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Excessive APAP Pressure Wakes Me Through the Night
#1
Excessive APAP Pressure Wakes Me Through the Night
I need some help in understanding the difficulty that I have been experiencing using my APAP with a number of different full face masks. I'm being awakened throughout the night.

I had been using a nasal pillow successfully for many years with an AirSense 10 APAP.  But a few years ago, I tried full face masks after a tech woke me from a sleep study and exclaimed that I was a mouth breather.  I thought that a full face mask might reduce my dry mouth, which was really the only complaint I had with using a CPAP.

I tried a ResMed Quattro FX, and F10 and an Amara.  But I found that each one seemed to leak too much, primarily around the bridge of my nose.  Seems they are designed more for a Roman nose and since I have a flat bridge, I’d get air leaking up into my eyes no matter how I adjusted them.

So, I had returned to using a nasal pillow until recently when I decided to retry using a full face mask.  I thought perhaps some newer models might provide a better fit.

I have tried the ResMed F20 (S, M, L), F30 and the DreamWear (M, MW). 

Despite trying all these, I have still had difficulty finding one that will work.  They seemed to initially work with my ramp set on auto.  But after falling asleep I would wake about every 1.5-2 hours feeling the pressure was too high and the air was leaking out the sides of the cushion.  In the case of the DreamWear and the F30 it also seems that the higher pressure dislodges the nasal orifice so it’s not aligned with my nares and I can no longer breath freely through my nose.  Each time I wake I have to reach over and turn off the machine, readjust the mask and let it recycle again.  The result is that I don’t feel very rested because of the recurrent disruptions.  I spoke to my sleep tech about this and he didn't know what was happening but said maybe I’d just have to resort to restarting it as I had been doing.  But this is clearly not a very good way to promote sleep efficiency.

In the meantime, I got a repeat cycle timer off of Ebay to automate the process and avoid being woken up. This allows you to precisely program ON and OFF intervals in HH/MM/SS and it repeats the cycle in an endless loop. 

   

I have attached some examples of OSCAR graphs.  The first shows results using a full face mask and having to recurrently recycle the APAP manually when I am awakened (indicated by the discontinuities in the mask pressure graph).  

The second shows the results when the APAP is automatically recycled by the timer. I set it to briefly interrupt the AC to the APAP for 1 second every 90 minutes throughout the night.  After the first night of implementing this, I woke much more rested and slept through the entire 8 hour period without a known arousal.

I do wonder if restarting the APAP with the ramp on  might run the risk of partially defeating the autoset feature? Clearly, using the timer produces a more even mask pressure graph. The average pressures are significantly lower doing this though I still do get AHIs that are generally at 1 or less. Why is there a cyclic, extended interval of low, nearly flat pressure for 30-40 minutes after each interupt?  Could this be an artifact produced when the CPAP AC is fully powered on and off instead of only turned off using the start button?

   

   

Anyway, I'm hoping the many sharper minds on the forum can clarify and interpret what is happening. I haven’t taken the time to really learn how to interpret the various graphs in detail.

Any thoughts or advice would be appreciated.

Doug
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#2
RE: Excessive APAP Pressure Wakes Me Through the Night
In my experience, while Ramp is on, you get no therapy. OK maybe you might get a little depending on what pressures you need to get therapy. But the machine cannot increase pressures while under control of Ramp. I'd say there's some issue that needs addressed if you have to automate resetting so you get Ramp almost all night. Ingenious concept? Yes. Good idea? No.

If the leaks are the culprit, you have to resolve the mask fit or whatever else is causing it. You said the main leak area was the bridge of your nose, but the Hybrid F30 didn't resolve it. And the F30 doesn't seal against the bridge of one's nose. It's got a nasal cushion like top section. Maybe adding cushioning material will help with true full face masks.

I also suggest reviewing Mask Primer in my signature to see if you gain adjustment and fit info to help. Hope it maybe can help out.
Dave

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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: Excessive APAP Pressure Wakes Me Through the Night
This constant cycling of the machine to reset ramp is very disruptive. If you feel you need a lower pressure, then limit your maximum pressure, and deal with what events arise. Limit your pressure to 8.0 or 9.0 or whatever you tolerate without waking, and quit cycling the machine. In fact just turn off ramp. Stop the automatic shutdown and restart of the machine, and let's figure out a maximum pressure that works instead. I don't see your leaks as pressure dependent based on these graphs. Your fit deteriorates over time and even when pressure is dropping you get leaks. The solution is to find the right mask.

Look at hybrid masks. These use the nasal pillows interface you like and cover the mouth like a full face. It would also help on your charts if you would include the Daily Sidebar on the left side. That gives us a lot of vital information on settings, therapy and respiration.
Sleeprider
Apnea Board Moderator
www.ApneaBoard.com

____________________________________________
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INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#4
RE: Excessive APAP Pressure Wakes Me Through the Night
Doug, I see you have the F20 - I suggest you try the Airtouch cushion with memory foam. I found it gives a much better seal across the top of the nose. The memory foam cushion uses the same and headgear as the normal F20 silicone mask.

Another trick to try is to pad the mask where it bears on your nose I used a piece of flannelette about 100 mm square. Fold it so you end up with a narrow strip about 3 or 4 layers thick. Drape this over your nose then don the mask. The mask will hold the fabric in place and the fabric will help control the leaks.

Please post your charts again, but organise them according to the link in my signature. We need to see the statistics in the left side bar. Make sure the calendar and pie chart are turned off.

Finally, congratulations on a very lateral approach to the problem. But as Dave said, it probably won't help in the long run.
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#5
RE: Excessive APAP Pressure Wakes Me Through the Night
Thanks for your helpful suggestions.

I'm posting the OSCAR print screens with the left sidebar as suggested.

   

   

   

It doesn't seem that a high leak rate is always associated with these events--at least as I read it.

I am going to try running the APAP without the ramp feature since I don't really need to use it.  I am going to try it with and without the repeat cycle timer engaged to see how the graphs compare.
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#6
RE: Excessive APAP Pressure Wakes Me Through the Night
If you include your flow limits graph instead of AHI, you will see why pressure rises, and why I suggested fixed pressure or a limit on maximum pressure. The flow limits are a key to why your Autoset increases pressure, whether or not they end in an event. You can stop it, by setting a maximum pressure that is comfortable.
Sleeprider
Apnea Board Moderator
www.ApneaBoard.com

____________________________________________
Download OSCAR Software
Soft Cervical Collar
Optimizing Therapy
Organize your OSCAR Charts
Attaching Files
Mask Primer
How To Deal With Equipment Supplier


INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#7
RE: Excessive APAP Pressure Wakes Me Through the Night
Thanks.

Here are the graphs with the flow limit included.

   

   

   

So I'm not very clear on this stuff.  I thought the autoset feature resets to the pressure needed to overcome an event So I assumed it would continue to increase and reach a pressure ceiling where no further events were occuring.  So, in reasoning this, I would think that capping the pressure would possibly allow some events to occur if they reqired a higher pressure  to overcome them than the max set.

Can you tell me where the best thread in the forum is on learning about the significance of each parameter in the graphs?
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