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AHI higher on cpap than before therapy.
#41
You definitely don't want to be opening your mouth while the CPAP machine is on. It greatly reduces the efficacy of your treatment and will dry out your mouth terribly. At least it does for me.

Don't fear the muzzle. It's really not all that bad. Smile

Also, as Sleeprider suggested earlier, you would be better served with a minimum of 7.5 AND leaving the maximum at 15. Leaving the maximum at 7 would not be a high enough setting to head off any obstructive and Hypopnea events, in my opinion.
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#42
Point taken. I had thought about that upper pressure. I think I will experiment tonight with it to see what happens with the high at 7, which I also think may not be high enough, and this should show it after one night. I already put in a 2.8 hour nap today with it set at 7 and felt more comfortable with it right away than I ever did with it at 4.  But even with the high at 15, I never exceeded 11,  so when I check the chart tomorrow I think I would not change the settings any higher than 11. Doc said he did not want me using higher pressures right now. Should have asked why, and what he considered "high" yes? Does this sound reasonable or am I missing something?
Thanks,
Sweetpea
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#43
I think the doctor is trying to ease you into therapy keeping pressures lower. That's fine, but the consequence will be higher event rates. We can take the same approach here, but I would definitely set you up higher than the doctor. A cervical collar works differently than the ergonomic pillow. The pillow does exactly what you found; it holds the airway open by tilting your head back, and this can cause problems with an open mouth in some people. The cervical collar fits under the jaw and helps to keep the mouth shut, and pushed slightly forward, which helps significantly with obstructive apnea. The chin strap has the unfortunate habit of pushing the jaw back. Not very many clinicians look beyond the obvious benefit of the mouth being pushed closed, but the angle of a chin strap is generally bad for apnea, while a cervical collar gently pushes the jaw closed and forward, while maintaining alignment in the neck...lots of advantages.
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#44
(05-09-2017, 10:16 PM)Sweetpea Wrote: I already put in a 2.8 hour nap today with it set at 7 and felt more comfortable with it right away than I ever did with it at 4.  

Yep - 4 is just not enough air flow/pressure.  My dr Rx'ed a fixed pressure of 5 for me.  I told him I had to take my mask off to just get a couple deep breaths throughout the night... and he was STILL unwilling to up the pressure since my AHI was at an acceptable # to make insurance happy. 

Once I nudged the min pressure higher, I was SO much more comfortable.
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#45
So, this is how it went last night. Settings on my apap were 5/7. I logged 6.7 hours. Unfortunately, at least 3 of those hours were just lying there hooked up, not sleeping.
No leaks
90% pressure= 7.0
periodic breathing= 1%
AHI= 30.8
I do notice that AHI accumulates very quickly while not being able to sleep, so I am not too concerned about that presently. The doctor is just trying to find pressure numbers that will work right now, and then adjust for AHI. He has given me the okay to adjust as I feel needed, keeping in mind he would not like me to use "higher" settings right now. There is only one time last night I was aware of being annoyed. That was actually this morning when I woke up because it was taking extra effort to exhale against the machine. I checked the pressure and it was 7. 
Any advice on all this? Thank you! This is so much easier when you have my back!   Shy 
Sweetpea
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#46
Pressure at min 5 max 7 is simply not high enough to avoid the events you are experiencing. I suspect you are spending most of your time at that max pressure.

As Sleeprider and I suggested, you should be leaving your max at around 15 to give room for the machine to react to flow limitations and snore events which are pre-cursors to Apneas. At the present time your settings do not allow for the machine to go high enough with pressure to circumvent the many events you are having.

An AHI of 30.8 is waaaaaaaay too high considering you are being treated with an excellent APAP machine. If you set your max to 15 it does not mean the machine will actually go to that number. Your pressure gets raised in small increments in reaction to the events that you get. I have my max set to 15 but I usually never go above 13, for example. If you didn't have any events at all while you were sleeping, your machine would stay close to your minimum setting of 5 all night. Which is still too low in our opinion.
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#47
Okay. All this seems very logical. Thanks. And what about being awakened because I am having difficulty exhaling against the higher pressures? Any clue? I hate that it sometimes results in chest pain and/or arrhythmia.
Sweetpea
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#48
Not sure what your flex settings (exhale support, comfort settings) are set at on your machine, but since I am not as familiar with your machine as others may be, I will let them comment on what you should set that at. If you posted some fresh data from Sleepyhead it would be very helpful.
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#49
(05-11-2017, 02:31 PM)Sweetpea Wrote: Okay. All this seems very logical. Thanks. And what about being awakened because I am having difficulty exhaling against the higher pressures? Any clue? I hate that it sometimes results in chest pain and/or arrhythmia.
Sweetpea

The inability to "tolerate" CPAP often results in a prescription for Bilevel, although a pressure of 7.0 is considered relatively low.  CPAP really should not result in chest pain and especially arrhythmia.  If you are having A-fib, arrhythmia or chest pain, discuss it with your doctor.  Be aware that aerophagia (ingestion of air) can cause some similar symptoms.

At this point, you are having all obstructive events.  You have expressed an intolerance of pressures that are likely to relieve that, so your doctor is working to make you as comfortable as possible, in anticipation that as you adapt to the current pressure of 7, you will eventually tolerate the higher pressures that are going to be necessary to fully treat your obstructive apnea.  However, it is better to have you on a pressure of 7 and having some events, than forcing a pressure on you that makes you quit.  We would all rather see you at least partially or mostly treated, than to quit and go back to untreated.
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#50
(05-11-2017, 05:38 PM)Sleeprider Wrote:
(05-11-2017, 02:31 PM)Sweetpea Wrote: Okay. All this seems very logical. Thanks. And what about being awakened because I am having difficulty exhaling against the higher pressures? Any clue? I hate that it sometimes results in chest pain and/or arrhythmia.
Sweetpea

The inability to "tolerate" CPAP often results in a prescription for Bilevel, although a pressure of 7.0 is considered relatively low.  CPAP really should not result in chest pain and especially arrhythmia.  If you are having A-fib, arrhythmia or chest pain, discuss it with your doctor.  Be aware that aerophagia (ingestion of air) can cause some similar symptoms.

At this point, you are having all obstructive events.  You have expressed an intolerance of pressures that are likely to relieve that, so your doctor is working to make you as comfortable as possible, in anticipation that as you adapt to the current pressure of 7, you will eventually tolerate the higher pressures that are going to be necessary to fully treat your obstructive apnea.  However, it is better to have you on a pressure of 7 and having some events, than forcing a pressure on you that makes you quit.  We would all rather see you at least partially or mostly treated, than to quit and go back to untreated.

Thanks for the replies. The arrhythmia would likely be V-tach, as that is what has plagued me. But maybe it could have been swallowing air, though I did not have any "results" that would confirm that.
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