jlsmithseven - Therapy help requested.

[jlsmithseven]

   

Hi
I have been on APAP since 2021 and only missed maybe 4 nights since then because this thing has changed my life for the better. There was a year long struggle last year to try to get my therapy better because I was getting so many leaks and I was still waking up 4-6 times a night. So, I feel that I've come a very long way and after maybe 22 mask changes I finally settled in. But, my therapy still isn't great and I still wake up 1-2x a night. I also just ordered a Lowenstein Prisma 20a because I saw that it gives a 1cm boost on the inhale which I think would do me well. I've tried almost every setting but I can't figure out why I'm still not getting sound sleep. I get 7 hours a night, and would love to get 8 because that's when I feel best but my brain won't let me. Here is a recent chart that looks like the past 4 months is very similar almost every night. EPR 3, min 9.2 max 10.4, ramp auto, humidty 4, temp 80-84. I wear a P10 nasal pillow mask with heated tube. I also get dry mouth most mornings and my snoring has completely gone away and my leaking isn't bad not even close to what it used to be. Just wondering if anyone can see something I can't. Thank you.

[Deborah K.]

Your chart looks good.  I wonder if maybe you would feel better if you raised your upper-pressure limit to 12.  I suggest that you give it a try. As to your dry mouth, we use Xylimelts, little discs that you stick to your gum.  They very slowly dissolve and keep your mouth moist.  My husband and I  like them a lot.  Good luck with better and more comfortable sleep!  

[PeaceLoveAndPizza]

Please do a 2-3 minute zoom at 00:00 and another at 00:10. I want to get an idea of what is causing those arousals. 

The likely reason you are not feeling rested are the arousals occurring during the night. Those now need to be addressed.

[jlsmithseven]

Thank you. The main reason I capped my max is because resmed really likes to ramp it way too high then I wake up. I’ve narrowed it down pretty far so I have the most therapy without waking me up but I can try to put it a little higher. I have a bottle of xylimelts and they helped a ton this winter but  I don’t like to count on them.

I’ll add a zoom, but are you sure it’s at those times I don’t see anything at those time points.

[jlsmithseven]

Here are the zooms.

[PeaceLoveAndPizza]

Thanks...

The first looks like a typical flow limited reduction followed by a recovery breath. You can clearly see the FOT doing its job, so we know it is not a complete blockage of the airway. The second looks like a cough as there is a big breath, then a cough, then another big breath, then some softer coughs. 

I would creep pressure up just a bit, maybe something like:

Min pressure 10
Max pressure 12
EPR 3 full-time
No ramp (unless you absolutely need it to fall asleep)

To keep the airway open and reduce the arousals you need more pressure, but I prefer to do it in small increments to help with adapting to it.

[jlsmithseven]

I will try 9.6-10.6 this evening. I know my body does not acclimate well when I make too much of a change. I really should change it by .2 but I think .4 will still be OK to start out with. We will see how that goes. Thank you for the help! I do need RAMP to fall asleep not sure why but it definitely is more comfortable to me. I think having the peace of mind knowing that it won't bump me up in pressure is why because I can feel it when the pressures are too high when falling asleep. It does a fairly good job I think.

[jlsmithseven]

Well I tried those settings and it was a fail. I woke up too many times and the last time I woke up I had extreme trouble getting back to sleep from a gigantic headache. I do not feel well at all this morning. Anyways I went back to my original settings and bumped the 10.4 to 10.6 and see what will happen this night.

[PeaceLoveAndPizza]

There is almost no difference between your original posted chart and last night. The difference is 0.2 cmH2O in pressure per OSCAR. Arousals look about the same. I do not see anything in the charts that gives the impression there is a dramatic difference in treatment or comfort between the two. 

You can try creeping up the pressure and see if you tolerate it better. You need more pressure to help with the arousals, so it is just a matter of what it will take for you to be able to be comfortable with it.

[jlsmithseven]

There is a difference if you look closer. I only changed it back at the end of the night when it woke me up for the 4th time.