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[Pressure] Suggestions to optimize my results
#1
Suggestions to optimize my results
(Hopefully "pressure" is the right prefix...)

Hi All, 

I've finally gotten to a point where comfort and fit issues aren't waking me up too regularly, so I'm hoping to get some feedback on my OSCAR charts. I'm attaching two different nights, two screenshots each (since I can't get the last graph in without making everything very small). 

Some general observations: 
  • Historically-speaking (and outside of a one-time mask-related issue) max pressure stays below 17. Most nights it's just above 14.
  • Even though my ramp time says "45 minutes", the machine is set to "auto" - just checked again. I initially started without any ramp, and had issues falling asleep.
  • The "best" AHI that I've ever hit was around 1.9. Most nights are between 2.4 and 5, with occasional nights that hit 6 (or on very rare, rough nights just over 9).
  • I've noticed that, at least in my case, the "clear airway" number is more of a "general interruption" indicator: if I overheat, "clear airway" goes up ... if my wife tosses a lot during that night, "clear airway" goes up. I'm sure that there are some centrals included, but it seems like the S/N on that figure isn't as good.
Looking forward to "getting optimized"  Grin   Thanks!
                              
                            
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#2
RE: Suggestions to optimize my results
Hi there.  I think you should pay attention more to the median value of your highest pressure.  While there are indeed peaks at 14 cm, the median pressure, in the table box at left, suggests the machine is busiest at around 9-10 cm.  Also, your 'clear airway's, which are meant to be 'centrals', are few and ignorable.  Instead, I'm going to guess that all those obstructive spikes suggest something like a sag as you lose tone and fall more deeply into sleep.  This often means chin tuck....you get all warm 'n comfy, feel secure, fall deeply asleep, roll a bit mebbe, and next thing we both know, your chin is down nearer your chest and your airway gets constricted....some.  However, at least a couple of those light blue spikes show larger leaks concomitantly.  It could still be the chin tuck, but also mask deformation or displacement against an arm or the pillow, even off the mattress.

If you suspect chin tuck might be a good chunk of the problem, we recommend a soft foam 'cervical' collar available at medical supply stores, most large box stores, and on line for often quite a bit less...plus shipping.  They take some getting used to, mostly because they feel warm, so don't be dismayed.

I'm new here, so please wait while more experienced and knowledgeable people offer their opinions.
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#3
RE: Suggestions to optimize my results
Your EPR=3, set the min pressure to 7 (4 + 3) to fully utilize it then re-evaluate. You need a little boost in pressure, this is a little.
Fred Bonjour - Project Manager and Lead Tester for OSCAR - Open Source CPAP Analysis Reporter 
OSCAR

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#4
RE: Suggestions to optimize my results
Thanks for the suggestions! 

As far as chin tuck is concerned, right now I'm still wearing a chin strap (works pretty well, although I may again look into other options later). Hopefully most of the chin tuck is being eliminated. 

I bumped my min pressure to 7 last night - went okay. Going to give it a couple of days to "settle" before re-evaluating.
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#5
RE: Suggestions to optimize my results
chin straps help keep the mouth closed but often have the opposite of the desired effect w respect to chin tuck as they tend to pull the lower jaw back, further restricting the airway. maybe it's working for you but it sounds like there are indications in the data that it's not. for many folks a soft cervical works better.
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#6
RE: Suggestions to optimize my results
(07-19-2019, 10:20 AM)sheepless Wrote: chin straps help keep the mouth closed but often have the opposite of the desired effect w respect to chin tuck as they tend to pull the lower jaw back, further restricting the airway.  maybe it's working for you but it sounds like there are indications in the data that it's not. for many folks a soft cervical works better.
This.  From what I have been reading over many dozens of posts the past 19 months, the chin straps are meant to keep one from opening one's mouth and the dreaded accompanying 'dry-mouth' problem, or experiencing RERAs due to the expulsion of air from one's opened lips.  Even so, the results would merit a global B- grade in that respect (quite a few report marginal or no beneficial results from wearing chin straps, but a great many say that the straps saved their foray into PAP therapy).

The cervical collar keeps the chin from tucking....NOT the lips from opening.  In preventing the former, it also keeps the airway open.
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#7
RE: Suggestions to optimize my results
"The cervical collar keeps the chin from tucking....NOT the lips from opening."

I have a different take on this: the cervical collar helps reduce positional clusters of events by inhibiting chin tuck. as it happens, it also works very well to prevent jaw drop, and for reasons I can't explain it greatly reduces my lip leaks. not completely but by like 90% (to make up a number). mostly due to facial hair I have found no solution to mouth/lip leaks that works as well as the soft cervical collar.
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#8
RE: Suggestions to optimize my results
sheepless, it isn't a complete fix for you, and my father reports the same thing with a chin strap.  In fact, I think he's finally ditched it because it is unreliable at keeping his lips closed.  But for chin tuck, it has meant that my collar-wearing wife is still with me.  I use neither device; I tape.
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