[Treatment] PurpleOx Therapy: Diagnosed with Moderately Severe OSA

[PurpleOx]

I'm having a lot of mask fit issues and hoping that someone can help... 

Back sleeping

• Needs higher pressure (1-3 more cm H2O) vs side sleeping. Issues with jaw drop and/or chin tuck. 
  
• Without cervical collar or rolled up towel, I have to tighten the bottom straps a lot, which leads to jaw discomfort in the morning.
  
• With rolled up towel, still have problems with jaw drop. Have to tighten bottoms strap (jaw discomfort).
  
• With the Releaf neck pillow: too tall in the front (3.5-4"), too bulky in the back, and the closure puts a lot of pressure on the back of my neck. The neck pain in the middle of the night translated to labored breathing which the CPAP registered as flow limits which drove up the pressure and caused leaks... All of those factors combined led me to ditch the CPAP in the middle of the night, and I had severe neck pain and vision problems in the morning.
  

Side sleeping

• Slight leaking from around nose, to massive leaking (14 L/min) if I shift around in deep sleep and don't realize I need to adjust.
  

I've ordered a 2" cervical collar for tonight but I have a feeling that it might not work, so I want a game plan so I don't ditch my CPAP again. Should I just resort back to overtightening the lower straps, which pushes my jaw back? (At least it worked!) Maybe a rolled up towel under my neck plus a chin strap? I'm not looking for a perfect solution at this point, just a workable one. Thank you.

[PurpleOx]

Adding some screenshots

[SarcasticDave94]

Just commenting on the tight strap issue: short answer, no, avoid doing this.

Too tight ain't right when it comes to CPAP masks. As this was to control leaks, it strongly suggests the mask or cushion isn't the right fit. Replace it with one that fits and controls leaks better.

[PurpleOx]

I appreciate the feedback, Dave. Pulled out my nasal mask again and did some naptime testing. I'll try the nasal mask with rolled towel and tape combo tonight.

[PurpleOx]

I had a ton of mouth leaks and my mouth did not appreciate that (I will have to look up non-porous tapes) but I woke up feeling more rested. Do the leak rates look alright? Thank you!

[PurpleOx]

What do you do when your pressure needs on your back is very different from than your side? 

We picked low pressure of 8 cm H2O based on a mix of back and side sleeping (before I fixed my positional apnea through a cervical roll/pillow). Please see attached screenshot, it's pretty clear when I'm on my back vs my side. If I click on just the sleep-on-side portions, median pressure is 8.34. If I click only on back portions, median pressure is 10.3. Maybe since the flow limitations start immediately and the machine responds very quickly, it's fine to keep the min pressure at 8, versus raising it? Although I will say I'm always awake while those pressure increases happen, because I can feel my epiglottis or something fluttering lol and it's not exactly comfortable...

Also, do I need to think about reducing my min pressure? (i.e. if I were a side-only sleeper, are the settings ok?) Thank you for your help.

Edit: OH and I got news today that my insurance has come through and I will be getting an AirSense 11 Autoset! RIP OSCAR data, IIRC data won't integrate cross-machine.

[pholynyk]

Au contraire, OSCAR supports the AS11, and, since both machines come from the same company, you won't even need a new profile. You will need a new SD card for the new machine, since they have slightly different data formats - similar enough to confuse.

[PurpleOx]

@pholynyk, More positive news, awesome to hear!   Thanks!

[PurpleOx]

Insurance came through and I switched over to AS11Auto plus Resmed N30i on Wednesday. Also started using a chin strap (PRIMADA Super Deluxe CPAP Chin Strap) Thursday night.

• In the AS11 screenshot: I really like the Resmed N30i (quick release, doesn't shoot a jet of air at my husband's face, frame is firmer which I like) but the nasal cradle doesn't fit my nose as well and I'm seeing non-zero median leak values. Might have to switch back to DreamWear but I'll mess with the other size nasal cradles in my fit pack first. If those have similar leak values, is it bad enough I should ditch them and switch back to DreamWear nasal?
  
• In both AS10 and AS11 screenshots: A sudden decrease in required pressure which I'm attributing to hormone fluctuations. I'm on hormonal birth control and this drop lined up exactly with resuming active pills. Should I decrease min pressure to 7?
  
• FYI I did have a night with AS11 + Dreamwear nasal with similar low leak rates as AS10 + Dreamwear nasal mask.
  

Thank you so much!

[SarcasticDave94]

About the mask and leak rates, it depends on you. Your comfort is the main goal and motivator. I don't know this will play out, but assume that you do nothing and this leak rate trends very closely for a long time. That would be ok really, the values aren't that high. A 99.5% at 10.x is actually pretty good and where I was after months of adjusting mask on a ResMed ASV. Leaks from the 3/10 chart is what I'm referring to.

So you could do nothing, and if it trends like this, you're fine. However, if comfort is currently compromised, such as leaks disturb sleep, or mask is not quite comfortable, then you do have to change something.

If me, I would change an easy thing to reverse like cushion size. Then try it and view OSCAR results. Did it help or not? Then from there decide to keep that change or not. Worst case is you elect to do nothing and results might be what you see now, which are actually very good.