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First night of data and seeking help
RE: First night of data and seeking help
It's a bit of a guessing game to determine whether leaks are from the mouth or the mask, but in general, a constant low-level leak or a spike will probably be a mask leak, and a flare or plateau will probably be a mouth leak. My guess is that you're having mouth leaks with the P10.

If you want to test that hypothesis, here are some things to try.

1. Tongue position. Try putting the tip of your tongue behind your upper front teeth. Then position the main part of your tongue up against your upper palate. Finally, give a little suck or swallow to create a bit of suction. You should now be able to open your mouth while breathing entirely through your nose. Practice this during the day, and see if you can get it grooved in deeply enough to help while you are asleep at night. For some people, this is really all it takes to avoid mouth leaks.

2. Collar. If your jaw tends to drop down during the night, pulling your mouth open, then a soft cervical collar, or a firmer snore collar, can be a big boon. More here:

3. Although chin straps tend to pull the jaw back, which is not helpful, the Knightsbridge Dual Band strap has a design that pulls the jaw straight up, which makes it a possible alternative to a cervical collar.

4. Tape. Some people (including me) rely on tape to keep the lips from opening. (I can't rely entirely on the tongue thing.) When the lips open, all too often that eventually leads to a noisy and disruptive mouth leak. To see whether tape would be feasible for you, I recommend that you invest in a box of Somnifix strips. They are very gentle on the skin but hold very well. Be sure to curl your lips inward per instructions before placing the strip. If these work for you, then you can experiment with lower-cost options.

About guidelines for better sleep, here you go:

• Keep a consistent sleep schedule. Get up at the same time every day, even on weekends or during vacations.
• Set a bedtime that is early enough for you to get at least 7 hours of sleep.
• Don’t go to bed unless you are sleepy.
• If you don’t fall asleep after 20 minutes, get out of bed.
• Establish a relaxing bedtime routine.
• Use your bed only for sleep and sex.
• Make your bedroom quiet and relaxing. Keep the room at a comfortable, cool temperature.
• Limit exposure to bright light in the evenings.
• Turn off electronic devices at least 30 minutes before bedtime.
• Don’t eat a large meal before bedtime. If you are hungry at night, eat a light, healthy snack.
• Exercise regularly and maintain a healthy diet.
• Avoid consuming caffeine in the late afternoon or evening.
• Avoid consuming alcohol before bedtime.
• Reduce your fluid intake before bedtime.
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RE: First night of data and seeking help
Hi guys,

Can you help me tweak my settings?  Last night was my worst night symptoms wise since I started CPAP 2 weeks ago.  I still don't really feel a difference.


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RE: First night of data and seeking help
I’m NOT one of the experts but a couple of things. You need a mask type entered into the machine so it can tell about large leaks (full face masks have more leaks than nasal). Your pressure chart is strange, it should have 2 lines. The first night did the second started with 2 and ended with 1 and the last one had only one pressure all night. Did you change the settings?

One one of the nights it looks like you had chin tucking or some way cut off your airway.

I hope one of the gurus will be by and help.
Apnea (80-100%) 10 seconds, Hypopnea (50-80%) 10 seconds, Flow Limits (0-50%) not timed  Cervical Collar - Dealing w DME - Chart Organizing
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RE: First night of data and seeking help
your numbers are really good. The first chart your Centrals were your highest number, this calls for a reduction in EPR, you did.

If you are typical, you have many years of untreated apnea under your belt, You are not going to overcome this overnight. A few people get lucky get immediate refief, but for most it takes time and consistent use. Stick with your current settings for a while and do report how you feel (these are symptoms) which will help us to get you tweaked in.
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RE: First night of data and seeking help
Thank you for the reply. I’ve actually been experimenting with EPR settings based on what I’ve learned here.

I will try the cervical collar to see if that helps. Any other adjustments on pressures or anything else?
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RE: First night of data and seeking help
You do seem to have fewer CAs with the EPR turned off. With time, I think CAs won't be much of an issue, and at that point you can experiment with adding in a little EPR. But maybe for now keep it off.

