Help request...

[zsearcher]

   
 
Greetings,

In September, I was diagnosed and my sleep test showed >45 events per hour.  I started on cpap therapy in early October and so far it's been pretty frustrating, with being semi-awake most of the night, due to being generally uncomfortable, mask leaks, and dry mouth. 

Last night was my second night with a ResMed N20 nasal mask, replacing the nasal pillow mask I had.  I thought it would be more stable but with the short time I've used it, it doesn't seem so.  I also began mouth taping, which helped my dry mouth the first night, but not so much last night.

I can't get in to see my sleep doctor for another month.  

I do have access to my machine's settings, and I now am using OSCAR.  I'm just hoping that someone can offer suggestions on what I need to do to improve my situation.  Thanks!

[SarcasticDave94]

Welcome to Apnea Board,

OK, a few things I'm seeing that are hindering. Leaks and flow limits are probably tied for top issue. To me, some mouth and mask leaks seem to show in the leak line. More jagged is likely mask, more rounded are mouth leaking. Take a look at our mask primer in the wiki if you'd like.

The flow limits have the shaggy look, and needs either one of two actions. If you have EPR on, it needs to be full time, and I would max it at 3. If that's already set this way, then you'll likely need higher than 9 as your low pressure number. Flow limits are the throat beginning to restrict that is a precursor of an Apnea event. Within OSCAR, FL go from 0 to 1. Think of this as percentages, 0 no limitation, 1 is 100% limited. Yours are between 14 - 30%.

[zsearcher]

Thank you. Lots of mask info in the wiki. My EPR was already on, full time, and at 3. I raised my low pressure to 9.6 and will leave it there for a bit and watch my AHI before moving it up more. Thanks again!

[Dormeo]

Zsearcher, in the chart you posted, your EPR wasn't on. So check again, would you? Set it to 3, as SD recommended, and raise your minimum to 9 to compensate.

I wouldn't worry too much about the CAs at this point. They may just reflect awake breathing or longish pauses after arousal breathing. As you begin to sleep more soundly, I wouldn't be surprised if they diminish.

Pillow masks tend to be more stable because they anchor themselves a little bit on your nostrils. Which pillow mask were you using, and what about it wasn't working for you?

If your tape gets wet from saliva, it will loosen. You may need to use some anchoring pieces, especially at the corners of your mouth. Be sure to make little tabs on each piece of tape you use so you can get it off comfortably.

You can also try using your tongue to help avoid mouth leaks. Try putting the tip of your tongue behind your upper front teeth. Then position the main part of your tongue up against your upper palate. Finally, give a little suck or swallow to create a bit of suction. You should now be able to open your mouth while breathing entirely through your nose. Practice this during the day, and see if you can get it grooved in deeply enough to help while you are asleep at night. For some people, this is really all it takes to avoid mouth leaks.

[zsearcher]

Good morning,

I checked my machine, and it still said that EPR was on. This morning my OSCAR also says EPR is on...not sure if there's a lag there?  It seems OK now. 

My original mask was a ResMed N30, with the nasal cradle cushion under the nose.  No matter what adjustments I would make, I could not keep it from moving off my nostrils whenever I moved to my side.  I had a 30 day "try out" period and traded it for a ResMed N20 at 28 days.  The N20 came with a silicone nose cup that covers the whole nose and also has more support adjustments.  I also purchased a memory foam nose cup. 

I'll post the OSCAR charts from the last two nights. 

The first one is with the new mask, silicone nose cup, and mouth tape.  I felt like I was awake all night with leaks around my nose and mouth.  It was not a good night.

The second chart was last night.

Last night I changed up by installing the memory foam nose cup, and trying your suggestion of using my tongue to stop mouth leaks after practicing that all afternoon.  I woke up this morning feeling better than I have in months!  I remember waking once because of congestion, and after I cleared that, it was morning.  I am not sure what helped, the EPR settings, or the mouth leak technique, but it was sure nice to sleep well.  I am not going to post in "Success Stories" yet, but I am certainly more confident that this is gonna work!

Thanks SarcasticDave and Dormeo!

[SarcasticDave94]

Good job, if you're comfortable and gaining rest, your next thing is to get a repeat chart. Keep an eye on your leak rate, but if you're satisfied this should be passable. I wouldn't let it increase from this leak level though, or you might get disruptive sleep.

[Dormeo]

Yes, good job! Let us know how things go over the next few days.

If you ever want to try another mask, you might see how you do with the P10. If you try it, be sure to get the fit pack, which has three different sizes of pillows.

[zsearcher]

The last few weeks were pretty decent overall, as far as rest.  I was congested for a week after a bout with flu.  My mouth leaks, which I thought I had gotten past, came back somewhat.  I tried everything I could find here, but they persisted.  I decided I needed to change masks. 

At my three month appointment, which lasted all of three minutes, my sleep doctor said that I probably could take care of mouth leaks with a full face mask.  I asked what he recommended and he dodged that question.   As he walked out the door he said, "See you in a year".  Enough about that.

I did buy a ResMed F20, with the memory foam mask.  I was pretty confident when I went to sleep last night, but it was not a great night.  I was awake quite a bit.  My Oscar showed my AHI was up along with leaks.  I was not aware of the leaks, even being semi-awake most of the night. 

Today, I read the Wiki Mask primer, (better late than never) and went through the fitment procedure, under pressure.  I noticed that as I reached the end of my inhalation, there was a "puff" of air that lifted the mask off my face, by my cheeks, obviously leaking. 
 
I'll post some random charts from the last week, along with the chart from last night.  Are there any settings that I might try to reduce this "puff"?   Any other suggestions that may help?

Thanks!

[Dormeo]

I wish I knew what to suggest about the "puff." A few thoughts:

Did you change the mask type in your machine's settings?

Is it possible you were having more mouth leaks because of flu-related congestion? If so, and if you're all cleared up now, you might consider going back to your old mask (or to a P10, if you're feeling adventurous).

Although the charts reflect just a few nights, I do wonder whether you'd be wise to raise the minimum back up to 9.8, or maybe even to 10. This might head off a few more of your OAs.

[BoxcarPete]

Looks like you have some event clusters. I can't say why, but I also noticed when switching from a nasal mask to a FFM that when sleeping on my back the events can cluster like that. I don't know why it wasn't happening with the nasal mask, but it may be a difference in sleep position leading to chin tucking. Have you ever used a cervical collar to support your chin and jaw? I know that when I use my FFM I don't always stay on my side very long, sometimes I go right to the back and boom, events everywhere.