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Newbie in need of help
#21
RE: Newbie in need of help
(12-23-2019, 06:48 PM)bonjour Wrote: I am a big proponent of nasal masks, I use the P10 and used to be a "full-on" mouth breather. 
Bonjour how did you get the air to stop entering your mouth? I know about the tongue trick but it won’t stay there while I’m asleep.
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#22
RE: Newbie in need of help
If you have nasal congestion, then a reasonable experiment would be to try Afrin nasal spray just for short-term relief. you will need to find something else like Flonase for a long-term solution, but we can see immediately if it helps. A soft cervical collar can support the back of the jaw and encourage a good mouth position to stop leaks. Your leak problem is not bad in this graph, but it's only 2-hours of therapy time.

Try the Afrin. If you really find exhaling against CPAP pressure is a problem then you should talk to your doctor about a bilevel for greater comfort and direct treatment of the flow limitation. Another option is to lower the maximum pressure. You are not having obstructive apnea. I don't think a maximum pressure of 10.0 will interfere substantially with the efficacy of your therapy and it may be more comfortable.

I'd like to see a zoomed in view of a 2-minute segment of the flow rate. That will show the individual flow waves and will do more to help us understand what your problem is with inspiration or expiration than just talking about it.
Sleeprider
Apnea Board Moderator
www.ApneaBoard.com

____________________________________________
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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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#23
RE: Newbie in need of help
The tongue trick. It took me a long time, but it worked.
I taped my lips (not trying to stop the mouth from opening) just to provide an air seal.

Some exercises I did.
1. While under pressure, awake, and with the tongue of the roof of the mouth, CAUSE A MOUTH LEAK. This way you will learn better what causes it. Then try to stop that mouth leak by moving your tongue back into position. You likely will fail for some time, maybe weeks, maybe months so try than turn the machine off and re-establish the seal.
2. Talk while under pressure. It will be difficult at first and improve over time.
3. Take a drink. I suggest with a straw at first. If your mask allows, try drinking from a glass once you get the swallowing down.

This is about learning the new environment and practicing in it.
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#24
RE: Newbie in need of help
(12-23-2019, 06:48 PM)bonjour Wrote: I am a big proponent of nasal masks, I use the P10 and used to be a "full-on" mouth breather.  BUT I don't have any major structural issues with any part of the airway.

BUT the right mask is always the one that works for you.  With an FFM, when side sleeping try to position the pillow so that your masks hang over it so the pillow itself doesn't dislodge it..  Also use a CPAP Hose clip to attach your hose to your pillow or PJs so you do not have the full weight of the hose trying to dislodge it.

Try the masks under pressure (bring your machine) while you are relaxed as possible and lying down in a sleeping position, for you try both sides and on your back.

Really great to hear that you and harrywr2 (and I'm sure many others) were able to switch to nasal breathing at night, I really hope I can get there! I do have the structural issues, but I also am able to breathe through my nose for a couple hours before I've been taking it off, so I'm still holding out hope I may be able to stick with the nasal mask

Osiris357's earlier comment got me rethinking my strategy... I was hung up on my nasal airways, thinking they were the main culprit, but now I'm thinking I may need to focus on keeping my jaw from falling back. Just picked up a soft collar and am going to see how that goes

Though if I do end up needing to switch to FFM, these suggestions are super helpful, thank you!
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#25
RE: Newbie in need of help
(12-23-2019, 07:34 PM)Sleeprider Wrote: If you have nasal congestion, then a reasonable experiment would be to try Afrin nasal spray just for short-term relief. you will need to find something else like Flonase for a long-term solution, but we can see immediately if it helps.  A soft cervical collar can support the back of the jaw and encourage a good mouth position to stop leaks. Your leak problem is not bad in this graph, but it's only 2-hours of therapy time.  

Try the Afrin. If you really find exhaling against CPAP pressure is a problem then you should talk to your doctor about a bilevel for greater comfort and direct treatment of the flow limitation.  Another option is to lower the maximum pressure. You are not having obstructive apnea. I don't think a maximum pressure of 10.0 will interfere substantially with the efficacy of your therapy and it may be more comfortable.

I'd like to see a zoomed in view of a 2-minute segment of the flow rate. That will show the individual flow waves and will do more to help us understand what your problem is with inspiration or expiration than just talking about it.

This is great, thank you. I just picked up a soft collar and am going to try it tonight.

Honestly I don't feel like I have a ton of congestion, more just a really narrow airway on my right side (from the deviated septum) but I'm also wondering if I may not even realize I'm congested. Definitely will try your recommendation and see how that goes

I thought I did have a couple of obstructive apneas (in the last charts I sent), but I may be misreading? Though my understanding is that's not really considered significant, and I'm wondering if the soft collar will help with that, since my jaw  tends to fall back

Planning to touch base about the bilevel for sure if the next few experiments aren't successful... seems like it could really be a better option.