Do you feel you need the ramp? Many people on the forum wind up turning it off, especially if waiting for the ramp-up makes it harder to fall asleep. And with a ramp minimum of 6, you may be feeling a little air-starved as well.

A few people (including me) find that pressure changes during the night can cause wake-ups. If you think that might be an issue for you, you can experiment setting your min and max to the same pressure. If you'd like to try that, I'd suggest picking a pressure between 9 and 10. If that leads to too many obstructive events, or makes it hard to exhale, just change back to the 8 - 17 range.

Leg movements while falling asleep are quite common; the majority of people experience them at least some of the time. They are called hypnic (or hypnogogic) jerks, and they don't call for treatment as a rule. Standard advice for avoiding them includes avoiding exercise in the evening, avoiding caffeine late in the day and in the evening, and reducing stress. Avoiding blue light from screens in the evening might also help.
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RE: First night of data and seeking help
I agree that hypnogogic jerks are common and benign but plmd is much more disturbing and should be treated to reduce arousals.

my experience is that apnea can cause all kinds of thrashing in the struggle to breathe. emaNTD, you indicated plmd, which is quite different from hypnogogic jerks. my thrashing, movement I would generally be aware of as it awakened me, calmed considerably after pap. lingering is plm, that can be subtle or violent and I am completely unaware of it. like most people, I get occasional hypnogogic jerks, but they are infrequent and are usually once and done. in my experience, they're not leg movements so much as full body jerks. hypnogogic jerks are common and happen infrequently enough that they're nothing to fret over. otoh, plmd is repetitive and can be very very disturbing, occurring on and off throughout every night, frequently rousing or awakening the sufferer. if you have plmd, best to try different remedies until you find something you can handle that works.

here's a brief description of some movements during sleep from verywellhealth.com.

What Is a Hypnagogic Jerk and What Causes Sleep Starts?

Just after falling asleep, you may wake with a sudden jerking movement. What causes these so-called sleep starts? Learn about hypnagogic jerks, or hypnic jerks, including the most common symptoms, and whether further evaluation and treatment may be necessary.

What Is a Hypnagogic Jerk or Hypnic Jerk?
A hypnagogic jerk is a sudden and strong involuntary twitch or muscle contraction, that occurs while an individual is beginning to fall asleep. The same phenomenon is called a hypnic jerk if it occurs upon awakening. Both are often known as a sleep start. It may affect only part of the body, like an arm or leg. It may more commonly seem to cause the entire body to jolt suddenly. In some cases, a vocalization or sharp cry may occur.1

These movements may occur without waking the affected person. If an awakening does occur, these sudden movements are often associated with a brief mental image.2 For example, you might believe that you were falling. A leg movement may incite a fragmentary dream image that you were perhaps kicking a soccer ball. It is believed that the movements occur first, perhaps due to an electrical discharge along the body's nerves, and that the mental image or explanation follows. In a sense, the brain creates a story to account for the movement.

Why Do Sleep Starts Occur?
Sleep starts can be a normal part of sleep. It is estimated that 60 to 70 percent of people recall experiencing them. If they occur infrequently, as they often do, they are not usually distressing. However, frequent events may lead to anxiety about falling asleep and insomnia, especially if the recalled explanation for the movement is upsetting (such as falling from a great height).

Hypnagogic jerks typically occur during stage 1 sleep.2 This is the lightest stage of sleep that occurs immediately after falling asleep. It may be misinterpreted as wakefulness, leading to confusion about when sleep starts to occur. It may occur periodically later in the night, but these events are less likely to be recalled.

Sleep starts to occur more often with the increased use of caffeine and other stimulants. It may be provoked by physical exercise or emotional stress.2 It is possible for sleep fragmentation to be caused by another sleep disorder, such as obstructive sleep apnea. Frequent episodes may prompt further evaluation.

