One month in, trying to improve

[wdarner]

So I had my 30 day follow up on a Telehealth visit with my doctor's office. I did not get to see my doctor but was relegated to the PA. As expected, he was resistant to the idea of changing to a different machine at this point, citing difficulties with insurance to do this too early. So he wants to tweak the settings first to see what they can do and I get that. As long as we move toward improvement.

One big issue at the moment is that my wife has become intolerant of being in the room due to the noise over the past week or so due to the adjustments I have been making. She thinks my mask is leaking in a big way after I get to sleep, but it doesn't seem to show up in the data. So the doctor is trying to figure that out also.

The PA made 3 changes: My original pressure range was 5.0 - 20.0, I had adjusted it up to 7.0 - 20.0 with some minimal improvement, but he suggested upping the lower limit toward my 90% average but lowering down the upper end to control the spikes. So he changed it to an 8.0 lower - 9.0 upper range, almost treating it like a CPAP.

He also wants me to try a chin strap to make sure I'm not mouth breathing, and he wants me to revisit with my medical supply to check other mask options and confirm best fit.

After 2 nights sleeping with the 8.0 - 9.0 setting, I have to say it's much better (at least for me). My AHI is down below 5.0 for the first time ever, and I seem to be feeling more refreshed waking up the next day. I am attaching my last 2 nights data.

My wife's complaints of noise and leaks continues, though, and she can't stay in the room with me. So that part is a mystery I am trying to figure out. To me, the mask fit on the Dreamwear Nasal Cushion feels secure and I'm getting very comfortable with breathing on it, so I'm not sure what's going on. If anyone has any thoughts on my data related to possible leaks, I'd appreciate any input. My wife is going to try and video me to document what is going on. I will update more as things progress.

[Sleeprider]

I often move people towards a narrow range or even fixed pressure. It can make for fewer sleep disruptions, and requires some thought as to what we're trying to accomplish with pressure, rather than rely on a machine algorithm, which in the case of the Philips is a bit faulty. I could see you going to fixed pressure at 9 or even a bit higher. Residual events are minor obstruction. The main advantage of Resmed is a more comfortable pressure delivery with a predictable inhale/exhale pressure(s). Lots of people get good therapy with the Philips, but the minimum pressure must be optimized.

[wdarner]

Over the past few nights I have tried to decipher what is waking my wife up in the middle of the night. She was able to grab her phone and take of video of the situation. Apparently when in deep sleep late at night, with the nasal mask on my jaw muscles relax and my mouth falls open causing free flow. These events don't seem to show up on my Oscar charts, at least not as grey area free flow large leaks, but from her video that's definitely what's happening. So I have tried a few remedies.

I have a chin strap I have tried with the nasal cushion mask, but the combination together is extremely painful and I can't tolerate it. It does solve the problem though. I have also used a Dreamwear Full Face mask, which also solves the problem. It works OK but causes severe dry mouth. It seems to increase my OAs though. Finally, last night I tried a Releaf cervical collar with the nasal cushion mask, which does work and is the most comfortable setup for me of what I have tried. Still, my AHI is back up to the 8.5 range and my OAs are way up. The general trend since my machine was changed to the 8.0-9.0 range has been upward from 3.7 back up to the 8.6 range. I am attaching last night's chart with the collar and the nasal cushion mask. There was a huge cluster of OAs during the last 30 minutes of sleep just before I woke up.

I have ordered a DreamWisp mask to try and see if that will make a difference. My guess is my body is adjusting to the 8.0-9.0 pressure and I may ultimately require a higher pressure to get my numbers back down. As always, any input is greatly appreciated.