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Questions about re-starting therapy, researching before doctor visit
#51
Okay, thanks folks.

My doctor had wanted me to be at a fixed pressure of 7 so I guess I will bump that up to 9 for for a couple of nights and leave EPR at 2. If I have CA events, I might try doing without EPR and going back to 7. 7 is the level I titrated at in my sleep study.

I won't use the P10 pillow for a couple of days while my nose heals. It hurt quite a bit the past two mornings (even with the medium, that's why I switched to large in the first place).

I had my charts organized per the guide once but I guess that changed when I started using a new machine, will go back and adjust.

Overall, my results have been good but I felt lousy last night and I have had more events the past couple of nights. I see the charts of some others and understand things can be much worse than I have it but I don't sure want better than what I had last night.
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#52
Remember to adjust the straps waaaaaaaaaay wide apart when you do try the P10s again. A lot of folks make the mistake of putting them too close together which really makes them way more tight than is needed. I spread mine very far apart. The lower one is basically as low as it will go and the top one is very near the crown of my head. They really do not need to be very tight at all once the machine starts going. For the first few times, use the bathroom mirror to check your fit and remember to keep the straps wide apart! Use a good cream on your nose to help the healing in the meantime. It won't take long.
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#53
Thanks, I have done both of those things already.
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#54
I wonder if your setup is causing the mask to be pulled to one side...sure sounds like it. I use a hose holder made of metal that I purchased through Amazon. It holds the hose straight up above my head and the hose sits in a loop with a bungy type attachment so that it can swivel and give some slack as well as stretch if I turn side to side. Ever since I got that, I never have any problems with the hose pulling from one side and irritating either side of my septum...might be worth a look for you.
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#55
I do have something on order to help with hose management but I'm pretty sure the problem is just that my septum is deviated, it obstructs my left nostril somewhat. I had surgery for it 18 years ago and it improved it but not as much as I thought it should have been for the pain I went through (mostly because the idiot doctor constructed his own splint that had a sharp edge that was cutting into me for a week although his yanking out of the gauze at the end of the week literally felt like he just pulled my lungs out through my nose...and he laughed).
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#56
Yikes! That guy sounds like a nightmare. Keep us posted as to how things work out. All the best!
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#57
Okay, time for an update.  My septum is healed and I wore the P10 for the past three nights.  I had problems Thursday night with my mask being pulled to the side and had quite a few large leaks so I developed a hose management device (separate thread for details) and used that the past two nights.  I still had some leaking Friday night so last night slept with the straps a bit tighter and had good results.

Interestingly, most of my events last night were in the first 30 minutes.  Why might that be the case?

Also, I'm curious, please help me understand what was going on from 4:40-4:52.

Friday night's results were similar except for the LLs.  Overall, I feel much better during the day.  I do still yawn some of the time during the day, though I'm often only getting 6 hours of sleep, feeling good today after getting more sleep than I've had in a long time.  One interesting thing I noticed is that my shoulder blades (inside edge of them) would always hurt in the morning when I awoke but not since starting PAP.

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#58
Congratulations! Those look like really good numbers. Aside from that one leak you had which wasn't even all that extreme. Your results look stellar to me. Why those events occurred in the first 30 minutes...well it could be that you were just starting to fall asleep and your breathing wasn't quite normalized. It's a period that can result in what is commonly referred to as "sleep/wake junk" data. That period between sleep and being awake when your breathing has not quite normalized yet. I would say collect some more days of data but your numbers are enviable by many folks already.

As to what happened between 4:40-4:52, I would say perhaps you went through a period of REM sleep and you were dreaming thereby causing your breathing to become irregular and your breath intake happened during a period when the machine expected you to exhale. Until the machine adjusted and realized where your breaths were occurring. That is what I suspect. Perhaps some other experienced members here could comment further on it. But I get them occaisonally too.

Overall you are doing great! I hope you get your hose management system sorted out so that you get less pain in your septum. Ever since I purchased my hose holder from Amazon and it holds the hose straight up above me, I don't get any more pain on the side of my nostrils.
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#59
Update - overall, therapy has gone pretty well.  In about a month that I've been under therapy maybe 1 or 2 nights had an AHI above 1.  I like how quiet the P10 nasal pillow is but it continues to hurt my left nostril because of a deviated septum.  This is even with the straps spread apart to loosen it and using lanolin.  I think it's just the pressure against the septum that makes it hurt, no so much of an irritation.  I am using the medium pillow.  I tried the large one night and that did not work out.  Maybe I'll try small tonight.

I've had some leakage issues some nights and have tended to keep the straps tighter if I've awoken with leaking problems but that increases the pain on my septum.  I think I've been moving quite a bit during my sleep as I get uncomfortable after being in one position for a while.

Based on advice given in earlier feedback in this thread, I've mostly been using a setting of 9-11 with EPR of 2 and no ramp.  In my sleep study follow-up my doctor had stated I should be at a pressure of 7 constant and stated that APAP is not best for everyone.  I did feel rested after the night of my sleep study, better than what I've felt since then to be honest.  Maybe part of that was the expectation of a tough night sleeping like in the prior sleep studies 10 and 11 years ago.  I did need an afternoon nap once this past week but should try to get more hours of sleep, just got too many things keeping me busy for now.  I decided to try using a fixed setting of 7 with no EPR to see how that worked out and if leaks were less of a problem and if maybe I could keep my straps loose all the time and if that would help with septum pain.  Also, I have a follow-up appointment with my sleep doctor next month and figure I better be prepared to show why I ignored his prescribed setting.  I think it seems to have worked out okay, though septum pain is still a problem.  I may try to stretch out the straps but will first try the small pillow size tonight.

The charts below include 2 nights with the pressure of 9-11 and EPR of 2 then the past 3 nights with a fixed pressure of 7 with no EPR.  On the second night of my fixed pressure of 7 I had my first ever RE show up on my chart.  I'd appreciate your thoughts on how this looks to you.  Thanks!

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#60
Have you tried the nasal masks like the Eson or the N10? They surround the nose. That might relieve pain on your septum. The P10 being a fall back then because your numbers are excellent. Concentrate on comfort now.

Fred
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