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[CPAP] Pressure mandating very tight mask & worsening AHI
Two things:

First is the mask issue:

In the past month, the pressure that was initially prescribed last year, 11.0 cmH2O, is no longer effective. AHI consistently in the double digits for about 2 weeks. So I experimented with higher pressure settings and then contacted my pulmonologist over MyChart with the data and pressures I tried and he recommended 17.0. 

I have a spare brand new mask (exact same kind I received back in October) and I tried that at the 11.0 setting and AHI was still high - so I can probably rule out the mask as being somehow faulty.

The sole issue with higher pressures for me is that I must REALLY tighten my mask (F&P Simplus Large Full Face) to avoid major leaks and it causes major irritation on the back of my neck from the strap. 

I cannot get a new mask until April (I am on Medicaid and they will only pay for a new complete mask kit every 6 months) so I am stuck with this one for now -- I intend to get whatever the latest full face ResMed one is that my DME has in April. At the 11.0 cmH2O setting this mask was great - no problems. But it seems very difficult to avoid pressure leaks at pressures above 15.0 cmH2O.

So my question is, does anyone else use this mask and/or have similar issues with the strap? Am I somehow positioning it wrongly? Like should the back strap be positioned over my neck or should it be higher? Any other workarounds to last me until April?


Now the second issue. I mentioned my prescribed pressure was no longer effective above. At first when I experimented with an 18.0 pressure setting it gave me an average AHI of 0.5 over 3 nights. My pulmonologist evaluated the screenshots from SleepyHead to recommend I notch it down to 17.0 so I did, and at first that was also giving me <5 AHI (he says I should aim for under 1.0 AHI though) but after a week or so I notice again my AHI is above 5 at the 17.0 setting. My CPAP only goes to 20.0 cmH2O so there's not much more pressure that can be added at this point.

I intend to stick it out with the 17.0 pressure until at least I can get a new mask, tube, and humidier water reservoir in case one or more tertiary components are the cause. Or, at least I'll give it a month to see if AHI ticks down to below 5 consistently before I consider trying 20.0 (my doctor knows I experiment with the therapy settings and seems OK with it). 

I should note that I am not bothered by higher pressures at all (although it is causing me figurative headaches with my mask as stated above). They do not prolong the time it takes me to sleep, and in fact I seem to like the feeling of higher pressures.

Are there machines with higher pressures available? Or is it looking like I'll need a different type of machine? What do they use for people with the most severe OSA and/or CSA (I only have OSA) where 20 cmH2O isn't enough? If I need a new machine I am probably going to have to wait 4 years as Medicaid only pays for a new one every 5 years AFAIK. 

I plan to ask for a new sleep study at my next annual appointment with my pulmonologist but was just curious what people have to say on this. 

For those curious, here's the output for my last night at the 11.0 cmH2O pressure setting. I have been a lifelong mouth breather, so VS2 events are not out of the ordinary for me -- though this is far more than usual.


Attached Files Thumbnail(s)
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I'm a F&P Simplus user too.  I have the bottom of the headgear adjusted where it is positioned to be just at the base of my skull.  Your graphs look like your chin may be dropping towards your chest while asleep.  If you can, try sleeping on your side and adjust your pillow to keep your chin away from your chest.  

Also, please review this page on organizing your SleepyHead charts to give us better information:
Organize your SleepyHead Charts

I hope this may help. Good luck!
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Last night, you have groups of OAs in approximately 2 hour intervals.
Possibly connected to sleep stages. (Impossible to know without an EEG)

The bilevel machines like mine can go to 25 cm-water pressure.
Medicaid might pay for a new machine if your present machine cannot do the job.

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JustMongo passed away in August 2017
Click HERE to read his Memorial Thread

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You need to correct the physical obstruction that is causing this problem. Your chin is tucking towards your chest and cutting off your airway. Alternatively, this may be REM related sleep stage apnea. If so, you should have been prescribed an Auto CPAP or auto Bilevel. The image attached to your post above clearly shows a pressure of 11.0 is not going to work. On future graphs, please follow the tutorial in the first link in my signature for organizing your charts. We need to see Events, Flow, Pressure, Snores, Flow Limits (if available).

