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New guy not getting much results from CPAP machine
#1
Hi all. Glad to have found this forum!
I'm male, in my mid 40's. I was diagnosed with severe sleep apnea about 3 years ago. I decided to go with a dental appliance instead of a CPAP machine. There is a well known dentist where I lived who specialized in appliances for sleep apnea patients. This appliance forces your lower jaw slightly forward and also keeps your upper and lower teeth from touching. Both changes open the airway up to prevent apnea. I spent a lot of money on the appliance and it seemed to work well. I was sleeping much better and not getting the headaches I had every morning. I was still unsure how effective it really was so I talked the sleep clinic into letting me take a sleep study while wearing it. Much to their surprise it cured most of the apnea however I still snored and never reached third stage sleep. I decided to try a CPAP machine and got a ResMed S9. At first I had the nasal mask and felt terrible when I slept with it. The supplier felt I should try a full face mask as I could be opening my mouth while I slept. While the mask seemed to fit well it seemed prone to leaking unless I slept on my back (I like to sleep on my side). I kind of gave up on the machine and went back to the dental appliance. Well, lately my mild case of TMJ has gotten worse and I suspect it's from wearing the appliance. My jaw muscles now ache and I am getting some severe headaches centering at my left jaw joint. I've tried going back on the CPAP machine and after two nights with the face mask I gave up. I'm waking up constantly and I really feel like it's the apnea. The problem I have is I have now moved 2000km from where I purchased the machine. Where I am located there is no retailer (or sleep clinic) for this equipment. Before I moved out here the retailer bumped up the pressure (It's set to 7). I just acquired the ReScan software and am about to install it. Should I boost the pressure? I'm really frustrated as I really would like a good night sleep without the dental appliance!
Thanks
Todd
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#2
We can't tell you about boosting your pressure because we don't know what your data shows. However, I don't understand why they didn't suggest you stay with a nasal mask and try a chin strap before changing you to a FFM. FFM's do leak more. Can you try a chin strap with your nasal mask/pillows and see how that does? You can make one from an ace bandage until you are able to purchase one. Boosting your pressure, especially if it isn't needed, isn't always a wise idea (look at your data and see what your leaks are like and look at your median, 95% and max pressure and your AHI's) and higher pressures can cause more leaks.

what kind of S9 do you have? Look next to the start button and tell us what it says (Escape, Elite, Autoset)

SleepyHead has a great program to monitor your data as well as long as your machine is not an Escape as the Escape only records compliance data.
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#3
Thanks for the reply. My model is an Elite. I now have the ReScan software and just read my SD card. Here is the data for Friday (for the 4 hours I tried it).
Apnea Index: 6.9
Obstructive: 5.2
Central: 1.4
Unknown: .2

Hypopnea index: 1.8

AHI: 8.7

Leak:
Median: 3.6
95th percentile: 19.2
Maximum:164.4

The leak readings are likely not accurate as I usually just take off the mask and leave the machine running if I need to visit the washroom etc. during the night.
Thanks!
Todd

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#4
(12-29-2013, 09:51 AM)Esprit Wrote: Thanks for the reply. My model is an Elite. I now have the ReScan software and just read my SD card. Here is the data for Friday (for the 4 hours I tried it).
Apnea Index: 6.9
Obstructive: 5.2
Central: 1.4
Unknown: .2

Hypopnea index: 1.8

AHI: 8.7

Leak:
Median: 3.6
95th percentile: 19.2
Maximum:164.4

The leak readings are likely not accurate as I usually just take off the mask and leave the machine running if I need to visit the washroom etc. during the night.
Thanks!
Todd

well, one or two nights is not a good judge of how things are going. My first thought is that your AHI's are too high but that could be from the leaks. Does your data say that your pressure is at 9? My suggestion would be to go back to the nasal mask and try a chin strap with it to see if you are a mouth breather (if you aren't sure if you are a mouth breather or not). I have been using the wisp for a month now along with a chin strap after trying the Quattro fx for almost 3 years and also the mirage Quattro and the amara gel (all 3 FFM failures) and it is working well for me. Too bad you don't have the auto set but we all have to work with what we have and the elite is a good machine but you just cannot use a pressure range. Also, are you using the humidifier? when you are not going to use your machine, I would turn it off and disconnect the hose from the mask while not in use so you can get a more accurate picture of your leaks.
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#5
Actually the pressure is set to 8. It also shows "EPR: Full Time" and EPR Level is at 3.0 cmH20. Is that the ramp up pressure?

