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

[SarcasticDave94]

IMO jaswilliams is describing tongue trick evidence w/o knowing it

funny thing we all can do that stuff w/o mask, then we mask on and what we do automatically gets automatically forgotten

[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?

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

Good for you, and nice to know that it was perhaps merely having a clear intention and "time."

[jaswilliams]

Dave,

It’s not the tongue trick as it’s the closing of my soft pallet as I can stick my tongue out and not let air escape so has no relationship to tongue position

[SarcasticDave94]

Oh OK, it just sounded the same as an automatic tongue trick seal.

[Liteheart1]

1.         Need to solve significant large leaks using nasal pillows; likely have gotten some very recent improvement with mouth taping. YET am willing to explore full face mask. Continued fatigue especially in early afternoon; recent sleep Dr appt - she said that with large leaks I'm having mini arousals too often and sleep quality is not very good.
   
2. Just reread forum suggestion to keep all/most of one's info in ONE thread so apology for having recently started (Pls suggest mask change for my "leak problem" http://www.apneaboard.com/forums/Thread-Pls-suggest-mask-change-for-my-leak-problem) moderator might wish to delete it; I will PM and thank 2 had made a few suggestions; and will summarize unneeded thread below.
   
3. Oscar (14 Aug. and 1 Aug.) attached:
   A) Since starting mouth taping a week ago with Somnifix and paying a lot more attention to mask, head position and pillow during side sleeping, there is improvement as seen on 14 Aug. only 8% large leaks, but other recent nights have been 31% 18% and 12% and while the last three are a good deal better than the +40% which was NOT atypically bad as shown in 2nd chart) it seems that there is quite a lot of room for improvement and hopefully more consistency. NOTE Data starting about 530 when going back to sleep on back; all other session data starts with side sleeping and I expect that position retained til about 430.
   B) Data from 1 August before sleep Dr appt and before mouth taping and changes to my mask, head positioning, etc. changes.
   
4. With recent changes I have noticed: I do not wake up with horribly very dry mouth - expect that prior exp. was due to much mouth breathing. Wake up somewhat more refreshed and while there is slight noticeable improvement, in the past once starting therapy I almost always woke up feeling quite refreshed and at what seemed like an acceptable level to me.
   
5. Sleep DR suggested that if I stick with nasal pillows that they should be changed @ 10 days rather than the "standard" 14 days due to the fragility of the material and to help knock down large leaks.The 14 Aug. data is from 7 day old nasal pillow. She also suggested chin strap and from forum I had gotten cervical collar, but find especially collar a bit claustrophobic. It seems to me that trying FFM or hybrid might be worthwhile experiment. (I have also renewed my training of tongue position to reduce mouth breathing.
   
6. More detailed description/info:  copied from other thread from my initial post there:
   Excerpt From 11 Aug post ...
   For about 2 years have been using DreamWear nasal pillow. It seems to fit quite well. I'm 5'10" 150#, clean shaven, and don't have unusual face or nose shape. Almost entirely side sleeper and not a lot of movement in sleep. Predominantly Central (not obstructive) apnea. Heated climate line hose and high humidity setting. Typically wake up with extremely dry mouth
   
   
   Early on in therapy I had mouth breathing and followed some forum suggestions here to train myself to reduce/avoid. And for last two nights since dr visit have returned to mouth taping with Somnifix - the first night this resulted in green happy face for leaks but not true the 2nd night - this was with brand new nasal pillow cushion. In using the built in mask leak test I suspect that as side sleeper that slight movements on pillow might be triggering leaks. 
   
   As usual I am very grateful to members of this forum.
   
   
   

[Liteheart1]

• I'd appreciate any suggestions for improving treatment regarding my post #75 above.
  
• While both large leaks and AHI continue to be pretty inconsistent, there has been improvement in last few weeks. In addition to good trend for Oscar data, I am less tired and need for (giving into) short day time nap is greatly reduced.
  
• I am finding better results and consistency with continuing to use DreamWear Nasal mask AND mouth taping. After in person input at DME store I tried quite unsuccessfully two FFM (Evora Full; and Vitera) and even though per forum advice to others I kept upper strap very loose, I had very large leaks (after falling asleep). While not my preference to use FFM, I am happy to do so if treatment is improved. For now it seems using DreamWear Nasal more effectively might be better approach.
  
• In last few weeks I changed sleeping pillow to buckwheat as has been recommended by several predominantly side sleepers such as myself. Changed pillow I believe maintains my head in more consistent position for longer period of time.
  
• I fall asleep very quickly. Except for one bathroom break, I am not aware of mini arousals during sleep nor any adverse response to pressure or changes in pressure. I am looking at O2 monitoring during sleep. I live at 3,000' and typical sitting resting O2 is 91 or 92. Heart rate is slow at 58-60; 137/81 blood pressure. Take only 1 Rx (thyroid disease) not related to sleep.
  
• Recent Oscar below.
  Thanks in advance for your knowledgeable input.
  
     
  
  
  
  

[Liteheart1]

• Really would appreciate analysis/comments on my two prior posts above.
  
• While the only two things sleep doctor verbalized during mtg a few weeks ago were concern about significant large leaks; and mini arousals and thus poor quality of sleep, from reading forum it seems there are other markers than Large Leaks that I should be monitoring and using as data feedback about whether new things I am doing are going in the right direction. Please educate me ...  (It seems that I have a pretty good handle on large leaks and that mouth taping and buckwheat pillow have helped - what else should I be looking at and what experiments to try?}
  
• Having recently read in another thread about Flow Limits and UARS, I have looked at last month and. quite consistently my 95% is 0 or at most 0.04
  
  Thanks to this wonderful forum ...  
  

[Liteheart1]

• Have sleep Dr appt on Monday/tomorrow so would greatly appreciate input especially as sleep Dr does not hold as a high a standard of what might be possible to improve treatment.
  
• While true of some other thread requests, a bit disappointed that there has been nothing here since my request for review on 15 August.
  
• Most recent Oscar which is a good deal better than other recent data, however it does continue the positive trend that has happened since mouth taping and paying alot more attention to mask placement, and head and body position. Subjectively I continue to feel a bit better energy and far less fatigue in mid afternoon.
  
  Thanks ...
  
     
  

[Brazen]

Sorry an expert hasn't weighed in lately.  I know they are busy but it's unusual.

I'm a newbie myself, so can't offer much advice. But, your leaks do seem to still be quite high.
What did the sleep doc have to say at your appointment?

I absolutely can't make a nasal mask work. The ResMed F30 airfit is a hybrid and after quite a few trials is the only one that I can get a pretty good, consistent seal. Masks are very much individual preference and can take an annoying amount of trial and error to find one that works. (and then 2-3 months later the leaks come back and you realize the cushion gave up and you have to replace that.)

[Gideon]

Everything looks good for an ASV user. Pressures and flow limits on ASV are typically wild as yours are.