me either.
Those cut-outs just aren't a one-size fits all.

When using your regular pillow, the secret is to sleep with your head more to the end of the pillow so that the mask part is hanging off the side of the pillow just a bit.

Or sleep on your side, but more of a slight 45 degree angle facing upward.
Another words, in between side sleeping and back sleeping.