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Struggling with therapy lately
#1
Struggling with therapy lately
Hello All,

I'm new to this forum, but not to CPAP usage. Ive been on CPAP for about 4 years now and its worked great. I was diagnosed at 12 AHI, and therapy brought it down to usually below 1-2. Its worked great for me. I do have some considerable issues with aerophagia though. Sometimes I wake up in the morning with so much air in my stomach it hurts and I can barely stand up straight.

Lately, Ive been having worse nights of sleep due to high leak. I'm averaging 30-50% leak every night. If I get a night at less than 30% leak its very rare and a really good night of sleep. Those nights I average .5AHI and feel significantly better. I think a lot of the leak is coming from my mouth, since I struggle with aerophagia and extremely dry mouth. Ive tried a few different masks and it doesn't seem to help. Currently using a chin strap, but its messing up my jaw and making it pop. Ive tried lip tape, but that either comes off, or even if it stays on, doesn't seem to make a difference, I still wake up with dry mouth. Its been like this for months and I'm nearing the end of my rope.

I was hoping someone could look at my charts and see if they have any ideas that might help.


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#2
RE: Struggling with therapy lately
I would focus first on addressing the leak problem. After that, I wonder if you could use a lower pressure, which should reduce the aerophagia problem.

With nasal mask or pillows, the usual advice is a chin strap or taping the mouth closed. I couldn't stand that myself.

Have you considered a ResMed F30 mask?  It's called a full-face mask but has also been described as a nasal mask with a mouth cover. It doesn't go over your nose like your current mask does. And it eliminates mouth leaks since the mouth is now inside the mask instead of outside.
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#3
RE: Struggling with therapy lately
Absolutely. Currently you're using your machine as a leaf blower. (Please turn the calendar off in your next screenshot: simply click on the current date.)
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#4
RE: Struggling with therapy lately
Holysmartone, I have suffered from both aerophagia as well as dry mouth. I would agree to focus on the leak problem first. In some cases it seems to work itself out, but in your case it certainly sounds like you are a mouth breather. I switched to a full face Resmed F20 and then for the past year went to a F30 and then the newer F30i. I recently went through full hip replacement surgery on both hips and my numbers went up and all of a sudden my masks aren't sealing around the mouth very well. Unfortunately the F30's only come in a small or medium and it pulled away from my mouth. As far as the dry mouth I increased my humidity to about 5 and I am not near as dry as I was. You noted you are unsure about a humidifier. I have mine set on "auto" and it does it's job.
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#5
RE: Struggling with therapy lately
You will get better results and a lot of relief if you turn on exhale pressure relief (EPR ) on your CPAP. EPR will lower pressure during exhale from 1 to 3 cm pressure depending on the setting. This will definitely help with aerophagia and may help with leaks.

Most chinstraps pull your jaw back which increases airway resistance and hurts your jaw. The Knightsbridge Dual Strap from Supplier #37 pulls upward and stabilizes your jaw. Take a look at the Reviews. http://www.apneaboard.com/forums/Thread-...-ChinStrap
Sleeprider
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INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#6
RE: Struggling with therapy lately
Wow, thanks for all the replies. Fixing the leak would obviously be my priority. I have tried the resmed F20 and F30I masks, and couldn't get either of them to seal well on my face. Maybe I will give the F30 a shot. I will definitely try turning the EPR setting on, and see if that helps for a few days. I will take the Knightsbridge strap under consideration. I'm not sure if I can handle having to wear a full cap like that.

I appreciate all the help. My sleep doctor has been all but useless in this process.
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#7
RE: Struggling with therapy lately
I'll look forward to seeing what results from using EPR. On future charts, please minimize the daily calendar by clicking on the triangle in the date line or using the view menu. There are useful statistics we are not seeing due to the calendar. Your priority of dealing with leaks is good as they disrupt a lot of what we see as well as your sleep. An alternative to the chinstrap is a soft cervical collar or just an airline pillow that supports your jaw. Your leaks are all from your mouth dropping open and all it takes is a gentle nudge from below. The Knightsbridge has worked, but I'm sure if you think about the mechanics of pulling or pushing up and not back, you can figure out something better and more comfortable. Good luck.
Sleeprider
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____________________________________________
Download OSCAR Software
Soft Cervical Collar
Optimizing Therapy
Organize your OSCAR Charts
Attaching Files
Mask Primer
How To Deal With Equipment Supplier


INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#8
RE: Struggling with therapy lately
Hi I'm broken record Dave, if you are looking at a different full face mask or any other mask type, then give Fisher and Paykel a look. My Vitera works great at leak control whether side and back sleeping. This mask has roll fit bellows and required minimal strap tension.
Dave

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INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEBSITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#9
RE: Struggling with therapy lately
I'll chime in and give a plus 1 to SleepRider's cervical collar suggestion. I don't need any help keeping my mouth closed on my side, but my back is a different story. Mouth tape didn't work for me (and also seemed... scary?) so I tried the soft cervical collar. Now I can sleep like a champ on my back with no leaks. It takes a little getting used to on your side, but honestly it's not nearly as awkward as I was expecting.
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#10
RE: Struggling with therapy lately
I found the soft cervical collar and the Knightsbridge chin strap  both surprisingly comfortable.      
Regarding the soft cervical collar...I made a few for myself at home,    it was a frustrating job to try to get it the right size.     The corflex collars work better for me.    One of the reviews   read   "the velcro is loud."     yes, surprising loud.    Heavy-duty velcro, it works.    Apparently, we did not measure accurately.     I think I could have returned one.   

The Knightsbridge chin strap has loud velcro, too--  that velcro works, too.      Have you looked up    this   "chinstrap"  ?      It looks like a cap,  with two wide strips under the chin.    It reminds me of the swim caps that we girls and women  were required to wear at swimming pools--years ago.  

 I am finding that when I can sleep/breathe  more comfortably,    with few leaks,    I can tolerate some of these sleep  accessories more readily.     

This is all a process.    We learn as we go.      You are  asking great questions.     Please  keep us posted.
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