Zero reductions in AHI after 4 masks

[jmamacat]

Hello!

Here’s last night’s data. I bumped my Min. pressure up to 12.40 and didn’t wear a collar. 

The airflow definitely felt too forceful for comfort. My throat got really dry and the suction (for lack of a better word) was pretty intense when I tried opening my mouth during use. I also have abdominal pain and gas from too much air in my esophagus (that hasn’t ever happened). I don’t know if my body just needs more time to get used to the stronger air flow, but I’m seeing more leaks on OSCAR so that concerns me.

My Med. pressure is still a good bit higher than my Min. pressure, so I’m not sure how to get those closer together without feeling like the airflow is too strong. I did see that some people use the full face setting with this mask (and subsequently need a higher pressure to compensate) but I’m unable to find any more information to help determine whether it might be a good thing to try. I was also hoping to find the best Min. pressure setting before making further adjustments.

As always, any thoughts would be much appreciated!

[ejbpesca]

Higher pressure can cause trouble with aerophagia, Leak Rate and Large Leaks.  I know of nothing but reducing pressure to relieve aerophagia but research the topic for advice on how to deal with it.

Getting the mask in proper position and tight enough is the only way I know of how to deal with leaks unless as in your case it is a nasal or pillows mask and then leaks may be coming from the mouth opening during sleep.  Do you think that is where the "suction," sensation is coming from?  To deal with this some tape their mouth closed and/or put an appliance in their mouth that seals it.  That's another topic you can research here and on the rest of the net.  I'm not saying you have that problem but many on this forum do.

I see those big pressure swings you have that do not treat OAs and that brings up the topic again of airway-pinching apneas caused by the chin tucking down toward the chest. Some relieve that with a cervical collar.

I may be repeating myself but please check your prescription pressures from your Sleep Study. 

Please reduce Min pressure if it is causing a problem. 

I am going to have to punt and hope an expert sees this Thread and hopefully recognizes your pattern of pressure jumps and then produces a possible solution.

[super7pilot]

I had a bit of stomach bloating. But It seemed to go away when I found the proper tight pressure range. I think it was the quick pressure increases that were forcing air into my stomach.

Now my pressure rarely increases more than 1cm from my set minimum.

Not sure if I'm off base. But seems logical that an EPR of X would help lower the chance of air getting into the stomach. I reasoned that if you are inhaling. The pap pressure has somewhere to go because the inhalation does create a low pressure area in the lungs. The opposite would then be true of an exhale. And of course our bodies adapt. But it can take time.

Did you get and try the new eliminator Collar? Are you sure you are staying off of your back?

[jmamacat]

Higher pressure can cause trouble with aerophagia, Leak Rate and Large Leaks.  I know of nothing but reducing pressure to relieve aerophagia but research the topic for advice on how to deal with it.

Getting the mask in proper position and tight enough is the only way I know of how to deal with leaks unless as in your case it is a nasal or pillows mask and then leaks may be coming from the mouth opening during sleep.  Do you think that is where the "suction," sensation is coming from?  To deal with this some tape their mouth closed and/or put an appliance in their mouth that seals it.  That's another topic you can research here and on the rest of the net.  I'm not saying you have that problem but many on this forum do.

I see those big pressure swings you have that do not treat OAs and that brings up the topic again of airway-pinching apneas caused by the chin tucking down toward the chest. Some relieve that with a cervical collar.

I may be repeating myself but please check your prescription pressures from your Sleep Study. 

Please reduce Min pressure if it is causing a problem. 

I am going to have to punt and hope an expert sees this Thread and hopefully recognizes your pattern of pressure jumps and then produces a possible solution.

I appreciate all your detailed help! Once I get a handle on things I will start a new thread to ask about the pressure jumps.

Yes, it’s a nasal pillow mask — I think it was the force of the pressure causing the leaks so I’m looking into ways to adjust that. Sadly my at-home sleep study gave me very little information so we’re having to gather our own data about what pressures are helping. 

I don’t *think* I’m opening my mouth; when I even part my lips it is very uncomfortable so I can’t imagine my mouth opening and staying that way during sleep. I did try a chin strap a while back and have also tried full-face masks but they hurt my cheeks too much. That said, I’ll keep it in mind, but since it correlates to the pressure jumps I’m guessing that’s what’s behind it.

