[Equipment] New user- Humidifier

[txrpls]

Sleeprider - Thanks for the help. I think I have the order correct and I have attached two windows where the spiking was occurring at the time you specified. I think I need to take a nap. 

          

[Sleeprider]

That answers a lot about the unbalanced looking flow rate. Those flat-topped inhales show a lot of flow limitation. To understand this better, you can right-click on the Flow Rate label and format the y-axis to add a dotted line at zero. Everything above the zero line is inhale, and everything below is exhale. Your inhale starts from the zero line and quickly flattens. You are inhaling, but the airway is restricted. Instead of a normal rounded wave-form yours is flat or downward sloping showing very impaired flow. This is a form of restricted or obstructed airway, and it is very disruptive of sleep. As inspiration ends, you begin to exhale rapidly. Flow slows to zero and holds there until the next inhale begins. This exhalation appears normal. I see two normal looking breaths at 23:47:10, so the majority of breathing in this sequence is disrupted or restricted. Normally the Autoset should increase pressure when it detects flow limitation, but in your case, there is so much flow limitation that there is no unrestricted inspiration airflow to compare against, so the flow limit is not detected. This could be a fault with how the Resmed algorithm works to detect flow limitation. Instead of calculating the roundness of the inspiration, it is comparing changes in flow rate or volume.

I'm going to suggest a bigger change to you than I previously did. I'd like to see you minimum pressure at a minimum of 8.0, but change EPR to full time at 3. This is going to give you a lot of help from pressure during inhale, and relief during exhale. This contrast should help to overcome flow limitation by removing some of the effort of breathing and letting the machine do more of the 'work' by increasing your inhale (IPAP) pressure. Since this will drop your exhale pressure (EPAP), you may need a higher minimum pressure. You will know that if obstructive apnea increase. This change should smooth out your respiration and allow you to sleep deeper, since you won't be working so hard to inhale. If it significantly increase CA events, we may have to back off a bit, but some CA is normal when making this change. You will adapt and those events will go away soon.

Read this section on Flow Limitation from the Beginner's Guide to Sleepyhead Wiki http://www.apneaboard.com/wiki/index.php...imitations

[txrpls]

Thanks again for all your help. I set the Humidity to 1 and the hose temp to 86 and ordered a cover. Changed the min pressure to 8 and the start pressure to 6 and the EPR to fulltime with a setting of 3. and the ramp time set to auto. This sound about right?

[Marillion]

Sleeprider will confirm I am sure...but I am fairly certain he did not want you to put your start pressure at 6. Especially with an EPR setting of 3. Your min setting at 8 with an EPR of 3 should be fairly comfortable. I personally wouldn't recommend you set your start pressure at 6 though it wouldn't be the end of the world if you did.

[txrpls]

I’m a little confused. Set the start at 8 or leave at 6 or go back to the original 4?

[Marillion]

Sleeprider had mentioned putting your minimum pressure at 8 and setting EPR at 3. He said nothing about your start or ramp pressure. I assume when you said earlier about putting your "Start Pressure at 6" you were referring to the Ramp pressure.

My point was that if I was you, I would not even set a Ramp or Start pressure up. Just set your minimum at 8 and EPR at 3, disable any "Start" or "Ramp" settings and try that for a while.

[txrpls]

Gotchya. Thanks!

[txrpls]

@Sleeprider Tried the recomended setting last night and slept much better. A lot less incidents in Sleepyhead. A had a couple of drinks last night so will not post charts yet. I am definitely a mouth beather. Woke up with a wad of cotton in my mouth.   Should i get a chin strap or just not worry about it?

[Sleeprider]

First, the intention was a minimum pressure of 8.0.

Glad this was more comfortable. If you have a lot of air coming from your mouth, that will either resolve by you learning to block that using your tongue to keep the air out of your mouth, or you will have to resort to a chin strap or soft cervical collar. Chin straps work by pulling your jaw up, while a soft cervical collar works by applying soft pressure at the back of the jaw to encourage the jaw to stay closed. The soft cervical collar has worked well and been more comfortable for many members. This is basically a soft 2-1/2 to 3" tall foam donut that fastens loosely around the neck. When you sleep it helps keep the airway aligned and also promotes a closed mouth. If you have a really bad problem, a full face mask is the most likely answer. Be sure to read the mask primer wiki http://www.apneaboard.com/wiki/index.php...ask_Primer

It is really encouraging you found EPR to be more comfortable. Leaks were apparently your biggest problem, and as long as you did not have a lot of obstructive events, just keep things the same and work on the leaks. Another member DariaVader suggest the "tongue suck technique" for learning to prevent leaks.
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Tongue Suck Technique for prevention of mouth breathing:
Place your tongue behind your front teeth on the roof of your mouth
let your tongue fill the space between the upper molars
gently suck to form a light vacuum
Practising during the day can help you to keep it at night
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[txrpls]

I read the article previously. What I am unsure of is it ok to mouth breath if you wear a full face mask?