[CPAP] Mask leaking during events, can't go back to sleep!

[tseaholtz]

Good afternoon! 

I started my CPAP therapy 4 days ago due to me getting bariatric surgery in early March and my insurance requires me to use this machine and I have been trying to find tips and tricks regarding staying asleep and preventing mask leaks during AHI events. My DME provider gave me a small sized Simplus Mask to use for the AirSense 11 AutoSet and my prescribed pressure is 5-20 according to the machine.

My sleep study was apparently really bad. The results said on average, in an hour of sleep, I stopped breathing around 112-113 times. My oxygen levels reached 74%.

The first 2 nights I felt like I was choking and found somewhere that turning off EPR could fix that, which it did which is helping getting asleep but now I am waking up with hissing and whistling near the bottom corners near the ends of my mouth while exhaling. I usually slept on my stomach before getting this mask but the duration of me sleeping with this mask has been with me sleeping on my back.
I do have a full beard, mustache and hair under my bottom lip.
I made a homemade mask liner out of a sock last night and in terms of falling asleep, I think that was the fastest so far as it was very comfortable but still had the same issue with waking up due to the high pressure causing the hissing and the whistles during exhalation.

I just downloaded OSCAR to import my sleep data from the SD card the DME provider installed into my CPAP machine. I do not know how to analyze it but I am willing to upload it to someone who can analyze if there is anything that can be done to prevent leaks during these events.

I would be grateful for anyone who can give me advice on what I could possibly do to stop these leaks and hopefully for once get a full night sleep with this mask. Thank you for reading and I appreciate your time.

[Sleeprider]

You can share your OSCAR data on the forum and we will interpret the results we see. Tutorials on organizing charts and attaching file images to your posts are in my signature links below. If your mask is leaking uncontrollably, inform your DME that the the F&P Simplus does not fit and you cannot control leaks. They may change the cushion size or try a completely different mask. The Simplus is a full face mask and proper fit is important. I usually recommend people start with nasal therapy and move to a full face mask only if necessary. A nasal cushion mask is so much smaller and less intrusive if you can avoid mouth breathing. Anyway, it's clear the size small does not work, and I'm not surprised a male with recent bariatric surgery might not fit a size small. Did your DME actually fit-test, or just issue this mask based on a guess?

[tseaholtz]

Thank you a lot for your response and advice. I took a screenshot based on the guide in your organizing charts guide and will attach it. I am waiting for Monday to arrive to I can speak to my DME regarding getting a bigger mask. When they were scheduled to come to my house and show me the machine and how to use it, they made me scan my face via a website on my phone which apparently told them what mask I needed along with the headgear. Maybe this scan messed up? I am not sure, but I have attached the photo of my most recent usage of the AutoPAP and maybe there would be some insight as to why the leaks are so prevalent. Thank you again, sincerely. 




   

[cdplatt]

Looks like your leaks are mostly within acceptable limits with respect to therapy requirements, though they can certainly interfere with sleep.  The larger a mask is, the more likely it is to leak; there is simply more, irregular surface area to seal.

DME's like to ask if you breath through your mouth at night.  When you say yes, they automatically push you into a full face mask.  That is not necessarily the correct answer for a mouth breather.  Taking steps to reduce or eliminate mouth breathing and using masks that are more comfortable and easier to seal is a better approach IMO.

A full face mask combined with facial hair can be particularly challenging.  Nasal cushion or nasal pillows masks tend to work well with facial hair.  Combined with a chin strap or cervical collar to assist in keeping your mouth closed they may be more beneficial than a larger full face mask.  They can also be very comfortable.

[Sleeprider]

We're going to cut your flow limitations and improve your results with some minor changes to your settings.  Well-done posting a useful and informative chart.  The settings I want to see are, minimum pressure 7.0, Maximum pressure 12.0, EPR On Full-Time, EPR setting 3.  This is going to eliminate over half the events and lower 95% flow limits from 0.22 to less than 0.10. In addition, the therapy will feel more comfortable and result in fewer leaks.

[tseaholtz]

Thanks for the suggestion. I went ahead and tried to take a small nap with these settings and I don't think it went well according to the app but let me know what you see regarding these OSCAR results. Thanks!

   

[SarcasticDave94]

Take a look at my signature on the Apnea Board wiki involving Positional Apnea patterns. See your chart for what it looks like. A big cluster of events probably means your chin is tucking into your chest, externally kinking off the airway. This is very much like the kinking off a garden hose.

Several pillows stacked will do this. Side sleeping and rolling your head inward will also. You'll need to physically block this.

[tseaholtz]

Thanks for the insight on that. I took a small nap again earlier today and forgot my bed is slightly elevated near the head level which while laying on my back seems to force my chin to be tucked throughout the sleep.
I contacted my DME and they are sending me a AirTouch F20 kit as they suggested it since I have a lot of facial hair and continuing to experience leaks that wake me up.
I should have a new OSCAR data in the morning late afternoon while laying completely flat on my back, with the bed levelled and not raised up from the head level. I am going to see if that makes a difference while using the original 5-20 pressure and EPR on 3.

[tseaholtz]

Good afternoon,

It has been a week or so since this and I got a new mask which is the AirTouch F20 which is the memory foam mask. It is a lot more comfortable, and although I went back to the old 5-20 pressure settings, The issue is still here where I will wake up with a small leak in the mask and have severe trouble going back to sleep with the pressure so high. I will attach the most recent OSCAR screenshot and see what you guys think. I have contacted my prescriber for tips as well as to what he might think could be best for me going forward. Thank you guys a lot for the help so far and tips and such. Hopefully I can get this fixed soon to get a full night sleep with this on because this has been feeling more like a chore than it is pleasure lol.



   

[SarcasticDave94]

My opinion, I think you'd do better going back to 7-12 pressure and EPR 3, no Ramp. Flow Limit and Hypopnea should improve with this.