Sierra

I use a ResMed AirFit P10 mask and I don't see how it could move teeth. To keep my mouth shut I use a horizontal strip of 1" 3M Micropore tape, and then cover that with a 10 cm wide x 6 cm high patch of Molnlycke Mefix fabric tape. The Micropore resists the moisture and the Mefix keeps it all in place.

Good to hear you are at least in the queue for a test. If you have a one on one test that should at assure they watch what is happening.

The Libre 2 has settled down a little bit. The annoying alarms are the signal loss ones. There seems to be no reason for them. I have the phone in my pocket less than 2 feet away from the sensor. For some reason I do not see an option on my app for a Urgent Glucose Alarm. I just have the high, low, and signal loss. My app version is 2.8.1.6120, and it seems to be the latest one available. I have been afraid to update my iOS as I initially had problems a few months ago with my first try with the Libre 2 and Abbott blamed it on my iOS. Perhaps I should update my iOS.... My phone wants to update to 16.5, but I keep holding off waiting for Abbott to update the app. Supposedly it is only approved for 16.1.0.

I hope you are making progress with your in-clinic sleep study.

You mentioned in an earlier post that you use a FreeStyle Libre 2. I have just started my first Libre 2 sensor that has worked (kind of), but I am having significant issues with it. I have an Apple iPhone 8+ and am on IOS 16.1.1. What is happening is recurring "Signal Loss Alarms". When I check the Bluetooth on my phone, the pairing has been lost. This is happening even though I always carry my phone in my pocket and it never gets more than a couple of feet away from the sensor on my arm. To clear it I have to turn the alarm functions off and back on again. Are you having any issues like that, and can you suggest any solutions?

I don't think you can selectively edit out sections of the data, unless it is a separate session. In the bottom left of the Daily screen there is a session information box. You can check and uncheck those boxes to suppress sessions. They are not deleted, just suppressed for the display of sessions you want.

On lowering the CA frequency about all you can do is keep lowering the pressure until OA's become a problem.

Actually unless the leak is very large, the machine is quite capable of keeping up with the leakage flow. If you look at the blue mask pressure graph you can see it is not affected by the leaks. The problem the machine has is that it does a rapid cycle of the air flow once an event is detected, and from that it also looks at what impact that has on pressure. If it is an obstructive event then a flow cycle causes a larger pressure cycle. With an open airway or central event it does not impact pressure much at all. That is how the machine distinguishes between an obstructive event and an open airway event. Then it decides based on the type of event whether or not to increase pressure in response to the event. With an obstructive event it increase pressure to open the airway. When the airway is already open then it is of no value to increase the pressure. And since increased pressure can cause more frequent open airway events, it is actually counter productive to increase pressure. When the leakage is high, the machine apparently cannot detect the impact of flow on pressure so it simply ignores them. So you may be having events during a high leakage event, but you will not know about it. The solution of course is to solve the high leakage cause. . She tried mouth taping for a while, but does not like it. She told me that women are smart enough to learn to keep their mouth closed... I am smart enough to not contest that one! I do remind her when she is having significant events and sometimes she makes improvements by adjusting her mask. Overall her long term average of AHI is less than 0.5, so I don't think it is having a significant impact to her overall AHI. My AHI is about 0.8 and higher so I am in no position to tell her that she has to improve!

OSCAR works with ResMed machines that have an SD card, and also I believe the DreamStation and DreamStation 2. It may not work with some very basic CPAP machines that do not have auto mode or even a SD card slot. To use it, you need a PC or Mac, and a SD card reader to transfer the data from the card to your computer. And of course you need the SD card in the machine. Some clinics pull a bit of a dirty trick and remove the SD card so the machine does not capture data. I have no idea why, because when you don't capture the data on a SD card the data is lost permanently. If there is no card, then any SD card less than 32 GB should work.

My wife and I both use a CPAP and I track the results with a freeware program called OSCAR. It lets you see when there are excessive leaks and displays them as grayed out areas on the data graphs. These are times when the leak rate goes above the 24 L/min red line (at least on our ResMed machines). My understanding is that the leaks from an open mouth tend to be flat topped in shape. I mouth tape and generally do not have leaks above the red line. My wife does not mouth tape, and does have more leaks, and some of which I suspect are mouth leaks. See the graph below. Some of the leak periods have flat tops and perhaps are mouth leaks, while one other is ramping up and perhaps is the mask not sealing on the face. She uses a Brevida nasal pillow mask. You will also see there are no events recorded during the grayed out high leak periods of time.

As far as the impact on AHI, large leaks above the red line on the ResMed (and I think DreamStation is similar) suppresses the reporting of apnea events. If it is a marginal event sometimes they can be reported as unidentified events. The high leak prevents the machine from determining what type it is. But in general events get suppressed during high leaks and as a result reduces the frequency of events and AHI. You could be still having them, but they are not reported. I agree with your thoughts that your machine is likely under reporting events during large leaks.

Hope that helps some,

CPAP can take some getting used to. Getting the machine set up properly and finding a mask that works for you are the keys to success. Assuming you have a machine like the ResMed or DreamStation that captures data on a SD card, it is worthwhile downloading it and viewing it with a freeware program called OSCAR. That will let you know how well the CPAP is working for you and what adjustments may be needed.

I use a CPAP but have no TMJ issues. My wife also uses both a CPAP and a TMJ splint made by the dentist. The combination seems to work for her.

About all I can say is that you should not be seeing O2 drop significantly below 95% during sleep. Drops below that suggest apnea events which may be central or obstructive.

The issue with CPAP clinics is that most do not want to take the time to look at your detailed sleep data. Some of us look at our own data using OSCAR which is a freeware program that runs on a Mac or PC. You download the data from your CPAP SD card with a card reader. It can be very helpful in figuring out what is going on while you are sleeping, or trying to sleep. Many sleep clinics do not fine tune the CPAP settings based on the detailed data. They just set a wide range between minimum and maximum pressures and put the machine in Auto.

The other big issue with CPAPs is the mask. There are many different types and one pretty much has to try them to find the one that works best for you.

As for heartburn, I just take one or two Tums before bedtime and the issue pretty much goes away. I also attribute them to my good bone density tests.

It would be helpful to see your mask pressure chart as well. I would try setting Your minimum pressure at 8 cm, with a ramp start pressure of 8 cm also. I like to use the Ramp Time set to Auto. And set the EPR to 3 cm (that is the max) and also to Full Time. That will start you out with an IPAP of 8 cm, and EPAP of 5 cm. When the machine detects you are asleep it will switch to auto and increase pressure as needed above 8 cm.

So far I have never run into an airline that charges for bringing a CPAP on board in the cabin. They are classed as medical equipment and I believe they are obligated to allow them at no charge. You do have to open the bag and allow an inspection of them when you go through security. The later ResMed bags have convenient straps that attach them to the vertical bars on a carry on bag with wheels.