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Need some help/advice - here's my symptoms and machine settings
#21
RE: Need some help/advice - here's my symptoms and machine settings
I suppose the prices are about what to expect. If I've got it right, the Ext Allow column is what your insurance allowed to be charged, with you paying a percentage.

The humidifier is definitely built-in on the ResMed 10. This separate charges for PAP and humidifier is from older models that the humidifier was a separate unit. The DME's leave it like this, the 2 separate lines charge, because it increases the amount they get away with on the bottom line of the bill.

On the mask issue, if it leaves marks it's a sign of the straps being too tight. You will not need tight straps for the Vitera. In fact, they must be loose or it leaks badly. When you get it, we can address step by step adjusting.
INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEBSITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#22
RE: Need some help/advice - here's my symptoms and machine settings
Just to update the progress, I've attached the chart from last night, using the F30i. I would say though nowhere near perfect (still woke up 5+ times), as far as quality of sleep its probably the best I've had since I started CPAP. Still woke up plenty of times throughout the night but I definitely feel a bit more well rested than usual. Might have been because I was exhausted after 2 straight nights of bad sleep but still, guess its positive.

My appointment is in about 2 hours to replace the f30I to the F&P Vitera. I hope I'm making the right decision because this mask felt fine last night. Not sure if leak is bad or not. I always thought as long as it was over 24 you're good but you're comments from the other day make me think otherwise. I guess worst case I'll make them switch me back if the F&P is a no go. Dang'd if I do, dang'd if I dont.....Coincidentally, when talking to my dad yesterday he found his model and told me he uses this exact same mask. He tried 4-5 different masks before finding this one so with his face structure being at least similar to mine I'm hopeful.

Chart wise, from what I can tell things look decent. Still CA's but 7 is a lot better than 18. Will keep you posted...


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#23
RE: Need some help/advice - here's my symptoms and machine settings
24 leak rate on ResMed is the redline, like a cars tachometer has redline. You cross that and it's a sure sign something will break. In the case of PAP, redline leaks mean too much air is leaking for the PAP to give acceptable therapy and accuracy is being lost in tracking your needs and events.

Your current chart shows Max leaks at 16.x, 95% 13 and median at 6. Looking at the leak chart, that Max leak didn't happen a lot, but that 95% at 13 would have. 13 is probably OK, but you need to factor in how comfortable the mask was adjusted to get that.
INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEBSITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#24
RE: Need some help/advice - here's my symptoms and machine settings
I just got back from the CPAP place and got the F&P Vitera.  The size chart showed me right in between a Medium or Large on the cushion size so she gave me some mediums and also a Large to try.  So when I get home I'll mess with both cushions and see what's most comfortable.  I noticed the medium fit maybe 5-10% down the bridge of my nose and I think I can get the large to rest at the very very top of my nose basically between my eyes.  If my size is right between M and L, any advice on which one I should go with, is too large or too small better?  I know I'll just need to try both to see.

The other plus is she let me keep the F30i because since its used they were just going to trash it anyway.  So very worst case I know I have the f30i if all else fails.  That's another perk of using that company, they are super great with swapping everything out for me and helping me size things and they haven't charged anything else for all the swapping....its all included in the first 30 days.

Hopeful this new mask will work good for me tonight.  I'll report back in the morning.
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#25
RE: Need some help/advice - here's my symptoms and machine settings
Try the medium first. You need a bit of room to move the mask down a bit on your nose without breaking seal at your chin.

My version of how to adjust the Vitera:

First adjust the straps out to very loose, there are the lower, upper, and top of head straps.

I use the top of head strap to prevent the mask from going too low and breaking chin seal.

The very first time I adjusted my Vitera, I did so with hose disconnected and adjusted straps to be just adding tension. After that, add hose and turn on PAP.

Lying back on your bed, put the mask on as you normally would.
Start at the bottom set, adjusting equally, tension just enough to feel very slight tension. Then the same for the top. Very light tension.
Loosen the top of head strap, and then lift the entire mask off your face, resettle down some, feel for the bony area across you nose, about where that ends is where your mask top point should rest. Check that top and then bottom at your chin to ensure it's sealed.
Tighten top of head strap.
Edit top and bottom sets to minimize leaks. Bottom set being loosened increases nasal bridge seal, top set with forehead bar loosening leverages tighter chin seal. Edit these 2 until leaks are minimal, include light shaking the mask on your face.

