What is causng these Hypopnoea please?

[gzimmer]

My figures are slowly getting better.

I still have serious mask leaks, but  have a couple of new masks coming to try (including a Bleep DreamPort).

However I would like to understand what is causing the remaining Hypopnoea

(see attached graph for last night, and an expanded version).

I can't see anything which indicates a problem. Can anyone enlighten me please?


........Zim

[sheepless]

well, for one thing they're kind of clustered, which suggests a positional issue. the most common solution to that is a soft cervical collar if you're not using one yet. if you are, you might have to adjust it ensure your jaw and chin stay supported. it might even help with leaks if your mouth opens and changes the shape of your face causing a leak with the ffm. if the hypopnea are associated with being on your back, you can try a large pillow or a tennis ball sewn into your pj's to help keep you off it.

[gzimmer]

Thanks sheepless,

Yes, that does make sense.
I'm not using the collar at present. Will try it for the next few nights.

I don't think I'm sleeping on my back, but could be wrong.

I had expected to see something in the flow rate which caused the Hypopnoe spike.
There is indication of a deep breath following the first one, but not in the latter ones.

Thanks again .... Zim.

[sheepless]

the more-experienced members might have something to say about min pressure relative to hypopnea and about how to reduce flow limitations.

[gzimmer]

Thanks,

Now that you mention it, I can see that the bursts of Hypopnoe occur when the pressure drops towards the minimum setting.
(and there's a slight flow limitation at each Hypopnoe).

I'll try lifting the pressure a little.

I do try to make only one change at a time, then observe for a few nights.


.......Zim

[Gideon]

As long as you mentioned it

To mimic a BiLevel with PS of 3 and maintain the same therapeutic level for OSA.

Min Pressure to 15
EPR from off to fulltime with a value of 3.

OSA is controlled by EPAP and the pressure difference or Pressure Support (PS) between EPAP and IPAP is for Flow Limit and hypopneas.

Initial EPAP is 15 - EPR (3) = 12 the current min pressure and is to treat Obstructive Apnea.  Thus initial pressures are EPAP = 12, IPAP = 15.

Note: this is a single, paired change

[gzimmer]

Thanks Fred.

Will try your settings tonight and report back.

.........Zim

[gzimmer]

Wow,

Fred's suggestion gave quite spectacular results .

I still have bad leaks, but the pressure lines are straight as a ruler.
(I wasn't wearing the hated Collar either).

Oscar reports "You had an AHI of 3.02, which is under your 7 day average of 9.41"

Hopefully when my new masks arrive, I'll be able to eliminate the leaks.


Thanks Fred .......... Zim

[Gideon]

See the flat tops on the leak chart, that usually means mouth breathing.
The collar can help the mouth breathing as well.

Mouth Breathing is when you open your mouth and the air pressure from your PAP is venting out your mouth typically showing on your charts as a large leak which can substantially negate the effectiveness of your therapy. It is generally not good. The solution varies depending on the person
With OSCAR look at your Leak Rate graph where it is shaded (large leak/ LL), flat tops on this graph suggest mouth breathing. In OSCAR right click on the left header of the Leak Rate graph and click on Dotted Lines then select "Leak Rate Upper Threshold" to get a line across the graph for ResMed. Manually set the value for Philips Respironics. Severity depends on how much over this threshold and for how long it is in the Large Leak territory.
How to manage Mouth Breathing, not in any particular order.
Tongue Trick. Place the tongue on the roof of the mouth, Practice during the daytime. The idea is to train the tongue that this is a good place to be, not overnight, but it works for some.
Cervical Collar. A "soft" Cervical Collar (Releaf is popular). This helps support and align the neck and keeps the jaw/mouth from dropping. This is becoming a very popular option. Rarely used prior to mid 2016. Users are posting a high success rate with this device. When OA tends to occur in clusters at different times of night. It's an indication that an obstruction may have occurred when the chin tucks towards the chest. It's common, and the solution is either an ergonomic pillow or soft cervical collar that prevents the neck and head from being out of alignment and cutting off the airway, but they can be comfortable, prevent leaks and prevent an airway from closing up due to tucking your chin to chest and other issues. An Anti-Snoring collar, which has a small strap in back (Dr. Dakota is popular)
It's a very small investment that has worked very well for some people. More pressure may solve the obstruction, or it might go away with positional therapy.
Chin Strap. A chin strap is to manage mouth leaks from a variety of causes. Most result from the jaw-dropping or opening either partially or wider. The chin strap is to gently keep the jaw closed. If you have to crank it shut to make it work this is not the correct solution. Note that your jaw is strong enough to open if it wants to. There is one chinstrap that is notably different than others, the Ultimate Chinstrap, Search for it if you desire.
Ergonomic Pillow or CPAP Pillow, The purpose is to maintain a proper head and neck alignment while allowing for the mask maintaining the seal in multiple positions.
Mouth Guard The concept here is a closed mouth guard to keep the air from leaking out.
Taping. Definitely the most controversial. The purpose of taping is to seal the lips and prevent mouth leaks/mouth breathing. It is not to stop the mouth from opening. I make sure that I can easily open my mouth when taped, if I need to.
FFM – Full Face Mask or Hybrid Mask. This is a very traditional solution and it is generally effective.
Dry mouth is a symptom mouth breathing that is uncomfortable. It can and does occur with some users of a Full Face Mask.

• Many users use a product called Biotene to get relief from this symptom.
  

[gzimmer]

Thanks Fred,

I really appreciate your explaining things in detail.

As well as finding a cure, my goal is to understand what is going on.

I do agree about the mouth breathing.
I'll go back to a full face mask and see what happens.



...Zim