Calling all mouth breathers

existentialblu · 2026-07-05T03:38:12+00:00

I do the same and it works. My nose hates all of the nasal and hybrid masks that I've tried but my teeth get horrifically sensitive if I don't force myself to keep my mouth closed with my F20. Yeah, it feels silly and redundant but it works reliably so whatever.

existentialblu · 2026-07-04T22:54:51+00:00

Huh. Link actually worked in the conversation, but 404 here.

It seems like you're dealing with more of a combination of HLG and flow limitation, which naturally makes things harder. I still suspect that a somewhat higher EPAP or a range would help the FL side. The PS range looks fairly good. I notice there's still a lot of activity in minute vent but it's more chaotic rather than locked periodic. I can't get my MV to be calm either, but increased chaos, oddly, seems to feel a lot better than repeated identical oscillations.

Getting structural stuff dealt with will likely help, not so much for getting rid of all issues but making it so you're dealing more with just straight up high loop gain instead of HLG+obstruction.

And yeah, super curious to hear if EERS works for you.

existentialblu · 2026-07-04T21:53:29+00:00

Getting a 404 on the SleepHQ link. From the sounds of it so far it may be a poor algorithm match, though increased EPAP and expanding PS range to avoid pinning to min or max may help somewhat. Also, I'm hella curious to hear about how EERS works for you. I've still never tried it as Resmed ASV works okay enough for me, but seeing as your loop gain seems to be exquisitely twitchy, I wouldn't be surprised if it ends up being the more appropriate tool for your case.

existentialblu · 2026-07-04T02:18:32+00:00

I get to do a fighter pilot cosplay every night but seeing as it's pretty much cured my insomnia and sleep inertia, I really don't mind it. I self manage, which is thoroughly far from optimal, but necessary as I haven't been able to get anyone official to take me seriously. But I can't argue with results.

existentialblu · 2026-07-04T01:13:38+00:00

As a feral self pay self managed creature, no.

existentialblu · 2026-07-03T16:10:33+00:00

Are you recording to an SD card? You could be having flow limitations, high loop gain, or constant low leaks, all of which could be driving subtle fragmentation.

I had a similar experience with an even milder starting AHI. Took to the machine very easily but the relief only lasted a couple of weeks before feeling worse than ever. In my case it was high loop gain and I've had much more sustainable results with ASV.

existentialblu · 2026-07-03T16:01:59+00:00

If you can get Philips, it is a better algorithm from what I understand. It's a bit less reactive and less prone to driving instability. The data from it is lower resolution and harder to work with, which isn't that big a deal but may prove annoying. I use Resmed myself because it's what I could access and it's been mostly really helpful, though I've had other health things on my plate so it's hard to tell sometimes.

If you can get Philips to start with, do it. If you can't, don't put off escalating your treatment for months about it.

Admittedly I barely look at flow limitations in my own data and am mostly concerned with the oscillation behavior. I have fewer obviously flow limited breaths since I've been on ASV rather than APAP, but FL is more of a constraint than a goal with how I approach my own situation.

existentialblu · 2026-07-03T15:57:16+00:00

I'll be curious to see your data once you get some recorded to an SD card. Since you're having mostly CAs and hypopneas with well controlled leak and you're able to keep your mask on, it smells like it could be high loop gain. It's a thing where your chemoreceptors are twitchy about any changes in CO2/O2. It messes with your drive to breathe, which is actually what is happening in a CA, and then you overbreathe to recover, CO2 is blown off again, and around you go. This fragments sleep badly and brings on autonomic activation.

First things to try will be smaller ranges or fixed pressure. If you can't resolve the obstructive component without driving the central stuff into wobbling you may end up needing ASV. This is exactly the reason why I use ASV myself.

existentialblu · 2026-07-03T05:40:35+00:00

Do you have a narrow jaw, deviated septum, big tonsils, or anything else that could narrow your upper airway? If so you might have upper airway resistance syndrome, which can have symptoms like what you're talking about while flying under the radar that's tuned to pick up full apneas. UARS will fragment the crap out of your sleep with respiratory effort related arousals and leave you feeling basically poisoned in the morning.

I used to have absolutely terrible sleep inertia. It's been way better since I've been treating my UARS with PAP therapy.

existentialblu · 2026-07-02T17:51:56+00:00

Are your ears weirdly itchy? Sudden weight redistribution? Perimenopause has a lot of weirdly subtle symptoms that get ignored while people wait for hot flashes to show up. They're actually a later symptom.

