Ian 3 2026 Optimizing Sleep Apnea

  • cutoff for usage is 70%
  • using it enough

  • like mild Bipap
  • exhale against a lower pressure

  • climate control: humidity. Higher level is more humid
  • higher temperature: tube will be hotter and prevents condensation

  • pillows so mask sit in cut outs
  • masks with hose coming out of top

  • Xylimelts: slowly melts in mouth

  • Optifellow: no prescription needed

  • American academy of dental website: sleep dentist in the area

  • strengthens muscles to treat sleep apnea

  • if given during first 2 weeks of new PAP therapy can improve adherence

  • OSA makes asthma worse

  • asthma makes osa worse

Hypoventilation

  • complex pathophysiology
  • increased airway mass and leptin resistance

  • stage 1: rise during night but recovery during day
  • stage 2: bicarb now rises to buffer chronic retention
  • stage 3: sustained hypercapnia. 45 mmHg and not 52 in COPD
  • stage 4: developing PHTN or other complications

  • AHI > 30 is more obstruction
  • Less than 30: more hypoventilation than obstruction

  • hypoxemic because he’s not breathing
  • initial bipap settings:
    • backup rate at 12
    • PS: 4-6
    • IPAP minimum 14
  • less than 88% for 5 min: qualify for nocturnal O2
  • titrate tco2, pCO2 to 40 or 45
  • trend vbg or bmps in clinic
  • gradually trend pCO2 down from high to low to avoid alkalosis.