Jumping on my laptop now to send the zoomed in charts,  thank you so so much for your help!
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#26
RE: Newbie in need of help
(12-23-2019, 07:34 PM)Sleeprider Wrote: I'd like to see a zoomed in view of a 2-minute segment of the flow rate. That will show the individual flow waves and will do more to help us understand what your problem is with inspiration or expiration than just talking about it.

Attached a couple of versions for you... wasn't sure if including some other charts in addition to the zoomed in flow rate would be helpful, so I put together a couple of options

I picked the 2 minute segment where the flow limitation was around its highest (0.31)

Happy to send additional info or reorganize if needed! Thank you again


Attached Files Thumbnail(s)
       
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#27
RE: Newbie in need of help
(12-23-2019, 07:34 PM)Sleeprider Wrote: I'd like to see a zoomed in view of a 2-minute segment of the flow rate. That will show the individual flow waves and will do more to help us understand what your problem is with inspiration or expiration than just talking about it.

As I was exploring the flow rate I realized it looks a lot different (at least to me) a little later down the line (without much flow limitation this time, but shortly before a hypopnea)... thought I'd send this other 2 minute segment, just in case that's helpful

Can you give any pointers as to what to look for with the flow rate? Apologies if this info is available elsewhere, haven't been able to find


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#28
RE: Newbie in need of help
Zoraa I’m sorry I’m completely missed your post from 5 hours ago. I think your question was already answered but flow limitations are mainly caused by soft tissue falling back and partially blocking the airway. 

I have a soft cervical collar but it is very uncomfortable but it does it’s job of getting rid of flow limitations and flow limited breathing that don’t quite meet the criteria for flow limitations  from your chin going to your chest. I have a Dr. Dakota neck pillow on order from WalMart but it’s taking forever to get here because of the holidays. Not expected till the 30th and I’m anxiously awaiting it.

I’m glad my thread has helped you. Read as many as you can that you feel pertain to your situation and even some that don’t because sometimes they hold the key you haven’t found yet. Do that along with the help of the experts on settings and therapy and you’ll be successful with this sooner rather than later.

Good luck, any questions just ask and someone will either answer or point you in the right direction.
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#29
RE: Newbie in need of help
(12-23-2019, 11:00 PM)Osiris357 Wrote: Zoraa I’m sorry I’m completely missed your post from 5 hours ago. I think your question was already answered but flow limitations are mainly caused by soft tissue falling back and partially blocking the airway. 

I have a soft cervical collar but it is very uncomfortable but it does it’s job of getting rid of flow limitations and flow limited breathing that don’t quite meet the criteria for flow limitations  from your chin going to your chest. I have a Dr. Dakota neck pillow on order from WalMart but it’s taking forever to get here because of the holidays. Not expected till the 30th and I’m anxiously awaiting it.

I’m glad my thread has helped you. Read as many as you can that you feel pertain to your situation and even some that don’t because sometimes they hold the key you haven’t found yet. Do that along with the help of the experts on settings and therapy and you’ll be successful with this sooner rather than later.

Good luck, any questions just ask and someone will either answer or point you in the right direction.

Thank you so much for all your insight, it's been incredibly helpful. I am really thinking my jaw positioning may be a huge factor. As mentioned before I tried an oral appliance that held my jaw forward, didn't notice much improvement, but even just sleeping for a bit last night with the soft collar I already think helped a lot

I agree it is a bit uncomfortable, going to try it out for a while but I do like the sound of the Dr. Dakota pillow. Seems like it could be a lot more comfortable. Sorry you have to wait for it Sad agh... that's frustrating. But I really hope it works for you! Will keep an eye out for your review

I was able to fall asleep with the soft collar on and nasal pillows in, but unfortunately my dog decided to bark like a maniac at something outside lol, after I woke up I could not fall back asleep with all the gear on no matter how hard I tried. But even that short amount of time I was asleep already looked a lot better

I also found the wiki on flow limitations which has been really helpful. And as you said, all the great info from the threads and the experts has been a game changer. Fingers crossed I can finally find the magic combination that works for me lol
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#30
RE: Newbie in need of help
Good job on the zoomed charts. The first set of charts show a pretty classic moderate inspiratory flow limitation with no evidence of expiratory flow limit. This just means that your respiratory effort is insufficient to overcome resistance in your upper airway and so the flow rate reaches a peak flow that is less than an unobstructed or free-flowing airway. This is why the peak flattens ahead of expiration. The cause of the airway restriction can be any number of causes from nasal congestion to physical limitations. It can be remedied by assisting the airway through use of decongestants, soft cervical collar, surgery etc. or using more inspiratory pressure support as in bilevel.

The second set of charts looks like arousal or awake breathing. We are often not aware of or remember periods when we're awake at night, but breathing is not on the autonomic nervous system and this is what it looks like.
Sleeprider
Apnea Board Moderator
www.ApneaBoard.com

____________________________________________
Download OSCAR Software
Soft Cervical Collar
Optimizing Therapy
Organize your OSCAR Charts
Attaching Files
Mask Primer
How To Deal With Equipment Supplier


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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