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Looking for some help - almost 5 years and not feeling a lot better
RE: Looking for some help - almost 5 years and not feeling a lot better
Last night had more flow limits than the previous two nights.  Felt worse today.  Made an odd out of sequence error when making coffee this morning.  Very uncharacteristic of me.  Actually worried me that something was really wrong.  Definitely not as well rested and mentally foggier.  Just didn't sleep as well.  As a consequence it's much harder to concentrate.

So coming back here for suggestions.  Flow limits seem busier than before.  Willing to stay the course another day, to see if this is a trend, but am surmising that more PS is required to reduce the flow limits.  Not liking how I feel today, so will need to change things.  Headache is creeping back.  

Numbers.  
11/10:  AHI=0.64, H=0.64, 
11/11:  AHI=1.45, 0/0.53/0.92 CA/OA/H

   
Thanks for any further guidance.
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RE: Looking for some help - almost 5 years and not feeling a lot better
Not there yet, but making some progress.  My collar might be not tall enough - I'll try the next height.  It seems there is a two finger gap between the bottom of the cervical collar and my collar bone now that I have had the collar for a week.  Got some clustering this week.

Tried a Simplus mask.  It has lower leaks than my F10 and is more comfortable, if I could get it to not leak!  Unfortunately the leak rate varies a bit during the night (6 to 12) and it changes if I rock my head even slightly.  Out of a 4 day trial, only one night was good.  The Simplus either leaks into my eyes (very annoying) or farts near the corners of the mouth.  It's easy to get the leaks to stop in the corners, but quite difficult to control the bridge of nose leaks.  I seem to be very sensitive to leak rate change.  Any tips specific to a Simplus?

Question: Is it harder for the PAP machine to regulate when the leakage is very low?  For one thing, the leak rate seems to be very quantized with the Simplus.  A bit change is relatively large compared to the leakage rate.  

Last night went back to the F10 and was rewarded with a restorative night's sleep.  But I got a lot of leakage into my eyes.  Could be the most of the leakage is straight into my eyes!  The leakage rate only varies by 20%.  Big eye bags, and undoubtedly aggravating my dry eye.  Lower teeth feel like there was a lot of pressure on them this morning.  They are being pushed inward by the mask.  But, despite that, it has been very productive this morning.  Overall, feel better than in quite a long while.  That's a reflection of how poor I've felt over the past decade.

Wish I could use the Simplus, the shape is better as it puts less pressure on my lower teeth.  But the leakage at the slightest movement of my head (over 100% change) seems to result in a poorer less restful sleep.  The F10 pushes my jaw backwards - which is probably not so good for maintaining a clear airway.

Current settings: PS=4.0 over 8.8 to 14.2
Last night
AHI =0.89  CA/H/OA/UF2 = 2/2/3/1  F10        restorative

Previous night was PS=4.0 over 8.2 to 14
AHI = 1.55 CA/H/OA/UF2 = 0/4/8/3  Simplus  jittery, not together.  Nonrestorative

If anyone wants, I can post an OSCAR chart.  Guidance sought.  Thanks for your help.
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RE: Looking for some help - almost 5 years and not feeling a lot better
I don't know if it helps on the Simplus, but I have it now. I adjusted the straps out from where the sleep study tech had positioned them. I went very loose then I tightened the top of head strap to pull mask upward a bit to sit on my nasal bridge further up. Then I tightened up to forehead bar strap and then the lower strap till it just stopped leaking. I also moved it around my face a bit and then also pulled if away from my face to allow the silicone seal space to reform a bit. All done while lying down and therapy pressure is on. I still get a very slight leak at the right top nasal bridge area, but having done the readjustment, it's nearly leak free even when side sleeping. The tension is far less than the F20 I've been using.

I am going to try lowering the mask tonight on where it sits with the top o head strap. I may have taken it up too high. This may well remove all leaks, and making this a leak free mask. Try the above but move mask up and down the face first to find best location and then lock in that top o head strap.

