Help required to reduce AHI and Aerophagia

[vandownbytheriver]

Thanks for your response vandownbytheriver.
Thanks for the info on MAD. One potential issue with this for me is that I currently wear teeth aligners and will be on a nightly retainer soon. I'm not sure if this would prevent me from being able to use such a device?

Up to your dentist. Normally they defer to sleep dentists who specialize in MADs. Certainly complicates things.

Also another thing to note, I have quite a small throat (it takes me longer than most to eat). Would a small throat/airway be a cause of sleep apnea, and if so are there any common remedies for this? Would a MAD device help with this?

The MAD moves the hyoid bone and the base of the tongue forward. If this is constricted then yes. Again, your situation complicates things. You should see an ENT, they can usually just take a look and make an educated guess... mine said 'tongue'. When I use the MAD I can sleep supine no issues... if I don't use it I can feel it catch sometimes when supine. The big bi-level pressures do help, you really need good sea legs to tolerate 20cm though.

Regarding sleep position, I always sleep on my side (I've tried both sides and there isn't much difference between them on their impact on aerophagia or AHI) but last night I tried sleeping on my back for the latter part of my sleep. My aerophagia wasn't too bad today, but AHI score increased to 12.8 with a big increase on CA Apneas. Not sure if that was the cause, but interesting to note. Here's the graph - https://sleephq.com/public/b6e3e6c5-a0b ... 5055668c6f

Flex is limited at 4cm... as the pressure climbs you will get more flex, until at 7cm the Flex 3cm is fully active. Flex can cause CO2 stripping... this causes cycles of CA. I'm wondering how you do with less Flex... have you tried it?

[Jude92]

Thanks for your answers regarding MAD, that's really helpful. I have a follow up sleep appointment which I've been told will be some time in June or July, so hopefully they'll be able to give me more information then on what may be causing my apnea.

I think my flex has been set at 3 since I started. I'll give it a try at 2 tonight and report back on how it goes. Thanks again!

[Jude92]

I thought I would provide you with an update on my progress as I haven't posted in several weeks. I turned FLEX down to 2 and have kept it there for over 7 weeks. My aerophagia has been up and down as has my AHI score. I had a really good period between 27th May and 7th June on both counts, which was then halted by a really poor nights sleep due to external noise. My AHI was scoring below 5 for a good few days but has went back up again to my normal score of around 7. No idea what caused it to go down and then back up. Despite this my level of daytime fatigue and tiredness is still as bad as ever.

I called my physiologist to enquire about trying a bipap but was told that this is very hard to get through the NHS as it's only given out for complex types of sleep apnea (they assumed I had OSA at this stage). It was on this phonecall that I was told that I had been removed from the waiting list for a 2nd sleep study as they assumed my symptoms had improved on CPAP. I'm guessing this was because I had a short period of scores under 5, but I explained that it was very much still needed. I then got a cancellation, so had my 2nd sleep study last week and it went awful as I really struggle to sleep under pressure. I'm awaiting my results but dreading they either didn't get enough data or the data won't give a true reading of my regular sleep.

From my phonecall with the physiologist, I think the 2nd sleep study was to get a better understanding of the type of sleep apnea I have. Could someone explain to me if there are any differences in the symptoms between OSA and central sleep apnea? I've searched a bit online and I can't tell which one I'm likely to have. I don't really snore so I'm wondering what the chances are that I have central.

Here's a few links to some recent night's sleep. If anyone has any advice from looking at these, I'd really appreciate it.

OSCAR graphs including overview, example of good score and last night sleep - https://imgur.com/a/VW0fSyz

Sleep HQ: Recent poor score - https://sleephq.com/public/f48778f3-c0f ... fb9de1cea5
Recent good score - https://sleephq.com/public/eeeaf13a-0dc ... dd8c475ae3
Trend - https://sleephq.com/public/ae4099dd-ee8 ... 1965bf1563

[ozij]

Back on the first page of this thread many suggested you raise your minimum pressure.

The trend data shows you tried that with a very dramatic rise, to min 6.5 , one time only. I can't see you sticking to any other change from a minimum of 4.

Start raising your mimimumbpressure as gradually as you can, and stick to the change for a number of nights, unless its truly catastrophic.

IIRC, Respironics machines let you make changes of no less than 0.5 cm at at time.

And don't use ramp.

[Jude92]

Thanks for your post ozij. I think the trend data on sleephq gives a bit of a false impression as I did try several nights at 5, 5.5 and 6 before going to 6.5. The ramp feature makes it appear as if the minimum was 4, but this was only used at the start of my sleep to get me to sleep as I struggle to get over at anything higher. When you hover over the dates between 11th April and 24th April you can see this based on the medium and 95% scores. I have been on 4-7.5 since 25th April as that was the pressure my physiologist recommended.

I'm planning to give them a call next week to enquire about a v com and a new humidifier as my hose connector loosened last night and will need either fixed or replaced. What pressure settings would you recommend? 4.5-7.5? One of the physiologists advised that a nasal pillow mask can only handle pressure up to 8. Is this true?

[Pugsy]

One of the physiologists advised that a nasal pillow mask can only handle pressure up to 8. Is this true?

