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Seem to be moving backward
#11
So had a pretty good night last night. New pillow and it worked well. I have wondered about mouth leak. Going to try a chin strap tonight to see. Improved data last night, and Id be interested in any observations. Found AHI jumped when I slept on left side rather than right -

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#12
(11-19-2016, 01:08 PM)Sleeprider Wrote: You're using EPR at 1, and I was wondering if you have ever considered a higher exhale pressure relief?

I dialled it up to 3, with a view to seeing if this might make some difference. May be a bit of coincidence, or not, but numbers fell again after so doing.

(11-19-2016, 11:56 PM)Sleepster Wrote: [No dry mouth means nothing. Your leak rate graph shows signs that you are leaking, and my guess is it's mouth-leaks. Try a chin strap. If that doesn't work, a full face mask.

I borrowed and used a chin strap last night. Thought there might have been some leak even so, but that was first night, and I only got about four hours because of a late meeting. I think I will hold off posting graphs until tomorrow to give it a fair shot to see.

Thanks very much for your help.


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#13
Saskie, I was looking at sleep disruption, and just thought taking a chance on a bit more EPR might be a good thing for you. Glad it worked out. Everyone has their own needs and tweaks that seem to make this work better, and what works for you, may not be the thing for someone else.
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#14
(11-23-2016, 06:50 PM)Sleeprider Wrote: Saskie, I was looking at sleep disruption, and just thought taking a chance on a bit more EPR might be a good thing for you. Glad it worked out.

Tonight we are at day three with a proper pillow, day two with a chin strap, and day 30 with the machine.

Have been working with a temporary machine provided to prove out effectiveness. Tomorrow I go in to get my own.

Got an unexpected boost today. Read my insurance and my wife's, and both said they covered supplies only, and not machines. The DME said, "I know what they say, but last spring [the biggest municipal employee health plan in the province] put the heat on for full equipment coverage, and they provided it to keep the business, and since then they have extended the coverage to their other plans."

Sure enough, he's right. 80% coverage on my plan and the remainder on the wife's.

Hard to take, huh?
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#15
Since my last post I went in for my one month follow up. Results with the trial machine were sufficiently positive for them to issue me with a new machine (at my insurer's expense of course).

There is a part of me which is cynical and wondering if the new machine is measuring the same as the old. However -

At the last session, therapist looked things over, and decided to drop my max pressure from 17cm to 16 cm to see if that might help me sleep longer. Raised min pressure from 9cm to 10 cm. Put me back on auto ramp and asked me to not use a chin strap for a short while to set a baseline.

AHI dropped like a stone from 8-10 to 3.38 first night, 4.48 second night and 2.36 last night. First night, i somehow got up and fell asleep before getting the mask back on so missed a couple of hours. Am posting the last two nights below.

With the rock like drop, I am left wondering if it the change in approach or just the measurement, however, I have felt quite good the last two mornings.

If this looks bona fide - as I try to make the transition from sitting at the feet of the wise and asking questions, into reasoning and trying to help others - it looks to me that leaks sometimes but don't always coincide with waking, but that since the new machine leaks are in particular coinciding with hypopnea?

I also see the pressure flattening out at max, but that doesn't appear to be as linked to events?

Thinking, subject to suggestion, that I will stay on this course for a few days to consolidate gains and then try to address that lead again as was earlier suggested?

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#16
Your settings were changed just 3 nights ago, and your results have steadily gotten better since then. You might want to delay further changes for a few more days. In spite of lowering your maximum pressure, there is still no problem with obstructive events, and flow limitation is fairly low, so it appears you could further reduce maximum pressure. Your sleep pattern is very consistent with very short sleep sessions with breaks early in the night, then several longer periods of sleep. The machine is in ramp for 10-30 minutes in each session, then rapidly increases pressure from 7.0 to 16.0, then generally falling back to around 14.0. Although you have some major leaks, I don't think those are excessive unless you perceive them as disruptive to your sleep and a source of awakenings and discontinuation of therapy.

