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advice to fine tune sleep
#1
advice to fine tune sleep
Hi all.
First off, it has been quite the learning experience reading the posts here on this forum and would just like to say thanks in advance as I know I am already starting to sleep better by following some of the excellent advice on this forum

Now a little bit about me. I am 47 year old male from the east coast of Canada. I currently am 160 lbs, 5'6", no medication, gym most days at lunch, very good eater and I have the occasional glass of wine. Oh yes, never smoked or did any drugs of any kind. I have had sleep apnea for about 13 years and have up to now, always been on straight 13 pressure, no variation at all. I  just assumed that the machine and the pressure they gave me was correct and blindly followed it for many years. As of late, I have been wondering why I am tired and cranky which is affecting my relationship with my wife and kids so I decided to evaluate my life and realized that my sleep is one variable I have never changed and perhaps I should, which led me here to this forum and to discovering sleepyhead. I discovered that in the last 6 months (according to my SD card) that I have had only 5 days with an AHI under 5. Other than that it varies from as low as 3.5 to 22.


Now, since I started using sleepyhead, and reading as many posts in this forum and others, I have started to make adjustments that I think may be beneficial. Here are the ones I have tried,
  1. I switched from straight 13 CPAP to 14-16 APAP to see if I that would help. Narrowed it down from 13-20.
  2. I removed flex from 3 to off. I can handle the starting pressure at 14 with no ramp, no problem.
  3. Humidity is set at 3.
  4. I also have started using positional sleeping by placing a large pillow behind my back as I am a side sleeper and a active roller(working on that)
  5. I recently bought a cervical collar and have worn that for the last 3 nights. Alot more comfortable than I would have thought. It stays.
  6. I bought Lanisoh Lanolin and have used that the last 2 nights. Feels like it working but I still have issues.

May try a chin strap as I occasionally mouth breath. Not sure how bad though. Some days I have dry mouth, other days I am fine. More good than bad for dry mouth. I am trying the "tongue suck" technique throughout the day.

At night, I find that I tend to wake a lot and move around a lot. Hoping pillow in back helps with moving.
My main issue at the moment is that I cannot get my nasal mask to not leak during the night. My wife tells me that it is leaking at night and she will usually shift my pillow to get it to stop. I have tried all 3 sizes, currently use large, and have tried loosening and tightening the straps with no success yet. Still trying and using the Lanolin. Work in progress I guess. I really don't want to move away from the P10 as they are so quiet and so comfortable, (when not leaking). May need to change to a new set of pillows as I think they are a few months old.  
Once tried a nasal mask and did not like that at all. Never tried FFM but am open to trying either that or a different nasal pillow.
So I am just wondering, based off of chart data, if fixing leaks would help get AHI down, help me sleep through the night, everyone goal, and would that lower things that are flagged, like centrals, hypopnea, etc.  
My personal feeling is that if I can stop the leaking, then some flags should disappear and perhaps I may be able to lower the pressure, even thought it does not bother me now.
Any other help guidance would be appreciated. 
Thanks again.
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#2
RE: advice to fine tune sleep
At 14-16 your events are evenly divided among CA, OA and H events. Leaks are not a factor with therapy, but may be a comfort issue. You're not using Flex, and that might be more comfortable. I would start at a setting of 1 and see if it suits you. Based on snores, flow limits and the OA and H events you seem to need more minimum pressure. I would just leave the maximum at 16 for now and try increasing minimum by .5 cm. The events seem to be responding well to the higher range of your pressure settings, so no need to move too quickly, but I think higher minimum is what you need...or a Resmed Autoset Smile
Sleeprider
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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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#3
RE: advice to fine tune sleep
Thanks Sleeprider

I will try 14.5-16 tonight, flex at 1 and see how that goes. I tried starting at 15 a couple of times but it felt like to much pressure in my mouth.
When I get a chance I will call and inquire on when I am eligible for an upgrade machine wise and mask wise and see if I can make that transition.
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#4
RE: advice to fine tune sleep
If you find you may be qualified for a re-evaluation, you are right on the cusp of a bilevel. You would be treated much better and more comfortably using bilevel treatment. I really don't like the efficacy results I see from more challenging patients using the Philips Respironics auto CPAP. It just doesn't give us the flexibility to use the bilevel pressure we see in the Autoset to deal with issues like yours such as hypopnea, flow limits and snores.
Sleeprider
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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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#5
RE: advice to fine tune sleep
[b]Sleeprider[/b], how would an AutoSet help?

Kosoku, I'm amazed (and chagrined (but not jealous; the help I've gotten here has lifted me to a very good level)) at what you've accomplished! Kudos, and good wishes for rapid progress.

I'm curious why you're using Lanisoh Lanolin -- is your mask hurting your nose that bad? If so, is it because you have it so tight trying to eliminate leaks?

