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Struggling to keep mask on for 1hr+
#1
Struggling to keep mask on for 1hr+
Hi,

General Health: 35, male. Fit. Weight training 5 days a week. A glass of wine at dinner on the weekends is the most I drink during the week. 

Conditions: I have complained to my doctor of feeling tired for the past six years. Across this period I have had three sleep studies. The first two indicated 'mild' OSA at ~5 events per hour. The third was in combination with a daytime sleep study. This was triggered after I explained to the doctor that I felt uncontrollable urges to sleep and would do so, no matter what I was doing or where I was. I have fallen asleep eating breakfast, at my desk at work and while walking through a park. The daytime sleep study confirmed a sleep latency of <4 mins in 4 naps and led to the diagnosis of Idiopathic Hyposomnia - a sleep condition similar to narcolepsy, with the exception that I do not feel rested after sleeping or napping. This symptom is masked or compounded by OSA. The third sleep study indicated an increase of OSA events to 17 per hour, occurring 'almost exclusively in the supine position'.
I sleep 8 hours per day. I have trialled sleeping for 6, 8, 10 and 12 hours for three months at a time and did not experience any improvements during wakefulness. I dislike napping as it leaves me feeling incredibly lethargic for the remainder of the day, however it is unavoidable on some days.

Medication: Vyvanse, 50mg, daily. I find it is effective for approximately 4-6hrs, however I have fallen asleep within 2-3 hours. It does not affect my ability to fall asleep in the evening. 

Problem: I have been using a Resmed Airsense 10 for about 6 months and I have been unable to keep my mask on for longer than an hour on most nights. Occasionally I am able to get ~4hrs, but this is usually a 3hr period when I first go to sleep, then early in the morning when I use the bathroom. On some occasions I am aware that I am pulling the mask off, but I am not in a state to realise what I am doing. Most mornings I find the mask on the floor. My girlfriend occasionally watches me remove my mask in my sleep and says that the motion is 'quite aggressive'.

CPAP 
Settings: For the most part, pressure has been set to 4-20 auto, EPR3, ramp off, auto temp (27°), Humidity on. After finding this forum I have narrowed the pressure range to 7-12, EPR3, ramp off, climate control off. Climate control was turned off as I realised that my nose feels congested some mornings and the humidity might be causing this. Also, it is currently spring in Australia; I felt that 27° might be a little warm. Ideally, I would like to keep the humidifier off. I will be travelling Australia in a caravan for a year and running my cpap off a battery. The humidifier uses a lot of electricity. 

Masks: I have trialled virtually every nasal mask/pillow Resmed offers, each for about a week. I have also tried the F&P Eson 2 and Philips Dreamwear. They have all been relatively comfortable, particularly those with the connector on the top of the head, but in all cases I have averaged 1-hour mask-on time. For the last two months, I have been using the N20 mask. It's no better or worse - I have just run out of options. I thought the magnetic bindings that most masks use were easily detached if I pawed at them in my sleep or moved while sleeping, hence trying the Eson2 and Dreamwear, but these are just as easy to remove. I have trialled one full face mask and disliked it the most. 

Chinstrap: My sleep study demonstrated that I breathe through my nose when I sleep. However, I purchased a chin strap that covered the cheek area, in addition to the jaw. I thought that this might make the mask more difficult to remove and result in increased mask-on duration. I did record a few more nights in the 4-hour region, but putting it back after using the bathroom is a difficult in my early-morning stupor. 
 
Sleep position: I sleep mostly on my side/chest. My right hand is placed on my sternum and my head lays in a cradle between my forearm and bicep. I have used the Resmed CPAP pillow designed for side-sleepers but I found this was not effective. I also found it uncomfortable. 

I have attached several images to this post that are characteristic of my sleep patterns, in addition to sleep study data. I would be grateful if someone could review the data and provide recommendations that improve compliance. 

Thank you.

[attachment=37418][attachment=37419][attachment=37420]
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#2
RE: Struggling to keep mask on for 1hr+
Additional files

[attachment=37421][attachment=37422][attachment=37423]
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#3
RE: Struggling to keep mask on for 1hr+
Changed screenshot lay out as per wiki

Additional files


Attached Files Thumbnail(s)
                       
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#4
RE: Struggling to keep mask on for 1hr+
About half the settings are min 4 and Max 20 but the other ones are min7 max 20. You wrote your min was 4.

With that being said 4 is to low. 4 would make you air starved and needing more air. 7 is still low but probably ok. For comparison I need 9 or I too am pulling off my mask. 

In my opinion you need to continue to raise the min until you can keep the mask on. What ever the min is the amount of air on inhale. 

Keep EPR 3
Apnea (80-100%) 10 seconds, Hypopnea (50-80%) 10 seconds, Flow Limits (0-50%) not timed  Cervical Collar - Dealing w DME - Chart Organizing
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#5
RE: Struggling to keep mask on for 1hr+
Thank you for your response, staceybourke.
I apologise, I was using the default pressure of 4-20 for the majority of the time but for the last week or two it has been set to 7-12. 


I have increased the minimum pressure to 8 now and will trial it this evening. I am reluctant to set the minimum too high as I find the exhale uncomfortable.
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#6
RE: Struggling to keep mask on for 1hr+
The exhale should be taken care of with the EPR - exhale pressure relief.  The way it works is the min - EPR  is the exhale.  So for instance min 9 - EPR 3 gives an exhale of 6.   Again, 4 is the absolute lowest the pressure can be so Min 7 EPR 3 is the min to use the EPR at 3  (7-3=4)

So be sure you have the EPR at 3
Apnea (80-100%) 10 seconds, Hypopnea (50-80%) 10 seconds, Flow Limits (0-50%) not timed  Cervical Collar - Dealing w DME - Chart Organizing
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#7
RE: Struggling to keep mask on for 1hr+
What I did to get used to apap was to sit and watch TV or read with it on every day before going to bed. I found i would end up wearing longer and longer at night
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#8
RE: Struggling to keep mask on for 1hr+
Hi,
I increased the min pressure to 8.5 and stayed at that pressure for 3 nights. The mask stayed on for about 3.5, 3 and 3 hrs. I do not have data as I forgot to return the SD card to the machine. Last night, I increased the minimum pressure to 9.6. I got used to exhaling against the pressure and fell asleep within minutes. The mask stayed on for ~1hr. I feel discomfort in my ears when I swallow; similar to the pop you get when you change altitude. 

The attached file is from last night, at 9.6cmH2O

Any advice will be appreciated.

Kind regards


Attached Files Thumbnail(s)
   
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#9
RE: Struggling to keep mask on for 1hr+
If it were me, I would reduce the pressure back to 8.6, and get some data. Hopefully, the pressurized sinuses will subside.

QAL
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#10
RE: Struggling to keep mask on for 1hr+
I spoke to Resmed about my situation and they suggested I changed to fixed pressure. They recommended 9cmH2O based on my history but my ears are still popping from earlier in the week, so i changed it to 8. I got my second highest mask-on time last night; nearly 6hrs.


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