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[Equipment] New to CPAP - possible mask issue?
#1
New to CPAP - possible mask issue?
Hi all!

New to this forum and pretty new to CPAP, but really grateful you're here. I've been browsing today and am stoked to see such a wealth of helpful information. Hope I can contribute something to it in the future, but thanks for all you do. 

I'm a 39 year old guy and have probably had sleep apnea for several years, but it was a stealthy case. I didn't snore, never woke up gasping, never nod off during the day, and have a sub-23 BMI, so my doctors were bemused when I asked for a sleep study, and frankly, I felt a bit like a dope asking for it myself, especially when I went to pick up the home testing kit and answered "0" to every question they asked me about daytime sleepiness. (I later learned this was the Epworth Sleepiness Scale.) My wife is in medical sales and actually sold sleep apnea machines back in the early 2010s, so she had a lot of fun teasing me about my latest harebrained stab at cracking the cause of my mysterious symptoms. 

But I'd been having awful sleep, even by my low standards, and a sudden rash of intractable GI symptoms like GERD, esophagitis, and indigestion that were totally new to me, not to mention inexplicably disintegrating molars, and sleep apnea runs so deep through my dad's side of the family that it seemed worth ruling out. I took the home test and had an AHI of 25, but I had to take pills to fall asleep (otherwise I wasn't going to get the 4 hours of data required) and sleep aids seem generally to worsen my apnea, so my true baseline AHI might be a little lower than that. In any event, I was diagnosed with sleep apnea to my doc's surprise, and started on a ResMed AirSense 10 AutoSet.

The good news: I took to CPAP after only two nights, an absolute miracle given my finicky sleep habits and vigilant, hairtrigger unconscious. The GI symptoms vastly improved, well, literally overnight, and I fell to my knees in gratitude the next morning as I enjoyed my first easy breakfast in months. 

The bad news: CPAP mostly hasn't extended my sleep, which has been stuck at 5.5-6 hours a night for the better part of the last two years. My compliance is 100%, but my average CPAP usage per night (= my total sleep) is 5.9 hours. My AHI is seemingly OK (?), ranging from 0.7 to 4.7 and averaging out to 2.5, with a total AI of 1.3 and a central AI of 1.0. (My pressure is 10.3 and my leaks 8/min.) I've been on the CPAP since August 2020, and it IS working: the GI stuff is so much better and the incessant headache I associated with low sleep has mercifully vanished (guess that was apnea, not just insomnia), relief that alone would keep me on CPAP as long as I need to be. 

That said, I had a run of almost ten days a few weeks ago during which I slept at least 7 hours every night, with two nights even north of 8, the sort of sleep I haven't experienced in years. Even with the few sleep drugs that work on me I struggle to get to 7.5, so 8 without drugs is staggering. This was heaven on earth, and such a freakish run that I can't believe it happened by chance; I think I can count on one hand the number of days I've slept over 7 hours without pills in the last couple years. 

There are so many possible confounds here that I don't know what caused this, but I'm started to think it was because of my mask. I'm almost an obligate mouth breather (deviated septum on top of some sort of blockage behind the nose that makes it hard to nosebreath even when I'm awake) so I use the full face mask, and looking back it was around when the mask was coming loose and needed to be replaced that I experienced this heavensent run of sleep. I got a new mask (same as the old, AirFit F20 L) and the sleep went back to 5.5-6. 

So my questions here: 

1:: Is this improved sleep really likely to be due to an old, loosening mask? I keep thinking maybe my immune system was fighting something off and thus kept me asleep, but I had no other symptoms, just increased sleep, and as mentioned ... I never get that. Does anybody have tips for how I should I be wearing the AirFit F20 in particular?

2:: While I sleep about 5.5-6 hours almost no matter what (CPAP or no), the worse I sleep the more I follow a pattern. (This is without pills.) I'll wake up about 2.5 hours into sleep, then about 4 hours in, then about 5, then about 6 and for good, *ALWAYS* from a dream, sometimes with a racing heart. If I don't wear my CPAP I seem to follow this pattern no matter what, but it sometimes happens even when I do, especially this week with the new mask. The event at 2.5 hours seems to be my first of the night - when I hit the button on the ResMed, it'll say something like 2.5 hours of sleep, 0.4 events per hour - but the events multiply as the night goes on, wrapping up around 4 to 4.5 per hour for the night. If I sleep like this I have some mild GI symptoms and can't eat much comfortably the next day, but other than that (and the fatigue) life is fine. This seems to associate with the mask too: I've had it with the new mask and with an AirFit F20 M that I had to wear after my old L seemed too loose but my new L hadn't showed up. Has anyone else experienced this pattern? What does it indicate, and what could I do to combat it? 

3:: What's the best way to try out new masks given that I can't go try them on at the moment? (COVID's everywhere, so no thanks.) 

4:: Are there any other newbie CPAP hacks that aren't in the wiki or that I might have overlooked? I'm eager to make this work. I didn't even realized OSCAR existed until I found this board, so I'm ordering an SD card and will start compiling data soon. 

Thanks a bazillion in advance for any help!
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#2
RE: New to CPAP - possible mask issue?
Welcome to the Apnea Board.

AirFit F20 and most other masks; how to adjust tension, more or less like the bonjour method: lie back on the bed as if you were going to sleep, hold mask on your face in the proper position without the strap holding it but your fingers, start therapy pressures, do not use Ramp, adjust finger tension until reasonable leak free status is gained, Now add straps and adjust top then bottom to mimic finger tension from a moment ago. That should do it.

If you want to replace an F20 with another full face, consider Fisher & Paykel Simplus or Vitera. Buy same cushion size as you use on the F20. Both Simplus and Vitera are more comfortable and much easier to attain leak free status.

To get masks at this time, it's likely you want/you buy. I was given the Simplus after a sleep study as COVID rules means tech tosses mask or gives to patient.

SD card info: it must be a standard SD physical size, in SD or SDHC, 2-32GB capacity, any brand and not necessarily ResMed's or Respironics, etc. Once you get OSCAR up and running, make sure the SD is inserted in the PAP unlocked to save detailed data. Once you do that you may upload the data to OSCAR. Use F12 to take screenshots of the Daily tab. We need Events, Flow Rate, Pressure, Leak, and Flow Limit not zoomed in. The left panel needs calendar closed/minimized and pie chart off. IF you scroll that left panel down to where AHI is showing, it should show pressure stats below.
INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEBSITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#3
RE: New to CPAP - possible mask issue?
Thanks Dave! I'm on it, will be back with the OSCAR report and my experience with the new mask.
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#4
RE: New to CPAP - possible mask issue?
OK good luck. Hope we can help out with it.
INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEBSITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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