Newbie in need of help

[zoraa]

Hi everyone,

First, I'd just like to say how grateful I am that this community exists! I have been struggling for years and it's been amazing to read through the board and learn from you all. I still have a lot of reading to do, but I thought I would post with my questions in case anyone might be able to provide more specific answers 

Please feel free to let me know if I need to adjust my post/attachments, or post elsewhere, etc. Still familiarizing myself a bit!

A little background on me.. I am 30 years old, been struggling with severe daytime fatigue for about 4-5 years now. I first started suspecting it might be related to sleep disordered breathing when my long-term partner at the time made a compelling argument that I was NOT breathing normally at night (he took it upon himself to record my crazy noises as well lol). I also mouth breathe at night. This convinced me to get a sleep study. They determined I did not have sleep apnea, decided it was not respiratory related and sent me on my way.

A couple years later, I saw a different sleep specialist as I was interested in an oral appliance to help with my bruxism and snoring. This provider found that I have a very deviated septum and other signs that could point to sleep disordered breathing. However, he really just specialized in oral sleep appliances, not PAP therapy. I tried the appliance for a while but still felt just completely fatigued and not rested. I did see an ENT on his recommendation as well, who said I should have surgery for the deviated septum. I am considering this, but wanted to try other options first.

My primary finally suggested that it may be worth it to try PAP therapy, which I was definitely on board with. I just received my first machine a few days ago, an Airsense10 Autoset with nasal pillows. My provider has it set on auto from min 4 to max 20. Though, after reading through some threads, I am wondering if this is the right machine/setting for me. I do not really have issues with apneas, but more so it seems with hypopneas, flow limitation, and mouth breathing. I have been taping my mouth and trying to use nasal pillows, really hoping that I can train myself to breathe through my nose at night (with the help of the APAP).

Unfortunately, I've only been wearing it about 2 hours a night before taking it off in my sleep. However, I am hopeful I'll eventually be able to wear it through the night if I say consistent. I figured I'd post my results so far, though I know they are probably not super helpful since they show only 2 hours of sleep. At this point, I will take any insight that may help me with this process. I also included the results from my last take home sleep study. 

*one note I will make, the flow limitation graph goes as high as 0.40, but the side panel said my max was 0.29 - not sure if these are different measurements or not?

After I post, I will double check to make sure the attachments all went through okay, again please let me know if I need to adjust anything!

Thanks so so much!

[sheepless]

regarding your note, max in the oscar daily details is actually the 99%tile value whose column heading will be changed in a future release, as I understand it.

[zoraa]

Thank you Sheepless! That makes sense

Quick update on my OP, after some further reading here I am going to try setting the EPR level to 3, and possibly consider going the bipap route. Given the fact that I have RERAs, hypopneas, and flow limitation all present, but few to no apnea, this seems like the better option.

Basically, I have not officially been diagnosed with UARS, because I have not been able to find a provider who is even knowledgeable about it... sigh... so I'm in the self treating camp. My primary did put in a prescription for the APAP, so I'm thankful she's working with me to find a solution.

[Gideon]

Welcome to the forum.

I was going to state that this looks like pretty classic UARS but you need to include the Flow Limit chart. Please read the Organization in my signature for what to include.

As you indicated set the EPR = 3 The min pressure should be no lower than 7 to take full advantage of the EPR=3. That should also be more comfortable for you. Also consider shortening or turning off the ramp.

[zoraa]

Welcome to the forum.

I was going to state that this looks like pretty classic UARS but you need to include the Flow Limit chart.  Please read the Organization in my signature for what to include.

As you indicated set the EPR = 3   The min pressure should be no lower than 7 to take full advantage of the EPR=3.  That should also be more comfortable for you.   Also consider shortening or turning off the ramp.

Thank you SO much Bonjour, that is really helpful. Will try that tonight and see how it goes!

Just checked out the organization link, it's fantastic, thank you! Though I included what I thought was flow limitation (7th chart on the first attachment), is there another flow limitation chart I should include?

Really appreciate your help, thanks again

[Sleeprider]

Your sleep study chart was a study in flow limitation. That is the reason your breathing volume becomes depressed giving rise to hypopnea and oxygen desaturations. As suggested by Bonjour, the solution for flow limitation is pressure support, or exhale pressure relief on your machine, which gives up to 3-cm of pressure support to your inspiratory effort. Turn off the Ramp! you are sitting there for over 30 minutes with the machine idling at 4 cm pressure and that is going to undermine your comfort.

Minimum pressure 7.0, Maximum pressure 14.0, EPR 3 full time. It looks like you are already onboard for those settings but you do need to kill the ramp, or set it to a higher starting pressure and less time.

[zoraa]

Your sleep study chart was a study in flow limitation. That is the reason your breathing volume becomes depressed giving rise to hypopnea and oxygen desaturations.  As suggested by Bonjour, the solution for flow limitation is pressure support, or exhale pressure relief on your machine, which gives up to 3-cm of pressure support to your inspiratory effort.  Turn off the Ramp! you are sitting there for over 30 minutes with the machine idling at 4 cm pressure and that is going to undermine your comfort.

Minimum pressure 7.0, Maximum pressure 14.0, EPR 3 full time.  It looks like you are already onboard for those settings but you do need to kill the ramp, or set it to a higher starting pressure and less time.

This is incredibly helpful, thank you! Im definitely on board with all of the above. I turned off the ramp and set the levels as you and Bonjour suggested. We shall see how it goes

[zoraa]

Unfortunately haven't been able to get a good amount of data, keep falling asleep and taking the mask off shortly after in my sleep... argh

In the meantime, I had another question for the board. As mentioned previously i do have a deviated septum and am naturally a mouth breather at night. I've been trying desperately to use nasal pillows and mouth tape as I'd really prefer to breathe nasally, but I'm wondering now if using a full face mask might help me be more compliant

My question is, for UARS/flow limitation type issues, does mask type make a big difference?

Im sure this has been discussed, my apologies, tried to search but wasn't able to find specifically about mask type and UARS/flow limitation

Thanks so much!

[Sleeprider]

We have had a lot of new users that had problems keeping the mask on, subconsciously removing it after falling asleep. The good news is you're falling asleep, the bad news is obvious. We need to make the mask more difficult to remove without arousing you, and at the same time deal with your inclination for mouth breathing. A FFM may be a good solution, but first, do a search for the Knightsbridge dual band chinstrap. It may seem like a bit much, but it will help you to secure the mask and keep your mouth comfortably closed at the same time. At under $24 it is an economical solution that might help you get past this stage. If necessary you can put your mask straps under the cap and you won't likely take it off without being aware.

[ApneaQuestions]

.... but I'm wondering now if using a full face mask might help me be more compliant...
... does mask type make a big difference?...

I guess it may depend on how "blocked" your nose is. 

In the extreme case where no amount of stenting pressure can comfortably get air through your nose then avoiding that route and turning iinto a mouth-breather with a full-face mask may be the only option.

For me, The key word there is "comfortably". I think I am in that category even after septum surgery and a modest turbinate reduction so I use a full face mask. My nose continues to close off significantly whenever I get horizontal.