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Amara view issues, air swallowing....
#1
I'm fairly new to APAP therapy, with an AirSense10 for her and my fourth mask. My mouth falls open when I sleep, regardless of a chin strap, so I use a full face mask and tape so my mouth doesn't dry out. I'm using an Amara View, fitted for a medium cushion but just moved to a small because of constant leaks from cheeks and nose no matter what I did(silicone earplug material, aloe, strap adjustment, etc ). My pressure is 5-20 and was averaging 6.8 most of the time, AHI 1-3 with many centrals. I can't sleep when leaks spray my cheek or eyes with air. My old FFM gave me pressure sores on the bridge of my nose. I move around a lot at night so it's tough to know whether a mask will wake me with leaks... Most are fine when I first try them.

The small cushion yields few leaks, and definitely seems to fit better, but introduced some new issues. My pressure is now averaging 7.8(no other changes other than the smaller cushion) and this is causing me to swallow air for the first time. I never that issue in the previous 2 months of therapy. I have tried using uncomfortable positions to keep my neck from flexing and that reduces it, maybe by a third, but gives me a neck ache. My AHI has even gone up for unknown reasons, not much, but it seems odd with the higher pressure. I'm also not sleeping much, and have higher AHIs when i sleep well(of course, I'm awake so breathing normally). My average was like AHI 1.5 with 1.2 of those centrals.

I called the DME about this and they had few ideas other than to reduce my pressure range(that would just give me CPAP.... I'd have a range from 5-6?). My thought was that my machine shouldn't be set for a FFM anymore since the mask volume is so small, and that might be the issue. They are saying that's not possible and don't want me to change it. I'm really uncomfortable with the air swallowing and bad sleeping angle! I do have some facial pain from the lower part of the mask, too. That's been about the same between the masks I've tried.

When I'm eligible for a new mask, I'm going to try a nasal one with my mouth taped... But I definitely need a FFM on hand for colds and stuff, which is the main reason why I started with one.

I hope to find some answers here!
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#2
Hi Recipefordisaster,
WELCOME! to the forum.!
The mask si the hardest part of this whole thing so don't be shy about trying different ones 'till you find the one that works for you.
Hang in there for suggestions and answers to your questions and much success to you with your CPAP therapy.
trish6hundred
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#3
Thank you! I'm past my 30 day trial period so am stuck with this mask until December. I do have the medium cushion which leaks like crazy. I'm not in a position to buy at my own cost... Copays are high enough. I'm fairly small and the DME is saying there aren't that many FFMs that come in my size. I probably can't do one with much nasal bridge contact, so they actually didn't have any more masks they recommended I try.
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#4
(07-28-2015, 10:40 AM)Recipefordisaster Wrote: I'm fairly new to APAP therapy, with an AirSense10 for her and my fourth mask. My mouth falls open when I sleep, regardless of a chin strap, so I use a full face mask and tape so my mouth doesn't dry out.

If you have been adjusting the chin strap so that it feels comfortable (loose), rather than snug (tight), you have the option to give it another try. I use the type that is a wide elastic strap that resembles an ace bandage. When I put that on snug my mouth/chin isn't going anywhere. Over time I have graduated to a middle snugness which now feels comfortable. I was able to start it tight and put up with it because the immediate relief from escaping air was a major improvement and allowed me to wear the most comfortable mask (for me) without having to go FFM.
if you can't decide then you don't have enough data.
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#5
I'm 3 months into therapy and a month into Amara View mask with the A10. Boy, I'd love to have your pressures and AHI! If your leaks were quite high with medium, it's possible the machine missed some events that it is now picking up. My A10, and I assume all, respond to Flow Limits (you can see in Sleepyhead) and OAs by jacking up pressure. Maybe with the small mask that leaks less it can "see" more of these events with a resulting higher average pressure.

