getting rid of air in my mouth

[howeyb]

Continuation of post above - this is the last attachment of my overview graphs. You can see that the flow limitations have gone down since my pressure was raised from 8 to 12. Is some flow limitation normal or do I need to get this reduced further (in light of my still fragmented but getting better sleep)?

Thx

[sheepless]

there may be an answer to your question about degree of flow limitation on this site but I haven't seen it. I have no good basis for my answer other than hanging around here for a couple years so I'm going to say it in the hope that someone with more info will either confirm or correct me.

it's my sense that if the 95% flow limitation statistic is anything other than zero, it warrants closer attention. obviously, closer to zero is less concerning than higher numbers. how you feel is an important factor.

fragmented sleep and/or continuing to feel poorly are good reasons to fix them or rule them out as a problem.

I'll leave the practical guidance on how to handle flow limitations to the more experienced members. it's also my impression that what helps flow limitations may aggravate ca and vice versa, but the ca I saw in a recently posted chart was all but negligible.

[Dormeo]

I'm glad to hear you're seeing some improvements, and also that you seem to be working with attentive people (technician and sleep doc).  

I can't advise about pressures or TV, but I can say a word about gas and bloating.  I use a nasal pillow mask with mouth tape and usually have virtually no leaks.  Yet when I inch pressure up, I see an increase in swallowed air, with the gas and bloating that come with that.  In other words, aerophagia (eating air, literally) isn't a sign of mouth breathing.

The comment about centrals that aren't real might mean that the technician can see you had a mini-wake-up followed by a central.  Some people here call that "sleep/wake junk," or SWJ for short.  You breath more deeply during the arousal, then don't have a need to breath for a bit afterward.  That kind of thing happens during daytime breathing a lot.

So this wouldn't indicate a disregulation in your CO2 systems, but on the other hand, it would represent an arousal.  I'll post a screenshot I took a while back that I think illustrates a SWJ central.  You can scroll through your flow rate at maximum zoom to see if something like that is going on.

[howeyb]

Dormeo - interesting. I just looked more closely at some of my CAs and many look a lot like the graph you posted as SWJ.
But I didn't have CAs when my max pressure was 8 instead of 12. The higher pressure seems to have reduced my flow limitations but perhaps the pressure is causing some mini arousals followed by what looks like CAs.

Also thanks for correcting me about swallowing air not necessarily associated with mouth breathing.

Thanks Sheepless too. Hopefully someone else will chime in. I have to figure out how to balance CAs and sleep limitations to get some better quality sleep.

[Sleepster]

I had a AHI of 23 untreated. I had fragmented sleep which persisted after I started CPAP therapy. Even after I got my machine and settings tweaked, it persisted. Eventually, though, I adapted and the fragmented sleep is gone most nights. It takes a while to adapt after living with untreated sleep apnea for so long.

[howeyb]

Thanks for the encouragement sleepster...in fact I got a 4 1/2 hour chunk of sleep for the first time last night and only had 2 sessions...best night ever and I feel more rested. I notice you are not on a bilevel. Where you able to get your flow limitations down to 0 (95%)?

I also noticed that you say you conquered aerophagia. How? sometimes I wake up burping into my mask. When my pressure was at 15, I would sometimes have to get up and lay on the hardwood floor and /or give myself the Heimlich manouver to deflate myself.
I don't want to go up from the current pressure of 12 epr3. I am thinking I need a bilevel for more PS to try to get my flow limitations down and hopefully get rid of my real or not central apnea which is pretty much all I have left since starting to wear the collar.

I think I am dealing with UARS now and bilevel is recommended for that (I believe). I fit the UARS profile.
I don't want to "settle" just because my cpap treated AHI is usually under 2.

Thanks again.

[Sleepster]

Thanks for the encouragement sleepster...in fact I got a 4 1/2 hour chunk of sleep for the first time last night and only had 2 sessions...best night ever and I feel more rested.

You'll have set backs, of course, but progress gets made slowly.

I notice you are not on a bilevel.

Yes I am, my machine auto-adjusts the pressure, and it's a bilevel.

Where you able to get your flow limitations down to 0 (95%)?

I don't remember and I can't look it up on this computer. Flow limitations were never a concern for me.

I also noticed that you say you conquered aerophagia. How?

Lower pressure. With a bi-level machine you can lower your pressure on exhale (EPAP). With a machine that auto-adjusts the pressure you can spend more time at lower pressures.

[Sleeprider]

Hi all: update - 50 days of CPAP - overview graphs attached.

After reporting to my technician my experimenting with the collar and pressures (collar pretty well eliminated my OAs as of Aug12 - thx forum), she wanted to titrate me again and now I am now on constant pressure of 12 EPR 3. We are trying to get my flow limitations down which we believe are fragmenting my sleep.

