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New to Bipap, 4 years on Cpap
#1
Hello from a 4 year user of cap, with pressure roughly 8-13. I started out with a brick machine and Mirage Quattro mask, but quickly changed to the Mirage FX nasal mask, upon recommendation of my sleep doc, who took a great deal of interest in my therapy, inspecting the machine, the mask fit, as well as reviewing the compliance data, almost monthly, never longer than every 2-3 months, all based on an unattended home sleep study that showed mild-moderate sleep apnea. 

That Cpap therapy changed my life, from acute daytime sleepiness and my day organized around afternoon naps, to more energy, less sleepiness, better breathing, etc. I took the machine with me for short and long trips, rarely missing a night.

After four good years of Cpap, I became eligible for Medicare, we moved from NY to NC, found a new sleep doc, and a pulse/ox study showed oxygen deficiency of 1.5 hours below 90. I could not get the oxygen thru Medicare without a sleep study. So I had a sleep study and of course obstructive breathing and sleep apnea showed up, AHI 14, along with open mouth breathing. The titration study came up with 18-20 pressure and that was side sleeping. The sleep tech could not get a reading with me sleeping on my back, even going up as high as 25. I didn’t need oxygen with a FFM.

New sleep doc orders the data producing resmed AirCurve 10 VAUTO and the PR Amara View mask. The machine pressure is set at EPAP min 16-IPAP max 25. For 8 straight days I had nothing but leaks with that mask. In the meantime I tried the Quattro Air (from my sleep study), the AirFit 10 For Her (rode up on my nose) and the Mirage Quattro (my very first mask with Cpap), which leaked so badly with the new machine I didn’t try sleeping with it, and a resmed chin strap with the Amara View which caused my worst night of leaks and snoring.

Back to DME RT, who gave me my one free mask exchange to a F&P Simplus. One night of leaks and snoring. I have even tried my old Mirage FX with a closed mouthguard and had yet another night of leaks and snoring after I promptly lost the mouthguard once I went to sleep. The RT also announced he had no idea where we could go if this mask didn’t work, since I had exhausted the resmed lineup. (Really???) I really don’t have any faith in the DME RT, where they still don’t even have the newest resmed AirFit F20 available, can’t even order one.

That back story brings me to your forum and its experts for mask recs, at this remarkably high pressure. I’m trying to imagine why the sleep doc went so far above the sleep study findings, but I do plan on trying to find out. Sleepyhead shows 95% EPAP is 16.46 and IPAP 20.46.

I thank you for all that I have already learned from your members and I am glad to be here too. Additionally, I thank you in advance for any mask suggestions, or any other comments, especially pressure settings. Looking forward to being a member of this forum! All the Best, Fabby
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#2
Welcome to the message board.

If you take some screenshots with SleepyHead, upload them to IMGUR or similar online file storage, and link to them here (after a minimum of 4 posts), the experienced folks will be able to give you feedback.

Other than that, some background things that can affect sleep, if not already ruled out (and you may have done so):
Have you ruled out GERD (reflux)?
Ear, nose, throat issues? (ex allergies, large tonsils/adenoids/tongue base, allergies, sinus blockages)
Endocrine issues (low thyroid and diabetes)?
Heart and lung conditions (ex asthma, pulmonary edema, poor circulation)
                                                                                                                                                                                  
Please organize your SleeyHead screenshots like this.
I'm an epidemiologist, not a medical provider. 
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#3
Your machine is capable of auto bilevel functions with a fixed pressure support. It appears you are using a PS of 4, and in spite of the range of 16-25 your machine is staying at the minimum. Maybe with the bilevel pressure support you can try some lower pressures and still get the leaks under control. I have always used nasal pillows, so can't help much with these full face options.

If you have successfully used nasal therapy, try it again. Your results so far suggest you may be over-pressure on our prescription. It might however be interesting to see what your machine has recorded so far in terms of events. If we can maybe set your machine in Vauto mode with pressure from 13-25 and PS 4.0, we might find your nasal therapy still works. In any event, the machine pressure will rise if you need it, and we can see where the leaks get out of control.

My signature provides guidance on organizing and posting sleepyhead charts. It might help to see where you're at.
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#4
I have a good deal of experience on CPAP and recently BiPAP at high pressure.
My original F&P brick was set at Max, 18-20 on my intellepaap and I started BiPap (ResMed Aircurve CAuto, same as you) at fixed (S mode) 25 IPAP, 20 EPAP PS 4.

I can easily get a mask seal with Pillows. Nasal, or FFM at the highest pressure. Because of my beard the FFM I use is the Amara View. I had to go to a FFM because I was defeating ChinStraps with both the Pillows and the nasal masks.

I suggest you try Vendor #1 because of their Return Insurance policy. You should be able to try multiple masks and return them within the allowable period.

Look up you-tube videos on mask fitting for help

In general I find that I need to set a mask loosely and then tighten until leaks stop, or at least become acceptable. I'll even "tighten" my mask by pressing down with my hand while checking the leak on my AirCurve, then tighten the mask to match.

