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Titration Study Results
RE: Titration Study Results
On May 11 around 2 am I had a really vivid nightmare and when I woke up my mouth was so dry that my tongue was stuck to the roof of my mouth (it's happened before) so I got up and had a drink.  I took a close up screenshot of this timefra,e, can someone tell me what happened?  Is the CA that I have screenshot a real one?  Also I am bookmarking sections when the graph gets very bumpy is this times when I am awake?

I have found over the past 2 nights that I feel like it's easier to breathe, I feel like my pressure wants to settle around 10.0 as that what feels most comfortable.

I am working on my vitamin deficiencies and weight, as I know both are key to my sleep issues.  I have lost 20 pounds so far and hopefully my next bloodwork shows an increase in my vitamin levels.

I have increased my starting pressure to 8.0-12.0 should I stick with this for awhile longer or increase the maximum to see what happens with the flow limit?  I'm with you in thinking that I just need to find a comfortable pressure and give it time to work.  It's crazy but I like sleeping with CPAP now and wouldn't dream of not using it.


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RE: Titration Study Results
Increasing your max pressure probably won't do anything (although increasing your min pressure to 8 cm might make it rise a bit higher now). For the most part your pressures are staying below 12 cm, this is related to how the autoset for her APAP mode works (it keeps pressures lower and increases/decresaes them slower). To use higher pressures you would probably have to increase max to 15 cm and either increase minimum further or change to APAP mode which is a fair bit more aggressive to flow limitations. Your tidal volume and ventilation appear to still be higher indicating this higher pressure might be helping you. I would probably just stick with these settings for now and give them a while for your body to adjust and they may continue to improve especially if this has already improved sleep quality and with your other steps against mineral deficiencies and weight. As mentioned before your only other step is higher pressure or a different machine (likely out of pocket) and the higher pressure may start to cause more issues then help so best to let it work for a while as is imo.

It sounds like you are slowly adapting and feeling benefits, your body will continue to adapt for months. It sounds like you might be having mouth leaks against this higher pressure (would have to see your leak rate chart to confirm), this would cause the dry mouth issues you mention. Leaks at higher pressure are common because it becomes harder to breath out against the pressure so your body starts exhaling through mouth which then can cause leaks. If leaks are happening regularly then trying to treat that is the next step. I had to switch to a full face mask because of leaks, some people prefer to try chin straps or mouth tape. Sometimes they will go away with time as body adapts to the higher pressure and some people try and train holding tongue against top of mouth but I never had luck with that myself.

The last couple zoomed in examples you posted are arousal breathing but a cause is not obvious. Could be spontaneous, could be PLM, slight chance of being a RERA, if there were leaks present before hand the leak might have caused it.

Edit: The 8 cm min is probably good too, it will reduce some of the pressure swing when starting/restarting machine. I don't think I would go higher than that though unless as a future test for higher pressures.
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RE: Titration Study Results
(05-12-2021, 10:02 AM)Geer1 Wrote: Increasing your max pressure probably won't do anything (although increasing your min pressure to 8 cm might make it rise a bit higher now). For the most part your pressures are staying below 12 cm, this is related to how the autoset for her APAP mode works (it keeps pressures lower and increases/decresaes them slower). To use higher pressures you would probably have to increase max to 15 cm and either increase minimum further or change to APAP mode which is a fair bit more aggressive to flow limitations. Your tidal volume and ventilation appear to still be higher indicating this higher pressure might be helping you. I would probably just stick with these settings for now and give them a while for your body to adjust and they may continue to improve especially if this has already improved sleep quality and with your other steps against mineral deficiencies and weight. As mentioned before your only other step is higher pressure or a different machine (likely out of pocket) and the higher pressure may start to cause more issues then help so best to let it work for a while as is imo.

It sounds like you are slowly adapting and feeling benefits, your body will continue to adapt for months. It sounds like you might be having mouth leaks against this higher pressure (would have to see your leak rate chart to confirm), this would cause the dry mouth issues you mention. Leaks at higher pressure are common because it becomes harder to breath out against the pressure so your body starts exhaling through mouth which then can cause leaks. If leaks are happening regularly then trying to treat that is the next step. I had to switch to a full face mask because of leaks, some people prefer to try chin straps or mouth tape. Sometimes they will go away with time as body adapts to the higher pressure and some people try and train holding tongue against top of mouth but I never had luck with that myself.

The last couple zoomed in examples you posted are arousal breathing but a cause is not obvious. Could be spontaneous, could be PLM, slight chance of being a RERA, if there were leaks present before hand the leak might have caused it.

Edit: The 8 cm min is probably good too, it will reduce some of the pressure swing when starting/restarting machine. I don't think I would go higher than that though unless as a future test for higher pressures.

Here is a closer look at the 2am event.  It was preceded by a RERA and the leak rate looks high.  I think the higher pressures are causing me to open my mouth.  The Dr. did suggest I switch to a full face mask as I have issues with nasal congestion too, although the nasal spray prescribed really helps with that.

I think I will look at some full face masks, it won't hurt to give it a try.  I'm not claustrophobic so that shouldn't be an issue.


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RE: Titration Study Results
A better view of the 2 am event.


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RE: Titration Study Results
The machine flagged that as a RERA because there was reduced flow rate amplitude followed by an increase. I don't know the exact algorithm Resmed uses to flag RERA's but lets just say it is far from perfect. In your case it is hard to tell if that was an actual RERA because like you say the leak rate dropped just as flow rate dropped. That could have just been your sleep being interrupted by the leak, you taking a couple smaller breaths while changing position/falling back to sleep then the return back to normal amplitude breaths caused RERA flag. You had the same thing happen again at 1:50 but not the right profile to cause RERA flag. It might have been a real RERA but just wanted to point out that it might not have been as well (hard to tell). These machines provide a lot of good data but their interpretations aren't perfect.

I like the F20 mask and it is one of the more commonly used/liked models. Nasal congestion is the reason I ended up having to switch to a FFM.
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RE: Titration Study Results
(05-12-2021, 07:35 PM)Geer1 Wrote: The machine flagged that as a RERA because there was reduced flow rate amplitude followed by an increase. I don't know the exact algorithm Resmed uses to flag RERA's but lets just say it is far from perfect. In your case it is hard to tell if that was an actual RERA because like you say the leak rate dropped just as flow rate dropped. That could have just been your sleep being interrupted by the leak, you taking a couple smaller breaths while changing position/falling back to sleep then the return back to normal amplitude breaths caused RERA flag. You had the same thing happen again at 1:50 but not the right profile to cause RERA flag. It might have been a real RERA but just wanted to point out that it might not have been as well (hard to tell). These machines provide a lot of good data but their interpretations aren't perfect.  

I like the F20 mask and it is one of the more commonly used/liked models. Nasal congestion is the reason I ended up having to switch to a FFM.

I will look at the F20, thanks for your help!
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