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New member - some questions
#21
RE: New member - some questions
Ok, thanks Dave, I will read up on EPR (no idea what that is right now) and try to adjust the lower pressure setting up a bit. And also read up on OSCAR to see how that works as far as uploading data.

I do have a positive update: last night I actually slept for real with CPAP for the first time. The first night (the one before), I had a weird half awake half asleep state for 4 hours, but last night, I slept for about 5 and a half hours with the thing on and everything. Wasn't the greatest night of sleep or anything, I tossed and turned a lot, and woke up a few times, but still, small steps, right?

In the morning, got an 83/100 score on myAir app. 21 Liters/minute leaking, which they say is good, especially since I turned and tossed a lot, and slept at least partially on both sides. 3.9 events per hour, which I know is not optimal, but hey, after 48 AHI pre-treatment, I will take it for now, and hopefully work to decrease it more as I get better with this.

So one thing, not just for me, but for all the guys out there, changing your facial hair definitely seems to help with mask fitting and sealing. I had a beard around the mouth area before and yesterday, shaved it a bit inside, so it's more like a goatee now. That removed hair under the lower lip, where the bottom of the mask goes, and also shaved more hair on the sides, so there are thinner strips there now, and more skin to the mask to touch. In addition to that, made sure to wash my face with soap and drying before applying the mask (usually I do this in the morning). Well, those things definitely helped. After putting the mask on, I ran the CPAP machine leaking diagnostic, and it said "Good Seal" not just when it started at 4 pressure, but even after it went up to 11 pressure (diagnostic max), which is something I could not get the previous night. So I think the mask having more direct touch with the skin is great for sealing/fitting.
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#22
RE: New member - some questions
Also read up on Pressure Support because EPR is effectively PS with settings of 1,2, or 3.
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#23
RE: New member - some questions
Hi Dreamscape99. I am a newbie to cpap too. So I leave the advice to the experts on here. But I want to share just a teeny bit of my journey to give you support. My first week was hell. But I was determined to conquer this machine. I echo that the number one thing is finding the right mask. I spent 16 days struggling with a ResMed P10 because of it simplicity, minimal straps. etc. Alas, I finally gave up on it. I am NOT a mouth breather but apparently my lips part enough to make major leaks. I tried taping, chin strap, "glue." You name it and I tried it. I finally went with a full face mask, really sort of a hybrid. It sits under the nose and covers the mouth. I immediately took to that mask and now find it comfortable. I especially love the tube coming out of the top. But I digress.

I would never, ever have been able to stick with this if it were not for two forums, this one and a DME-owned forum .com. I read every single word on both forums. The people were and are so nice, helpful and supportive. I have my first sleep clinic appt. since being diagnosed this week. And I intend to tell the RN and the Doc that they should refer people to these forums. Whether they will or not remains to be seen. People on these forums are taught to be proactive in their therapy. This may not sit well with some sleep clinic personnel, but who cares.
I am an old retired RN so they do not bother me,

So I encourage you to keep a positive attitude. You can do this. Best of luck (actually it is not luck, it is determination).

I thought I referred to another cpap forum??? The other big one. I had no idea it was owned by a DME company?
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#24
RE: New member - some questions
I'd like to back up Quiescenceatlast's comments about nasal pillows and nose breathing. I was a mouth breather and like you, initially tried a full face mask with similar results. I came to this forum and was given two initial pieces of advice that changed the game for me. The first was to go for a nasal mask and the Dreamwear had just come out so I opted for that. It worked!

The second was to retrain myself to become a nose breather. This took a little bit of time but was helped, as someone mentioned, by the fact that your brain wants you to breathe through your nose if you can while sleeping. I simply practised during the day by sucking my tongue up to the roof of my mouth and breathing through my nose.

The last issue was chin droop where the chin drops towards the chest during sleep which restricts airflow. A soft surgical collar solved this and also helped to keep my mouth closed. I've not tried taping but have heard positive reports.

Finally, the comments of setting a good minimum pressure make sense. Based on the fact that my initial AHI when I did my sleep study was 57 can I suggest that anything below 8 is not going to work well for you. Mine is currently at 11 (but I use a BILevel). Max setting is immaterial at this stage.

Can I recommend either the Resmed P30i or the Philips Dreamwear nasal pillows for the best chance of minimising leaks. A nasal mask would be your next choice. Resmed N30 or the Dreamwear seem to be good.