I'll definitely check into a chin strap. I have the humidifier however I found my mouth was really dry and I didn't notice the water level dropping a whole lot after 4 hours of sleeping. How fast should the reservoir empty?

Thanks again.
Todd
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#6
(12-29-2013, 10:09 AM)Esprit Wrote: Actually the pressure is set to 8. It also shows "EPR: Full Time" and EPR Level is at 3.0 cmH20. Is that the ramp up pressure?

I'll definitely check into a chin strap. I have the humidifier however I found my mouth was really dry and I didn't notice the water level dropping a whole lot after 4 hours of sleeping. How fast should the reservoir empty?

Thanks again.
Todd

The EPR is for exhale relief. The humidifier depends on your settings for the humidifier, the temperature, etc. of the room you sleep in. What are your settings and what type of hose are you using? what is the temperature at night in your room?

I like carefusion chin strap but it is so individualized, just like the mask is. I do NOT like Resmed headgear but I haven't tried their chin strap as I feel that if I don't get along with their head gear, I am less likely to get along with the chin strap. Some people make their chin straps or improvise. If you can find the old style ace bandages, you can try and make one with that until you can order and get one that is designed as a chin strap.

EDIT: I don't know where you live but ask your supplier if they have a modem they can send you and hook it to the back of your machine and they can also monitor your data for you since you are so far away from them now.
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#7
As ME50 suggested, the most important thing you can do right now is download, install, and start learning how to interpret the software, either Sleepyhead or Rescan. This will answer most of your questions.

Since you are so far away from your doctor, accessing your own data is critical in solving your problems. Your pressure set at 8 is pretty mild so you are not so far away from success. Many others have pointed out, one of the biggest obstacles for all of us to overcome is mask fit and leaks. This is probably where your problems come from.

If you can gain success with nasal pillows/nasal mask and chin strap you will be happier. They are easier to control leaks compared to a full face. Do you have access to a DME where you are now? You might drop by one and see if they can help you. They may be able to let you try some options on a trial basis. You may also have to contact your sleep doctor and send the DME your RX. Good luck.
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#8
Hi Esprit, Welcome to the forum. I began CPAP a month ago. I found the nasal pillows to work well for me. Finding the right mask is the key to CPAP therapy. The pillows are the least invasive headgear and objects on your face. As me50 has mentioned you can try chin straps to keep your mouth closed. I also have the Wisp that me50 has mentioned. That is the mask I used during my sleep study. It is small on the nose and the headgear is soft and comfortable. I keep it as backup.

Your AHI sholud be under 5 for normal range and leaks should be under 24 L/min. You should turn your machine off when you get up in the night.

Keep reading through the forum. It is full of tips, advice, experiences of others using CPAP. You will find a lot of valuable information and encouragement here. Good Luck! Stick with it! OSA is dangerous and hard on the body.
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#9
Thanks for the kind words.
My humidity setting is at 4.
The hose is a slimline and the face mask is a Mirage Quattro
The nasal mask is a F&P Eson.

Thanks to this forum I now have the software and have started to read the data. It's nice to be in control! I was ready to throw the machine in the garbage!
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#10
Hi Esprit,
WELCOME! to the forum.!
I encourage you to stick with CPAP therapy, it can take some getting used to.
You might try a nasal mask and a chinstrap before you resort to a full-face mask, (FFM,) as the are more proned to leaks. Also, when you get up to use the restroom, turn your machine off because your data will be more accurate.
Good luck to you and hang in there for more responses to your post.
trish6hundred
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