[Diagnosis] I am commited to make it work - Need Help and guidance

[ebitansky]

Hello.
I have been trying to get compliant for long time. It will be 5.5 years. With three sleepd studies and moving from S9 Vpap Adapt ASV to Resmed Aircurve 10 ST, I really want it to work. I am sure it has to do with Anxiety as I fall asleep without any issues but keeping it on as a mystery. I got the P10 and it feels better on the face. started with medium but after reading some of the posts here, moved to large size. Sometimes I wake up with "Large Leek" warning, and sometimes, it shows "No Leaks".
Although I have access to the menu, I do not know if anything needs to be tweaked, not sure my doctors is interested to go into the depth of th ST params either. So yes. no cliniciaian to get advice from.
I put image of my Sleepy Head, if any of you could help, I could take different snapshots, to show better scale of specific time.

5.5 years and not giving up but not getting sleep either is quite exhausting

Thanks of any of your help

[Crimson Nape]

I'm sure a more knowledgeable member will come along to provide a more detailed insight on your ST.   Normally, hypopneas are a result from too low of a pressure setting.    A slight increase in the IPAP pressure to 11cm should be easily tolerated.

Since your using a P10, I would guess that you are mouth breathing.    Do you awake with a dry mouth?    The mouth breathing can be addressed by several different ways, these include: chinstrap, soft cervical collar, and mouth taping.   Of the three, I would regard the mouth taping as a last resort.  Of the two remaining suggestions, I'm having very positive results with the cervical collar.  It is less expensive, helps prevent chin tuck (an obstructive airway problem) and is more comfortable for me.

I hope this may provide some points to consider.

[quiescence at last]

do you feel that you were not asleep for some parts of your nights? please say what part you know you were just lying in bed struggling.

is something generally true each time you wake up, like nightmare/dreaming/surprise or strong feeling such as dry mouth or sinuses, sweats etc.

you'll probably get other questions, but also let's add welcome to the forum, and enjoy your stay.

QAL

[ebitansky]

Hi. Thanks for your response. I do not have dry mouth or sweat, or anything of that sort. While going to sleep is not an issue, i find out that after an hour (Almost always around the 60 minutes mark) I take the mask off. When I wake up aware of it, and put the mask back, it is just overwhelming, I can be another hour with the mask but won't be able to fall a sleep. Taking the mask off, and voila I am sleeping like a baby. This is why I thought it had to do with Anxiety. I did get my doctor prescribed Lunesta 3mg and the only result I got is that I never realized that I took the mask off. Xanax didnt do any better.  When I had my sleep study I was told that I woke up multiple times without an explanation or anything they could see in the study.
If it helps I can provide links to those study reports (All I have is the report and not the study itself)

[PoolQ]

Like the others have said, those with more experience than I will be around. Your Hypopnea count is high, as was mine, I found it disturbing. For me this kept me from getting good sleep, at the suggestion of some here I increased my lower pressure (by 1-2cm) by it turns out I needed 1.6cm and the hypopneas went away and I am sleeping fine now.

[dmeRT]

I think you need more pressure.

I would increase your settings to ipap 12/epap 8. Could try 11/7 if you want to move slower/cautiously.

As Crimson Nape stated, you may be leaking air through your mouth. this may become more of an issue with increased pressure. a swich to a full face mask might be in order if you can't fix the leak.

Taking the mask off without realizing is quite common. Maybe try switching to a mask that is harder to remove. I would suggest a F&P Eson as an option if you want to stay with nasal masks.

[ebitansky]

Hi. thanks for getting back to me.
How can I tell that indeed I am breathing through the mouth. I know that When I  speaking while wearing the p10 I feel air torbulance so strong that I close my mouth right away. I can go back to the resmed Mirage quatro full face, but I actually had worse results with that mask and found it less tolerable. (Most of the time I was not even aware taking it off). Do you have recommendation for which soft cervical collar, should I try?

[Crimson Nape]

I would initially try an adjustable collar. They are more readily available.  The size range specific models come in narrow, medium and wide for different neck lengths as well as neck size ranges.  The biggest problem was trying to find a sizing guide for these.   As luck would have it, my neck size is exactly on the break point in sizes.  


Based off a casual observation here on the board, it would seem that the two most currently popular full face masks (FFM) are the F&P Simplus and the Resmed F20, now available with memory foam cushions.  I've had very good result with the Simplus, but the new F20 really has piqued.my interest.

As a point of trivia; Each one of us has a maximum tolerable pressure before things like mouth breathing, and aerophagia occur.  You can use it at your next cocktail party.  

I almost forgot; In an attempt to reduce the mask removal, you could try wearing it while watching TV or reading to grow use to wearing it. This simple exercise has proven very effective.

- Red

[ebitansky]

Thanks for the recommendation. looking at the collar right now. About wearing it while watching TV. I could have wear the Full Mask (Resmed Mirage Quatro) with the P10, There is not enough air coming in if the CPAP is not working. I feel suffocated (with the medium size for sure).  I still dont think it is the issue of the mask being on, otherwise, I would assume I would not fall asleep first time either, which is not the case.

[ajack]

First I'd be asking why they swapped you from an Adapt/ASV to a ST, the ASV treats more breathing patterns and there must have been a reason for the adapt/ASV in the first place. I would be contacting my doctor and unless you have developed CHF, I'd be jumping up and down.

I'd get a full face mask working with your apnea treated first, as it removes a variable, You can choose to use a nasal later and work on mouth leaks. You need to get a full face working for when you have colds anyway.
I used a chin strap over the top of the mask, as another layer that helps stop nocturnal removal. Head bands etc could be used too, keep making it harder. Just keep the vents of the mask clear. when you intend to take it off, sit up first, so you can't go back to sleep without it.

This may help you get a background understanding of how a ST works and it's titration.
from page 21 onwards and page 34 onwards
https://www.resmed.com/us/dam/documents/...lo_eng.pdf