Observations, Aerophagia, Pillows/vs Mask

[PappinLikeABoss]

Quickly:
Dx severe only on my back, only during Rem. All else WNL

Dr. suggested tennis ball in a sports bra to avoid rolling over. Was extremely uncomfortable.

Then suggested dental device, but I insisted on Pap.

Tried FFM, got the cushy comfy liner, leaks were worse and unable to fix. Revisited pillows that I had ditched after one night with a new attitude.

Now with the pillows, I have been trying tongue technique, which in the middle of the night goes south. I sleep with a chin strap and a piece of vertical tape at the center of my lips.

1. Air blows out both sides of my mouth, when it is closed, enough to wake me up.
My gut tells me this is hindering treatment efficacy, as my events are next to
nothing, one night 0.0, another .51 for example. For perspective my AHI on the
FFM is about 1.5

2. The pressure on the FFM varied 7-10 during the night with more events.
The pressure on pillows is almost steady at 7 or so, with hardly any events.


Questions:

You think CPAP Is this overkill? I really pushed for it, because I had an unexplained PE that put me in the hospital for 5 days last year, horrible insomnia for years, and a cognitive mess. (which is much better btw) My father has OSA so I believed I was dealing with a hereditary factor.

Any comments on whether I should just go backwards and try a dental device? The DME said they hurt. Ok, well that's subjective IMO. Dental devices don't make them money (as I've now figured out)

Are my numbers down on pillows because of blowout? So if I don't fix that blowout, my machine is missing events? That's my big question.

Any advice is welcome, and thank you for reading.

[OpalRose]

Post a couple screenshots of your data. Include the following graphs: events, pressure, flow rate, leak rate. Also include the detailed data on left. You can get rid of pie chart and calendar.

Did you have a sleep test and titration? What was your untreated AHI?
Cpap isn't overkill if you need it.

[PappinLikeABoss]

Post a couple screenshots of your data. Include the following graphs: events, pressure, flow rate, leak rate. Also include the detailed data on left. You can get rid of pie chart and calendar.

Did you have a sleep test and titration? What was your untreated AHI?
Cpap isn't overkill if you need it.

Yes, had a sleep test. I am obtaining a copy of my AHI now, (i know should have done it before.) I was told it fell into the severe range.

I can do the screen shots no problem, but I need to figure out on the Mac how to make it a clickable thumbnail-I will use IMGR if that works..I'll post later today-have to go to work. Thanks for responding

[PappinLikeABoss]

Post a couple screenshots of your data. Include the following graphs: events, pressure, flow rate, leak rate. Also include the detailed data on left. You can get rid of pie chart and calendar.

Did you have a sleep test and titration? What was your untreated AHI?
Cpap isn't overkill if you need it.

Yes, had a sleep test. I am obtaining a copy of my AHI now, (i know should have done it before.) I was told it fell into the severe range.

I can do the screen shots no problem, but I need to figure out on the Mac how to make it a clickable thumbnail-I will use IMGR if that works..I'll post later today-have to go to work. Thanks for responding

===============================
FFM:

Statistics
Channel Min Med 95% Max
PressureTherapy Pressure (cmH2O)
W-Avg: 8.49 4.22 8.42 10.32 11.00
Minute Vent.Amount of air displaced per minute (L/min)
W-Avg: 5.42 0.00 5.25 7.00 20.75
Resp. RateRate of breaths per minute (Breaths/min)
W-Avg: 16.93 0.00 17.00 19.80 35.00
Flow Limit.Graph showing severity of flow limitations (Severity (0-1))
W-Avg: 0.01 0.00 0.00 0.00 1.00
Leak RateRate of detected mask leakage (L/min)
W-Avg: 1.80 0.00 1.20 7.20 32.40
SnoreGraph displaying snore volume (?)
W-Avg: 0.00 0.00 0.00 0.00 0.18
Insp. TimeTime taken to breathe in (Seconds)
W-Avg: 1.41 0.44 1.32 1.98 6.52
Exp. TimeTime taken to breathe out (Seconds)
W-Avg: 2.18 0.10 2.22 2.77 5.44
Tidal VolumeAmount of air displaced per breath (ml)
W-Avg: 322.72 0.00 300.00 440.00 1240.00

Total time in apnea 00:01:41
Time over leak redline 0.007%

===============================
Pillows:

