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First night ever - First Nights Data
#11
Is mouth breathing a problem even with a full face mask?

And this feels like a really dumb question - but does increasing pressure also increase the force of air coming in the mask?

Do you eventually not notice this?

I feel like I'm swallowing air and my lips get air under them and blow out.

...And I can't believe patients are released into the world with this machine and expected to just "figure it out".
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#12
I don't wear a full face mask, but heard from some here that even that even with a full face mask, they mouth breath, which is going to cause dry mouth. Experiencing that dry mouth on a consistent basis can cause you to have dental and gum problems.

If your mask isn't fitting properly and causing leaks throughout the night, then the machine may not be reporting your events accurately. But from your graph, it doesnt appear to be leaking throughout the night.

Increasing the minimum pressure will handle your Obstructive events and lower your AHI which is too high, but if a higher pressure bothers you, take it slow, and work on mask leaks and/or mouth breathing first.
If your notice the air leaking from your mask, then it is not fitted right.
If your mouth is consistently dry, you are mouth breathing.
Have you tried a chin strap?

We certainly dont want you to swallow air, as that will cause aerophagia.

And yes, unfortunately patients are given a machine and sent home to figure it out for themselves.
OpalRose
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#13
Meredith, I think we need to back up a bit. Your charts are showing that increasing pressure may be the source of the problem, not the solution. I'm going to assume you did not have a titration study where you wore the cpap in a clinical trial as a technician attempted to find an optimal therapy pressure.

There are two possibilities of what might be happening here. Either you have positional obstructive apnea that you machine is unable to overcome, or your Resmed APAP is misinterpreting the type of apnea you have, labeling what may be central or mixed events as obstructive, and increasing pressure inappropriately.

One way to narrow down the possibilities is to set your machine at 7 cm fixed CPAP and see what happens. You may be one of those "lucky" people who have a more complex apnea when presented with higher CPAP pressure. If the pattern of OA continues to occur with that lower pressure, then I think we would want to look at using pressure and sleep position or a soft cervical collar as an approach.

Opalrose mentioned flow limitation, and I'm not seeing it. There are almost no snores, and in the one graph large enough to read, your 95% FL was 0.34. This is why I question the obstructive flags.
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#14
Something else that might help here, is if you have the results of your sleep study, please post it. There may be a clue there.
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#15
(12-20-2016, 10:01 AM)Sleeprider Wrote: Opalrose mentioned flow limitation, and I'm not seeing it. There are almost no snores, and in the one graph large enough to read, your 95% FL was 0.34. This is why I question the obstructive flags.

Yes sorry, I was looking at the max flow limitation number instead of the 95% number.

Sleeprider, I am curious to see the results if Meredith sets her machine to cpap with a fixed 7cm. I am also wondering about the "for her" setting. I thought that it would be less aggressive in raising pressure, than the regular auto mode.

She can also set her machine to the regular auto mode with a 7cm min pressure and
7cm max pressure. (7-7). That way, it would still report FL if it occurs.

Just my thoughts. Dont-know
OpalRose
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INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.




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#16


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#17
(12-20-2016, 10:01 AM)Sleeprider Wrote: Meredith, I think we need to back up a bit. Your charts are showing that increasing pressure may be the source of the problem, not the solution. I'm going to assume you did not have a titration study where you wore the cpap in a clinical trial as a technician attempted to find an optimal therapy pressure.

I did not. It was Alice I mail away at home test.

There are two possibilities of what might be happening here. Either you have positional obstructive apnea that you machine is unable to overcome, or your Resmed APAP is misinterpreting the type of apnea you have, labeling what may be central or mixed events as obstructive, and increasing pressure inappropriately.

It "seems" like it is arbitrarily increasing.... Is there a way to make it next to unnoticeable until you fall asleep?

One way to narrow down the possibilities is to set your machine at 7 cm fixed CPAP and see what happens. You may be one of those "lucky" people who have a more complex apnea when presented with higher CPAP pressure. If the pattern of OA continues to occur with that lower pressure, then I think we would want to look at using pressure and sleep position or a soft cervical collar as an approach.

I think last night may have been an anomaly - the very first night seemed to go much smoother....

Opalrose mentioned flow limitation, and I'm not seeing it. There are almost no snores, and in the one graph large enough to read, your 95% FL was 0.34. This is why I question the obstructive flags.

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#18
Your home test definitely shows obstructive sleep apnea. Since you have the Autoset For Her, you do have a choice of therapy options. You can get a clinical manual to learn how to access the therapy settings on your machine. It is basically just pushing in the control knob and home button at the same time, then selecting the clinical menu with the control knob. That will take you to therapy settings. On your machine you can select several operating modes. You are currently in regular Autoset mode.

Autoset for Her provides a reduced rate of pressure increments designed to help prevent arousals, has slower pressure decays, and treats apneas up to 12 cm H2O and continues to respond to flow limitation and snore up to maximum pressure. This would slow down the rapid pressure response, and will keep it higher until obstructive apnea is resolved.

There is also a CPAP mode mentioned earlier, which will hold a constant pressure. It's your choice how you proceed. The two examples we have so far show you are not responding well to pressure increases, so the idea was to slow that down by either using a steady pressure, or as OpalRose suggested, you could try the for her auto mode. Whatever you choose to do, we will be here to answer questions and help you understand the data.
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#19
I got into the settings (very easy thank you). It was set for AutoSet for her. Is it acting like the regular?

I spent some time today just wearing the mask and think I may try it again one more night with the adjusting rate (7-20).

If it goes like last night I will try to set it at a constant. I do think that is a good idea.

Thank you.
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#20
Would this mean it is time to try a constant pressure?

The part in the day is me laying up right in bed, watching TV. I don't think I slept.

I went to bed around 9:30 and wore it for a while, I dozed, while husband was able to observe. He said I did begin some snoring but the machine changed its sound and seemed to stop it. The third set was for the longest I know I fell asleep. (The solid black lines in chart, if this was consistent is this what we want to see?) Was up again - bathroom and back to sleep. Also, is the AHI number cumulative or for one 24 hour period or one session?

Thank you.

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