Reacquaintance w/ CPAP - Some Questions

After quitting my job as a school bus driver in 2012, I stopped using my CPAP for various personal reasons. I have since moved to the Philippines and several days ago received my ResMed that I had my daughter ship to me. Surprisingly, all the settings, which I assume are kept via internal battery, were still there. Not having distilled water available, the first night I used the S9 without the humidifier. Other than a very dry mouth the next morning, all seemed okay. But the machine reported I had only used it for less than 3 hours. The second day I started using the humidifier and had a less than restful sleep because the mask seemed to be moving around on my face more. The report showed again that usage was a fraction of what it actually was. I realized the time settings were off and after searching on how to access the secret menu, adjusted the time/day settings.

Last night I had a problem which again resulted in disturbance of my sleep. While laying on my left side, airflow was fine and other than infrequent contact with the pillow the mask stayed on fine. But after rolling onto my back I was awakened by the mask "billowing" off my face and causing leakage. It was like the air pressure was way too high and inflating the silicone seal so that the mask was "floating" on my face. When I inhaled the mask would settle down, but on exhale it would have the billowing effect, puffing it up so much that leakage around my chin would occur. When I rolled back onto my left side, everything was fine. I tried searching for a possible cause but using terms like billow, puffing, and floating yielded nothing but CPAP issues involving pillows, puffiness, and bloating.

I am hoping someone can lead me in the right direction for resolving this issue. I don't know if obstructive apnea is increasing while on my back and is causing mask pressure to increase or if something else is in play. I considered improper mask fit because I have gained a lot of weight, and also degradation of the silicone from years of non-use, but these would not explain why all is perfect when on my side but not so on my back.

Also, living in the Philippines where the air is warm and humid, and now my breathing air is being further warmed and humidified, I am asking if anyone knows of a way to cool down the air being delivered to the mask.

Before anyone responds with replies involving going to a physician for answers, my experience here with doctors is less than ideal. For a country that has so many universities and teaching hospitals it is surprising how many doctors seem to know so little about medicine. I have consulted with 3 different pulmonary doctors about other issues and have gotten nowhere.

Something similar has happened to me. It sounds like your mask is simply reacting to the different shape your face has when on your back as opposed to on your side. Gravity doesn't care whether we wear a mask or not; it will always pull our looser flesh (e.g., cheeks) closer to the earth from whatever position we happen to be in, and that will change the shape of our face. Thus some headgear or mask adjustments may need to be made if we change position from the one in which we fitted our equipment.

Have you tried slightly tightening the headgear straps while you are lying on your back? That may help.

Jean

Most do whatever they can to not flip onto their backs because it provokes more apneas and FFM's are more difficult to seal then... plus even a small weight gain (or loss) can make quite a difference as your face is usually where that shows up first - it's always best to try them on lying down, and as you say it's also very possible the silicone has deteriorated over time, all of which are possibly affecting things for you, but specifically which aspect is hard to say of course. Maybe it would be best for you to try on a variety of new masks if at all possible (lying down) to at least see if a size change, never mind different style would help, but at least replace the thin cushion if nothing else. I would not advise tightening the mask - all you're likely to do is create new leaks somewhere else and mash the thin cusion that needs to inflate properly. You'd be better off, at least on a temporary basis, to e.g. wear a backpack stuffed with towels, etc. while trying to not back sleep. Something else that might help would be a Pappillow.com (you may be able to make your own version) that has cutouts for the mask when you side sleep (though you say that you have fewer problems then anyway).

You should look at the clinician manual for your machine for info on lowering the humidity and hose temperature - if you in fact need the humidifier at all - it's not 'therapy' but a facilitator for those who need more, but many (myself included) never need any at all. If you need help with adjusting it however, I'm sure someone else who uses that machine will be by here soon. Just stick with this thread so we can follow the 'story' until you feel better - and good for you for trying again, we will help with whatever you need that we can.

The straps are okay. I spent over twenty years working jobs in which a respirator was required so I know that over-tightening can result in increased leakage. Laying down on my back, it actually takes a little effort to lift the mask off my face. That is why I am wondering if I am experiencing more events on my back. ResScan shows maximum pressure as being 14 (the high setting) so I upped it to 16 and will see what happens tonight. I'd like to be able to looks at some events but having lost ResScan version 3.10 I downloaded 5.5 and no longer see a way of zooming in. As far as trying other masks, that is most likely not a possibility as the situation here is different. I had extra seals, filters, hoses, etc. which my daughter sent so I am pretty much stuck with my Quattro. If I continue to experience the problem I will try swapping out the silicone seal, but as far as pliability and cleanliness, what was on there seems very good. Everything was closed up in the case so there has been no exposure to light.

