Newly diagnosed severe CSA & OSA (AHI=108) seek advice

[Dormeo]

The right mask for one person is not necessarily the right mask for someone else, but I'll put in a plug for the Aloha, which is giving me many nights with zero leaks. Its big downside is a vent that doesn't do a good job of diffusing; the P10 is far superior in that respect. The big plus is that it really stays in place despite my need to turn over frequently. It also angles in such a way as to go around, not over, my cheekbones. If you try it, I strongly recommend getting the strap covers that Pad-a-Cheek makes for the Aloha. The ones that come with the mask are not nearly as good.

[Liteheart1]

[attachment=21026]Just read most of the 6 pgs of still active Yankees123 thread on his leaks changing to P30i.
My good news is that now 3 weeks into therapy I am feeling much better with more energy even though actual hours of sleep are less (too much going on in my life and the world!).
 3 days ago I shifted from Respironics WISP to P30i, and while results with WISP were very good with AHI <1 and very minor LL, there was some minor "bruising" and it seemed like a more comfortable mask would be possible for me. WISP had been only mask I ever tried.
P30i feels really nice and feel better upon waking AND the duration of my sleep session is much longer before getting up for bathroom - all good news/encouraging. However LL was 8% 3 then 4 for the 3 nights with AHI of 1.4. 2 and 1.9 so those stats are worse than with WISP.
Reviews at supplier 1 for P30i showed that many were side sleepers as I am.
I do not think that I am an active sleeper, and during both of my recent sleep studies, tech had to ask me to change my sleeping position so that they could get data in all 3 sleeping positions.
I have moved setting from Nasal to Pillows.
Heated hose as usual hangs down from head board and I will tongight add the hose management device I had bought which is pole with "foot" that fit under mattress.

While I have Knightsbridge chin cap (the one night I tried it with WISP) i didn't like it at all and LL went up. I have Somnifit but recently have not been using AND realize that I should add that back in and work toward getting used to it.

Aside from advice in Yankees thread, my ?s:
1) How do you know you have a good nasal pillow seal/fit: I think I know how to check for leaks (with mask fit and under normal pressure). DME person said they were very experienced with mask fitting and gave me Small pillows and seemed confident that a medium would be too large (nonetheless I will acquire a Med to try it). I wonder if tension on the straps is too much?? It doesn't feel tight on my face and I understand that newbie mistake is to think that tightening straps is best approach to solving leaks.

With WISP after a few days I would do the tongue suck exercise for mouth leaks and within 30 seconds of starting machine there was clear sensation of slight pressure in (inner) ears. With P30i that sensation is less consistent. For a good seal with (any?) mask is that a typical experience? is it a good indicator of good seal? My hunch is that while it might be helpful to a good seal, it is not a necessary pre-condition of good seal.

2) Mouth leaks: Seems like definitely have at least some, and I should address this (with Somnifit). Since I wake up with a very dry mouth (even on nights with <1% LL) that that indicates at least some mouth breathing.

I guess I am at the phase in therapy where I am searching for a better mask, and/or tweaking what I have. Nice to read that many others are liking their pillows, yet have to fiddle with it to keep leaks low.

Thanks as always for wonderful forum participants.

[Dormeo]

It's great to hear your good news! Do be prepared to try all sizes of pillows. When I was using the P10, my technician said I should use small; I quickly found that medium was more comfortable; then later found that large was better still. With the Aloha mask, medium is just right.

I use Somnifix every night and like it a lot. What about it will take getting used to for you?

[Liteheart1]

I use Somnifix every night and like it a lot.  What about it will take getting used to for you?

The getting used to for me is: 1) harder to talk to my two cats when I wake up for a bathroom break and they want some attention which is fairly common; 2) a slight anxiety over being "suffocated" as I usually stop machine first and then take off mask so that large leak isn't recorded. 

