New and Lost; Need Guidance on optimal treatment

[jabdoulaye]

Thank you for your feedback Sleepster. Appreciate it.

I understand that the pressure starts at 9. However, when I woke up and felt the leakage from the mask, I saw on the machine the pressure was already at 13. That usually does not happen for pressures below that. 

You are right about the sudden drop in pressure. I turned it off as I could not tolerate the pressure and also because of the leakage.

So, just to get it right, my mask does not fit me that well. That is why at higher pressures, the mask becomes dislodged. Before I give up on the Airfit F20, is there any way I can make it fit me better? Any insightful or unusual tip that helped you fit the mask better? And how would I know that a mask is a proper fit for me?

Thanks again for the support.

[SarcasticDave94]

I tried making an F20 work myself for about a year. Spoiler, in the end I got a different mask.

Things to check: cushion size, try all and one will have best fit and lowest leaks. Try adjusting straps in different order, different tension, never uncomfortable tight. Allow reasonable time depending on leaks but I'd not go beyond a few weeks. You need the CPAP therapy going as soon as you can.

What does the OSCAR chart show regarding therapy and leaks?

[OpalRose]

Agree that it seems your mask fit is not optimal for you.  You may in the end have to try a different mask, but in the meantime, read through the Mask Primer,
especially this:  

https://www.apneaboard.com/wiki/index.ph..._Jeffy1958

[Sleepster]

You are right about the sudden drop in pressure. I turned it off as I could not tolerate the pressure and also because of the leakage.

The chart doesn't show significant leaks at that first pressure drop, but it was still enough to wake you up, and along with the high pressure, create a bother. It's good that you didn't give up, though.

So, just to get it right, my mask does not fit me that well.

Call your equipment supplier and tell them your mask doesn't fit you well. This is a very common condition. You may have to try several masks before you find one that works. And I remember having two masks and switching between them in the middle of the night. Now, don't be discouraged by this. I now have a mask that fits me well. I can wear it all night long without it bothering me in the least. This is what happens once you adapt. As I told you before, the human body and mind has a remarkable ability to adapt to circumstances. You just have to persist and be patient. And of course, if you sleep without the mask you delay or possibly event prevent the adaptation process. Not to mention what sleeping without the mask does to your body and mind. You lead a brain-fogged miserable life, and increase the chances of cardiovascular disease, stroke, and early death.

The good news is that your equipment provider is required by your insurance company to fit you with a mask. Call them and go in for a mask fitting. If they won't cooperate (they don't like to because they've already made the lion's share of profit when they sold you the machine) call your insurance company. Your equipment provider is required to provide this service, and sometimes you have to make them do it. They do not want to lose their ability to make contracts with your insurance company because they want to continue to sell CPAP machines to new patients. Sometimes you have to hold their feet to the fire.

If you're wondering why cooperation and proper care are so difficult to receive, it's because of the way the medical insurance industry deals with CPAP therapy. It's a relatively new endeavor and when they had to start doing it they turned the task over to DME's (Durable Medical Equipment suppliers). DME's are the ones who supply prosthetics, canes, wheel chairs, and the like to patients. CPAP therapy got dumped in their lap and they don't, except in rare cases, know how to handle the responsibility properly.

It's a mess!

[jabdoulaye]

I attached last night's result.

I was able to sleep throughout most of the night with my mask. I had to learn how to make it fit. So, it was not that uncomfortable, even though the pressure was high.

I observe that my OA and UA are at their lowest they have been. I don't give that much importance to CA as I was told in this thread as it will go down eventually with time. However, my H are large. Why? 
I thought that OA and H would move in the same direction as they are quite similar.

I also attached one OA event so that you guys may infer something from it.

Should I change something or just continue like that? Thanks again for the help.

[OpalRose]

Your flow limitation is high.  Usually where we see FL, we'll see hypopnea.  

What SoftPap setting are you using?  Try the highest setting your machine will allow, which I think is 2.

If you were on a ResMed machine, EPR probably would have taken care of flow limitation by now.  It's hard to say what is causing such high readings with FL and Reras.

The only other thing other than using SoftPap is to raise your pressure, which you stated many times that you are unable to tolerate.

I also see some Positional Apnea.  Did you read through the link I gave you in a prior post?

Tell us how you sleep... on your side or back?  What type pillow do you use?

[jabdoulaye]

I also saw that my flow limitations are high. Can it be caused by CA?

What SoftPap setting are you using? Try the highest setting your machine will allow, which I think is 2.

I am using the highest setting, which is indeed 2.

It's hard to say what is causing such high readings with FL and Reras.

Is there any way I can pinpoint exactly what's the cause?

I also see some Positional Apnea. Did you read through the link I gave you in a prior post?

I already read that when just starting my treatment. I actually bought a soft cervical collar and used it a few times. I saw that it was not helping at all. I will try it tonight and see if the high pressures complement the soft cervical collar in eliminating the flow limitations.

Tell us how you sleep... on your side or back? What type pillow do you use?

I sleep on my side. However, the polysomnography showed that I slept one third of the night on my back, of which I am unaware. The pillow I use are normal pillows that can be obtained anywhere.

[Sleepster]

I also saw that my flow limitations are high. Can it be caused by CA?

Not as far as I know. CA is a brain thing (your brain is not telling you body to breathe because the CO2 level in your blood is not high enough. Flow limitations (FL) are a throat thing. You aren't getting enough air flow through your upper airway.

As others have pointed out, this could be your sleeping position. As I have pointed out it could be because your pressure will need to be raised, but only after we can get you comfortable enough to wear the wear the mask all the time you are sleeping (compliance). It will do no good to make any kind of adjustments to the machine if you are not sleeping with the mask on!

Is there any way I can pinpoint exactly what's the cause?

It's a process of trial-and-error. That's why we are focused on sleeping position and soft cervical collar. We're trying to see if that will help. Often these problems are a combination of factors, so, no, you can pinpoint them.

I sleep on my side. However, the polysomnography showed that I slept one third of the night on my back, of which I am unaware. The pillow I use are normal pillows that can be obtained anywhere.

Go to Amazon and search for Papillow. Although they no longer sell that particular pillow, they have many like it. Currently I'm using the Contour CPAPMax 2-in-1 Cooling Plush CPAP Comfort Pillow.

I'm a side sleeper, too. But if you are rolling on your back some people recommend sewing a tennis ball or the like into the back of your nightshirt to stop you from doing that. Keep in mind that you will be trying these different things in sequence, so be patient. I know you are anxious to find that magic bullet, but for many of us it's a trial-and-error process that takes weeks or even months. Remember that we are trying to come with a solution that you will be using for the rest of your life, so spending a bit of time now to find it is well worth the effort.