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New CPAP User, looking for improvement help
#1
Grin 
New CPAP User, looking for improvement help
First, thank you in advance as this board is quite amazing with great content. 

I'm brand new to CPAP, and looking for improvement help. I was diagnosed in Oct 2023, with an at home study then a titration study in December 2023. My symptoms were fatigue during the day, spouse saying she could hear me stop breathing, and brothers who are on CPAP. The sleep study presented AHI of 23, RDI of 27.3 and Cheyne Stokes was noted. Average O2 was 93%, 8.9% of night btwn 80 - 90% O2 saturation, and 7.5 min < 88% saturation. 

I started using Resmed AirSense 11 Jan 15th and then as of Jan 18th started tracking the detailed data on the SD Card which I've attached the last 3 nights. My pressure is set to 10, with Ramp starting at 5 for 5 minutes and Pressure Relief is on.

Now having gone 8 nights, the first 4 nights I used an Airfit P30i pillow mask, then developed nostril irritation so I switched to the Airfit N30 nasal mask. I prefer the P30i for comfort which I can go back to now that the nostril irritation has subsided. I am a mouth breather so after the first 4 nights I started using a chin strap - perhaps to mild effectiveness. I also have the F30 full face mask but have not wanted to use it just yet - I'm attempting to get comfortable in the Nasal masks first.

While the AHI has come down, some days below 5, my leak rate is high - in the 30's to 40's L/hr. Probably because I am a sleep mouth breather but not sure. 

I definitely am feeling better - less tired during the day, and more comfortable with the masks. However, looking for input on the leakage and what else can improve my performance such as perhaps my sleep position? What else do you see in the Oscar data?

Thank you for your help in advance.


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#2
RE: New CPAP User, looking for improvement help
Your main problem is leaks both mask leak and mouth leak.  As high as these are you are not getting any therapy.  The cpap uses pressure to keep your airway open - if the pressure is escaping from your mouth and mask you are not getting any help from your cpap.

You do have some positional apnea.  You can see positional apnea where either H or Oa events are clustered together.  Getting rid of as many as you can will lower your AHI.  Positional apnea can NOT be controlled by pressure changes.  You have to find out what position you are getting into and cutting off your own airway.  Have you changed your sleep position?  Sleeping on your back?  Using more (or new) pillows?  These things can cause positional apnea by chin dropping to your sternum and cutting your airway.  Think of it of a kinked hose – nothing can get through – you have to unkink the hose…

IF you can’t make a simple change like changing to a flatter pillow helps then you will need a collar.  I have a link to collars in my signature at the bottom of the page.  It shows people who are not wearing a collar and the SAME person wearing a collar.  There is a huge difference between the two.  BUT again your main problem is the leaks.
Apnea (80-100%) 10 seconds, Hypopnea (50-80%) 10 seconds, Flow Limits (0-50%) not timed  Cervical Collar - Dealing w DME - Chart Organizing
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#3
RE: New CPAP User, looking for improvement help
That's definitely mouth breathing and mouth leaking, and you definitely need to address that first. No wonder your nose is irritated, you are blowing a leaf blower up it all night! Use the FFM if you have it on hand, but I would consider ordering some tape for your mouth if you want to make the nasal mask work. I use 2" cover-roll flexible tape, it's a good balance between sticky and easy to peel off in the morning, works fine clean shaven or with some stubble, and it's inexpensive.

But do switch to the FFM for tonight if you don't have tape in hand when you're ready to go to bed. Those mouth leaks are worse for you than you might expect.
Look, I'm an engineer, not a doctor! Please don't take my opinion as a substitute for medical advice.
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#4
RE: New CPAP User, looking for improvement help
BTW, Pete is being a funny bunny with the leaf blower comment. You could not blow up a small balloon with a CPAP machine, so really not near as much pressure as you may think. CPAP pressure feels strange at first, but it is definitely not at a leaf blower level. 

Your nasal irritation is typically caused by one or two things. The first one is an incorrectly sized cushion as many use one that is too small or too large. It should sit outside your nostrils and when inflated fill the opening. There are videos on YouTube that give detailed explanations on sizing them correctly. Start with the LankyLefty27 and you will fall down the rabbit hole quickly.

The second is strapping the headgear too tightly such that it causes irritation. The videos explain this as well, but they should just be tight enough to hold the pillows/mask in-place. You can use a lanisol-based cream (e.g. lanisoh) to reduce the irritation.

Both Stacey and Pete are spot on with the collar and mouth tape suggestion. Some of us prefer collars, others mouth tape. Try both out and find what works. Some of us gave up on nasal pillows/masks and just use a full-face mask. 

There is absolutely nothing wrong with using a full-face mask as you can still nasal breathe and when your mouth typically opens during REM you will continue getting therapy. I use a full-face mask and use a SCC as well. Again, find what works for you.
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#5
RE: New CPAP User, looking for improvement help
Yes, the comment about the leaf blower was made with tongue planted in cheek, but the statement stands: 40L/min is too much air to run through your nose. It's an order of magnitude higher than minute vent, which is the amount of airflow the nose is meant to warm and humidify for the body's use.
Look, I'm an engineer, not a doctor! Please don't take my opinion as a substitute for medical advice.
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#6
RE: New CPAP User, looking for improvement help
Ok, well thank your for that insight. I will do what your are suggesting and report back with an update.
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#7
RE: New CPAP User, looking for improvement help
On the question of positional apea, how do you discover what position causes it? 

Would one of my sleep studies (original or titration sleep study) have captured data on that?
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#8
RE: New CPAP User, looking for improvement help
Some ENT doctors will do what's called a sleep endoscopy. What that means is they will lay you down and give you a sedative to cause all your muscles to relax, then insert a camera on a flexible scope into your airway to look at what's going on. That's the closest you'll get to having the action of your airway observed in real time while sleeping, but specific positions are probably not on the ticket. Most ENTs will do the endoscopy with you awake and sitting up, which is still valuable because there are often some obvious trouble spots.

Anything else is a guess. With OSCAR charts and additional information provided by you for context, we can try to make an educated guess, but it's still more of a trial-and-error process. The flatter pillow and cervical collar are things that help quite a few members of this board, so you will see them both recommended readily here. We see problems in the OSCAR charts and try to remember if we had been sleeping on the side or shifted to the back, or if the flatter pillow really made a difference or not. It can be frustrating, but that's the nature of sleep disordered breathing, you are unconscious while you are experiencing the symptoms so it's tough to nail down.
Look, I'm an engineer, not a doctor! Please don't take my opinion as a substitute for medical advice.
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#9
RE: New CPAP User, looking for improvement help
Many people have it when they sleep on their back BUT not always. It is also called chin tucking and that happens when your chin drops down to your sternum cutting off your own airway. The collar is helpful because no matter if you sleep on your back or side or even stomach, your chin is held up and air can flow through your airway.

Again, I would suggest you look at the link I put at the bottom of my posts (signature) to see how collars help people. The charts in that link show people without collars and THE SAME people with collars and how their therapy is helped with a collar.
Apnea (80-100%) 10 seconds, Hypopnea (50-80%) 10 seconds, Flow Limits (0-50%) not timed  Cervical Collar - Dealing w DME - Chart Organizing
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