Going down a rabbit hole!

[richcrab]

Thanks for looking at that Sleeprider.  I have linked to a six month history below.  As the summer approached, I noticed some deterioration in the AHI and a less rested feeling.  I ended up bumping the pressure up a bit, aware that I had gained a little weight over the last six months.  It was also suggested to me that I might want to narrow the range a bit as well, so I did that too.  Ultimately, 12-15 moved to 14-16.  

Do you think it might be wise to return to 12-15 and see how that looks?  And I am a little unclear as to how ERP fits into this.  I *think* that reducing ERP has the same effect as bumping pressure up.  Is that right?  Thanks again.

[Sleeprider]

It seems counter-intuitive that OA is increased with higher pressure, but that is what I see in your long-term trend. You definitely did better at 12-15 in both AHI and time in apnea. Another interesting artifact is that flow limitation FOLLOWS OA, rather than preceding it. When your machine pressure increases, so does your flow limitation. This is another sign that higher pressure is not your answer. Your results were previously pretty good and you raised pressure after one-week of increased AHI starting about June 29, and your first increase was about July 6. When you used lower pressure, your average and 95% pressure almost never hit the max. Now you are there all the time. My impression is that you were already near the top of your pressure requirements, and could have used a starting pressure as low as 10 and still done well. Also, you didn't have centrals, and EPR is really not that bad for you. Reducing it just increases EPAP and max pressure more.

I can't point to a cause, but my inclination would be to return to 12-15 and consider positional therapy as an alternative to pressure. You might do better with a pillow that holds your head in a better position or even a soft cervical collar trial. In any event, your AHI was acceptable, and got worse with the pressure increases. I would look at potential causes unrelated to pressure.

[richcrab]

Ok thanks.  I do use a buckwheat pillow.  And I recently ordered a cervical collar as well.  I often sleep on my side.  

Could mouth breathing play a role in any of this?  I use a pillow mask which I like very much, but I do have a tendency to mouth breathe, although I think I have trained myself somewhat at night to keep it shut.  Maybe I am wrong.

[Sleeprider]

The cervical collar will help, and your leaks are not out of control Large leak has decreased recently, average leak is not a concern unless it is disrupting your sleep. I would stick with what makes you most comfortable because it is not a direct contributor to your AHI results.

[Sleepster]

Your March 7 leak rate graph shows definite signs of mouth-leaking. You might want to try a chin strap or a full face mask. Leaks like that can ruin a night's sleep and make you feel kind of crappy the next day.

[richcrab]

Thanks guys.

Last night I went back to my 12-15 pressure range with ERP 2.  I also used a headband to try and keep the mouth closed a bit.  The leak numbers look good - 95% rate of 6 versus a six month figure of 7.8; but AHI was not good, especially OA (6.78 vs a six month median of 1.41)!

I'll post the chart and welcome any help 

[Sleeprider]

The OA clusters look more like something a cervical collar will be effective at addressing. It's fine to try higher pressures, and that should drive down OA, but this looks like classic chin tucking.

[richcrab]

Cervical collar arrives today, we shall see 

[Sleepster]

I also used a headband to try and keep the mouth closed a bit.  The leak numbers look good - 95% rate of 6 versus a six month figure of 7.8; but AHI was not good, especially OA (6.78 vs a six month median of 1.41)!

The leak numbers may look good, but the leak graph doesn't look good to me. I see it bobbing up and down, which is an indication of possible mouth-leaking. Given the fact that you can't get your AHI under control, and you don't feel rested, we need to consider possibilities, even if they don't seem especially probable.

Try the cervical collar, but if that doesn't work, and even if it does, I highly recommend a full face mask. It may make you feel more rested, and the only way to find out is to try.

[richcrab]

Thanks Sleepster.  I do have a full face mask as a backup.  I am spoiled by my nasal pillows!  When I put the FFM on, it feels like a hurricane.