I'm a dentist treating myself! CPAP Results... Advice please?

[nee]

Just curious what is your Mallampati score. A large tongue is hard to treat with CPAP even with high pressures.

BTW: I have done both MMA and genioplasty. My personal experience is they don't have any (durable) effect on sleep quality. When totally relaxed and having no muscle tone, a large tongue will always fall down to block the airway (in supine position).

1 or 2 according to Dr. Zaghi. Would myofunctional tongue exercises help for you? Have you tried them?

I bumped the APAP up to 15 last night and I'm still getting things like this:

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[Pugsy]

I bumped the APAP up to 15 last night and I'm still getting things like this:

I think that OA is arousal related. The breathing pattern prior to the flag doesn't look like asleep breathing.
I am not surprised that more pressure doesn't fix things like this....more pressure can't do a thing for arousal/awake breathing irregularities.
Instead we have to try to figure out why the arousal breathing happened in the first place....which unfortunately isn't nearly as easy as just cranking up the pressure to try to fix something.
Cranking up the pressure only fixes things that can be fixed with more pressure. Not everything can be fixed with more pressure.

[musculus]

Just curious what is your Mallampati score. A large tongue is hard to treat with CPAP even with high pressures.

BTW: I have done both MMA and genioplasty. My personal experience is they don't have any (durable) effect on sleep quality. When totally relaxed and having no muscle tone, a large tongue will always fall down to block the airway (in supine position).

1 or 2 according to Dr. Zaghi. Would myofunctional tongue exercises help for you? Have you tried them?

I bumped the APAP up to 15 last night and I'm still getting things like this:


Screen Shot 2020-02-14 at 9.06.25 AM.png

This looks to me as you have worse airway obstruction at exhalation than inhalation. note from 6:28:00 to 6:28:30 the exhalation air flow start a little and then quickly diminish to zero for ~1 second

might be caused by the soft palate as it could be pushed by the outgoing air to shut off (soft palate collapse on the posterior pharyngeal wall).

BTW: Tongue exercise didn't work for me. Considering tongue reduction surgery.

[nee]

Just curious what is your Mallampati score. A large tongue is hard to treat with CPAP even with high pressures.

BTW: I have done both MMA and genioplasty. My personal experience is they don't have any (durable) effect on sleep quality. When totally relaxed and having no muscle tone, a large tongue will always fall down to block the airway (in supine position).

1 or 2 according to Dr. Zaghi. Would myofunctional tongue exercises help for you? Have you tried them?

I bumped the APAP up to 15 last night and I'm still getting things like this:


Screen Shot 2020-02-14 at 9.06.25 AM.png

This looks to me as you have worse airway obstruction at exhalation than inhalation. note from 6:28:00 to 6:28:30 the exhalation air flow start a little and then quickly diminish to zero for ~1 second

might be caused by the soft palate as it could be pushed by the outgoing air to shut off (soft palate collapse on the posterior pharyngeal wall).

BTW: Tongue exercise didn't work for me. Considering tongue reduction surgery.

I groan and exert effort to breathe on exhalation, so this makes sense. Could I be shooting myself in the foot here by having my exhalation pressure set at 12 cmH2O? (15 cmH2O with EPR of 3)

[musculus]

it could be due to the high EPAP, but do you see similar flow pattern at lower pressures, at usual REM times like 4-6 am?

try lying down and relax jaw and throat muscles, you should be able to induce the blockage by breathing in and out at different velocities. repeat the test by sticking the tongue out to confirm it is the soft palate.

[nee]

it could be due to the high EPAP, but do you see similar flow pattern at lower pressures, at usual REM times like 4-6 am?

try lying down and relax jaw and throat muscles, you should be able to induce the blockage by breathing in and out at different velocities. repeat the test by sticking the tongue out to confirm it is the soft palate.

This was when I had EPAP at 7 cmH2O.

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It's definitely my soft palate; I have retruded jaws. A MAD didn't do much for me. When I lie down, jut my jaw forward, and relax my throat/tongue, I still feel the blockage.

[musculus]

so it happens at lower EPAP 8-9 cm as well. Using moderately low constant pressure might work better for you, with 0 EPR.

A good thing is that a flaggy soft palate is easily treatable with UPPP.

[nee]

I switched to the P10 for the past week because I was tired of the whole Bleep routine (shaving near the nose, witch hazel, extra tape around the Beep to neutralize leakages) and got massive leakages. This is with lansinoh AND cervical collar AND mouth tape AND mandibular advancement device AND the headband thing, the works... and this morning was the most difficult morning I've had in quite a while. Just could not get out of bed. I switched to the Bleep a few nights ago, but still, same leaks. Started at 15 cmH2O and thinking it was too high I went back down to 13 cmH2O last night. No luck.

I have a buckwheat hull pillow coming in today that I can't wait to use.

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I'm definitely puzzled by all of this; the leaks are definitely due to mouth breathing but everything I throw at it doesn't seem to stop it

Oh and something interesting I noted; it seems like the flow limitations directly precede the mouth breathing.

[nee]

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I know correlation does not mean causation, but this just seems like every time I switch back to nasal breathing, some type of blockage is leading back to mouth breathing.

[Pugsy]

I think the absence of FLs on the graph during periods of large leak are just the machine not being able to sense them due to the leaks.
So I think your FLs are likely fairly consistent but just look intermittent.
If those FLs originate in the nose then more pressure is unlikely to fix them.
Have you played around with humidity settings to see if there is much of a change with variations in humidity?

[ChicagoGranny]

Sorry, I haven't followed your thread, so feel free to ignore.

everything I throw at it

Have you thrown a FFM at it?

some type of blockage is leading back to mouth breathing

Have you had a total airway evaluation by an ENT?

[jimbud]

Ditto what CGranny said.

I finally had to give up on the P10 and switched to the F30i. I have a beard and now have no leaks.
I also use a Buckwheat pillow (I have two of them).

I fought mouth breathing every way I could think of. Tape, tape with gag, tape with gag and cervical collar.
I was successful, but not comfortable enough for quality sleep.
Thus the F30i. It is working well for me (with cervical collar).

As with all CPAP solutions it works for me. For you...?

I hope you find something.
It can be very frustrating, but you will beat it in the end.

Good luck.

JPB

[slowriter]

I switched to the P10 for the past week because I was tired of the whole Bleep routine (shaving near the nose, witch hazel, extra tape around the Beep to neutralize leakages) and got massive leakages.

Hmm ... there's only two cases where I have gotten leaks with the Bleep:

First, if I haven't attached the Dreamports quite right, in which case there's a slight leak around the adhesive.

Second, if I haven't attached the mask part to the ports correctly. This sort of leak can be bigger, and can be avoided by testing before attaching to CPAP hose.

[squid13]

I agree with Granny and jimbud, it's about time you try a full face mask. I switched a couple of months ago to the ResMed F20 AirTouch and have zero leaks.

[Dreaming1]

Do you care so much about the facial hair to avoid a full face mask? If not, shave it all off and get the mouth under control. OTHERWISE, try a full full face for a couple days and see what happens. You're a dentist, you can afford it.