I'm like you inasmuch as leaking is a problem. I'm a "side-sleeper" and though I don't toss and turn much I do roll over sometimes. However, I find myself moving my face a lot when I'm falling asleep and some when I'm waking. I suspect I'm shifting my mask or the pillows then. I'm working on implementing a chin strap to prevent occasional mouth breathing. (I don't know that I am, and my AHI is great but I occasionally wake with a dry mouth -- sometimes cheeks/gums, and even tongue stuck.) I'm going to have to make my own with the cap-and-strap devices several users have described.

Please keep us informed of your progress; the encouragement really helps, and in my case, the learning is continuous.
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#6
RE: advice to fine tune sleep
Um... Sleeprider, how would an AutoSet help?

Kosoku, I'm amazed (and chagrined (but not jealous; the help I've gotten here has lifted me to a very good level)) at what you've accomplished! Kudos, and good wishes for rapid progress.

I'm curious why you're using Lanisoh Lanolin -- is your mask hurting your nose that bad? If so, is it because you have it so tight trying to eliminate leaks?

I'm like you inasmuch as leaking is a problem. I'm a "side-sleeper" and though I don't toss and turn much I do roll over sometimes. However, I find myself moving my face a lot when I'm falling asleep and some when I'm waking. I suspect I'm shifting my mask or the pillows then.  I'm working on implementing a chin strap to prevent occasional mouth breathing. (I don't know that I am, and my AHI is great but I occasionally wake with a dry mouth -- sometimes cheeks/gums, and even tongue stuck.) I'm going to have to make my own with the cap-and-strap devices several users have described.

Please keep us informed of your progress; the encouragement really helps, and in my case, the learning is continuous.
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#7
RE: advice to fine tune sleep
Hi ShaunBlake

I am using the Lanolin mainly because of the results of my google searches. An extremely high percentage of threads I found have the OP stating that lanolin helps stop the leaks with the P10 nasal mask. So, I figure what is there to lose and tried it. I think it seals a bit better, can be a bit messy and still need to work out amounts needed, but all in all, no harm no foul in trying and extremely low cost and no side affects. Nose is soft in the morning now.
As for my nose, I was getting 0% issues with chaffing, rubbing, soreness, discomfort, etc prior to using Lanolin. The P10 was never to tight or to lose but I believe it was shifting due to my movement so the Lanolin became another step in the never ending quest for a good solid sleep.
I to am a side sleeper, roll a bit when restless(often), with the occasional mouth breathing. If I can make a chin strap or even find one locally, then I will give it a shot. May even try a CPAP pillow but I do love my new GelCool pillow.
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#8
RE: advice to fine tune sleep
How would an Autoset help?

Read a few thousand posts on this forum and observe the machines that people having problems are using. By far the Philips Respironics machines yield higher apnea and hypopnea, and offer no solution, other than higher pressure, to resolve. With the Autoset, we have an auto CPAP with faster response allowing lower pressure, and up to 3-cm of effective bilevel pressure support. I can coach users to lower minimum pressure settings, with up to 3 cm of exhale pressure relief, and achieve much better efficacy than is possible with the use of Philip's product. With a Philips Respironics, all you can work with is pressure, and Flex is unpredictable in its effect. With Resmed, I can suggest conventional bilevel titration protocols and achieve better results with many users. For those that need fixed steady pressure, there is no difference, but when dealing with UARS, flow limitation, snores, hypopnea and even some respiratory volume issues, the flexibility offered by the Resmed is incomparable.
Sleeprider
Apnea Board Moderator
www.ApneaBoard.com

____________________________________________
Download OSCAR Software
Soft Cervical Collar
Optimizing Therapy
Organize your OSCAR Charts
Attaching Files

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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#9
RE: advice to fine tune sleep
Kosoku, FYI, I used Lanisoh Lanolin at first - P10 was my first mask and I haven’t looked back. However, after a few weeks I was still getting leaks, and cleaning the cushions didn’t help. After about two months I replaced the cushion and stopped using the Lanisoh Lanolin, and leakage significantly decreased. My theory is that after a couple months my nose toughened up to the point that lanolin was no needed and at that point was only somehow degrading the cushion in my original mask. So my suggestion is that if you decide to replace the cushion, try it for a couple of nights without the lanolin and see if that makes things better. Good luck!
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#10
RE: advice to fine tune sleep
To help with your P10 leaks try some hose management.  You say you are an active sleeper, you need to keep the short mask hose "near" your mask without it being pulled.  I found the weight of the CPAP hose hanging off my bed was enough to cause very significant leaks.  Your leaks are well within parameters for your machine, unlike mine.  I use a velcro strap around the end of the CPAP hose attached to a clip which I attach to my collar or my pillow. Others use a lanyard they attach to the headboard.  

Fred

PS as SR said the AutoSet would not be a bad choice.
Fred Bonjour - Project Manager and Lead Tester for OSCAR - Open Source CPAP Analysis Reporter 
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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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