advice to fine tune sleep

[ShaunBlake]

How would an Autoset help?

...  With the Autoset, we have an auto CPAP, but up to 3-cm of effective bilevel pressure support.  I can coach users to lower minimum pressure settings, with up to 3 cm of exhale pressure relief, and achieve much better efficacy that is possible ...

Thank you!

[Kosoku]

Kosoku, FYI, I used Lanisoh Lanolin at first - P10 was my first mask and I haven’t looked back.  However, after a few weeks I was still getting leaks, and cleaning the cushions didn’t help.   After about two months I replaced the cushion and stopped using the Lanisoh Lanolin, and leakage significantly decreased.  My theory is that after a couple months my nose toughened up to the point that lanolin was no needed and at that point was only somehow degrading the cushion in my original mask. So my suggestion is that if you decide to replace the cushion, try it for a couple of nights without the lanolin and see if that makes things better.  Good luck!

Hi NotADr

So I have used Lanolin for 3 nights now and have determined that it is causing more leaks than without. So last night, I woke and fought with my P10 and then wiped it with a rag to remove the Lanolin and I believe I no longer had to fight it for the rest of the night. So I think for now I will stop using it. I am probably overdue for a new mask so I am going to inquire about one when I get a chance, hopefully today. I was only using it to see if it would help with leaks, not due to comfort issue with nose. Other than the leaks, this is the best mask I have ever owned.

[Kosoku]

So #'s improved a bit more. Had the one issue where the Lanolin was causing the mask to leak somewhere in the 3:00 A.M range. I wiped it with a rag and it seemed to seal much better after that so I think I may skip the Lanolin tonight. 
All steps in the right direction. Will call or visit DME today, if the 2nd nor'easter does not hit early, to inquire about a replacement P10 and to see if I am eligible for an upgrade to the AirSence Autoset 10. Believe I should be as I received my current CPAP machine in 2011 and I think I am eligible every 5 years for a replacement.

[Kosoku]

Called my DME and I am picking up a new P10 today. I spoke to the DME about a new machine and we had a conversation on why I thought I need a new one. I was pleasantly surprised at the fact that they did not seem to mind me playing with the settings. Thought there might be some resistance there.
I mentioned that my numbers tend to go as high as 17.5, when opened to 20. DME wants me to run it at 14.5-20 for the next month so that they can go to the insurance to show that pressures are constantly up there and if that is indeed the case, they would recommend a BiLevel machine. The insurance changed their policies last year so that they need a full month, no exceptions, of downloaded data from the DME to justify a new machine. Has to be 30 consecutive days of use without interruptions. So, 1'st day of 30 starting tonight at 14.5-20 and wait and see what the month brings. Hopefully it will justify a new machine for better/proper treatment.

[trish6hundred]

Hi Kosoku,
WELCOME! to the forum.!
Good luck as you continue CPAP therapy and also wit getting the proper treatment.

[Kosoku]

Just an update on my progress. Here is my latest sleepyhead report from last night. I did have to re-adjust my tape 2-3 times during the night.

Since the time I have joined this forum a few weeks ago and starting making changes, I have had more days with an AHI <5 then I had in the previous 6-7 months in total, so thank you for the suggestions, and for new users, read and learn as this advice from members is invaluable. Also have had the last 5 nights with an AHI <5. Never before had I had even 2 consecutive nights with a reading of AHI <5.

So here is what I have done so far since the March 1'st


[ol]
[li]I switched from straight 13 CPAP to 14.5-20 APAP to see if I that would help. Need 30 day compliance at this pressure to hopefully qualify for a bilevel machine as I constantly seem to hit a pressure from 18-20 at some point during the night.[/li]
[li]I lowered flex from 3 to 2. I can handle the starting pressure at 14.5 with no ramp, no problem.[/li]
[li]Humidity is set at 3.[/li]
[li]I also have started using positional sleeping by placing a large pillow behind my back as I am a side sleeper and a active roller(working on that)[/li]
[li]I recently bought a cervical collar and have worn that since. Lot more comfortable than I would have thought. It stays. This was one of the biggest factors in a constant lower number.[/li]
[li]I bought Lanisoh Lanolin and have used that for 3 nights. - No longer using this as I bought a new P10 nasal mask and it does not appear to be leaking. The Lanolin seems to cause me more leaks.[/li]
[li]I tape my mouth. Next biggest factor in lower #. This works great to make sure I am not mouth breathing, also makes me sleep more soundly as I am not waking up due to the noise or feeling or wife moving my pillow.[/li]
[li]Sleep with pillow in front. Now hug a big pillow which is another big factor I believe. I found that the way I hug the pillow also helps to keep my neck in proper alignment as I tuck it up under my chin and then squeeze it to my chest. Seems like another level of support over the cervical collar. Also helps with rolling as you don't tend to roll I find when hugging a big pillow.[/li]
[li]Turned my pillow 45 degrees which I find helps keep my head straight. I use a gel pillow and if not at a 45, then I find my head rolls off of it and putting it at a 45 just seems to add more real estate.[/li]
[li]No more coffee at afternoon break. Not that I drink a lot of coffee, but I would always have a small 1/2 decaf with milk at 3 P.M. Now, just water.[/li]
[li]I did have a few beer Saturday evening, a treat, and oddly enough I had the lowest AHI score yet. Occasional beer stays.[/li]
[/ol]
Still reading and looking for other things to try. Will try a Velcro strap or a hose buddy when I get a chance. If anyone has any suggestions I have not tried or have yet to come across, I would love to hear and try them.

[Sleeprider]

Your recent results are much improved as you also note. OA is mostly controlled but there was still one positional cluster at 02:40, but that feature is mostly gone. You still have hypopnea, and that will be easier to treat with pressure support if you are authorized for bilevel, but otherwise increased minimum pressure is usually the "cpap" approach. Yours is already kind of high, and I don't see H events being closely correlated with lower pressures. This seems like good progress, especially if you are getting more comfortable. Keep in mind that if you want bilevel, you will need to complain about comfort issues with the higher pressures.

I have never seen any issues with reasonable alcohol use and the sleep apnea results. If you're not using a fleece hose cover, add that to your list of things that make you sleep better.

[Kosoku]

So Saturday I bought a full length body pillow to try and managed my best numbers ever by far. I used this in front to hug and to help keep chin up and to keep body straight. Still have a pillow behind my back. Nice thing was that when I rolled over it stayed put and keep my back straight and prevented me from rolling onto my back on that side. It was large enough that there was enough friction between it and the sheets that it would not move. When I was using a regular pillow to hug, it would end up on the floor several times a night.So now with a pillow on both sides, I should not be able to roll onto my back on either side. Thursday night I know I was on my back and had a score of 12.56 with a ton of OA. Last night was 3.99. 
Question I have now is how do you prevent swallowing so much air. Before I started this journey on this site, I would occasionally wake up with a belly full of air, but now that I have the pressure higher, it seems to be a daily occurrence. Not painful but annoying.
Oh yes - I tape at night, use a cervical collar and P10 Nasal pillows.

[Kosoku]

Best night ever. 
Switched to an even larger pillow for my back to prevent rolling over, and if I do, I can hug it like the body pillow in the front which really keeps my chin in line properly in conjunction with the cervical collar. I still mouth tape which works great. Amazing how much positional sleeping has made a difference overall. 
Another 7 days needed before I can hopefully get a new machine. Good timing as my current one has a short in the power cord, so if not angled just right, it may and has turned off.