PS here's screenshot of # 4 picture instructions on the Simplus

   
Dave

OSCAR
Standard OSCAR Chart Order
Mask Primer
Dealing With A DME
Soft Cervical Collar Wiki
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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RE: Looking for some help - almost 5 years and not feeling a lot better
Thanks, I'll try that.  The Simplus really fits better and is more comfortable, but the leak changes seem to cause events.  I want the Simplus to work.  I will copy your instructions so I can have them bedside.  I have fiddled with the fit of the Simplus every night, but after 4 days, it hasn't gotten significantly better.  Maybe with a written card next to me it will be better.  The average leakage into my eyes is better with the Simplus than the F10.  The eye bags are diminished with the Simplus.

The soft collar seems to hit the Simplus but not the F10.  It's noticeably more work to fit the collar after getting the Simplus on, than with the F10.  Don't know if that is significant or not.
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RE: Looking for some help - almost 5 years and not feeling a lot better
I'm a Simplus/Vitera user and love them.  Several members that have the F10/20's for comparison have written that the F&P's like to be worn lower on the face.  

It sounds like you may need to tweak the tension settings a little more.  If you can determine what position you get the leakage, lay in that position. While using the Mask Fit feature, use a free hand to achieve the seal tension needed.  Still holding this tension, take up the slack in the straps to maintain this seal.
Crimson Nape
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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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RE: Looking for some help - almost 5 years and not feeling a lot better
I'm adding in steps 1-3 images just in case you'd like the reference.
           

PS I would agree with letting the F&P sit a bit lower. I positioned it as I did for an F20 and it tends to leak occasionally at nasal bridge. I'm planning on lowering the landing spot for tonight via a loosening of the top o head strap AKA step 1 of image 4 above in my post #253.
Dave

OSCAR
Standard OSCAR Chart Order
Mask Primer
Dealing With A DME
Soft Cervical Collar Wiki
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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RE: Looking for some help - almost 5 years and not feeling a lot better
Thanks guys.  I'll try that.  I have to loosen everything up again and disconnect the clips - that way I get a chance of correct positioning without the straps influencing the result.  Wasn't doing that before.  Sometimes you just can't take shortcuts...
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RE: Looking for some help - almost 5 years and not feeling a lot better
Missed Crimson Nape's comment on Mask Fit feature.  Attempted to fit while in therapy mode.  Oh well.  I followed Dave's instructions (which mirror the picture-gram).

Managed low leakage in the beginning, but the numbers don't lie.  Double the number of events from the previous night.  Don't feel restored today.  Feel sleepier today than yesterday.  Only difference is the mask.  No changes in settings.  Yesterday was quite good.  

I'll give it another try, (using the mask fit feature) hope it's going to be better.  I found a rotation of my head by less than 30 degrees would create leaks by my nose.  The mask was very low on my face, nearly at the very bottom of my chin.  

How can a mask that has twice the leak rate work better than the one with a low leak rate?  It seems the VAuto over reacts to Simplus leaks but doesn't (overreact) with the F10.
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RE: Looking for some help - almost 5 years and not feeling a lot better
My speculation: it depends on the actual leak value. The problem I see is that sometimes leak rates get so high the machine cannot track your therapy or events accurately. And then things occur where seemingly you had lesser events but higher leaks with one mask vs the other. BTW the value for ResMed is 24 L/min. Now I forget the details of the ResMed Vs Respironics leak calculation thing, but Respironics shows 2 lines for leaks I think, the lower one is expected leaks and the higher one is an overall leak rate which is expected and unexpected as in mouth or mask leaks uncalculated factored in. ResMed just shows a single line and I am pretty sure the redline of 24 I mentioned means the further above this line means accuracy gets skewed. Respironics I think seems to handle higher leak "redline" figures, but there's probably a splash of murkiness involved somewhere.
Dave

OSCAR
Standard OSCAR Chart Order
Mask Primer
Dealing With A DME
Soft Cervical Collar Wiki
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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