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First Night on APAP--what does it mean?
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sleepy1235 Offline

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Machine: S9 Elite
Mask Type: Nasal pillows
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Post: #11
RE: First Night on APAP--what does it mean?
The comments by others are correct. You do take a few days to adjust to the machine. I find that I didn't see a regular behavior until a few days when I make changes.

Also, an elastic head band can work as a cheap chin strap. I use nasal pillows and when I increased my pressure from 8 to 15 I had to start using the head band.

Also, if your doctor didn't use a written protocol and at least 4 hours assessing your sleep pressure you might not have the correct pressure and you will need to increase it.
02-15-2015 09:10 AM
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PaytonA Online
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Post: #12
RE: First Night on APAP--what does it mean?
(02-14-2015 09:56 PM)Sleeprider Wrote:  I agree with the comments that you need to have a few more days to develop a trend, but your apnea events are all occuring below a pressure of 9.0 cm. I'll predict you will end up with a minimum APAP pressure of 9.0 when all is said and done, and i will drop your AHI well below acceptable levels. Also, please turn on the events for Flow Limitations and Snores (VS). Those events cause pressure increases and they are important in the graphs. Just go to File/Preferences/Events and click the left and right checkboxes on those events.

According to the chart presented, most of the apnea events are happening above a pressure of 9 cm/H2O not below it. Second, the charts for flow limitation and snore are right there along with the rest.

Best regards,

PaytonA
02-15-2015 01:52 PM
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hootietoot Offline

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Machine: PR System One REMstar Auto BiPAP
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Post: #13
RE: First Night on APAP--what does it mean?
I successfully use a soft sports double mouthguard to stop the mouth leaking I tend to get at higher pressures. When I heated/molded it, I just left out the piece that you're supposed to insert to keep the breathing holes open, so those are all closed up and no air can get in or out.

The guard helps prevent my lower jaw from sliding back, too. No advancement, just keeps my upper and lower jaw in the comfortable alignment they have when I'm conscious. Wink

Edit: There is also a guard type with an optional/removable plastic piece that can be used to block the breathing holes while wearing the guard. On mine, that piece was attached to a stem and was only intended to keep the holes open during molding, but they make guards with a piece you can keep in there all the time if you like.
(This post was last modified: 02-15-2015 04:16 PM by hootietoot.)
02-15-2015 04:08 PM
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DariaVader Offline
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Machine: Resmed S9 AutoSet
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Post: #14
RE: First Night on APAP--what does it mean?
(02-14-2015 09:37 PM)SailingAway Wrote:  I realize I have to try to learn to keep my mouth shut, but how exactly do you teach yourself to do that. I'd much rather figure that out than wear a chinstrap. On our boat, many times it is warm and humid and I'd rather not have my head wrapped if I can learn not to do mouth breath.

Thanks

suck your tongue up to the roof of your mouth, and relax your jaw. i woke one morning with my tongue this way and mouth hanging open, and not a bit of leakage occurred... it has become habitual... leaking that hurricane thru the mouth wakes me up, so it was easy for me.

هههههه هههههه هههههه هههههه هههههه هههههه هههههه هههههه هههههه هههههه هههههه هههههه هههههه هههههه
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

هههههه هههههه هههههه هههههه هههههه هههههه هههههه هههههه هههههه هههههه هههههه هههههه هههههه هههههه
02-15-2015 04:15 PM
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SailingAway Offline

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Sex: Male
Location: Floating around French Polynesia

Post: #15
RE: First Night on APAP--what does it mean?
Day 2...
AHI 3.19 much better. However, very large mask leaks. I tried the full face mask I also ordered, in case of a cold and just to try out. Thought it would let my nostrils heal up a little from the first day. I woke up many times during the night with the mask audibly leaking. My wife said I snored the first few minutes of sleep, the trace confirms it.

I plan to try the pillows again tonight. I'm sure there is just a matter of getting used to it. I will have to experiment with trying to keep my mouth closed.

[Image: nF3DdyT.png]

[Image: AwmbQtr.png]

I know it's going to take some time. Just trying to get some of this worked out before we leave for French Polynesia in about 10 days.

What is the Aloha mod for the P10? BTW, the full face mask I tried was AirFit F10 from Resmed. I guess I could have maybe tightened it up more, which I did several times during the night, but it kept leaking and I took it off around 5 AM.

