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First week hell [mask issues]
#1
First week hell [mask issues]
            Hi all,

I was diagnosed with an overnight pulse oximetry as part of a workup for gastric bypass surgery (i'm BMI 50.6). I never considered I would have OSA, but it wasn't a surprise (and I'm a doctor). The technician told me that my average SaO2 was 83% during sleep, and that I had on average 75 'dips' lasting over 15 seconds per hour.

I had no problematic daytime sleepiness but do think I had fatigue, difficulty waking, poor concentration, irritability, lower mood, less motivation. 

Anyway, I was given a Philips Respironics DreamStation for a week set to AutoCPAP to check my necessary pressure. I was given a DreamWear mask. The technician said it was 'the Ferrari' of masks so I was very hopeful. And the hose on the head is good.

Well, the first week has been horrible. I have struggled with it, but the DreamMapper app says it's not going well. I think it majorly due to me being a mouth breather, and when trying to drift off and testing the nasal pillows, feeling really congested. I usually use a very strong antihistamine (fexofenadine 180mg) and Avamys steroid nasal spray all year round for allergies. 

The first night I was so conscious of the mask being in the right place I kept waking up to reposition it. That was my best night. The rest og my nights it has felt that the mask hasn't been in the right position or that I'm mouth breathing, as the stats are terrible. I kept it on for the whole night (at least 8 hours a night for 5 nights), but the machine registers only 1-2 hours of use. My AHI is still quite high too. Last night I was so p*ssed off with it all, trying to use my nose to breathe that I took it, and at least slept a long time. The first night is the only night I woke up feeling good although i had insane dreams. The rest have just felt like worse sleep. It's been freezing in the UK recently and the second night caused my nose to feel painful and icy, so I left the heating on for the rest of the week, but then it was too hot to sleep. 

I have a review with the technician tomorrow to see how it's gone, and I want to ask for a full face mask. I have a beard - will this affect things? Trying to breathe out against the nasal mask (along with my blocked nose) felt suffocating. Are mouth/full face masks like this? 

I'm a side sleeper, no partner. My apple watch shows I'm quite a restless sleeper (whatever that is measuring), and that only about 30% of my sleep is restful. 

Basically, I don't think the first trial week has been good as the mask feels like it's not on or not working, and I am just mega disturbed by having to have to smush exactly into the right place on my nose, even when I don't know if I am nose breather. 

Any ideas or help? I have attached some pics from my app if they're any use. Thank you.


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#2
RE: First week hell
This is very common for first time users. The mask is a vital part of the process. It can be hooked to the best machine available but that machine is worthless if you hate it, can't use it, and/or it isn't the right mask for you.

Yes, Full Face Masks (FFM) can be worn with beards. You'll have to try several to find one that works. There are mask liners that may help.

I suggest you download and try out SleepyHead software (link at the top of every page) to get a better look at how you are doing.
PaulaO

Take a deep breath and count to zen.




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#3
RE: First week hell [mask issues]
Thank you for advice!

It's a week's trial at the moment, set to Auto. So I think it starts at 4cmH2O, and then as I sleep goes up and down according to what I need. The technician said that tomorrow we'll see what the 90% pressure I needed is, then give me a new machine set to that to try for 4 weeks, and after that have the 4 weeks reviewed by a sleep doc. 

It looks like it's gone from 4cm to 20cm, with my 90% being at 6.2cm, but that seems artificially low. The only effective night I had (first night), said the 90% pressure was 19cm. 

I don't have an SD card reader yet to analyse the data (believe me, as a doctor myself, I am all about looking at this scientifically). I've ordered an SD reader anyway. I was a bit worried about meddling with the trial machine they've given me in case I wiped it as well, haha. When I get a reader, I'll be all over the software (assuming the softwares can read DreamStation?

As for beard, I'm willing to shave or go to stubble to get this to work... I felt good after the only successful night - I sprang out of bed which is really unlike me. And I need to it to work to get me safe and ready for gastric bypass, and for recovery after that.
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#4
RE: First week hell [mask issues]
Don't let them give you a straight CPAP. Get an APAP. Even if you decide to use it as just a single pressure machine, you'll have the option of the auto later.

Full face masks can take a while to get used to. The first step is finding one that works for you and your face. The second is getting that mask to fit your face right. I went through several until I used the Simplus. See if your supplier (DME) has a mask trial option. Sometimes they let you trial a mask for a bit (mine does 2wks) then try another if that does not work.

Go to an online supplier (see our Supplier's List link at top of page) and check out the masks. When you find one that interests you, read the review of it here in our Review Forum.
http://www.apneaboard.com/forums/Forum-C...sk-Reviews
PaulaO

Take a deep breath and count to zen.




