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How to stop FOT arousals?
#11
RE: How to stop FOT arousals?
Have you tried a nasal mask? Nasal masks are more effective and could have a positive effect as well.

You are right should try one change at a time. Up to you which to try first. Can try PS of 3 or cycle sensitivity of either low or high. To try and dial in cycle sensitivity to what is comfortable you could try adjusting them while awake and seeing if one seems more natural.
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#12
RE: How to stop FOT arousals?
Under normal circumstances, I would say you can try a Philips because their air puff comes 1-2 seconds later during an apnea. It could help you if you breathe slowly.

But, now Philips is out of the game for a long time.
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#13
RE: How to stop FOT arousals?
(06-26-2021, 05:40 PM)Geer1 Wrote: Have you tried a nasal mask? Nasal masks are more effective and could have a positive effect as well.

You are right should try one change at a time. Up to you which to try first. Can try PS of 3 or cycle sensitivity of either low or high. To try and dial in cycle sensitivity to what is comfortable you could try adjusting them while awake and seeing if one seems more natural.

I am using a Full Face Mask right now but once my nasal breathing improves through palate expansion I am planning on getting a nasal mask (or perhaps try a couple, maybe start with pillows). 

I'm going to start by bringing PS down to 3 and see how that goes, then try the Cycle on both higher and lower settings and see what happens. I think the EPAP and other settings are fine so I will leave that for now. 

My symptoms are improving but I think there are just still things hindering my process - partly my poor nasal breathing and perhaps partly because I am still not getting the ideal settings.
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#14
RE: How to stop FOT arousals?
Your settings don't look that bad. I would try these couple minor changes to see if they have any effect, if not just stay with what you have.

What could be happening is that you may be mostly breathing out through nose (at least during these periods) but pressure from FFM is applying some pressure to under/backside of palate reducing PAP effectiveness and extending exhalation. Figures 3 and 4 from the following study give some example/explanation of this known issue with full face masks. P10 is a good mask to try for a nasal mask.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4301251/

If any of these changes work you will mostly see it in your average expiration time statistic. It is currently over 4 seconds and should drop to like 2.5-3 (roughly double inspiration time).

Potentially increasing PS to 4.5 or 5 may help by speeding up flow (if it is a restricted nasal passageway). The PS of 3 test will tell us if it helps or makes things worse by heading in the wrong direction.
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#15
RE: How to stop FOT arousals?
(06-26-2021, 06:08 PM)Geer1 Wrote: Your settings don't look that bad. I would try these couple minor changes to see if they have any effect, if not just stay with what you have.

What could be happening is that you may be mostly breathing out through nose (at least during these periods) but pressure from FFM is applying some pressure to under/backside of palate reducing PAP effectiveness and extending exhalation. Figures 3 and 4 from the following study give some example/explanation of this known issue with full face masks. P10 is a good mask to try for a nasal mask.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4301251/

If any of these changes work you will mostly see it in your average expiration time statistic. It is currently over 4 seconds and should drop to like 2.5-3 (roughly double inspiration time).

Potentially increasing PS to 4.5 or 5 may help by speeding up flow (if it is a restricted nasal passageway). The PS of 3 test will tell us if it helps or makes things worse by heading in the wrong direction.

I don't think I'm breathing out through my nose at all; my nasal breathing is pretty bad. Especially wearing the FFM. The only times I nasal breathe are when I use Afrin (1-2x a week to avoid rebound congestion) and then mouth tape. But once I expand enough on the MSE I'm planning to start doing regular mouth taping and hoping I won't need to use decongestants.

Are you saying that the ideal inspiration:expiration time ratio is 1:2? Do you know why this is the case?

I'm planning on doing Afrin tonight so I'm not sure if this will affect the results. So I might use PS of 3 tonight with Afrin+mouth taping, then the next night have the exact same settings but be mouth breathing all night.
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#16
RE: How to stop FOT arousals?
I assume you have seen an ENT to try and understand why you have such bad congestion? A small nasal passage is one thing, your turbinates swelling up etc causing congestion is another. My ENT and doctors were useless at diagnosing and improving my congestion, mine finally improved after figuring out I have an intolerance to dairy. If you have been striking out trying food elimination diets for common allergens might be worthwhile.

Mouth breathing is inefficient and could be the cause of this slower expiration. The ratio is usually around 1:2. Inspiration is short because it is completely driven by muscles, expiration takes longer because it is mostly driven by gravity and muscles under tension after inspiration. The first bit of expiration happens quickly and then remaining part takes a while because there is minimal pressure/force pushing the air out.
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#17
RE: How to stop FOT arousals?
I'll agree with the I:E at around 1:2 sometimes even longer like 1:3. When I look at ventilation info 1:3 is mentioned due to what Geer1 mentioned, gravity etc.
Dave

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#18
RE: How to stop FOT arousals?
(06-26-2021, 07:14 PM)Geer1 Wrote: I assume you have seen an ENT to try and understand why you have such bad congestion? A small nasal passage is one thing, your turbinates swelling up etc causing congestion is another. My ENT and doctors were useless at diagnosing and improving my congestion, mine finally improved after figuring out I have an intolerance to dairy. If you have been striking out trying food elimination diets for common allergens might be worthwhile.

Mouth breathing is inefficient and could be the cause of this slower expiration. The ratio is usually around 1:2. Inspiration is short because it is completely driven by muscles, expiration takes longer because it is mostly driven by gravity and muscles under tension after inspiration. The first bit of expiration happens quickly and then remaining part takes a while because there is minimal pressure/force pushing the air out.

An ENT will just offer a soft tissue procedure, but I wanted to change the problem at the skeletal level which is why I am undergoing the MSE (Maxillary Skeletal Expander) procedure. I am working with a sleep and airway focused Orthodontist to expand my maxilla to improve my nasal breathing and increase the size of the oral cavity. Because the top of the palate is also the floor of the nasal cavity, expanding the palate improves nasal breathing and reduces airflow resistance at the skeletal level. The reason why I have a narrow palate is because I grew up with a "tongue thrust" and did not practice the proper tongue posture (resting on the palate) so my palate did not expand enough, impacting my nasal breathing.
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#19
RE: How to stop FOT arousals?
Imo you should also see an ENT if you can't breath out nose and have to use decongestants regularly. You think you know what the problem is but you don't really know the entire reason until you get it checked out. The fact that decongestants help you strongly supports that you have hypertrophied turbinates either from allergies or potentially vasomotor rhinitis. Decongestants wouldn't be of much help if your only issue was a small airway.

Don't consider UPPP or anything like that but septoplasty and turbinate reduction are two surgeries that are definitely worth considering depending on findings.
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#20
RE: How to stop FOT arousals?
(06-26-2021, 07:51 PM)Geer1 Wrote: Imo you should also see an ENT if you can't breath out nose and have to use decongestants regularly. You think you know what the problem is but you don't really know the entire reason until you get it checked out. The fact that decongestants help you strongly supports that you have hypertrophied turbinates either from allergies or potentially vasomotor rhinitis. Decongestants wouldn't be of much help if your only issue was a small airway.

Don't consider UPPP or anything like that but septoplasty and turbinate reduction are two surgeries that are definitely worth considering depending on findings.

I have got it checked out and I have looked into the problem. Research the MSE (or "Won Moon") appliance, it lowers AHI significantly more than soft tissue procedures do and improves nasal breathing much better.
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