Thanks for all the assistance guys.
02-15-2015 06:54 PM
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SailingAway Offline

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Post: #16
RE: First Night on APAP--what does it mean?
Oh yeah, BTW, the little popup at the beginning said "Last Night AHI 3.19 Technically Treated .... Mask leaking way to much talk to your CPAP advisor" >>>> That is you guys I guess.
02-15-2015 07:03 PM
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Sleeprider Online
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Post: #17
RE: First Night on APAP--what does it mean?
For nasal pillows, there are some training techniques you might find interesting. Wearing the mask under pressure, while awake, practice normal breathing while opening the mouth. This will teach you how the tongue is the seal that prevents leaks, and why chin straps are futile for the most part. If you think you've got pretty good control of your airway, try talking. Most people will get a rush of air out of the mouth, but you should be able to control your airway enough that you can talk intelligibly on the exhale stroke. This teaches a lot of control, and comes in handy when the wife asks a question, and you don't want to either shut down the machine, or "snork" a reply. It can be done. When you're really good, you can even take a sip of water...beware of return flow if you're not so good. This all sounds a bit weird, but it actually can translate in to autonomic control of your airway under CPAP.

Your AHI of 3.2 is moving in the right direction, but everything is still OA and Hypopnea. Your therapy pressure does not drop under 8.5 all night. I know Payton A doesn't agree, but that is a good minimum pressure for you. With EPR on, your actual EPAP will be lower. Other than the first few minutes when you start the night, you won't notice the difference, but it is snores and flow limitations that keep your pressure up all night. Why not just forego having those, and start with a higher minimum pressure?

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(This post was last modified: 02-15-2015 07:32 PM by Sleeprider.)
02-15-2015 07:30 PM
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SailingAway Offline

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Post: #18
RE: First Night on APAP--what does it mean?
Quote:According to the chart presented, most of the apnea events are happening above a pressure of 9 cm/H2O not below it. Second, the charts for flow limitation and snore are right there along with the rest.

Best regards,

PaytonA

Payton, what are you suggesting here? That the pressure is too high?

Sorry, I'm trying to get up to speed on this stuff.
02-15-2015 07:47 PM
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retired_guy Offline

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Post: #19
RE: First Night on APAP--what does it mean?
This is only your second night and the first night with a different mask. So I don't think too many conclusions should be drawn just yet. Let's see what happens over the next day or so at least.

But yes, I do think that once you have comfortably settled into a mask that your ahi will settle out nicely. Then a bit of tweaking should get you to your sweet spot.

I tend to think you will probably want to increase the minimum a bit. Maybe to 8. A 6 point range seems to me to be a good area. I do not think you'll want to increase the maximum based on your results so far. You are under 14 over 90% of the time. So that's not bad. Whether or not you use EPR is still to be determined. EPR is considered a "comfort" feature. If you have a good pulmonary system it really might not be anything you need to use, and using it can sometimes cause other issues, such as increased leaks or even increased CA's. For me the EPR is great, but it's not for everybody. So I would recommend you get comfortably settled in where you are, then tinker with it if you wish to see what it does.

I am curious about why your actual results show a low pressure of 4.08, when your set pressure is 6. I suppose it's because you are using the ramp feature. I would look at reducing the amount of time you are "in ramp," and/or increasing the ramp pressure starting point to 6. My personal preference for the ramp setting is "off."
02-15-2015 08:09 PM
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hootietoot Offline

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Machine: PR System One REMstar Auto BiPAP
Mask Type: Nasal pillows
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Post: #20
RE: First Night on APAP--what does it mean?
(02-15-2015 06:54 PM)SailingAway Wrote:  *snip*

What is the Aloha mod for the P10?

*snip*

I "stole" the top strap and hose management loop from the Aloha headgear and attached it to the P10 to stabilize it and keep the hose from pulling down on the pillows and causing leaks.

Like so:

[Image: y8HyVXe.jpg?1]
[Image: UFq3i3z.jpg?1]

I also recently "OCDeified" the setup by dyeing the P10 headgear black and making a slim hose cover out of several SnuggleStrap bella loop covers I had in my stash, but that's neither here nor there. *lol*

Regarding your pressures, good advice from retired_guy. I think Peyton was pointing out that you're still having events at higher pressures, so you could stand to increase your minimum and see what happens.
(This post was last modified: 02-15-2015 08:17 PM by hootietoot.)
02-15-2015 08:13 PM
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