On CPAP trial, need advice

[sleepsoundlynow]

Hi! I'm currently on a 30-day trial for the CPAP machine. I'm on my last week now. But the technician doesn't want to increase the pressure I'm in. I'm currently at Min 8.0 Max 14.0. My untreated AHI was 29.8.  I also asked her if I needed a higher pressure, would I need to use a BiPap instead? But she said no since those are for people who can't breathe and I can breathe. 

What she wants me to do now is tighten the mask since she's blaming the leaks for the still high AHIs. While I think the leaks are giving me more apneas, I still have a lot of apneas outside the leaks. Also, sometimes I wake up with my nose outside the full face mask. I have a problem with moving around when asleep, I even seat up on my sleep so that could be causing the leaks as well. 

Honestly, I think she's just looking at the summary of the data. She's only ever mentioned the leak being the problem and said if I were to use a higher pressure the mask would blow off of my face. I'm not sure and need advice about what I should do, whether I need a higher pressure or if I will benefit more from a BiPap instead.

My insurance will pay for my CPAP machine, but I'm not sure if they will pay for a BiPap instead. 

"Note: By protocol, Titration of 15 cmH2O or greater is justification to go to a BiPAP / BiLevel machine."

[Sleeprider]

You are using the Resmed Airsense 10 Autoset For Her in Autoset mode at 8-14 pressure with EPR 3. Your charts are typical of what we see with "positional apnea". Lots of OA in clusters is the characteristic of chin-tucking and other positional issues. Higher pressure is the usual approach to dealing with obstructive apnea, but when it occurs in clusters, we generally try to improve the sleeping position to avoid the obstruction before moving to higher pressure. Read our Positional Apnea article and consider whether you may just need to kick extra pillows to the curb, or move to a soft cervical collar. Most members find this works without a lot more pressure, but that remains an option. https://www.apneaboard.com/wiki/index.ph...onal_Apnea
https://www.apneaboard.com/wiki/index.ph...cal_Collar

[SarcasticDave94]

A few things I'm thinking about this:

1. Your leaks are a real issue. Your large leaks are at 19.24%, median at 9.07, 95% leaks at 43.2, 99.5% 61.2. It's just too high of a leak rate to get comfort and therapy, especially consistently.

Surprise the crazy tech is kinda right here. But also kinda not. Tightening the mask might not always be the right answer to fix leaks. A better answer might be one of several things, or a combo of some. It appears these might be mouth leaks. A Fisher and Paykel Eason 2 a nasal mask. Correct? OK first fix the mouth leaks. You can attempt a chin strap that only pulls up not back, mouth tape, maybe another method to stop the mouth from opening. You may need another mask, pillows, full face, or full hybrid. Maybe you need another size, or a new, cushion.

I have used full face Fisher and Paykel masks, Simplus, Vitera, Evora Full a hybrid, they do not like being tight. They will definitely leak more the tighter it gets. I'm sure yours does too.

2. I'm skeptical of your OSCAR chart accuracy due to high leaks. I'm tempted to say it's pretty inaccurate as is. You're possibly not being treated very much yet, until leaks are more controlled.

3. Now the fun part. This tech is absolutely wrong when it comes to bilevel, BiPAP, BPAP, all the same here. There's a lot of Apnea Board members that used CPAP and switched to BPAP to gain better therapy. This tech is selling a massive baloney sandwich and told you to eat ill informed bogus advice. Nope don't buy into that aspect.

I do know you might need more pressure to get better therapy, but again for now the leaks need to get fixed. Your pressure chart skips along to top being limited to 14. This can be due to leaks, therapy needs, or both.

Also there's some Positional Apnea aspect. This PA certainly can affect therapy pressure and leaks as well. So just adding another bit to the stack.

[sleepsoundlynow]

Thank you for your response. I have another post prior to this one, the only change the technician made after that post was changing my mask to a vitera full face mask, and increasing the minimum pressure by 1. She did not mention the possibility of positional apnea or increasing my max pressure while those two were the most mentioned by the replies during my first post so I wasn't sure.

My initial pressure before was at Min 7.0 Max 14.0. now at Min 8.0 Max 14.0. After the minumum was increased, I didn't change my mask right away and the AHI remained pretty much the same. However changing to a full face mask lowered my AHI by quite a bit, but the amount of leaks did also increase. My leak when I made my first post (using the nasal mask) was only at 4% but I guess I was mouth breathing then. 

Most of the replies on that post of mine were also to fix the positional apnea by using the soft cervical collar (which I have ordered already, but still waiting to arrive) and to increase the pressure to min 10 max 20. So I was wondering if fixing the leak and using a soft cervical collar is enough, or if I really need a higher pressure, and if so will I benefit more from a BiPap. I think since I was preapproved by my insurance for the CPAP, the clinic don't want me to explore other options such as BPAP. I don't think they sell those from their website lol.  

Also, aside from using the cervical collar for the positional apnea should I go back to using the nasal mask and tape my mouth or should I try to fix the leakage from the full face mask? If the former, how should I go about doing that?

[jdougc]

Consider using a SomNoSeal,  a soft, flexible mouthpiece that prevents mouth breathing and dry mouth during sleep.
https://www.youtube.com/watch?v=1u_S1ADwVmA

[sleepsoundlynow]

Thank you! I have ordered the collar online but unfortunately won't get it until the end of my trial. That's why anxious about trying to increase the pressure to see if I will benefit from doing so before the end of my trial. I think for now I will try to sleep without using a head pillow

[LaurenceShaw]

You can attempt a chin strap that only pulls up not back ...

I see you have ordered a cervical collar, but if you do want to try a chin strap that only pulls up I'd suggest you look into the Knightsbridge Dual Band.  Please use the link of Supplier #37 rather than a keyword search or you will likely end up with a counterfeit.


Briefly, beware/be aware that traditional chin straps aren't designed to actually work.  Traditional chin straps wrap around the tip of your chin and the top, back of your head, the problem being that the jaw joint (which is just in front of the ear) is located along the line between those two points.  This is illustrated by the drawing at the top of the More Info page of the above link.  This means that traditional chin straps force the jaw almost directly into the jaw joint.  The Knightsbridge is different in that the straps pass under the jaw and lift vertically to work with the natural rotation of the jaw.