Side Sleeping

Hi,

I am new CPAP user since the last 10 days. I am using the Philips Respironics Remstar System One A-Flex Auto CPAP. I am using a nasal mask (ComfortGel Blue).

I have managed to get along with the machine, as long as I am sleeping on my back with my face pointing towards the ceiling. The moment I turn to my side (which I do, quite often in fact during the night), I can feel a tornado blowing down my face. The airflow pressure nearly maxes out at 19.9 H20/cm on the CPAP display. Also a peripheral observation is that there is considerable leakage from the edges of the mask lining. This is accompanied by a shrill noise (as the air gushes out from the mask edges), which wakes up my partner without fail.

My question to long term users is : Is this normal? Have you too faced this issue before? Is this a mask issue? I somehow feel very uncomfortable with the increase in airflow pressure (and the noise), and more often than not, wake up in the middle of the night to remove the mask.

Please advise.

Thanks in advance,
S Roy

What are your pressure settings? Is the pressure increasing in response to the leaks or is the pressure increasing prior to the leak? You are awake when this happens and you see the pressure at 19.9?

I would be talking with my DME about trying a different mask. Have you tried any other masks?
You should have a trial period where you can try several masks.

BTW...check my signature line for the software you can use with your machine.
Also please add your equipment to your profile like I have added mine. That way we can see at a glance what you are using.

Yes, what are those settings? And if you had a sleep study, what was the recommended straight CPAP pressure? I think Pugsy suspects, as I do, that the top end may be unnecessarily high.

It is a mask issue. Getting the mask to seal and stay sealed is the most difficult part of CPAP for most of us.

It may also be a positional apnea issue. If I had to, I'd guess that the pressure actually increases while you're still on your back, because your apnea is worse in that position. Eventually you roll over onto your side, which dislodges the mask and unleashes all that pressure, waking both you and your partner up.

Hence the questions are:
1) Do I really need this much pressure?
2) Is my machine providing enough pressure to prevent apnea when I'm on my back?
and 3) How do I get this #@(|!#(|^& mask to stay sealed?

It's entirely possible that the answer to the third question is that you can't, and you need a different mask.

ssray23 wrote:My question to long term users is : Is this normal?

Hi,

No, this is not normal. While others have given you some good advice on where to go to start solving this problem, I just want to point out that while you are having mask leaks, your machine is not giving you effective therapy. Once it starts leaking, it isn't doing you any good. You really do want to solve this issue, and not just because it wakes up your partner.

I am also concerned that your machine goes to 19.9 for a pressure level. I fear that you had a drive-by sleep doctor who simply set your machine wide open with a range of 4 to 20, and then turned you loose. That does you very little good, and it makes it extremely hard to get good therapy. What is more ideal is to have a "titration study", and then have your machine set in a mode where it most closely matches the pressure levels that were established in the titration.

I hope I am wrong, but I think you found a person who calls themselves a sleep doctor, but is really only in the game to sell equipment and generate insurance company billings. If that is the case, you might want to find a different doctor, and get a 2nd opinion, and possibly a real titration.

-john-

jweeks wrote:I fear that you had a drive-by sleep doctor who simply set your machine wide open with a range of 4 to 20, and then turned you loose.

That's three of us.

Otter wrote:That's three of us.

Yeah, and it doesn't even have to be 4 to 20 to be a problem.
If someone is seeing 19.9 on the LCD display then they are awake and very likely either the pressure and/or the leak was what woke them up. Either way something is not working optimally and needs to be fixed.

OP has not returned to comment. I never know how much effort I want to put into explaining things until I know that have found their way back here. I have been very short on time this past week and didn't want to go into lengthy explanation to have it get lost in the archives.
Takes me too long to compose stuff.

I have tried many different masks in my mask experiment phase days...it didn't take me 2 weeks to determine that a mask wasn't working. We can't evaluate pressure needs until mask leaks are minimized.

I would love to see a detailed report from this OP. Without it...not much we can do but speculate.

In addition to the excellent posts above about your settings you need to understand that your mask is into the right one for you. The right mask for you seals properly in whatever sleeping position you choose, it's comfortable, and does not cause pressure sores.

ASAP you need to contact your DME to try other masks. Do not allow your DME to put you off! There is a one month "window" per mask in which the manufacturer will credit the DME for a mask that doesn't work out. Now this takes a little paperwork on the part of the DME, and some DMEs would rather run your time out past the one month period than to help you find a better mask. Furthermore, we are approaching the weekend and you should not have to suffer for 5 more days.

A good mask will be comfortable in all positions so that you can sleep.