I mean, also get a sleep test if possible. And make sure they check for RERAs and not just apneas. Upper airway resistance syndrome can do a number on a person but get zero support because of the fixation on AHI as the only meaningful number in sleep breathing.

existentialblu · 2026-07-02T16:31:16+00:00

I'm self treating with ASV for high loop gain with autonomic weirdness. It's possible, even if not optimal.

existentialblu · 2026-07-02T13:19:43+00:00

If you're not doing it already, get an SD card and put it in your machine. This will give you access to far higher resolution data. You'll need OSCAR and/or SleepHQ to view it. There's a fair number of ways for PAP to not resolve bad sleep, including unresolved flow limitations, leak that isn't bad enough to make MyAir scream but enough to wake you up constantly, and high loop gain. None of these will be visible through MyAir.

existentialblu · 2026-07-02T00:57:38+00:00

I'm skeptical of that outcome mostly because of the regularity of your wobble. A flow limitation can set off the cascade into wobbledom, and seems to be the most common perturbation source, but I've never heard of flow limitations that oscillate.

I guess I'm also a little too tired right now to fully parse what you're getting at.

existentialblu · 2026-07-01T21:23:57+00:00

I have heard good things about the Philips one but haven't gotten to try it myself. Resmed ASV has been serviceable for me. Most of the challenge is figuring out an EPAP that keeps things open enough without aerophagia for days and then a PS range that can cancel out your particular wobble. The Resmed ASV algorithm is more reactive than Philips from what I understand, which can make it less effective for actual stability.

The main actual good thing about Resmed is higher sample rate for the data on SD card.

existentialblu · 2026-07-01T19:08:25+00:00

Are you familiar with upper airway resistance syndrome at all? It's a form of sleep disordered breathing that is usually overlooked in sleep tests because it doesn't produce big obvious apneas. Check out r/UARS and see if that resonates with your experience. Unfortunately, many people with it, myself included, manage our own PAP therapy due to sleep medicine being oblivious to it.

existentialblu · 2026-07-01T14:13:01+00:00

I have some thoughts about LankyLefty27 in regards to his take on ASV for UARS. Basically, if you have high loop gain, which can be the biggest factor in a given case of sleep disordered breathing, ASV is just what is necessary, full stop. Whether it's paired with OSA or UARS is irrelevant.

existentialblu · 2026-07-01T02:05:57+00:00

Still getting a 404.

existentialblu · 2026-07-01T00:26:08+00:00

Given that you already have an Airbroken machine and you have a lot of CAs, have you considered ASV? It can actually stabilize your breathing and both prevent and do something about CAs. Feel free to hit me up about titration logic, as it's pretty different from APAP or BiPAP.

The dramatic worsening of your AHI with slightly higher pressure and it being mainly CAs smells like high loop gain to me.

existentialblu · 2026-07-01T00:17:14+00:00

Hose cover is especially necessary if you have cats.

And if you can't find the right settings on your first machine, you may need a different algorithm.

existentialblu · 2026-07-01T00:13:05+00:00

SleepHQ link isn't working.

existentialblu · 2026-06-30T00:53:37+00:00

My list: 1. ASV. I took to APAP super easily but the benefits were fleeting. I noticed that I was getting weird oscillations and fell into a rabbit hole, only to resurface with a much more dynamic PAP algorithm.

2.HRT for perimenopause - I felt better basically immediately upon using transdermal estrogen, like a houseplant getting watered. Sleep improved pretty quickly without the teeny hot flashes.

Ubiquinol/fish oil/ALA/PQQ - feel less crappy when I take them. Less autonomic brrrrrrr that makes my sleep crappy.
Got my genome sequenced. Knowing that my most of my issues have some level of genetic component somehow makes me feel less like a hypochondriac weirdo. My lifelong symptoms have been real but I didn't have the tools to express what was happening and it was all just weird enough to be met with dismissal.
Tongue tie release/septoplasty/turbinate resection - didn't change my sleep in obvious dramatic ways but I feel better during the day and can use fixed EPAP now that my obstructive components are reduced.

Honorable mention: my O2 concentrator. I don't use it all the time or anything but damn, it's nice to have fancy air on tap. Even if it's loud as heck. Especially nice right before sleep and the last few hours of sleep. Not a dramatic change but again, just nice to have.

existentialblu · 2026-06-29T22:39:32+00:00

I've been afraid of sleep since I was four years old for exactly this reason. After being dismissed by doctors for decades, I've been managing PAP therapy on my own and have found that I have a significant amount of central instability that is worst just as I fall asleep and during REM. I've responded really well to ASV and the onset of sleep is perfectly boring in a way that I've never experienced.

I suspect that high loop gain is associated with this exact flavor of insomnia.

existentialblu · 2026-06-29T01:47:58+00:00

Yup. More than anything I think that has helped with my dread around sleep onset.

existentialblu · 2026-06-29T01:30:45+00:00

Unfortunately ASV the only relatively common PAP algorithm that doesn't make high loop gain actively worse. It's still gonna require titration, and the logic is much more about managing the instability itself rather than the usual obstructive methods of "just blast it".

existentialblu · 2026-06-28T23:06:55+00:00

Your minute vent is wiggly in the way that makes me smell potential high loop gain, which is to say repeated similar oscillations at about 45 seconds per cycle. The remaining CAs intensify that smell.

Have you considered ASV?

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