It would help to see your results at 18 cm. Also, your Dreamstation Pro has an Auto-Trial mode to help with titration. You should obtain the free Setup Manual at the link on top of this page. The Auto-Trial mode can identify the most appropriate pressure for your therapy. Also, if you have results of your sleep study titration it would be helpful to know the recommendations. It is puzzling how they arrived at a pressure of 11.0. I really think you're on the wrong machine, and your results, so far, prove it. We might be able to help, but the correct way to address this is to talk to the doctor and let him know it's not working in spite of your best efforts. I think you need an upgraded PAP machine.
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Oh ok, as per the guide I adjusted everything accordingly, though I lack a 'flow limit' graph so I opted to resize the other 5 recommended ones to fit my screen height. 

Correction to my previous post it was actually 18.5 cmH2O that I tried and 0.79 AHI as the result. 

I'll try reorienting the strap to fit around the base of my skull, that should work better since I'll have hair to insulate. 

And yeah I guess chin tucking to chest is an issue since I typically sleep on my stomach (even with a full face mask I manage) so I'll explore alternatives to that.

I'll definitely check out the Auto-Trial feature.

And no, unfortunately I don't have the results for either of my sleep studies (initial and titration). I recall the doctor mentioned my AHI during the first study (before titration) was 15 but I am not certain about that. Because of Cushing's Disease I have gained a considerable amount of weight since both studies. I was only able to sleep about an hour in the first sleep study because I do not sleep well at all in unfamiliar places and it didn't occur to me to ask for Ambien beforehand -- for my titration study I did ask for Ambien and it really helped. But my doctor claims the one hour of sleep was enough to produce a diagnosis of OSA. I really wish this data was available on MyChart.

In the titration study I only evaluated a full face mask (because I have mouth breathed all my life for sleep) and I slept on my stomach there as well (I've also been a stomach sleeper all my life).

Here's the 18.5 cmH2O night as well as my most recent 17.0 (new prescription) night that was above 5 AHI:

Attached Files Thumbnail(s)
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The Simplus can handle high pressures. Mine goes up to 20.

Don't over tighten. Looser is better.
Consider using a mask liner such as the Remzzz brand.
The Simplus likes to ride low on the face. The bottom of mine is almost including my chin.
Adjust the straps. Go to YouTube and do a search for the Simplus. It is amazing what you learn from those videos. I have to go there myself because I sometimes get stuff so messed up in fitting, I have to start over. I go there so I get it right. (I also tend to do some things backwards)
Put on the mask and turn on the machine. Fiddle with the mask to get the right fit. Lay down with it on. Move around in your normal sleeping position. Keep working with the straps and the mask position to get the right place for you.
If you are a stomach sleeper, you may want to go with a nasal pillow and a chin strap instead. I use the Nuance nasal pillows and they handle the high pressures just fine, too.
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Wrz77, I want to tell you that you can use the Dreamstation Pro in auto mode permanently. You go to the A-trial setting and set it to 30 days. When the 30 days are up, the machine resets itself to fixed pressure mode, then you can simply set it to another 30 days auto mode.

Also, if tucking in your chin is a problem, perhaps a soft sleep collar could solve that. Alternatively, someone here shared once that they stuff a rolled up sock into another sock and secure the ends under the T-shirt collar while the "bump" stays under the chin. They do this to prevent mouth breathing but it might work for you too, even if it's just for a while, to train yourself to position yourself differently at night.
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What are they doing about the Cushing's Disease? Is the source an adrenal tumor?

Admin Note:
JustMongo passed away in August 2017
Click HERE to read his Memorial Thread

~ Rest in Peace ~
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I am a notorious chin tucker.  A soft cervical collar (available at drug stores) fixed that for me.  They are cheap and you will know right away if they help.
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The Simplus can handle the pressure as Paula stated.

If you can go to a chin strap and nasal interface your pressures would be much lower. But some feel they have to use a ffm
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