Why are you removing the mask and turning off the machine? Many of us awaken during the night, but just continue therapy until we fall asleep again. It would help to understand what's going on. This is not just disruptive to your sleep, but it is establishing a behavior pattern that will prevent you from getting good sleep. You need to consider why it is occurring.

You are back to EPR at 1. What happened? Last time you posted that more EPR was working.

What I am seeing in your most recently posted results is first of all, you need to continue using the therapy rather than breaking into over a half-dozen sessions. Breaking therapy is more disruptive, and reinforces a very disruptive pattern. I suspect ramp is either a problem, or that you need to prevent the pressure from climbing so high and disrupting your sleep. If you cannot tolerate higher ramp (or none), then I think a lower maximum pressure may help you even more than the 1-cm drop you already had. The setting changes you made 3 days ago show you may be responding better to a lower maximum pressure. The higher minimum pressure made no difference at all, because you are coming off ramp and immediately the machine rises to the maximum pressure, and it never falls back to 10. To minimize sleep disruption, I could see you reducing maximum pressure to as low as 14. As long as it does not significantly increase your OA, it may be a good trade for better sleep.


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#17
I'm somewhat experiencing a similar thing, I swore I wasn't leaking through my mouth because I never remember mouth breathing, especially in my sleep. As I've been more conscious about it, I've realized I may be leaking air through my mouth and I think it's usually when I end up on my back.
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#18
(11-28-2016, 10:34 AM)Sleeprider Wrote: Although you have some major leaks, I don't think those are excessive unless you perceive them as disruptive to your sleep and a source of awakenings and discontinuation of therapy.

I haven't seen them as such. Wondered if they might be contributing to waking, but leaking doesn't seem to be something I notice immediately when I wake.

(11-28-2016, 10:34 AM)Sleeprider Wrote: Why are you removing the mask and turning off the machine? Many of us awaken during the night, but just continue therapy until we fall asleep again. It would help to understand what's going on. This is not just disruptive to your sleep, but it is establishing a behavior pattern that will prevent you from getting good sleep. You need to consider why it is occurring.

Part of this was hose management. When changing sides, I just didn't figure out well how to do it. Have that figured out now.

Other reason - force of habit, in particular a perceived need to hike off to the washroom when awake to see if I could avoid that as a reason to wake later. Trying to work on that this week.

(11-28-2016, 10:34 AM)Sleeprider Wrote: You are back to EPR at 1. What happened? Last time you posted that more EPR was working.

Oddly just noticed that on Sunday, which was a horrible night. Woke up gasping almost. Took a look at the machine and realized it had been dialed back. I think that likely happened when I traded in my "loaner" for the new machine last week. Have reset. Not sure why I didn't notice earlier.

Thanks for all this Sleeprider. Very much appreciated.

Always grateful for help received. I am a part of all that I have met.
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#19
(11-28-2016, 12:43 PM)sleepyguy99 Wrote: As I've been more conscious about it, I've realized I may be leaking air through my mouth and I think it's usually when I end up on my back.

One theory is that if you lie on your back the machine will need to raise the pressure to clear the obstructed (or partially obstructed) airway. You can check the graphs and see if the periods of increased pressure coincide with the periods of elevated leak rate.

The higher the pressure the greater the likelihood of a mouth leak.

Do you wear a chin strap? Have you tried a full face mask?

For years I thought I would have trouble adapting to a full face mask because I'd had so much trouble adapting to a nasal mask. But as it turns out, a couple of years of wearing a nasal pillows mask entirely prepared me for a full face mask.


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#20
Settled back in on Tuesday night. After a couple of nights higher, it seems to have settled into the sub 3 numbers again.

Tried to work on interruptions but a bad night for that. Though the chart says no ramp, I did set it to 5 minutes for most of the night.

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