Best wishes for your therapy.
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#25
RE: New member - some questions
I increased the minimum pressure to 7 before last night.

However, my good mask seal from the previous night did not work last night, probably because of increased pressure.

If I start at 7, the AirSense 11 mask seal diagnostic runs from 7 to about 14, and the only way I can keep my current full face masks sealed at those pressures is by really tightening the straps on them. But all the online advice I've seen says not too tighten too much, so I am a bit lost about what I should do now.

I called my DME today and explained this to them, asking wherther or not I should get professionally fitted at their office (my original sleep study was a home test, so I never got fitted), or try different masks. Somebody from there is supposed to call me back in the next day or two.

I also have to extract a couple of wisdom teeth shortly, so I think I might have to take a few days off CPAP for the mouth to heal.

Did you guys experience similar problems with sealing issues when starting out? What helped you get over them?

Some notes on my sealing issues below:
- I have to use a full face mask. I understand people training themselves to nose breathe, sometimes I breathe through my nose too, but sometimes it's just completely blocked, so a nose mask is just not a realistic option now.
- I have a large head and a large nose, and facial hair (though I shaved much of the latter off to improve sealing)
- I had a pretty negative experience with the ResMed Quatro Air FFM. One, if I sleep on my side, which I often do, the pillow pushes it off, and the sealing gets a lot of worse. Two, that type of mask seems to be relatively hard, and over time, hurts my face, which causes problems with sleeping as well. Three, the hose is in front, which messes with me when I toss and turn or sleep anywhere else except on the back.
- My experience was a lot better with the Phillips DreamWear FFM. That mask is smaller, and doesn't seem to get dislodged the same way by side sleeping. It's also softer, so doesn't hurt the face as much, and the tube is on top, which allows comfortable movement and non-back sleep. The only two problems I have with it are 1. as mentioned above, to get it to completely seal, I need to overtighten it, otherwise air seems to escape on the outside cheeks, and underneath the mask sides, and maybe a bit above the nose. And 2. When I put it on snugly, it kinda pushes my nose inside, which leads to nose soreness over time.

So given the points above, would love to hear suggestions, or similar experiences.
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#26
RE: New member - some questions
using mask liners, commercial or homemade, helps to seal enough at lower pressures. low level constant leakage thru the fabric makes sudden bursts of leaks rare.

I sleep with a pair of socks rolled as a micro pillow, and stick it between my regular pillows and one cheek.  that keeps the pillows from rubbing and dislodging the mask.

[Image: K9gYqyQ.png]


QAL
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#27
RE: New member - some questions
I watched a you tube video comparing the ResMed F30i FFM with the Dreamwear FFM.  Both fit under the nose and over the mouth. The Dreamwear mask is a little "flatter" than the ResMed which is more rounded.  I have a small head and a small face (which belies my body, but it is what it is).  The flatter mask would never stay sealed on me. So you might want to watch the video and try the F30i mask. He states that the Dreamwear works better on a more rounded face rather than a narrow face.
I rarely have a leak now and don't have to tighten it so much that it hurts.

Stay on it. When you find YOUR mask, the rest will fall into place. Just do not give up.


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#28
RE: New member - some questions
@OP- I found that a lower minimum (like 5 or 6) seems to make me open my mouth to get enough air -- and that creates dry mouth. Increasing minimum to 7 seems to have cured that. This rationale may not pass muster with the experts -- but as the saying goes "it works for me."

Why do you think you MUST use a FFM? Because somebody told you so? Because you mouth breathe? Well, some experts disagree with that answer, and so do I (as a non-expert). If you train yourself to use the tongue trick (described above), which takes time not overnight, that may very well help. Masks are highly subjective and one of the variables is whether the basic shape of the mask is consistent with the shape of the user's face -- flat, rounded, pointed, etc. Like you, I found the FFMs don't seal well for me. The Brevida pillow mask works best for me. Although I do not have facial hair, several users with facial hair reports that the Brevida does not pose sealing problems because the seal is in the nose not on the face. Please consider challenging the "conventional wisdom" as to all the above points. There is a lot of trial and error involved with mask and fit.

One other thing. I have found that the mask gets pushed around LESS if I sleep with my head on the end of the bed pillow such that the nose is not on the pillow at all. Just a thought.
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