I can learn to "deal" with both of these things fairly easily. Since I have only been in therapy about 3.5 weeks, my tendency is to try to change only 1 thing at a time about my equipment or approach so I can better understand the impact on sleep quality and data. Since I had just changed to nasla pillows I didn't want to re-introduce Somnifit at the same time.

I liked Somnifit better than any chin strap approach that I had tried, and expect it will be part of my long term approach. Aside from the expense it seems like a good solution for mouth leaks. It does also seem that the tongue suck exercises are also helping me overall reduce mouth breathing.
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Since you tried all 3 sizes, regardless of which one felt more comfortable, how did you determine at the time (not from data the next morning) whether it was making the best seal? I will definitely get fit kit, and while DME tech was nearly adamant that Med would be too big, at least for you you went from small to large which is a two size jump!

[SarcasticDave94]

Keep in mind that you are the nightly user of the mask not the DME RT. Even if they think a Small is fine, further even if they are certain, it is still possible that other sizes may be better in practice.

[Dormeo]

I think most cats understand MMMM language. And just to reassure yourself, you might want to waste one strip by seeing how readily you can open your mouth without even touching the strip. I don't recommend it as a regular practice, but I did find it reassuring to know that I could do this in a pinch.

With the P10, the small was making the ends of my nose sore. I read on the forum here that that shouldn't be happening. I looked carefully in a mirror and saw that the pillows were wedging themselves slightly into my nose.

The P10 medium didn't have that problem, nor did I very often feel leaks on the skin of my face. I had a kind of weird problem with the medium. I would hear a wheezing or whining sound upon exhale. I'd hear the sound in whichever ear was on my bed pillow. I could stop it temporarily by pressing the side of my nose, but then it would be back. Drove me nuts.

In desperation, I tried the large, and lo, no more wheezing and whining. But I did feel some air blowing on my face from time to time. The leaks weren't big, but I wanted to eliminate every annoyance that I could, hence the further experimentation with the Aloha. (Quick review: terrible vent diffusion, a little bit noisy in the short hose, finicky work to assemble and adjust, but otherwise very comfortable and virtually leak free. Plus, with Pad-a-Cheek strap covers, no marks on my face.)

[Liteheart1]

@Dormeo thanks for details and glad you have something that works. It is hearing details on forum that gives me ideas of how to experiment and be a detective to solve the mysteries of this whole game. Usually I communicate with my cats telepathically but at night they like to talk and so I like to talk back with them.

[jaswilliams]

As far as large leaks go I go bare back with no aids when I started my mouth breathing was fairly high often over 15% but over time it reduced in a 6 month period it tailed off to basically 0 or pretty close and I am using an ASV with pressures upto 25 like yourself. I tried mouth taping cervical collars etc and I was happier and slept better with a few leaks with no additional clutter over time I learnt to keep my mouth shut

[Liteheart1]

As far as large leaks go I go bare back with no aids when I started my mouth breathing was fairly high often over 15% but over time it reduced in a 6 month period it tailed off to basically 0 or pretty close and I am using an ASV with pressures upto 25 like yourself. I tried mouth taping cervical collars etc and I was happier and slept better with a few leaks with no additional clutter over time I learnt to keep my mouth shut

Good to know. Did you do any of the tongue exercises or anything else to get that end result?

[jaswilliams]

As far as large leaks go I go bare back with no aids when I started my mouth breathing was fairly high often over 15% but over time it reduced in a 6 month period it tailed off to basically 0 or pretty close and I am using an ASV with pressures upto 25 like yourself. I tried mouth taping cervical collars etc and I was happier and slept better with a few leaks with no additional clutter over time I learnt to keep my mouth shut

Good to know. Did you do any of the tongue exercises or anything else to get that end result?

No it’s just about getting used to the pressure and developing the reflex I can now talk and drink with the machine on and my P10 nasal mask in place I can’t say how I do it it’s just been learnt over time I still get the odd mask movement leaks but nothing that’s adversely affecting my therapy