One thing to note. My sleep doctor discourages sleeping on your back. He has a handout telling how to use a tennis ball and simple harness that holds it in the middle of your back to help you use the side position.

Please accept my apologies for not posting as I was out of town with limited access to internet.
And thanks so much for all the helpful posts from everyone.

My pressure settings have been preset from 4 to 20 H20/cm.

Also, I strap my mask a bit loose, as I am trying to get comfortable wearing a mask during sleep. I feel a bit stifled with the mask strapped too tight and find it hard to doze off that way.

Regarding the mask, I thought ComfortGel Blue would be the perfect companion to the Philips Respironics Auto CPAP. (http://www.healthcare.philips.com/main/ ... efault.wpd)
When you say try a different mask, do you mean a different "type" of mask like full face mask, minimal contact mask or is the suggestion pointed towards using a different brand altogether? In that case, which are some of the good brands you would suggest for me?

Thanks again ...

S Roy

I just was going through the Fitting Guide for ComfortGel Blue Mask (http://www.healthcare.philips.com/asset ... gGuide.pdf), and it contains some tips to prevent leaking. Never tried these, but will definitely give it a shot tonight. Maybe I was not using the product correctly!!



Did anyone try these before and got results?

Regards,
S Roy

Hi - I hate to tell you, but those 4-20 settings are the machine defaults, and not your prescribed numbers... you definitely need to find out what those are so you can set your machine up properly to reflect what therapy you need.

Example - if the doctor thinks you need 10 cm of pressure to do the job, then you would ideally set your machine for 8 or 9 as the low parameter, and 12-13 for the higher one, which means that you're unlikely to need less than 9 at any time, but if you need more than 13, the machine can still get there when events occur but not have to take the time to do so all the way from 4 (rather than 8-9), likely missing the apnea altogether. In other words you're likely to hover at around 10-12 most of the time, but if an event occurs at e.g. 15, you'll be in a better position to deal with it (or at least your machine will).

Does that make sense to you?

No one's prescription is actually set at 4 and no one can really breathe at that setting, whereas 20 is very high and only rarely would anyone use that (or if they did, they're more likely to have been given a different type of machine), so 4-20 is just the normal available span the machine uses, but the vast majority of us are scripted for numbers in the middle.

A proper fitting is crucial, but again, if you can't get the mask to work for you, don't delay in getting back to your DME to try another one. Some of us literally went through a dozen masks before we found THE mask we could comfortably sleep with all night. You DME may not like it, but this therapy is doing you no good if you can't sleep comfortably all night because of the mask.

The brand of mask doesn't have to match the brand of XPAP machine you have, so don't feel like you have to stick with Phillips. I tried a full face mask during my titration study, and I had a lot of leak issues, too. I am primarily a side sleeper. A nasal mask was better, and now I use nasal pillows and I barely notice it. They stay in place even when I'm on my side. So definitely go back and try some different masks. I would also recommend looking at your data to see why your pressure is going so high.

Well, had a relatively good night's sleep yesterday by making the adjustments as illustrated in the Fitting Guide (see my last post). But it did not resolve all the issues. Yes, the whistling sound did reduce (my partner slept well) but the average pressure delivered was still around 17 to 18 H2O/cm.

So is my airway passage so narrow (I am "obese" unfortunately, ) that a pressure of 18 H2O/cm is required to open it up!!

Anyway, I will go for a titration test (as suggested above) to determine my recommended CPAP pressure settings. I'll also speak to my DME for an alternate mask (or maybe I'll buy a Resmed Quattro anyway).

Thanks again for all the helpful suggestions.

Regards,
S Roy

Don't kick yourself for thinking that being obese is the cause of your needing higher pressures.
It may have a slight impact on things but not all the blame. I am small, petite woman with tiny neck (maybe 11 inch circumference..I forget exactly) and sometimes I have seen my APAP reach 18 cm too. On the other side of things....some obese people can get by with pressure needs under 10 cm. Just luck of the draw and our on airway tissue patency.

If you consistently see the machine reaching near the maximum pressure settings and you are absolutely sure that it cannot be blamed on leaks....then you likely for sure need a higher minimum pressure than the 4 cm that things start out with. With the PR S1 machines I usually suggest that people consider something near the overall average pressure because the 90% pressure numbers sometimes are falsely inflated if looking at a single night.
Something around 2 cm below the overall average pressure or if your 90% pressure is consistently near the overall average pressure.. same thing.

Gotta make sure that leaks aren't impacting things though. Sometimes PR S1 machines will increase the pressure when trying to fix leaks and actually create a bad snowball effect which impacts the numbers negatively so that we can quite trust what we see.
I have some examples I could show you if you want to see them.