Other Causes of Movements in Sleep
Beyond sleep starts, there are other conditions that may contribute to movements during the transition to our state of sleep. These other causes may be considered:

Restless legs syndrome: Characterized by an uncomfortable feeling often affecting the legs when lying down in the evening that is associated with an urge to move that is relieved by movement. It occurs during wakefulness.

Periodic limb movements of sleep: Occurring during sleep, often these movements consist of flexion and extension of the foot (and sometimes knee) in a rhythmic fashion. These occur periodically in trains of events but may come and go in the night. Unlike hypnagogic or hypnic jerks, these are not single, isolated events.

Seizures: Depending on the type of seizure, there may be a large movement of the body. Generalized tonic-clonic seizures may be associated with tongue or mouth biting, loss of bladder control with incontinence, and even injuries. After the episode, there may be a period of confusion. These last 1 minute on average and are usually easy to distinguish from sleep starts.

Shivering: If the sleep environment is cold, or a fever exists, it is possible that shivering may cause movements in sleep. This high-frequency movement may affect the extremities with the whole body. These typically last longer than sleep starts, which are often sudden events that immediately resolve, and resolve with warming the body or treating the fever.

Fasciculations: If a specific muscle or group of muscles twitch, this may be called a fasciculation. It appears like quivering and may even look like a "bag of worms." These movements may occur across a joint and cause the contraction to move the extremity. These generally are more persistent than a sleep start and may be noted during wakefulness.

Further Evaluation and Treatment of Sleep Starts
In general, it is not necessary to seek further testing or treatment for sleep starts. Reassurance that this is a normal phenomenon is often all that is needed. If frequent movements occur—especially if they are associated with other complaints such as physical injury, mouth or tongue biting, bedwetting, or confusion upon awakening—it may be helpful to visit with a doctor to rule out other conditions.

Sometimes these awakenings can be provoked by another sleep disorder, most commonly disrupted breathing like sleep apnea1. Sleep starts may be exacerbated by medication or substance use. In addition, movements in sleep can sometimes suggest seizures. It may be necessary to have a diagnostic sleep study called a polysomnogram. Alternatively, an EEG may be ordered if seizures are suspected to be causing the uncontrolled movements.
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RE: First night of data and seeking help
Thank you both for the replies.  Attached are my last two nights.  I've worn a cervical collar the last 2 nights, but I seem to move it in my sleep so it's a work in progress.  I'm also having trouble with leaks and the mask moving to the point I wake up many times a night.

I tried the constant pressure last night and had no trouble tolerating it.  I did have trouble keeping the nasal pillows from loosening up. 

Does anyone recommend sleeping on my back to see if the mask will move less?  I have a hard time sleeping on my back, but I could get used to it if you guys think it may keep my mask from moving.  I've tried 6 different masks in the two weeks I've been using the CPAP.  The nasal pillows seem to the most comfortable, but I can't get them to stay put!

I still haven't felt any improvement from therapy, but I have felt terrible the last two mights.  I'm hoping it's just from waking up with air blasting into my eyes.

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RE: First night of data and seeking help
Which pillows mask have you tried?
Apnea (80-100%) 10 seconds, Hypopnea (50-80%) 10 seconds, Flow Limits (0-50%) not timed  Cervical Collar - Dealing w DME - Chart Organizing
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RE: First night of data and seeking help
Which nasal pillow mask are you using? People might have some suggestions specific to the mask. You might need to tighten the headgear just a little bit. Try refitting it while lying down.

A generic suggestion is to try all the pillow sizes (assuming you got a fit pack). You want the widest part of the pillows to rest on the outsides of your nostrils, so you need a size large enough for that. But you also want a good seal around the edges, and you want the pillows to help a little bit to keep the whole rig in place, so you need a size small enough for that.

And an idea that may just be off base, but I wonder what would happen if you wore a Knightsbridge Dual Strap rig over your mask headgear. Take a look at one and see what you think.
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