Statistics
Channel Min Med 95% Max
PressureTherapy Pressure (cmH2O)
W-Avg: 8.11 7.00 7.84 9.70 10.28
Minute Vent.Amount of air displaced per minute (L/min)
W-Avg: 6.34 0.00 6.25 7.62 18.12
Resp. RateRate of breaths per minute (Breaths/min)
W-Avg: 17.26 0.00 17.40 20.00 26.40
Flow Limit.Graph showing severity of flow limitations (Severity (0-1))
W-Avg: 0.00 0.00 0.00 0.00 0.83
Leak RateRate of detected mask leakage (L/min)
W-Avg: 3.91 0.00 3.60 9.60 84.00
SnoreGraph displaying snore volume (?)
W-Avg: 0.00 0.00 0.00 0.00 0.38
Insp. TimeTime taken to breathe in (Seconds)
W-Avg: 1.53 0.12 1.46 2.12 8.04
Exp. TimeTime taken to breathe out (Seconds)
W-Avg: 1.97 0.58 1.96 2.64 5.30
Tidal VolumeAmount of air displaced per breath (ml)
W-Avg: 372.70 0.00 360.00 540.00 1420.00

Total time in apnea 00:00:11
Time over leak redline 0.076%



===============================
link to screenshots:
https://www.dropbox.com/sh/osx7nzbrfh3du...ex3Da?dl=0

Set1: FFM AHI: 1.01
Set2: Pillows AHI: .15

[archangle]

There's a Youtube video in my Useful Links at the bottom of this post with info on a technique to reduce aerophagia.

In my opinion, CPAP is MUCH better than dental devices for most people. Success rate is higher. A modern CPAP will tell you if it's curing your apnea. With a dental device, there is no feedback. Dental devices can cause jaw problems, especially TMJ problems. Dental devices tend to give less complete reduction of apnea, and do nothing for some people.

However, if you can't make CPAP work, some people get success or improvement with dental devices.

[OpalRose]

Well no doubt you have a high leak rate with the pillows compared to the FFM..
The high leak rate can affect therapy, Your AHI may not be accurate with the pillow mask.

But you also have a low AHI using the FFM. 90% pressures on both masks are close, with the FFM being a little higher. It is normal when wearing a FFM, that a slightly higher pressure is needed.

Only you can decide what mask is most comfortable. If you like the pillows, you will have to work on the leaks. If you don't feel that's possible, then stick with the FFM.

Now reading your post, I get the feeling your real question here is should you use a dental appliance instead of using Cpap. No one can answer that except you.

If it were me, I would give Cpap a chance to work. Your AHI readings are very good, which means therapy is working. Finding a mask that is comfortable and one that you can control leaks should be your priority.

[PappinLikeABoss]

There's a Youtube video in my Useful Links at the bottom of this post with info on a technique to reduce aerophagia.

In my opinion, CPAP is MUCH better than dental devices for most people. Success rate is higher. A modern CPAP will tell you if it's curing your apnea. With a dental device, there is no feedback. Dental devices can cause jaw problems, especially TMJ problems. Dental devices tend to give less complete reduction of apnea, and do nothing for some people.

However, if you can't make CPAP work, some people get success or improvement with dental devices.

thank you!

[PappinLikeABoss]

Well no doubt you have a high leak rate with the pillows compared to the FFM..
The high leak rate can affect therapy, Your AHI may not be accurate with the pillow mask.

But you also have a low AHI using the FFM. 90% pressures on both masks are close, with the FFM being a little higher. It is normal when wearing a FFM, that a slightly higher pressure is needed.

Only you can decide what mask is most comfortable. If you like the pillows, you will have to work on the leaks. If you don't feel that's possible, then stick with the FFM.

Now reading your post, I get the feeling your real question here is should you use a dental appliance instead of using Cpap. No one can answer that except you.

If it were me, I would give Cpap a chance to work. Your AHI readings are very good, which means therapy is working. Finding a mask that is comfortable and one that you can control leaks should be your priority.

Thank you for taking the time to look at my stats, I'm grateful for that.

I had thought about the lack of stats with the dental device. That was a drawback.

Knowing that the pillow is leaking that bad confirms what i thought - that the blowout or air swallow is affecting the therapy. It doesn't "feel" like a leak, but air coming out the mouth can't be good. I'll keep trying.

[OpalRose]

Don't give up on the Tongue technique. It took me a couple of months to perfect it, and I had to use a chin strap at the same time. I know it doesn't work for everyone.

Sometime it means trying different chin straps. And your right, air coming out of your month isn't good. It's horrible! It leaves your mouth feeling like cotton, not to mention the detrimental effect on your teeth and gums if that goes on long term.

Good luck in your decisions.

[Sleepster]

It doesn't "feel" like a leak, but air coming out the mouth can't be good.

Check your leak graph. If you extended periods of time where the leak rate is high then that's a sign that you're mouth-leaking. When that happens the CPAP machine can't maintain the pressure splint and your airway can collapse just as if you're not using a CPAP machine at all. And the CPAP machine can't reliably determine if you're having an apnea, either, so things like the reported value of the AHI are unreliable.

Try different types of full face masks, even if you have to alternate between them on different nights. After a while you will settle into it and get adapted to a single mask that you like. It just takes time.