[Treatment] New to Oscar, looking for some help!

[bipap350]

                Hello everyone! For context I'm using a Resmed Airsense 10 with an Airfit P10 pillow mask. I am a mouth breather so i also use a very tight chin strap. I'm having some issues with my sleeping and recently found out about Oscar! I've been monitoring these past few days and I can't seem to find the issue. As you can see I have very low AHI and very low 'leakage', however I am waking up with an extremely dry mouth (even though I still use a chin strap). I have played around with mouth tape, but i wake up with huge aerophagia (I have to lay for 30 mins after waking to let air out). I was wondering if there were any tips and tricks to make this work.

[staceyburke]

As you know you are on a static pressure of 11.  That is not real high but I have found the lower I go without having more events the better I sleep.  I would try to lower the pressure by .5 a night until you have more apnea then go back up to where the AHI is best.  That way it should be at a lower max pressure.

[bipap350]

I will try tonight! thanks!!

[dlbzone]

I recommend a soft cervical collar over a chin strap.  The pressure to the jaw is upward so that it doesn't pull the jaw back towards the throat, which can lead to increased flow limitation.  The trick is to find the right size, but they are only $15-$20 and generally available in heights from 2"-4" or so and then you also need to consider your neck circumference when sizing.

I see a big difference in flow range and corresponding Tidal Volume on your charts.  I would be curious to see the corresponding Minute Vent and Respiratory Rate charts along with the Tidal Volume and Flow charts.  Basically Tidal Volume is a Volume, Respiratory Rate is Breath per Minute, and Minute Ventilation combines air volume and time in Liters per Minute.  

For myself, I am generally awake when my Tidal volume (Vt) is greater than about 700 and my Respiratory Rate (RR) is less than about 12-14 breaths per minute.  When I'm sleeping my RR is usually between 17 and 18bpm and my Vt is 400-600mL with minute vent around 7-9 L/min.  If I'm not in these ranges, there is a pretty good chance that I am not sleeping.  Everyone is different to some extent, but looking at your flow and Vt, I suspect you may be awake when your flow is nice and wide and when you are sleeping your flow is greatly reduced, but with RR and MV charts missing I can't be certain.

Also, how do you feel?

[bipap350]

[attachment=62449]     Im not feeling great honestly, still tired and yeah not the best sleep, sometimes with a little headache which I know its not good.

Here are my minute vent and respiratory charts so that you can compare. I have more than 700 almost all the time   .

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Heres another day as well. Changes Ive made since the last post have been, reduced pressure by 0.5, using mouth tape and sleeping at a 45 degree angle, helping my aerophagia and the closing of my throat.

[dlbzone]

I think I am on the same page as StaceyBurke.  If you can reduce your pressure without substantially increasing your events or feeling worse, you are likely to reduce or resolve mouth breathing and aerophagia issues.

EPAP (Exhalation Pressure) treats obstructive apnea.  8 and then 7.4 for you based on uploaded charts.
IPAP (Inhalation Pressure) treats flow limitation, RERA, Hypopnea.  11 and then 10.4 for you based on uploaded charts.
PS (Pressure Support) is the difference between IPAP and EPAP.  3 for you based on EPR of 3.

EPAP + PS = IPAP

This bit may sound a little technical since you are using straight CPAP mode, but since you are using EPR of 3 that is like having your EPAP=8 (Exhalation Pressure) and IPAP=11 (Inhalation Pressure) on a BiPAP machine.  The difference in pressure makes it feel easier to inhale and to exhale, but can also worsen mouth breathing/leaking and aerophagia. If you can achieve the same AHI results by just having EPAP=8 with EPR=off or at a lower setting, you may be better off.  However, this pressure difference of 3cm between EPAP and IPAP can help with flow limitations and related events including Hypopnea if you are susceptible to those events.

Now back to the reducing pressure idea.  If you read the Titration Guide from Resmed, they titrate EPAP first, because it is more critical to stop obstructions.  Once the airway is successfully stinted open with Positive Air Pressure, then they consider if Pressure Support is also needed, and so on.  Therefore, instead of beginning by reducing EPAP, I would suggest beginning by reducing EPR.  You could try EPAP=8 and EPR=2 and watch your results and how you feel.  Pay particular attention to Flow Limitation chart and Hypopneas.

Also, sleeping at an incline is more likely to help overweight and obese people because gravity moves that weight away from the lungs making it easier for them to expand.  If you happen to be a thin person, sleeping on an incline may do more harm than good.  Also, due to gravity, sleeping at a large incline can also make it easier for the mouth to come open during sleep.  

Make sure you read all information and tips here: Optimizing Therapy

[dlbzone]

Also, I am somewhat perplexed by your Minute Ventilation graph.

On the Minute Vent graph, there is a large portion of the night where it appears you are at about 5.5L/min.  Normal range is 5-8L so you are in the normal range still, but pretty low, whereas at other times you are well above normal range.

Perhaps one of the more experienced members will chime in with additional thoughts on this area.

[bipap350]

   

Ok so i made the change you said (EPR 3 -> 2) and I slept the best I have in the past few months! thanks so much!!!

My tidal volume is around 320 and my minute vent is around 4.38. It felt much more comfortable and I woke up without a headache and more rested at least.

My cervical collar is arriving this weekend and Ill try that, for now i am using just tape and the pillows. I am also still sleeping at an incline, my throat really closes when I sleep without an incline.

Thanks everyone!!!