There are all kinds of things I am wondering. Am I now dealing with residual UARS. My sleep is still fragmented although it is getting better since I am forcing myself to stay up until midnight and get up at 7 so I am tired at night and fall asleep quickly (sleep doc recommendation; I will gradually go to bed 15 minutes earlier every week until I am getting  8 hours sleep or can still fall asleep easy). I am getting more 3 hr chunks which is good for me (norm is 2 hr).

I have a lot of the indicators for UARS. My dentist says I grind my teeth. The sleep doc says my jaw/mouth physiology makes me a candidate for sleep disordered breathing. I have a bit of an overbite and you can't see my uvula at all when I stick out my tongue. I am not overweight and don't have many of the drastic symptoms that many others have such as needing to nap, falling asleep in the car etc. My main complaint was having to get up every 2 hours to go to the bathroom and fatigue on exertion (like stairs and walking uphill). After ruling out all kinds of other things (thyroid, anemia,kidney), my family doc suggested sending me to a sleep clinic where, with a take home test, I was diagnosed with moderate OSA - AHI 22 (more details on my firsts post) - much to my surprise I might add!

Has anybody read  this recent paper in the Lancet (e-version) by Dr. Krakow et al. I think it would be of interest to many people here.
Research Paper
Aug. 2019 - Prospective Randomized Controlled Trial on the Ef[font=AdvTT5235d5a9+fb]fi[/font]cacy of Continuous Positive Airway Pressure and Adaptive Servo-Ventilation in the Treatment of Chronic Complex Insomnia
Barry Krakow a,b,[font=AdvTT5235d5a9+20]⁎[/font], Natalia D. McIver a,b, Victor A. Ulibarri a,b, Jessica Krakow a,b, Ronald M. Schrader c

Anyways, I guess I am wondering if I will  eventually need to go to a bilevel  or ASV since with my settings now, I am getting almost only CAs (which the tech said aren't really CAs...is this true??...they seem to occur in the middle of my sessions in my deepest sleep I assume).

The summary graphs tell my journey. The flow limitations have gone down a bit since I was re-titrated but is that worth the CAs?? How long do you wait assuming the CAs might disappear over time?

I also decided to post my respiration graphs for the first time. Can somebody have a boo and assure me there is nothing too drastic happening? Are my tidal volumes ok (I weigh 150 Lbs and am 5'6)?
I also, in the last week, started using a nasal steroid spray since one or the other of my nostrils is often partially or fully blocked. That seems to help. I think I am mostly nose breathing at night but I also have some gas and bloating so I am mouth breathing sometime too.

I decided to rent for another month but have to make a decision about a machine by the end of the month or shell out another $200.

Thanks for your input and let me know if you need to see any close-ups. I added the last attachment in the next post.

You have certainly come a long way, and the positional apnea with high AHI is no longer an issue.  Your flow limitations may be residual positional obstructions, but to resolve flow limitation at the lowest possible pressure, it's hard to beat the Aircurve 10 Vauto or even the VPAP S. You certainly have no need for ASV. With the Aircurve 10 bilevels, you can find the pressure support that essentially eliminates the flow limits, while keeping EPAP pressure at the level that avoids obstructive apnea, and that pressure support can be fine-tuned in 0.2 cm increments.  If you're looking to make a machine decision and a bilevel is in reach, then the Vauto is hard to beat, whether you use it in fixed pressure, or a narrow range of auto-pressure.  You are doing pretty good with the Airsense 10 at this point, so the Aircurve is similar in feel with more versatility. 

On your charts, I think it is most useful to stick with the one with events, flow rate, pressure and flow limitations.  If you want to zoom into some 2-minute closeups, that will show us exactly how flow limit is affecting you.  The summary charts show us some trends and your response to the changes, and everything has been in a positive direction up to now.

[howeyb]

Thanks for your reply Sleeprider. I am going to try to get a bilevel sooner rather than later. My sleep tech says that order has to come from the sleep doctor so I will spend some time writing up my case for a bilevel and get him that information before my next appointment with the tech. I don't have another appointment with the doctor for another month.

Interestingly, my son sent me a "vice" article about the beginnings of Sleepyhead that was quite enlightening and makes me appreciate this forum and OSCAR even more. I plan to hit that "donor" button soon!

[howeyb]

I have not been able to convince my sleep physician to trial a bilevel yet (my tech tried on my behalf) but I have an appointment with him this Friday.

I am confused about how OSCAR reports flow limitations. In the stats at the left and in the overview graphs the "max" is lower than where I see the spikes go up to in the daily flow limitation graph. Is there an explanation for this? I attached my last 2 nights data and the maxs read 23 and 19 on the left but some of the spikes in the graph are definitely higher than 25, even 30.

Thanks.