When done, leaking should be near zero from the cushion. Obviously disregard that from the vent. Your biggest leak area, if like me, will be nasal bridge. Move mask up/down and left/right till it stops. Adjust straps if needed. To find out which straps, either pull out slightly on top or bottom or push in slightly. Find out which gives best results, mimic that with straps adjusting. If you pushed a bit, tighten slightly, if you pulled, loosen slightly.
INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEBSITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#26
RE: Need some help/advice - here's my symptoms and machine settings
Thanks for the tips.  I'll follow that and give that a try tonight.  I'll report back in the morning.
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#27
RE: Need some help/advice - here's my symptoms and machine settings
OK, if you have questions feel free to ask.
INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEBSITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#28
RE: Need some help/advice - here's my symptoms and machine settings
Here is my chart from last night.  This was my first night using the F&P Vitera.  What tweaks if any should I make?

Observations:  

1.  Obviously the leaking was a big problem.  Even the crappy Resmed "Myair" app gave it a 10/20 and looking at the chart you can see why.  I will say the biggest leak around 2:35 am was after I woke up the first time.  I woke up with my lower nose itching (that has only happened with this and the F20) and the only way to scratch was pop open the mask so that big leak was from that.  That said all the way from that point to 5 am it was bad and really was bad overall throughout the night.  Goes without saying I need to fix that.  I noticed a few times air leaking from below my mouth area.  No area leaked from the top area.  So probably need to tighten the bottom.  Will tweak and play with that tonight.

2.  Very interesting that I had zero CA events until 5:35ish am.  By then I was pretty much up tossing and turning drifting in and out of sleep like usual.  It did however record a lot more OA's, UA's and H"s than usual.  In fact I'm not sure I'ver ever had a Hypopnea or Unclassified Apnea with the F30i.  Funny how different masks will cause the machine to detect different things.

3.  My pressure minimum of 7 was adequate and felt fine for the F30i.  However, right form the beginning I never felt like I was getting enough air now that I switched masks from the moment I put it on.  Obviously in the middle of the night as the leaking was going on that would probably have something to do with it but from the very beginning it felt like there wasn't enough air to breathe through my nose.  I know as I woke up my usual 10+ times during the night that almost every time I was breathing through my mouth and I know I was doing that because I wasn't getting enough air flow to get through my nose.  With the F30i, it had me trained pretty well to breath through my nose the majority of the time.  Again, fixing the leak I know will help that.

So my plan tonight is probably tighten the mouth/bottom area.  I think I may also try loosening the top.  I have that red mark back on my nose.  It's faint but its there.  If that red mark comes back after the next few nights, that's a deal breaker and I will not be able to use that mask.  Since its red, my thought/hope is maybe it's too tight on the top (no leaks occurred at top) so maybe if I loosen the top a bit and tighten the bottom that will balance it out and stop the leaking.  I do also have the large I can try in the future if I need to.  I think the medium is adequate but hard to tell.

My Pros and Cons on the Vitera vs the Resemd F30i:

Pros:
1.  I could move around in to more positions and I felt like the mask would stay on better.  I had to be more careful with the F30i.  I think once I get leaks addressed I should be able to move in any which way and be fine.
2.  It's quieter compared to the F30i.  I don't hear myself breathing in and out like I did through the F30i.

Cons:
1.  At least on night 1, F30i definitely is more comfortable by a long shot.  I've never had to itch my nose/face area before cpap but with the Resmed F20 and now the F&P Vitera, for some reason, it causes itching around my beard/nose area above my lip.  Only way to get to it is to pop the entire mask open which wakes me up obviously by the time I pop off one strap to be able to get my hand in there.  No itching has occurred ever with the F30i.
2.  The hose being in the face area instead of on my head out of the way.  That said though, the way it worked out, the cord kind of slid up above my shoulder and never really affected me too much throughout the night.  I think I can get used to that.
3.  The red mark on nose.  That's the biggest con.  That will make this mask a no-go if I can't get rid of that.  So far it feels a lot like the F20 did.


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#29
RE: Need some help/advice - here's my symptoms and machine settings
On the mask-fit questions, I don't have anything to contribute, but I bet Dave will. When it comes to AHI, one night of data isn't enough to draw a lot of conclusions from. So let's see what happens in the longer run.
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#30
RE: Need some help/advice - here's my symptoms and machine settings
Adjust the top set looser to leverage a bit tighter seal on the bottom, based on your description. It sounds like you might have gone too tight for both sets of straps. The Vitera has a RollFit bellows, you should actually see the mask inflate a bit on inhale, where the pressure is increasing the seal.

Red marks from any mask come from two things that I can think of, over tight or allergic reaction to the mask.
INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEBSITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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