[Treatment] New to cpap, looking for help mainly with leaks

[pacardeoum]

First time posting here, got diagnosed with OSA a month back, been trying on and off for the past almost month to use the cpap i got sent, I'm feeling like I'm finally over the initial "wow this sucks really bad actually" and when I can manage to get it to work, I'm really noticing the improvement.

I've got an airsense 11 autoset, and a F&P vitera (using the large mask, tried using the medium for a bit while I was struggling badly with leak issues, I think large was the correct option I just needed to clean it more regularly)

after reading through a lot of threads on here I'm realizing i got really lucky getting sent one of the Good Machines without requesting one (common Kaiser W if I'm being honest)

I only got an SD card in my machine last night, because I completely missed that it had a slot for it (that little insert is neat and also very good at its job of hiding the slot!)

I've got screenshots of last night (annoyingly split into two because I was asleep until afternoon, probably going to just change the timezone on the device to make that a non-issue)

My main issue atm is air leaks!!! they were bad enough until last night that I was waking up with my bottom lip STUCK to my teeth, and having to take the mask off and sleep without it, I've been washign the silicone liner with soap and water, washing my face, I took a beard trimmer on the bare metal attachment to my face (other than my tiny little goatee, which I'm hoping is mostly inside the mask, and if possibly i'd prefer to avoid having to shave off, but I'll take losing it over losing sleep at this point)

I took the advice I found here and used the mask fit setting to slowly get the straps tightened down until it was satisfied, and got the best results I have so far after all of that, though I did still wake up after about 5 hours, with some dryness, but nothing like before.

I still need to actually call my doctor back and set up a follow up, (totally forgot i was told to do that) but I'm hoping to have things set up with OSCAR and whatnot so I can go into that follow up with lots of information and knowing what I want out of treatment, now that I'm actually paying attention to it and not just vaguely looking for youtube videos on the subject.

Still gotta find one of the old full size sd cards I have lying around (thank you 3 dollar thrift shop 2ds) instead of the microsd and adapter situation i'm using, but at least it's working.

I know i'm rambling, I've always been a huge yapper. Anyways, mostly looking for help with dealing with the Large Leaks I'm seeing, and hopefully that will be enough that everything else is working fine (though I'm aware I should probably turn ramp down or off and get the pressure range tuned from 4-20, I want to wait until I have good data without leaks to figure that all out).

Thanks in advance, you're all super kind for putting in the time and energy to help us newbies out!
       

[pacardeoum]

Okay wow huge difference switching to the medium mask, practically no leak now!! the pressure from the seal isnt even really uncomfortable honestly!

[Deborah K.]

You have a number of things going on.  Your pressure setting is way too low.  Your median pressure is over 16, so you need to set your starting pressure to at least 13 for now.

Also, your flow limits are too high, even with EPR set at 3.  

Your pressure needs and your flow limits make me think you probably need a bilevel, not an autoset machine.  If so, you want to get a ResMed AirCurve 10 or 11 Vauto.  I advise the 10, as it has a good, long track record and fewer complaints, but if the 11 is all you can get, take it.  Tell your doctor to prescribe it specifically by name, with instructions that no other machine or brand can be substituted.  Some suppliers will provide you with a machine that is cheaper for them, and they will get paid the same either way.

You also have some Positional Apnea on two of your nights.  PA shows on the charts where obstructives and/or hypopneas show up clustered together.  No setting will help, as the problem is your body's position.  PAs are caused when your chin tips toward your chest, blocking your airway,  much like a kinked hose causes water blockage.  Some can solve this by using a flatter pillow.  Others wear soft cervical collars that hold their chins up.  Yours is not extreme, so you might try a flatter pillow first.

As to getting a bilevel, you might want to read my story about how I got mine in the link below this post.

Again, welcome, and best wishes for achieving great therapy and comfort!  

P.S. Yes, do return to the medium mask.

[solfun]

Have you tried a nasal only mask like the resmed P10? I also started CPAP recently like you and struggled with leaks with a full face mask for almost a month. I finally switched to P10 nasal mask and have not had any large leaks since switching. 

I tried everything I could find online (chin strap, neck cervical pillow, xylitol tablets for dry mouth, heated tube) to help make the full face mask tolerable but just couldnt get the F20 or hybrid F40 masks to not leak like crazy. The neck pillow had the greatest improvement in leaks but not good enough. The xylitol tablets also helped a lot with dry mouth.

[ejbpesca]

I have had leak problems for years.  I am continuously adjusting my F40 mask which by week two is developing more leaks.  Unfortunately, with my full beard, I must tighten straps more than what is comfortable.  At day 7 today I'm getting a good seal but in a few days, leaks will begin.  Many times periods of large leaks happen as I move during sleep.  The F40 has been the best mask out of the six I've tried both for sealing and comfort.  Its flexible structure helps with my sleep positions.

I get clusters of apneas that are recognized as positional.  I tried collars, chin straps, and tapes but they failed.  By using a higher pressure and tighter straps I get much fewer clusters now.

[pacardeoum]

Okay looks like bumping min pressure to 13 did the trick to get me below 5 AHI!   I'm seeing on todays graph what you meant about flow limits and i was FEELING what you meant about bilevel for sure, I had to turn auto ramp back on last night because I could not handle trying to exhale into 13cm/H2O while falling asleep, and i felt the pressure on my face when i woke up too.

I'm noticing that i'm bumping up against 20 for sure, I'm wondering if best practice is going to be getting through the 21 days for the DME to get paid for the machine before trying to get an aircurve, im just worried about being told i acutally ahve to pay for the airsense now because im getting a different machine / they wont pay for the aircurve so soon after getting the airsense. I need to call do that follow up either way and I guess I can ask them about it.

either way I think having more nights of data to show the need for bilevel will help.

Thanks so much for the help, and let me know if there's anything else concerning in tonight's graph/ if I should be tweaking my minimum settings more, and thank you again for all your help!
 

[Deborah K.]

Please post only full night charts unless we ask you for close-ups. Otherwise, the close-ups are not useful.

[pacardeoum]

Oh my bad 

I forgot I was showing OSCAR off to a friend who I just learned has the same machine, I was showing them the zoom view, I meant to post the full view, ive attached it here

[ejbpesca]

What happens with my DME and Medicare Insurance is a rental period and then ownership.  Rental payments are made to the DME for a time period and then the DME is paid in full for the machine at which time I own it.  I take it this is to see if the machine works out okay before its price is fully paid to the DME.

[Deborah K.]

Your leaks are better, but still too high.  Same with your flow limits, better, but still too high.

Since you are asking for a different type of machine, your insurance company should be willing to pay for the new machine, even though you haven't had the other machine long.