jlsmithseven - Therapy help requested.

[jlsmithseven]

So here is my latest night uploaded to SleepHQ so you can zoom in and stuff. This range I'm very comfortable with. If I go higher on the EPAP or IPAP, I tend to get Aerophagia or extreme dry mouth. If I stay within this range with 3 EPR, it's mostly good enough. A weird thing that's been happening lately is 230am almost every night I wake up, and at that point I'm basically in REM Sleep which I need but I'm in and out of it because my pressures are too high I think. I've noticed a lot of my arousals that wake me up fully are when I have a pressure increase, then it slowly comes down, then I wake.

https://sleephq.com/public/a2e105ee-8347...43b382c524

[PeaceLoveAndPizza]

Thanks mate. I may be not seeing the IPAP/EPAP in the pressure graph, but if the colours are too close I’ll not see them anyway. 

Overall things look quite nice, though the zoomed in breathing does show a bit of limitation at the peak prior to the transition to EPAP. Nothing major, but it is worth monitoring.

I suggest giving it a bit more pressure to see if it helps with the arousals. Maybe even trying a fixed pressure either in APAP or CPAP mode. Something like:

Mode APAP
Min pressure 10.2
Max pressure 10.2
EPR 3
No ramp (unless you must use it)

You could also use CPAP mode with pressure=10.2 if you prefer.

[jlsmithseven]

Isn't CPAP mode the same thing as just doing one pressure in APAP Mode? I really like RAMP, but recently been waking up at 2:30am every morning and before I fall asleep, it kicks my pressures up so far because my breathing is sleep breathing, but I am still awake. I have tried turning off Ramp already, but it always kicks the pressure in too early and keeps me up. Thank you for the recommendations!

[PeaceLoveAndPizza]

APAP mode with min=max is the same as CPAP mode. The nice thing about using APAP in a fixed configuration is you can always add a wee bit of differential between min and max if you prefer. 

Some are just sensitive to pressure changes, so a fixed or minimal range works best.

[jlsmithseven]

Sounds good. Yes I did try to narrow down my range with the 9.2-10.4. I got those numbers because for the past year my numbers never went over 10.4 and the medium was like 9.2 something. I think I need just that extra little push but for some reason if I go to 10 my mouth dries out way more or I have more leaking. If I stay in the 9's range it usually stays there half a night, then burst up when I have different sleep strages, then creeps down. It's after it creeps down a bit that I am getting arousals so I'm not sure. Either way I am going to try the 10.2 in APAP mode tonight and will report back.

[PeaceLoveAndPizza]

I have been thinking about your 01:30-02:30 wake-ups and noticed that there is are what look to be similar events between the charts I have reviewed. It appears that you are moving around (based on the flow rate), then have a large leak, followed by a pressure rise, then you wake-up. No idea why you decide to move around at that time, but the pattern seems consistent.

Things to consider are not eating 2-3 hour before bed, no drinking an hour before, be careful with hose management so it is not getting caught upon something, basically anything that impacts sleep quality.

Rather than changing pressures for the moment, focus on sleep hygiene as a first step. If needed you can start creeping up pressure a wee bit over a period of a week or more to see if that helps. You can hold the max pressure as is and just creep up the min.

Something to ponder…

[jlsmithseven]

I have been thinking about your 01:30-02:30 wake-ups and noticed that there is are what look to be similar events between the charts I have reviewed. It appears that you are moving around (based on the flow rate), then have a large leak, followed by a pressure rise, then you wake-up. No idea why you decide to move around at that time, but the pattern seems consistent.

Things to consider are not eating 2-3 hour before bed, no drinking an hour before, be careful with hose management so it is not getting caught upon something, basically anything that impacts sleep quality.

Rather than changing pressures for the moment, focus on sleep hygiene as a first step. If needed you can start creeping up pressure a wee bit over a period of a week or more to see if that helps. You can hold the max pressure as is and just creep up the min.

Something to ponder…

Thank you. Yes I have been eating before bed recently and I am always thirsty right before sleep. Will try those things and see if it helps.

[jlsmithseven]

I have tried good sleep hygiene. Mainly not eating or drinking before bed. But I have also upped my pressure to try and get closer to that 10.2 mark. So I did 9.6 - 10.2 last evening. I also use a chin strap which I rarely do because I have controlled my leaking but I think at these higher pressures my mouth ever so slightly opens and that's all it takes to dry my mouth out. I got a higher AHI but I think I will keep at these pressures for a little because look!!! I didn't wake up at 230am for the first time in almost 8 days I think it's been. I still wake up at midnight, but one time a night is much better than the 3-4 I usually had and that 230am wakeup is the worst.

[PeaceLoveAndPizza]

Getting closer. I would give a fixed pressure of 10 a try with EPR=2. If it reduces the CA’s and it feels comfortable, Bob’s your uncle. If not we can tweak further from there.

Something like:

Mode CPAP
Pressure 10
EPR 2 full-time
No ramp (unless absolutely needed)

[WisNaeMe]

A bit left field, but have you considered the birds waking you up - dawn chorus . I've been getting woken up at around 4:00am most mornings by our local mob - they seem that bit chirpier at this time of year, it's becoming a real pain... Earplugs! ...or perhaps you've some other noise related problem - aircon, local traffic, nearby shift-worker, etc.

Also if you're struggling to reach the higher Pmin's, then maybe moving to a 19mm hose (assuming you might be using a 15mm one), it might soften the effect of increasing the pressure (reduces velocity of air...). Might be worth saving this one till you've exhausted your current titrations though.