Forum has helped...but now next step to improve

[nightgagger]

Last night, just for sh*ts and giggles, I decided to try the F30i full face mask again, along with the cervical collar, having not tried that with the lower pressure setting, just to see if the seal would be a little bit better.  Unfortunately that was not possible.  Around 3:30AM, it took that mask off and switched to the Nasal, used Somnifix tape in combination with the Fleximull (similar) tape, and got a better seal, although still getting a leak, but less cases of CA, RERAs and leaks than earlier in the night.

I woke up later than usual and I believe a better sleep.  Quite honestly I'm giving up and staying with the nasal mask and tape.  I'm comfortable with tape, but definitely have to shave and use the dual method of taping just to keep my lips together. 

Maybe I'll give nasal pillows a try.  Has anybody tried that with tape?

[nightgagger]

Nasal mask, Somnifix and Fixomull tape used.

AHI 0.0

There you go.  Do I feel great....well not really.  Kind of sleepy right now...5pm...but, felt good most of my morning.  I have some anxious things going on in life, the start of divorce, and when tired things like that really dwell and depress me...but today, no problem.  This will get resolved.  So, sleep helps.

Furthermore I ordered the N30i mask.  I want to try that mask and see if the comfort is a little better than the current one I use, N20.

[nightgagger]

Today I received nasal pillows for my N30i mask to try out.  These are the medium P30i ones, so I wanted to evaluate and see if ANY leakage was occurring.  Very comfortable btw.

The attached screenshot is from a 20 minute "nap", which I really didn't fall asleep, but just settled into a calm state with as normal breathing as I could.  I did not use mouth tape, but used the tongue to roof of mouth technique.

As I look at the data, there's a leak value of 7.20 l/min Median leak.   

Why would there be leaking if I could not feel it, out of my nostrils.
I'm very mystified by this.  I also have been using the N30i over the course of 9 days and the median leak average over those days is 14L/min.

Am I doing the wrong math?  Should I look at the median leak as the determinant of leak issues?

Very confused with the leak issues and any help would be appreciated.

[nightgagger]

Another update.

Using nasal pillows for about a week, P30i setup, got the following chart for a real top night of sleep.
Unfortunately, have developed a chaffing sore at my nostril and using lanolin creme to deal with that.
Otherwise I'm quite happy with the result.

Taping my mouth is the way to go and comfortable with it.

[Sleeprider]

Looks really good, and better if you are comfortable. Leaks are generally below large leak threshold, but your comfort and sleep are the first priority.

[nightgagger]

It's been awhile since I posted in my thread.  Over the past four months I've used the P30i with good results, but still wanted to try another mask feeling that it may be bettered, especially when side sleeping.  
I chose the F&P Brevida, and currently on my 11th night of using it. 

Good results, but last night I had a bit of difficulty with my sleep.  I noticed that I was having some difficulty and feeling like my breathing was labored.  Sometime during the night I switched my EPR to 2, as opposed to 1 which I've tried for a couple of nights.  The reason being is I'm seeing more hypopneas lately, but nothing excessive.  My average AHI over 11 nights is under 1.

I did not sleep well last night, but may have brought that on with a late night meal.

However, in looking at the flow curve during a period of deep sleep, I'm concerned with the shape.

I put up two screenshots.  One is a zoomed in section during my deepest sleep, and the other is the full night's sleep.

I really was tossing and turning most of the night, and did not get any real rest.

Not sure what to make of the flow curve.  I've noticed that with this particular mask, I have more of a peaked curve, as opposed to a rounded curve.

Then again, the aim of all this is to get the best, most restful sleep, and this mask has provided it on most of the nights.
This may have been a bad night..and an anomaly.

Any comments would be appreciated...thanks!

[sheepless]

it'll be interesting to see what those more knowledgeable than me say. a few things to note:

oscar indicates min pressure 10, epap 7. epr is set to 2 so min epap should be 8. in addition, min is set to 10.2 so it shouldn't be lower than that in the stats. could be oscar issues.

your minute ventilation & respiration rate are high. could be double counting the double breaths your asking about in your flow rate.

does this occur all night or just briefly?

the pattern could be panting or maybe cardio artifacts but to my limited knowledge the latter are usually not so pronounced (although it may only appear that way due to the view scale).

panting may explain the high respiration rate if the pattern is short & infrequent. cardio artifacts if it occurs much or most of the night.

your flow rate is 'hairbrushy' indicating a bit of a struggle to breathe. your inhale time exceeds exhale time maybe indicating the same.

how do you feel?

your ahi is outstanding so you may be more interested in an explanation than a solution but you might try raising min pressure a bit. it appears to be okay as is, barely fluctuating by 2 cmw with few events, but it might be more comfortable & might help address the I:E ratio.

let's see what others say.

[nightgagger]

Thank you for the observation Sheepless.

When I started the night, my settings were 10 and I had EPR at 1.  Sometime during the night, I didn't feel comfortable, so I went into the clinical settings and set EPR to 3, briefly, then back to 2, while upping the pressure to 10.2. 

I felt sort of OK today, not enough sleep. Somewhat tired, but not too wiped out, but not optimum. 

The respiration rate being high seems to be a very constant artifact, maybe, with this Brevida mask.  I've used it for 11 days straight and if we looked at the average of the 95% over that time, I calculated 35 BPM...that's definitely too high.  Very much a sawtooth graph.
I think you are correct that the waveform is counted to two times due to the deflection crossing the zero line, then dropping back.

What I'm also noticing is that the flow waveform when I used the N20 or P30i seemed to have a better trace.  I've attached a two minute view from one of my better nights for each respective mask.

[clownbell]

Nightgagger - your post of April 8th didn't get a very good answer, so let me try and help you with the question about leakage.

All masks have an exhalation feature, to get rid of the CO2 when you exhale. This is called "expected" leak. You need it. Otherwise it would be like trying to run a car engine with the exhaust manifold plugged up tight.

Anything exceeding "expected" is by definition "unexpected." PAP machines can deal with unexpected leak up to a certain point; they do so by increasing the volume to maintain the desired pressure even though the leak is present. There IS a point at which the machine can no longer compensate. At that point, the efficiency of your PAP therapy is likely very poor to non-existent. ResMed defines the redline at 24LPM of unexpected leak.

The main daily page of OSCAR has a series of colored bars below the place where it reports the AHI. The grey colored bar reports the percentage of time you were over redline leaks. That's what I look at.

[sheepless]

thanks for explaining you changed settings during the night; so not an oscar problem. respiration rate doubling with a different mask is a new one to me and idk why that would happen. go back to the masks you were using in the latest screenshots with rr around 18 to support the conclusion. 18 is close enough to half your current 35 to strongly implicate the double counting but what's causing the hitch in your breathing? is it a mask problem and if so is it the mask itself or is the mask affecting your breathing somehow? if the latter, you'd think you'd be aware, if not of the breathing, then at least the negative effects of it. if you're actually breathing that second breath within a breath, I'd think it something to be concerned about. in addition to going back to an earlier mask, you might try audio/video recording to monitor your breathing.

if you change mask types (nasal, nasal pillow, full face), remember to change the mask type setting in the pap machine.