I just pushed my upper pressure limit up to 18 from 16. Not very comfortable at those levels, though I do find myself sort of adapting. Hope it works :-). Before this I was using the ResMed P-10 pillows, which I loved. Much lower pressure (13 peak pressure); very low AHI. My issue was mouth leaks which a chinstrap didn't address. My last ditch is to go back to the pillows and use tape. How is your experience with tape?
Dick
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#6
Welcome.
I had a similar range on mine when I started but I progressively reduced it watching the data with sleepyhead. I found I got a lot of centrals at higher pressures and as I limited it to what it could go up to I got less and less centrals with no more obstructives. After a point I started getting obstructives so I crept the pressure back up till they stopped. I did a week between each change. I am now running with an AHI of 0.1 - 0.3, and the one or 2 I am having are usually centrals. Note: I only have moderate Apnea so ymmv.

I also found limiting the top pressure reduced the air swallowing substantially. It was also something that improved over 6 months - it was very bad when I first started but rarely a problem now as my body had adapted.

As for a mask, I love nasal pillows but I also have a nasal mask and a full face mask for when I must use them (colds, hayfever etc). Finding a mask that works for you seems to be the most critical, hardest, most frustrating etc aspect of this whole exercise and there seems to be no easy way to sort it except by trial and error (and much expense)
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#7
Interestingly, my reported leaks have always been low. The DME kept saying that the medium must have been working okay because no major leaks were reported. sleepyhead echoed this. Otherwise I'd like that theory of the events not being detected.

I do have the mask fairly loose as it really hurts when tight. My actual jaw doesn't fall open so much as my lips part, which is why I think the chin strap never worked. I only need a tiny gap in my lips and my mouth is like leather inside, even when humidity is high.

So, if anyone has a great recommendation for my next FFM, taking into account my small size, sensitive nose bridge, lots of moving around in my sleep... I'd really appreciate it! I'd prefer to sleep on my side angling towards my stomach, if I can be that demanding. I have a bad neck, too.

Tape has been decent for me, it's quick and effective, and the paper tape doesn't leave residue. It's definitely worth it and the only thing that has let me avoid waking from dry mouth. I use 2 1" vertical pieces of 0.5" tape on either side of my nose.

I do think that higher pressures have been unnecessary and maybe troublesome to me, but as I said if I lowered the top pressure there would hardly be a window.

I'm encouraged by your comment that your body overcame air swallowing! I really hope I can do that too. I've never had experience with this before!
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#8
I should add that I don't think my mouth taping is enough to allow use of a nasal mask... But I am planning to try. I can force air through it, but the thing that works is that my lips don't flop open without effort. I think pressurized air would leak out....
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#9
(07-28-2015, 09:58 PM)BKeeper Wrote: I'm 3 months into therapy and a month into Amara View mask with the A10. Boy, I'd love to have your pressures and AHI! If your leaks were quite high with medium, it's possible the machine missed some events that it is now picking up. My A10, and I assume all, respond to Flow Limits (you can see in Sleepyhead) and OAs by jacking up pressure. Maybe with the small mask that leaks less it can "see" more of these events with a resulting higher average pressure.

I just pushed my upper pressure limit up to 18 from 16. Not very comfortable at those levels, though I do find myself sort of adapting. Hope it works :-). Before this I was using the ResMed P-10 pillows, which I loved. Much lower pressure (13 peak pressure); very low AHI. My issue was mouth leaks which a chinstrap didn't address. My last ditch is to go back to the pillows and use tape. How is your experience with tape?
Dick

Dick, I used tape for a week or so, and it completely solved the lip bubble/mouth droop issue. However, I couldn't see taping my mouth closed every night for the next 20 years, so I abandoned it and am currently using the Amara View. The AV is fairly comfortable and so far has produced so-so results (2 weeks average AHI about 5). At my highest pressure the AV has distracting small leaks, so I'm still fiddling with mask fit issues.
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#10
(07-28-2015, 08:48 PM)trish6hundred Wrote: Hi Recipefordisaster,
WELCOME! to the forum.!
The mask si the hardest part of this whole thing so don't be shy about trying different ones 'till you find the one that works for you.
Hang in there for suggestions and answers to your questions and much success to you with your CPAP therapy.

I agree Trish, the mask is the hardest part, I'm also on my 4th mask and it is getting expensive trying all these masks as insurance says you already had one! Know of any loopholes?
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