Totally untrue. There are people successfully using nasal pillow masks with pressures in the 20's.

[ozij]

Thanks for your post ozij. I think the trend data on sleephq gives a bit of a false impression as I did try several nights at 5, 5.5 and 6 before going to 6.5. The ramp feature makes it appear as if the minimum was 4, but this was only used at the start of my sleep to get me to sleep as I struggle to get over at anything higher. When you hover over the dates between 11th April and 24th April you can see this based on the medium and 95% scores. I have been on 4-7.5 since 25th April as that was the pressure my physiologist recommended.

I'm planning to give them a call next week to enquire about a v com and a new humidifier as my hose connector loosened last night and will need either fixed or replaced. What pressure settings would you recommend? 4.5-7.5? One of the physiologists advised that a nasal pillow mask can only handle pressure up to 8. Is this true?

It's median score, which means you spent half the night at this pressure or above it (or half the night at this pressure or below it).
Whichever way we look at your data. On some of those nights, it looks like you limited the maximum pressure as well.

Based on the tred, I don't see you needing more that 7.5.
Stop the ramp.
Put your minimum pressure at 4.5 keep it there for a few days, see what happens.

The person who told you nasal pillow masks don't work above 8 knows nothing. Don't trust a word s/he says.

[Jude92]

Thanks Pugsy. I get the impression from speaking to some of the staff there that they don't have a great knowledge about sleep apnea which is concerning. The fact that they assumed that a few nights with an AHI score slightly below 5 was enough to take me off the waiting list for a 2nd sleep study was alarming. From reading online it's quite common for people to still have major symptoms at that score. They sort of have a dismissive tone when I speak with them as my original score was categorised as 'mild', without taking into consideration that the symptoms have had a major impact on my life for the last 8 years. It's very frustrating.

[Jude92]

Thanks again ozij. I'll give them a call on Monday to see if they can increase my minimum to 4.5 and see what impact that has.

[Jude92]

Hey, bit of an update since my last post about 5 weeks ago.

I increased my minimum pressure to 4.5 and it didn’t make much difference to my sleep quality or AHI score. My aerophagia remained awful so I finally got a V-Com and it did help massively and has been a great help, so thank you for suggesting it.

My main problem now (it has really been a problem since the start) is that I tend to sleep steady for the first 5-6 hours and then wake up with a dry nose where it feels like the air is bouncing straight out of my nostril. This tends to waken me constantly for the rest of my sleep despite me adjusting it multiple times. I have been using Ayr Nasal Gel since the beginning of March and my humidifier has remained on since I got it. I wasn’t really feeling much heat from it so I changed it from adaptive to fixed and it became more noticeable. So much so that I got my first case of rainout. I’ve been using a heated tube now for the past 11 nights but I’m still waking up early with a dry nose.

Yesterday I met with my physician and he recommended increasing the maximum pressure from 7.5 to 8.5 and increasing the humidity up to 4 (it had been at 3). Last night I woke up even earlier with dry nose and extreme wind. I’m hoping the wind will subside after a day or 2, but does anyone have any suggestions what I should do with my humidifier settings? Would lowering it to 2 help due to the summer heat?

[Jude92]

Looking for some advice on an issue I'm having now. CPAP has improved over the past couple of months, but my main issue now is my nose gets dried out after about 6 hours. This stopped for a while but has started again recently despite me keeping everything consistent. My humidity level was at 2 when it was going well. I've tried increasing it to 3 for several days and then 4, but it hasn't made any difference.

Does anyone have any tips on how to improve this? I use saline gel so I'm already trying that. Will changing the settings of my heated hose make any difference?

[Pugsy]

Will changing the settings of my heated hose make any difference?

Probably unlikely that increasing the heated hose air temp will do what you want.
More warmer air is really only going to reduce chance of condensation in the hose or mask.
It doesn't add water to the air....only heat.

What is your ambient humidity in your bedroom? Has it reduced lately?
Any new meds or change is dosage of current meds?

[Jude92]

No changes in medication.
Bedroom humidity isn't something I monitor. I checked there now and it's 58% (I have no idea what to read into this).
Temperature has dropped recently. I sleep with the window open, but had it closed last night (making the room warmer) and it didn't make any difference.

[Pugsy]

58% is higher than mine (runs about 45% unless it's been raining) but then my humidity level selected on the machine is close to the max of 8 I think. I did have it on 8 and backed it down to 7 due to condensation in the mask even with max hose air temp.

I honestly don't know what to suggest except increasing the humidity setting even more than you have and I have no idea if that will do what you want because it may just be that something has changed within your own body ....since you have been using things this way for years.

Are you finding that you are using up more water than you normally do or has water level in the tank remained the same after each night of use?

If it was me I would probably at least try a lot more humidity via the humidity setting as first thing to do and go from there depending on results.

BUT....just changing the hose air temp and nothing else is not going to help re-hydrate the nasal mucosa. Might potentially make things worse as well.

[Jude92]

Thanks for your help.
The water level has been pretty consistent recently, so I can’t really take anything from that.
As a general rule, do you turn your humidity level up during the colder months?