Are you using an Oximeter? I don't. SleepyHead works with several (see the Welcome Page)

"SleepyHead gives you the ability to track Oximetry data alongside CPAP session data, which can give valuable insight into the effectiveness of CPAP treatment. It will also work standalone with your Pulse Oximeter, allowing you to store, track and review your recorded data.
SleepyHead is currently compatible with Contec CMS50D+, CMS50E, CMS50F and CMS50I serial oximeters.
(Note: Direct importing from bluetooth models is probaby not possible yet)
You may wish to note, other companies, such as Pulox, simply rebadge Contec CMS50's under new names, such as the Pulox PO-200, PO-300, PO-400. These should also work.
It also can read from ChoiceMMed MD300W1 oximeter .dat fil"

Hope this helps.

Fred
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#5
I like Sleeprider's suggestion of VAuto mode with a 13 - 25 range

Question for now, Your PS is set at 4 for "relief", do you need it? did you use any while you were on CPAP?

I am using VAuto 12 - 25 rarely going more than .5 cmH2O above minimum, with a PS of 3. I don't need the 3 cm relief but it feel good.
I thought I would NEVER get below a 16cm pressure. I consistently an under the standard of 5 AHI, and usually under 1 AHI including WJN.
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#6
Hi Fabby,
WELCOME to the forum.!
Good luck to you as you continue your CPAP therapy and also with getting used to your AirCurve10VAuto.
trish6hundred
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#7
(01-22-2017, 05:29 PM)bonjour Wrote: I have a good deal of experience on CPAP and recently BiPAP at high pressure.
My original F&P brick was set at Max, 18-20 on my intellepaap and I started BiPap (ResMed Aircurve CAuto, same as you) at fixed (S mode) 25 IPAP, 20 EPAP PS 4.

I can easily get a mask seal with Pillows. Nasal, or FFM at the highest pressure.  Because of my beard the FFM I use is the Amara View.  I had to go to a FFM because I was defeating ChinStraps with both the Pillows and the nasal masks.

I suggest you try Vendor #1 because of their Return Insurance policy.  You should be able to try multiple masks and return them within the allowable period.

Look up you-tube videos on mask fitting for help

In general I find that I need to set a mask loosely and then tighten until leaks stop, or at least become acceptable.  I'll even "tighten" my mask by pressing down with my hand while checking the leak on my AirCurve, then tighten the mask to match.

Are you using an Oximeter?  I don't.  SleepyHead works with several (see the Welcome Page)

"SleepyHead gives you the ability to track Oximetry data alongside CPAP session data, which can give valuable insight into the effectiveness of CPAP treatment. It will also work standalone with your Pulse Oximeter, allowing you to store, track and review your recorded data.
SleepyHead is currently compatible with Contec CMS50D+, CMS50E, CMS50F and CMS50I serial oximeters.
(Note: Direct importing from bluetooth models is probaby not possible yet)
You may wish to note, other companies, such as Pulox, simply rebadge Contec CMS50's under new names, such as the Pulox PO-200, PO-300, PO-400. These should also work.
It also can read from ChoiceMMed MD300W1 oximeter .dat fil"

Hope this helps.

Fred
Thank you and others for warm welcome and suggestions. My PS is set at 2 in the machine, but I don’t understand much about PS yet. It is on Vauto, 16-25. If I am reading the Sleepyhead charts correcting, my nightly IPAP is running 20 all night, EPAP 16 all night and PS 4. Mask pressure is running right around 20 most of night. I just changed the pressure to 13-18, see if the AHI stays low and fewer leaks. 

I just tried your suggestion Fred, to start mask loose, then press on it until you get leaks and then tighten mask until no leaks. It is somewhat looser that way, will see tonight.

No pulse/oxy. Study showed low readings but was using the nasal mask then. Find many youtube videos helpful. 

Filmed two nights of sleep with the wildlife camera. Lots of tossing, turning and noise from mask leaks all night!

Tomorrow I will work on getting the Sleepyhead charts posted. 

Fabby
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#8
Fabby, your machine does not have variable PS. It is the same one I use. Please check your settings, or post an image with that information. The important settings are Mode, EPAP min, IPAP max and PS. My best guess is that you are running a fixed VPAP mode, not Vauto.
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#9
Somewhat steeper learning curve on getting the SleepyHead charts worked up, but here’s last night. The leaks were not quite as often as most nights, but hopefully you’ll get the picture. Could not find the Peak AHI chart. If there’s anything else you want to see please let me know. Presently using ResMed Mirage Quattro mask. Neither Simplus or the Amara Gel would stay connected to the hose, so they exchanged for the Mirage Quattro. Thanks for any and all suggestions.

Here’s the link to the charts.

http://imgur.com/a/uOfhm
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#10
Leaks are pretty bad. The fact you say the Simplus or Amara masks could not stay connected to the hose has me wondering if you have left a plastic connector in the hose-end. When you remove the mask from the hose, the end of the hose should have a 22 mm soft rubber connector. If there is a hard plastic piece there, remove it. That would be a mask connector, and it would explain the inability to remain connected or high leaks.
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