New member - some questions

[CorruptAlligator]

I totally agree with Dave. The doc that recommends MDD probably profits from the MDD device, which is the reason for recommending over others. If you go to a surgeon, they will recommend surgery. You did the right thing by doing research yourself.

It's unfortunate what doctors recommends are split the way it is. Docs provide advices based on their specialty and what they perform. They are most familiar with what they practice, and will not know much about what they do not practice. So, they will most likely recommend what is known to them and their area. This is what I really dislike this about how medicine works.

Medicine should be objective as possible, but that obviously isn't the case, and it cannot be due to branching out of specialties.

As a person that has TMJ issues myself, you do not want to get into TMJ issues. I would avoid MDD if possible.

[nightgagger]

I'm not an advisory member or expert and those members will hopefully chime in. I'm sure the machine you got is on standard setting, and should be set correctly after you supply some Oscar charts as well as your redacted sleep study, which was mentioned earlier.

I do want to address one point you made in an earlier post.
I am a mouth breather as well. I don't use a FFM because it doesn't work for me, my chin/jaw will slide back and relax and will leak out the bottom of the mask. I've tried cervical collars and chin straps to control this using a FFM and it doesn't work for me. BTW, I'm also a 41AHI person prior to using CPAP.

I now use a pillow mask, the P30i, and it is very effective. I also use mouth tape. Very controversial but it works and has worked fine for me for the past 8 - 9 months (been a CPAP user for three years now). Furthermore, I've used nasal masks and those work just as well and are comfortable, but again, I'm using tape to keep my mouth closed, and since staying solidly with nasal/pillow masks, my AHI has dropped <1 for the last four or five months. I do feel better, although there are things in life that are causing major anxiety, but overall I wake without a sense of panic and dread that I would normally have when I don't sleep.

To basically answer your questions quickly.

1. No, normally should fall asleep within 5 - 10 minutes. Again, once you post your OSCAR data (not sure if it's ready for Airsense 11) you may have ramp on.

2. 4 is the lowest setting, usually set for children. You may be air-starved at that setting. Again OSCAR chart will help determine a starting min. pressure.

3. Autostart setting is an option in the menu and when enabled should shut off the machine when the mask is taken off, and turn on automatically when breathing.

4. Experts will chime in on that.

Keep at it. It does take time to sort this out. Getting the right mask is one of the major hurdles in keeping up with this therapy. Once you do, you will feel the benefits.

[quiescence at last]

Thank you for your replies!

Have any of you had success with CPAP machines while also being mouth breathers (all or some of the time)? That's one of my big concerns, how that will work with a full CPAP mask, because during normal sleep, I will sometimes breathe through my mouth and sometimes through my nose.

Also, ditto with tossing and turning a lot while sleeping?

Do you find that using CPAP regularly affects your breathing in any way when not using it, during daytime?

Finally, if I was to seek a second opinion (as it seems from your responses and other places I've googled that CPAP is the first approach to be tried), what's the best type of doctor to talk to about this?

Just a note in reply about the mouth breathing and the effect of CPAP on breathing during the day.  

Before I started CPAP therapy, I only breathed through my mouth while awake because I was unceasingly clogged in nasal passages, 24/7 for years (decades?).  When I fell asleep, my brain wanted me to breathe through my nose, and I fought it, of course, because I could not breathe through nostrils. 

Then CPAP.  Ordering a full face mask was obviously the only choice.  Routine CPAP usage changed my mouth breathing to nasal breathing almost immediately, because congestion decreased, inflammation of sinus passages decreased, and the air-stent (positive pressure) slightly increased the nostrils internal size.  Since beginning in 2014, I only mouth-breathe during sleep maybe 5% of the time.  

DAYTIME.  This did have effect on my daytime breathing?  Yes.  Of course, no one has sleep apnea while awake.  But, the positive effects of clearness of sinuses and basically habitual nose breathing that CPAP restored, I usually sail through my days with a great deal of nose breathing. A positive quality of life, for sure.

full disclosure - I do use decongestants and antihistamines routinely to combat minor congestion and allergies.

Hope this helps!

QAL

[dreamscape99]

Ok, let me try to post the home sleep test results again.

---

Still won't let me do it.

Will post after somebody else posts.

[dreamscape99]

2. 4 is the lowest setting, usually set for children.  You may be air-starved at that setting.  Again OSCAR chart will help determine a starting min. pressure.

Can you explain this one to me a little? My knowledge of CPAP/Apnea is faitly limited. I was under the impression that while the initial setting is only 4, as soon as your airway gets blocked, the Auto machine would adjust and raise the pressure to clear it.

So if that's the case, what's the advantage of starting with a higher setting right off the bat?

Thank you.

---

Ok, here are my NightOwl home sleep study results:









Please let me know if the image quality is not good enough, I can take other screenshots (no scanner).

[Gideon]

1. A min pressure of 4 does not allow room for EPR to work. 7 will allow all values of EPR to work
2. Most adults find a min of 4 too low.
3. 4 and 5 are often considered a pediatric pressure setting
4. with EPR min setting should never be less than 4+EPR or you will be impinging on the therapeutic effects of the EPR which is to treat Hypopnea, Flow Limits, RERA, and UARS

[SarcasticDave94]

Correct, EPR isn't given room to work at 4 as it would at 7.

My top reason is this however. Raising the Min pressure to a reasonable rate prevents the Apnea from occurring because your throat is already air splinted open. You're viewing it as reactionary, but I'd rather believe PAP would be better as a preventative measure.

Your PAP can still adjust when the need arises, but with a higher baseline, those initial Apnea events don't even exist, eliminating a lot of Apnea issues in one action.

[SarcasticDave94]

PS I forgot to add in, you're definitely in severe Apnea territory at 48 AHI. Your Min SpO2 was 89% so worth keeping an eye on it, likely with recording pulse oximeter. This may have just been due to Apnea however.

[dreamscape99]

Ok, so what are the next steps for me, as far as changing the settings on the machine from 4 to 20? Should I just use it for a few nights and get that data into Oscar, and ask for suggestions? Is there some kind of a chart or something like that?

Regarding the mask leaks, I shaved my facial hair a bit today, to get more contact with the skin directly, hoping that will help some. If that doesn't work, will ask the DME on Monday for a larger mask frame for DreamWear Full Face. I am currently using large cushion/face-plate with a Medium frame (that's what they gave me), maybe a large frame would help as my head is pretty big. Also maybe ask them to do a fitting.

[SarcasticDave94]

With masks, there's general suggestions members can pass on, but the fine details are very personal. The mask and leak control also is your biggest PAP issue, that's for everyone not just yourself.

What I'd consider trying on edits should be bump Min pressure to 7 and add full time EPR 3. Then take note how you feel before vs after the edit. Tell us this info which should answer the question "How do you feel?" and post a standard view Daily Details OSCAR. It'll be pretty plain what direction the therapy is headed. Other edits may be needed, but take simple small steps to keep things in check.

You'll need to enter clinical menu to edit pressures.