[jmamacat]

I had a bit of stomach bloating. But It seemed to go away when I found the proper tight pressure range. I think it was the quick pressure increases that were forcing air into my stomach.

Not sure if I'm off base. But seems logical that an EPR of X would help lower the chance of air getting into the stomach. I reasoned that if you are inhaling. The pap pressure has somewhere to go because the inhalation does create a low pressure area in the lungs. The opposite would then be true of an exhale. And of course our bodies adapt. But it can take time.

Did you get and try the new eliminator Collar?  Are you sure you are staying off of your back?

I did try the eliminator collar two nights ago but took it off after a couple of hours because it didn’t feel comfortable or helpful. I will try it again once I get the pressures figured out a bit better. I also only sleep on my right side and would be shocked if I ever rolled onto my back!

I’m trying to get to the bottom of the quick pressure increases - do you think it could be the EPR and/or the positional issue?
And since I’m still working to find a tighter pressure range, I'm disappointed that increasing my Min. setting last night felt too intense.
I’d like to try shutting off the EPR, but I know that entails further pressure adjustments. I’m also considering switching my mask settings - others have found it helpful to use full face settings with this (nasal pillow) mask, but it’s recommended to also increase the pressures. That complicates things further since I don’t want to make all those changes at once, so I’m trying to figure out the most effective/potentially helpful starting point….

[SeePak]

i agree with Dave, pilot and others about positional.

And i was going to give you my current story, which is i wore my Caldera Relief a little loose i think lately and getting the rapid machine gun events again.

I have heard 2 fingers width for adjustment, try for yourself.

As for adjusting pressure, i think that needs to wait until the positional is sorted out.
Good chance you could have pressures that could be reduced, especially if mis-diagnosed.

Personally i have seen this happen, and now use tennis ball with buteyko belt on back to keep from going on my back, another Event Counter!

Stay working on the positional, the pressure will be pretty obvious i think after that, will seee......
just saw your chart, and mouth breathing is big contributor to CA events ! I had >200 last night!

Once you get positional sorted out, then i think your charts will be reliable, you will possibly have lower pressures needed AND less mouth breathing.

Also, you say you used full face mask, did you have LESS leaks then?

[jmamacat]

i agree with Dave, pilot and others about positional.

Once you get positional sorted out, then i think your charts will be reliable, you will possibly have lower pressures needed AND less mouth breathing.

Also, you say you used full face mask, did you have LESS leaks then?

I definitely need to do something about the pressure because it was uncomfortable last night - I could drop back down to Min. pressure 12 (which felt more comfortable) and see how tonight goes, OR I was thinking I could leave Min. at 12.60 (uncomfortable last night), raise Max. to 18, and switch machine settings to full face (but keep using nasal pillows). 

Does that second plan make more sense? Either way, I’ll also try wearing the Releaf again.

I had TONS of leaks with the full face mask! I was fighting it all night. My pressure settings were also much lower (Min. 8 Max. 14) so everything was a mess. Happy to attach a screenshot of an old OSCAR graph but have changed so many things since then that idk if it’s worth looking at.

[SeePak]

Cat I would say yes second plan however I don't think you need to raise any pressures I think just going to the full face Mass setting give that a try and see how you start doing with that

[super7pilot]

Of course collars are not the most comfortable. Not sure how you came to the conclusion after only two hours that it wasn't helping.

You HAVE to work on the positional issues first. Then you/we can move onto pressure adjustment. To blast through positional apnea's. You would likely need a dangerous amount of air pressure.

Start wearing that collar all night for a few nights.  Then post a full nights chart with the collar on.  Believe it or not, You will get used to it.

I started this journey in Oct 24 with an AHI of 22. And after pushing through the mental ups and downs and doing what I had to do even if it was hard, frustrating and uncomfortable.

And yes, I wear the eliminator collar, P10 mask with thick lanolin paste to help seal it, And a tall head band (made from a Buff) around my mouth to stop my lips from flapping in the breeze. And yes it sucks to have to do this every night. 

It took 6 months, But here is the end result.  You can do this!

   

[SeePak]

fully agree with superpilot.

cat....full face mask data?...sure i would like to see, to get a feel for your leak numbers.

please post!