Time To Change To Nasal Masks?

[AnnaS]

All,

I began my CPAP treatment with nasal mask (pillows) about a year ago but found that I was a mouth breather so moved to full face mask (F-10) about 2 months ago. However that brought on issues with leakage. To rule out various possibilities (and to rule out all options), I ran a tap test on my hose, bought a new F-10 flapper for and replaced on the face mask and regularly cleaned out equipment.

I also increased my min pressure to 9 from the earlier 6 on suggestion from some members here.

When that didn't stop my mouth from opening (had severe dry mouth ), on the welcome suggestion of some of the members here, I purchased a cervical neck collar about 2 days ago. That helped to keep my jaw closed through the might. However I am now experiencing a tremendous amount of leakage near my eyes and cheeks around the 3 am timeframe with loud whooshing sound, which is waking me up.



Should I:
1) Decrease the minimum pressure back down from 9?
2) Try the nasal mask again but this time with neck collar to prevent mouth leakage
3) Both

Please advise.

Thanks
Anna

[Pugsy]

On this report at around the 3 AM mark your pressure wasn't all that high. Now it was higher later but unless you meant 5 AM and not 3 AM...I don't think the pressure was the cause of the leak.
You might have a little room for minimum pressure reduction but you are using apap mode and that means it's going to go where it needs to go and starting lower isn't going to stop it from going to where it needs to go and only means it takes longer to get to where it goes and that could negatively impact therapy effectiveness.

I would try option 2 ....the nasal interface mask with cervical collar if I were in this situation.
You could of course try both...but if you do that then you need to try 1 and 2 separately also. Science 101... when doing experiments....keep variable to a minimum so you can evaluate results better.

[AnnaS]

Thank you. yes, I meant 5 am.. typo.

I will try the nasal pillows tonight with neck collar and report back.

I am trying to get to a point where I am not having to think about this everynight and day... and have it down to a recipe that works no matter what time I go to bed and which side I sleep on. Is that too much to ask?

[Pugsy]

No...not too much to ask at all but it can take some experimentation to figure out what works and sometimes what might be an acceptable compromise.

If you want to reduce the chance of leaks due to the higher pressures like you see at 5 AM....the pressure to limit is the maximum pressure and not that starting minimum.
Your machine wanted to go higher at 5 AM but why it wanted to go higher isn't clearly seen. Maybe it was a little flow limitation or snore that would be acceptable to let those small things happen in exchange for lower pressures that would reduce the chance of large leaks that wake us up. Any leak that disturbs sleep is unwanted no matter how big or little it might be.

Since the bulk of the night the pressure never went much above 12 cm and it looks like the large leak didn't happen until you hit near 13 cm you might consider limiting the max to 11.5 or 12 and see what happens. In other words the time spent over 12 isn't really all that much and if the leaks could be reduced (so they don't wake you up) it might be an acceptable compromise to rein in the max pressure a little bit.

So that's another experiment you could try...limit the maximum. Reducing the minimum wouldn't really help the leak situation and could potentially make therapy effectiveness sub optimal all night long.
Limiting the maximum wouldn't affect things all night...it would only affect the time frame where the machine wanted to go higher and from this report it doesn't look like that would be a whole lot of time..just a small section and it might be a workable compromise.

Long ago I decided that I didn't need "perfection" on the software reports in terms of leak management as long as I slept well and felt decent during the day. That's why I don't worry about a small time frame with maybe some mouth breathing and I don't do anything special to keep my mouth closed.
Going to extraordinary measures to stop what little mouth breathing I might be doing caused more sleep disruption and comfort issues than the little bit of mouth breathing created problem.
I could get a "perfect" leak line with taping my mouth shut but I found that the tape was a little annoying and I would wake up messing with the tape or it would come loose or lots of drool was annoying. Using tape to "fix" maybe 30 minutes of mouth breathing leak was more annoying for the entire night and I decided to just accept that maybe I would mouth breathe and it wasn't the end of the world since I slept great the other parts of the night. I made a compromise that worked well and it allows me to just go to bed and put the mask on and I don't worry about leaks or sleeping position or anything like that.

Figure out whatever allows you to sleep the best and if you have to compromise on "perfection"...well it isn't the end of the world if the software reports have a small time frame where things aren't "perfect".