Mouth Breathing-How to Figure Out?

[Pugsy]

Keep us posted....we do care.

Oh...send me a list of the masks on your list that you wish to try. I might have some of them you can try.
Main idea is to try them and see if they will work and if they don't then we pass them along to someone else to try.
I just got a box of masks donated and I haven't had a chance to see exactly what was included.

[Dallaslady51]

Thank you for your offer Pugsy. I actually have found a local DME (a Good one) that is not in network with Medicare, so I can't order using insurance from them. But, they have a wonderful experienced technician and a "sleep" room where you can bring your machine and they will let you try different masks and help you with fitting and comfort issues with your own machine. If you purchase just one mask through them (their prices are roughly the same as online ones), the whole service is free. Even if you don't purchase one, they only charge $45. And the entire staff is so Nice. I am making an appt for after Thanksgiving. I know I am having additional issues because my face is very swollen from having to take steroids for over 5 years - sort of like fitting a CPAP mask on a pumpkin....

The DME that I ordered my BiPap from (through Medicare) is just more than awful (like many or most). I had to fight for the machine I wanted - went to my appt and sat down in front of "Miss Grump". She shoved the machine at me and said "Well, since you've been on CPAP for years, you already know all about this - here it is - have a nice day"...I sort of shoved it back to her, and said "Actually I have never used a BiPap, so could you show it to me"...She opened the case, showed me where the "on" button was, said "here's the hose and power brick", and shoved it back. (Obviously, I didn't tell her I already had the Clinician manual to compensate for their total lack of support and assistance, and wonderful folks on sleep forums to get us through the tough times). Then it was "Oh yeah, what mask do you want" - and she threw one of each type on the table. She said they only had about 7 or 8 different ones. I just picked up the Swift FX and the machine and left. The whole thing was less than 10 minutes. How do newbies cope with being "thrown to the wolves" like this? Just crazy.

[Dallaslady51]

Should I start a new thread if I have questions about whether a BiPap is right for me?

For most days since the 8 days I have been on BiPap, I get 8-9 hours of sleep with AHIs of about 4-8. Been working on mask leaks and mouth breathing, but the AHI's are about the same as the APAP I used for several years. My pressure on the APAP always averaged about 13 - 14, and the BiPap seems to be just a little higher, but nothing dramatic.

The most dramatic change in the last 4 days is - I wake up about 8:30 (with an alarm), eat some eggs and toast as usual, take the same medicines and vitamins, and about 10-11:30 a.m., it's like my eyes are rolling back in my head. It's an overwhelming feeling like you haven't slept in days and can barely breathe and complete and total exhaustion. The last 3 days (and right now) I have to go take a one hour nap and then I don't feel quite as bad the rest of the day.

I did not have this happen while on the APAP, and I'm starting to worry that going to a BiPap was not a good idea, and that maybe I should have just stayed on the APAP and kept working on mouth breathing, mask issues, etc. I had always thought BiPaps were for people needing higher pressures than I do. Also I was not impressed with the technicians doing the sleep studies (the second person tried to put the masks on upside down - glad I know better).

So (1) Should I start a new thread for this since it is about problems/issues going from APAP to BIPAP?
and (2) Are there dramatic differences between APAP and BIPAP that could cause really negative results in some people?

Well off to my recovery nap even with 9 hours of sleep last night - just can't keep my eyes open. I was so hoping the BiPap would be the wonderful solution to feeling better.

[Pugsy]

So (1) Should I start a new thread for this since it is about problems/issues going from APAP to BIPAP?

I don't have a preference but others might ....but this thread is already 3 pages long so I would be inclined to vote for a new thread but be sure to link back to this thread so that people can get more history and an idea what has already been advised so they don't just repeat something that has already been said.

(2) Are there dramatic differences between APAP and BIPAP that could cause really negative results in some people?

Not normally unless there is a marked difference between inhale and exhale that makes the therapy itself not the same.
This happened to you...you were using EPR (which is essentially Pressure Support in terms of what it does) at a low number (wasn't it like 1) and you were started out with PS of 5 (big jump there) and even now using 2 or 3 which can still be a fairly big change from what you used for years and the body sometimes doesn't like change even if the change is "supposed" to help.
Some people's bodies just don't adjust easily to any change...and some people can easily adjust to big changes. Sounds like yours is the former.
I don't understand why they though that PS of 5 was better for you in terms of therapy.
The only real difference is going to be the PS and if it were me I would go with a PS that mimicked what I had been using for years and then consider working up slowly with the PS IF they (the doc) could explain why more PS is "better" in my situation.

I think that your residual daytime symptoms probably are nothing more than a by product of less than optimal sleep quality. Part of it may be showing up in the AHI data and part of it may be related to something that doesn't show up in the data. Part of it may simply be because things are different from the way they were for years.
The algorithm is a bit different in terms of how it responds and how the PS works but its not a huge difference. Same brand...pretty much same basic algorithm.

If you aren't sleeping well (for whatever reason) then you aren't going to feel so great the next day despite what the software reports might look like. I always have had really good looking reports but my sleep quality was crap from something outside the sleep apnea realm. Even now I have my own battles sometimes with the need to nap being extremely strong. I have learned that the hours of sleep as well as quality of sleep is really important in terms of how I might feel during the day. Most of the time it isn't just one single thing that can make it or break it in terms of how we end up feeling. Usually it's a combination of things that added together ends up being a bit ugly.

First and foremost...find a mask that meets the bulk of your preferences and needs and gives you the best chance of having decent sleep quality.
If you aren't comfortable and can't get comfortable (mentally and physically) then the sleep quality is going to be in the toilet and this whole feeling good thing starts with sleep quality. Without good decent sleep quality the chances of us feeling the good numbers are pretty much like a snowball's chance in hell of surviving.

Can you refresh my memory again...what pressure were you using on the apap....I remember the EPR of 1 I think but not the other and I don't have time to go looking it all up.
You have been changing pressures and PS and masks and humidity....lots of changes and we don't know who is responsible for what.
The humidity settings on the AirCurve don't exactly match up with what the older ResMed machines offered.
How did you do with things on auto last night for hose temp and humidity? Is the nose happy?

[Dallaslady51]

One last try - the system is not allowing me to post anything and I've tried twice. This is a test. If it works I will wait and try to post tomorrow