[Treatment] new to cpap therapy

[aggiegrinch]

    Howdy all, I'm new here. I've known for a couple of years that I had sleep apnea, but hadn't talked to docs about it yet. I've been told I snore and do weird breathing things in my sleep, and my Galaxy Watch 6 sleep tracking shows massive oxygen drops periodically, mostly during REM. Like even down to low 70s for short periods, and then back to 80s and low 90s. I slept most nights in my La-Z-Boy because I got better sleep there.

Anyway, finally did a sleep study via Gem Sleep and got an official diagnosis with an AHI of 20 which is considered moderate sleep apnea.
I have done 7 nights of therapy so far on airsense 11...definitely still getting used to the f40 full face mask. I opted for full because I have a deviated septum, plus I regularly have nasal congestion.  I've noticed that my nasal congestion seems to actually be better since I've started CPAP treatment, and am thinking about buying a nasal pillow too, because I don't like having my mouth covered. 

I am having lots of large leaks every night, which I am concerned about.  Every time I put my mask on, I use the "check mask" feature to make sure I get a good seal. But it never fails each night I am having a lot of large leaks.  The machine/app say its fine, however, I started using OSCAR and it doesn't seem "fine" to me.  Every session has had a large leak between 20-35%.  I have attached a pic of Friday night's session for example.  I have also noticed that most of the events that occur, happen during the large leaks, which makes sense. So I really want to get those lowered.  I have a bit of a smallish pug nose, and I think it might be leaking in that area, as when I make sure I have a seal, that is the "touchy" area I have to make sure seals right. 

Do you believe a nasal pillow mask might be better (or worse) in this regard? Any other suggestions? I have ordered a cloth mask liner for the mask, from Pad a Cheek, recommended by a coworker who also has apnea. I am hoping it might make a better seal in the problem area. Thoughts?

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I added an attachment, but i'm not seeing it show up.

[aggiegrinch]

OK, got the attachment in there.

[Jay51]

1st things 1st.  The leaks that you are having are far too big.  It is both affecting therapy and the chart that you posted - leaks over 24ml pretty much negate therapy - the machine cannot either correctly detect what is happening or adequately supply the correct therapy pressures.  

Other members may have some suggestions for you as well.  

A good long term plan would be to try to maximize your current mask as well as possible to prevent leaks.  You can always get a different mask in the future if/when you determine that this mask will not work for you.  Some people get the mask correct the first time, but other (like myself) had to try other masks to get less leaks. 

Here are some tips from our wiki on leaks:  

• 1Mask Primer
  

[ejbpesca]

Run the mask fit test on your machine.  Move some to make sure it keeps a seal with head/body movement.  Move your face, and open your mouth..does it still keep a seal?  Move the mask a bit to see if the seal holds.  Let the mask fit test run enough for it to reach maximum pressure.  

I have to tighten the F40 probably more than what most would find comfortable to get it to hold the seal which was the same will all six of my FF masks. (F40 best of lot)  I have to adjust straps often to keep the F40 sealed.

Check your sleep study report for APAP pressure settings and at least set the minimum pressure to what is prescribed.  The pressures you have are the default settings.

[aggiegrinch]

Thank you both for your information and suggestions! The prescription says 4-20 auto is how I should use it. I have an appointment with the Gem Sleep Coach on Tuesday. I will discuss these things with her too.  I do think I likely need to experiment with the strap tightness.  I also think maybe I can increase the lowest pressure a bit higher than 4, but wanted to discuss with the sleep coach before i messed with that sort of setting. It might be me not used to the higher settings, so I believe you are correct that I need to experiment with the fit while the pressure is higher. 

I have a feeling I adjust positions a lot in my sleep, likely causing some of the issue. I will turn the mask fit test on and actually move around and stuff, to test that, I have just tested it so far by lying still on my back.

[aggiegrinch]

Well I tried moving around a lot last with the Mask Test last night, and spent quite a bit of time adjusting things while the pressure was higher in the testing. thought I had a good mask fit too. I tightened the straps up considerably as well. And it was the worst night of LL by far. My AHI went from a 2 average up to 5.52 due to the bad seal.

The good news is I got my cloth mask cover in today. I tested it out for a few minutes this afternoon, and it was EASY to seal it with the cloth cover on there, far easier than it has ever been. it seems to help tighten up any leaks, especially around my nose. and it is more comfy to boot. so keeping fingers crossed for tonight, otherwise I might need to start looking at other masks.

[Deborah K.]

You need to raise your starting pressure to 7 for a bit, then 8, as your median pressure is almost 9.  I hope your leaks come under control with your new mask liner.

Best wishes for achieving great therapy and comfort!  

[aggiegrinch]

Thanks for the pointer with the starting pressure. 

Well, last night was a SUCCESS!! Only a small number of LL, very low percentage.  My AHI was the best of the last 10 nights at a .84, and for the first time I didn't even wake up to go to the restroom last night. I can't remember the last time I actually slept through the night without getting up to go do that. I feel more refreshed than I have ever felt in my life. wow!! This is amazing! THat mask liner really helped a lot. 

Thanks for the suggestions all, I have a virtual meeting with my sleep consultant today, going to discuss my starting pressure with her among other things.

[ejbpesca]

Which cloth mask liner did you use that got fewer leaks?  I am trying Silent Night but those cause more leaks.

[aggiegrinch]

I got it at padacheek. I think the issue for me was around the nose area, I kind of have a pug nose, I think it was real easy to get leaks there, the cloth has enough extra fabric to seal that area good. I also find it a lot more comfortable with the cloth on there. Before I had the liner, I was spending 5-10 minutes trying to get it right before going to sleep. I got it right immediately after the liner was applied.

My Gem Sleep Coach was happy I found a solution for the leaks because that was one of her concerns she was going to bring up. Apparently, if this mask doesn't work out, I can replace it with another one at no cost within 30 days. I'm hoping the liner will continue to do a good job though.

I did bring up the min pressure with her too. She is going to increase my min pressure to 6 and see how I like that for a few nights. she said I can request changes if I'm not happy with that. My average pressure is 11.69 and my 95% is 14.88. I will probably end up requesting she push that minimum up to 8 or 9 if I'm not happy with 6, especially given my average pressure is so much higher.