npsleepy - Therapy Thread

[npsleepy]

   
Had a few flow limitation spikes last night - not sure what to make of it but my soft cervical collar is arriving tonight. Should I adjust anything in the meantime?

[Melman]

I suggest you dial back EPR to 2 or 1 and post results. Since implementing EPR of 3 half your events have been CA.

[npsleepy]

Thanks for the advice @Melman! I turned EPR down from 3 to 2 and have worn my soft cervical collar. @PeaceLoveAndPizza - I'm wondering do I need to wear both a chin strap AND a soft cervical collar? I feel like the amount of stuff on my face is getting to be a bit much but I feel like I can still open my mouth a little if I just have the soft cervical collar on. Feel extremely grateful for everyone helping me out here! 

Here's my data from last night. 
   

[PeaceLoveAndPizza]

Please repost last nights chart with the standard format. Check the “Organise your OSCAR charts” in my sig for more information. I want to see the relationship between apnoeas, pressure, EPR, flow limits, snores, etc, so need the standard format.

I do not doubt Melman’s advice about too much EPR causing CA’s. His suggestion to dial it back to 2 as the next step is what I would have recommended.

[npsleepy]

Oops, sorry I must have accidentally scrolled down before taking the screenshot! Here is the corrected one. 

   

[PeaceLoveAndPizza]

Thanks…

Two suggestions for you. First, set your response to soft which may help with the CA’s. Next, keep the new settings for a few days and let’s see how things go. You may want to dial EPR back as Melman suggested to 1 for a few days after that to see how you respond. Of course, if at any time you are uncomfortable or something does not feel right go back to what previously worked. Experimenting is fine, but you still need to get rest.

Regarding chin straps and soft cervical collars, if you think one is enough go with it. Personally I could not adapt to chinstraps as I needed to winch it down like a logger holding down trees on a lorry. The collars I use work for about 6 months and are much more comfortable. The bonus with them is they not only help keep my mouth closed, they also help keep my chin from tucking.

Do what feels right to you. It is your therapy, we are simply your guides.

[npsleepy]

I tried to sleep last night with just the cervical collar and no chin strap. I was hoping the cervical collar would keep my mouth from opening but when I woke up in the morning I had terrible aerophagia and the data seems to agree my sleep quality was worse. So I guess probably I have to wear both the chin strap and the cervical collar. 

   

[Deborah K.]

The cervical collar is to keep you from allowing your chin to bend toward your chest, which can cause more apneas.  The chin strap is to help hold your mouth closed, but they don't work very well.  I use mouth tape and that helps deal with the leaking wonderfully.

[PeaceLoveAndPizza]

Deb K is spot on about the chin strap. Most just pull the chin back which causes issues for many. Mouth tape would help with leaks, but you don’t have any issues in the latest chart with leaks. I suggest staying with the collar for a bit and getting used to it.

I reckon there is going to be a trade-off of EPR vs flow limitations as too much EPR causes more CA’s. If you are open to another try, set EPR to 1 full-time and leave pressure where it current is set. A bit of flow limitations is fine as long as we can manage the pressure and you get a restful nights sleep.

I would also like to try dialing your response back to standard instead of using soft. I prefer making one change at a time, but it’s your decision.

Something else to ponder is using the machine in CPAP mode. Maybe give it a go on a non-work night in case you end up a zombie. I would try a pressure setting of 9 with no EPR. All the charts you have posted show a similar pattern in that when at lower pressure (9-10) you have few events. Once the pressure goes up due to flow limitations the apnoea party begins.

[npsleepy]

It's interesting you mention using the machine in CPAP mode because that is the setting that my sleep doctor had it configured to originally - but with pressure of 8. I guess I will be coming full circle if I go back to that! Granted back when I had it at that setting I was using the wrong size mask and was getting constant leaks so it did not feel like my therapy was effective.

My chin strap seems to do the job though I don't love it by any means, I have to strap it pretty tight and it's very flimsy. It sounds like mouth tape would be easier.

I will dial EPR back to 1 and go back to standard EPR response for tonight like you recommend @PeaceLoveAndPizza . I think I'll try it on those settings for the next two nights and then if I'm still not happy with results I'll try switching to CPAP mode.