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#5
RE: First week hell [mask issues]
Check out the link below called Mask primer. That will help with selecting a mask. Also check out Supplier #1 on the suppliers list. They show under each masks spec's weather they're recommend to use with facial hair.
Download SleepyHead
Organize your Sleepyhead Charts
Posting Charts
Beginner's Guide to SleepyHead
Mask Primer
5
Advisory Members serve as an "Advisory Committee" to help shape Apnea Board's rules & policies.

Membership in the Advisory Members group does not imply medical expertise or qualification for advising Sleep Apnea patients concerning their treatment.



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#6
RE: First week hell [mask issues]
JDRB, the free SleepyHead software works with your machine, and the forum can even set you up with Encore if you want...Sleepyhead is better for analysis. A SD card reader costs less than $10 US, and can be as simple as an adapter that plugs into a USB port. No need to go overboard. or delay on this.

Your AHI at 33.8 is alarmingly high, and of course, we want to know what kind of events these are and guide you to resolve them to much lower levels. With SleepyHead we see the event types, correlation to leaks and pressure and can make suggestions based on established titration principles and perhaps even some insight and innovation. Sleepmapper is essentially useless for this purpose.

You are being titrated using a Dreamstation Auto CPAP, with a pressure setting of 4.0 to 20.0. According to the Sleepmapper software, nearly all of your events are obstructive. Your minimum pressure of 4.0 leaves you vulnerable to numerous obstructive apnea and hypopnea. We won't know precisely the behavior of the machine and the events without the data. I think a good beginning here would be to increase your minimum pressure to a level appropriate for treating OSA. I would not expect obstructive apnea and hypopnea to resolve at pressures less than 8.0, so that may be a better starting pressure for you, at least until we can get a look at what is really going on. Please raise your minimum pressure to 8.0 and let's go from there.
Sleeprider
Apnea Board Moderator
www.ApneaBoard.com

____________________________________________
Download OSCAR Software
Soft Cervical Collar
Optimizing Therapy
Organize your OSCAR Charts
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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: First week hell [mask issues]
Welcome to the Apnea Forum.
On masks, as said above the Mask Primer is a good source.  The big Key is that masks MUST be tried on, under pressure, and preferably in sleeping position.

I'm not arguing your sinus condition but I do advocate mask trials proceed from the least intrusive (pillow masks) thru nasal and ending with the largest, bulkiest the Full Face Masks.
I use the P10 Pillow mask as my primary mask (which will fit most people) but have the Amara View mask as my backup.  And yes, my Avatar is me (full + beard with the Amara View mask).  

The best mask is the one that works and fits you.  

There are alternatives to manage mouth breathing, (If you were to post Daily charts from SleepyHead or other source we could identify if you are mouth breathing) I was a mouthbreather, a rather bad one at that, and I conquered it.  I just got over a very bad sinus "cold" that had me blocked.  I find that the added pressure from CPAP will work thru the blockage within a few minutes.

Machines are important, Most here prefer the ResMed because the algorithm responds faster than the PR (DreamStation) machines which require being set closer to your therapeutic pressure to be most effective..  Again the Auto CPAP is the best to get for treatment at at this machine level.  The data we can see is literally on a breath by breath detail if we need it.

Fred
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#8
RE: First week hell [mask issues]
Thanks guys. It sounds like when I have the software more will become clear. I've ordered an SD reader - it gets here on Tuesday. 

I am pretty convinced i'm a mouth breather, but who knows until we see the data?!

I feel like i just want something that covers my nose and mouth and fixes it all (eg the FitLife?). I'm sure that's a pipe dream though. 

I am going to ask for an Auto machine as i'll want to fiddle with it when I get some data. This trial machine starts at 4.0, but one night I woke up and it was blowing at 20, so I don't really know what to make of it. 

Anyway, I have technician tomorrow so let's see that he says. On the NHS, I am not sure I will get much choice - might end up havin to buy stuff if the guy thinks what i've got/am given is okay...
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#9
RE: First week hell [mask issues]
JDRB, if you are going to choose an auto machine, get the Resmed Airsense 10 Autoset. It is much faster to respond to obstructive apnea, and I can pretty easily predict your current AHI would be about 25% of what you're experiencing on the Philips Dreamstation. Also, the exhale pressure relief function is nearly identical to a bilevel ( BiPAP) limited to pressure support of 3. You can do a lot more with it.
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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#10
RE: First week hell [mask issues]
(03-04-2018, 07:27 PM)Sleeprider Wrote: JDRB, if you are going to choose an auto machine, get the Resmed Airsense 10 Autoset.  It is much faster to respond to obstructive apnea, and I can pretty easily predict your current AHI would be about 25% of what you're experiencing on the Philips Dreamstation.  Also, the exhale pressure relief function is nearly identical to a bilevel ( BiPAP) limited to pressure support of 3.  You can do a lot more with it.

100% agree
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