As far as the humidifier goes, the only reason I started using it after the 1st night was because of the extremely dry mouth I was experiencing. It is not a big deal, I was just hoping there was an easy hack to cool the air without ending up with condensation in the mask and drowning. LOL

Your mouth is most likely dry due to mouth breathing - so getting the mask fit 'right' is important even in an FFM. And you were the one who asked about the mask deterioration due to lack of use... just trying to find answers for you. What you want to do is download Sleepyhead (free) software that most now use and the instructions will tell you how to post here for feedback... it's much more comprehensive than any machine readouts (even Rescan) and easier to use apparently (I happen to not use it because of very consistent, unchanging results.

https://sleep.tnet.com/resources/sleepyhead/shorganize

And do read it all - it's worth it!

I use the same machine and same mask that you do...my pressures are similar and I have no problem with mask seals.I think you should read the attached which will give you helpful information on fitting the mask properly. As far as distilled water goes, you can use any clean water...even bottled water...but you will need to clean the humidifier cup frequently. https://maskarrayed.wordpress.com/tamin ... e-quattro/

Yes, it is possible to need more pressure when laying on your back. In fact it's quite common both for supine sleeping and REM stage sleep to have different pressure needs for different sleeping.

I know one person who needed 19 cm pressure when on his back but only 9 or 10 cm max when on his side. He made every effort to stay on his side.
I happen to have similar issues but with REM stage sleep. I sometimes need a lot more pressure in periods of the night where I am probably in REM sleep and during my sleep study it was documented that my OSA is worse when I am in REM. Sleeping on my back has never seemed to cause much of a change in pressure needs at least for me. I would see the high pressures when I built a wall to make sure I was on my side all night.
Now some people have both...REM and supine sleeping pressure changing needs....maybe you got lucky there and got both.

Either way...changing pressure needs does sometimes play havoc with mask sealing. What works fine at one pressure doesn't always work so great at higher pressures.

You can use SleepyHead software to see just what the machine is doing in terms of pressures during the night. It will work fine with your S9 machine but do note that if you are using Windows 8.xxx or higher you need to make sure to lock the SD card (write protect it) or else your S9 will squawk about the card being invalid. Windows 8 or higher writes a little file to the SD card that the S9 doesn't like. There is a way to remove the file but it takes more work than just sliding the lock to the write protect tab.
S9 machines are the only machines that squawk about that file.

What time zone are you in?
If your S9's clock was not reset, your S9 may think it is a different day;
and that "noon" was in the middle of your night.
In S9 time, days end and begin at noon.
If I sleep past noon here, my machine only reports my usage after noon.
Since I am retired, I set my clock to run an hour late.
Oddly, since I am no longer a "clock slave", I get up earlier, and more easily.

He's in the Philippines.

I noticed he mentioned the Philippines
But he does not mention where he used to live.
If he was in Australia before, the difference could be inconsequential.
If in the contiguous states, time could be waaaaay off.

I apologize for not mentioning that after adjusting the time/day the incorrect reporting is no longer an issue. I don't try anything to keep me on my side because I have gained a lot of weight and, along with the fact my disability lies with severe back problems, I find that I need to re-position myself during sleep.

Last night during my sleep I again rolled on my back and partially woke to discover the mask was not billowing as much. Maybe the high pressure limit increase was enough to get the pressure to "pop" my epiglottis open so that the pressure would ramp back down instead of continuing to blow full force. I was able to finally get the ResScan to download detailed data for the past 2 nights and saw that during the time the mask was billowing the mask had highest leakage and pressure was running at the upper limit of 14 cmH2O and that last night max pressure was slightly over 14 cmH2O. I am hoping that maybe an upper pressure limit adjustment will resolve the issue of the ballooning mask. If not, my next step will be to swap out the silicone seal for a new one.

Okay, so I have replaced the mask seal and headgear and tightened the straps to what I consider optimum and I am still experiencing mask fit issues whenever I'm on my back. One thing that I have observed from the ResScan data is that for many nights, the only time I am experiencing AH is when I am on my back. During those times pressure runs close to or at max and leakage is highest. I find I am unable to lay on my sides all night because of pain in my back and hips so I may have to consider going beyond my budget and get a memory foam mattress. If I can stay off my back for most, or all, of the night I believe mask fit will no longer be an issue.

Think about doing CPR. What's the first thing they tell you? To tilt the head back to open the airway. But when we sleep on our back, we don't often tilt our head back to open the airway. I know when I sleep on my back, since I use a few pillows, my head is tilted forward and that obstructs the airway to some degree. That's one of the reasons it's not a great idea for someone with apnea to sleep on their back.

So you have an auto-adjusting machine. When you sleep on your back, it's harder to maintain the airway, and your machine will increase the pressure. Meanwhile you are wearing the mask you adjusted when you first put it on at night, at it's lowest pressure. The adjustments that worked very well at a lower pressure tend to "blow out" at higher pressure. You need to adjust your mask at the higher pressure, not the lower one. I believe your machine has a "mask fit" option that will temporarily increase the pressure to the highest setting, so you can fit your mask at that setting. Then you put it back in the regular operation mode, and if the pressure increases, the mask seal should hold.

It's best if you can avoid sleeping on your back, but if you do, the proper settings will help reduce the problems you are having.