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Flat Mask Leak? Backpacking?
Flat Mask Leak? Backpacking?
Apologies in advance...long email alert!

Among XPAP users, I'm still a newbie...in my third month. I have an AirCurve 10. My diagnostic sleep studies diagnosed moderate apnea (AHI ~25), with ODI higher (in 30s) and desaturations regularly into the 70s; about 20% of my apneic events were central. I also have an enlarged left atrium and arrythmias, but not heart failure or afib...yet. The undiagnosed/untreated apnea undoubtedly made the heart stuff worse.

I have adapted to BiPAP relatively easily, I think, based on the stories of others, with virtually all of my nights since I started in October giving me MyAir scores in the 90s...and virtually NO desaturations from OA or CA events (which is amazing to me). With the help of suggestions from this forum (thank you!), I have learned a lot and reduced my AHI from around 5-6 (generally all CAs) to generally below 1. However, my actual sleep is probably worse and I'm still falling asleep almost instantly if I try to watch TV or read (yes...probably having events...have started wearing an oximeter with an alarm if I watch TV...I don't want to fall asleep as that alone probably messes up my sleep). Overall, good though. My efforts now are focused more on heart and quality sleep.

The attached OSCAR screenshot is from last night and is, to me at least, my best night. I used the Brevida XS/S mask with a loose Aveela chin strap (using to keep headgear elastic straps in place and stop them from tangling my hair...which is fine and slippery), and Simply Breathe mouth tape (was using MedVar, which works but gets wet...prefer a breathable tape). I am a back sleeper (am in pain and miserable on my side...can sleep on my back on a wood floor in the yoga shavasana position) and have gone back to sleeping with my head elevated (don't seem to have an issue with chin tucking) as this reduces increased nasal congestion/flow limitations toward morning.

You can see my current settings on the image; I'm also using high trigger...which largely eliminated my CAs. I also do not tolerate heated air or higher humidity (setting 2)...need cool air to breathe.

So, I have two questions...knowing that I should be thrilled with my BiPAP results so far. First, I LOVE the Brevida mask but my leak rate increases substantially (with tape...no mouth leaks). I think perhaps my nose is weirdly shaped. The leak rate is virtually the same with either size (XS/S or M/L) and I truly cannot feel any leaks at pressure around the swivels or around the mask. I earlier tried the N30 and it leaked too. For me, the Brevida is so comfortable and totally quiet. I can get 0 leaks and good AHI numbers with the P10 but I also wake up a lot due to inspiration/exhalation noise as well as minor nose bleeds that increase my flow limitations and morning congestion. My stats appear to me better with the Brevida (and I feel better I think during the day) and despite the constant leaking (mean 6 or 7 L/min), my HR is calmer (unusual for my PCs be under 20...often in 40s...lower with Brevida) and I don't see any responses to the leaking as I do with mouth leaks and bigger pressure changes (I'm constraining the pressure range because of this but may increase IPAP by .4 to see if that helps with the remaining OAs), which seem to trigger movement and erratic HR and breathing. In general, for me, the lower the PCs the better my sleep (higher HRV, higher parasympathetic control). SO, is it OK to stay with a mask that leaks continuously but relativley flatly? Is there another mask that Brevida lovers like that might fit better or some other adjustment (in addition to tape, have played with different headgear tightening/loosenings)? 

The second question is something I haven't seen addressed but is a big deal for me. I am a 75yo female with normal BMI...and an avid hiker/backpacker. I'm willing to buy a Mini but can't increase my pack weight over 40 lb and prefer a 35-pound limit and really don't have room for XPAP gear...and a battery for XPAP is way too heavy and big and would only give me about two nights...certainly not enough for a 5-10-day trek. I am considering surgery because of this. I'm willing to tote all of this XPAP gear around with me for non-hiking trips (major hassle as I love traveling light to remote areas of the world but apnea control outranks the hassle for regular trips) to protect my heart but giving up multi-day hiking seems to me beyond what I'm willing to do, even if it kills me. Any suggestions? Before I got my BiPAP (which took FOREVER...nearly a year), I tried positional changes, MADs, the EPAP Boogle thing and much more...all made my AHI and ODI worse. Nasopharyngeal exercises help a bit I think, if I'd do them daily. Any suggestions? Is Inspire worth considering (sounds scary and only for OAs)?

Happy 2023 all!

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