In the depths of relapse

[mdintx]

Hey Folks,

First post though I've been lurking for a while. I need some advice about where to go from here. I did my sleep studies in Oct. and Nov. of last year and got my machine in mid-December. I have a Resmed S8 Elite II with a 3i humidifier. I started with a ComfortGel nasal mask. No matter how I had it set, it turned the bridge of my nose red. The redness would dissipate by the end of the day, which is when it was time to put the mask back on. So I was switched to a Swift LT in January. This worked great and I was happy. In April, I started experiencing some mild fatigue and slight bags under my eyes. This escalated towards the end of May and I scheduled an appt. to see the MD. They looked at the data which looked good with the exception of a high level of leaks.

We agreed to try a replacement mask or go with something different if that didn't work. So I ordered a new Swift through my HME. Unfortunately, I've had the same results. My HME rep suggested a Mirage Micro. The first night with that resulted in feeling tons better but it roughed up the sides of my nose. The second night didn't go as well though I think I got the fit to be better. So I'm back to the Swift until my nose heals. I got some of the Lanolin stuff and taped my mouth shut (much to the amusement of my wife who decided to launch in with a series of important questions right after I put it on - gotta love her). I feel poopy again this morning. This is how I felt before I started treatment.

I think what's happening is that it's not remaining seated and air starts getting into my mouth. I'm not sure why this is happening now. The only 2 changes are the constant running of the AC (it's Texas y'all!) and I've lost ~15lbs since the start of the year. I wonder if the pressure is too high now. The doc didn't say anything about this at our appointment.

We're supposed to be leaving on our destination wedding/honeymoon in 10 days. I'd rather not feel miserable in paradise. So I'm wondering what to do. It seems the nasal masks rough up my nose and the nasal pillows don't seat properly. I don't have any data to show you since I don't have the reader or software. I would, however, appreciate any advice.

TIA,

Mark

[BeanMeScot]

First of all, get the reader and software. It will help you and us see what is going on. Knowledge is power!

Secondly, I don't know why they would say you are doing well if your leaks are out of line. If your leaks are too high, the other data is skewed. If you are leaking through your mouth (wake up with mouth like the desert) then search through here to check for mouth taping options. You can use a chinstrap, painters tape, or Polident strips. If it is the mask that is leaking, you can try lanolin around your nostrils when you use the Swift LT or fool with the straps. The mask should be as loose as possible without leaking. People have a tendancy to tighten it too much in an attempt to stop leaks and that can sometime conversly increase the leaks.

[Julie]

Hi, you sound so miserable, and I don't blame you, but things may not be as bad as you think. A lot of us find after a while that for whatever reason, we have turned into overnight mouth breathers (you can't know unless someone else wide awake the whole time is watching). The standard fix is a 'full face' mask (just a nasal one that's extended to cover your mouth) - popular ones being UltraMirage, Quattro, Liberty and Hybrid (see on Cpap.com). To test the theory, it's easy to use a 2" long x 1" wide piece of tape overnight and see if it helps. If you search on the site for "taping" you should get names of the various kinds.

[Wulfman]

I second what Julie said. Sounds like mouth leaking/breathing to me.


Den

[lktnky]

As said before, if your mouth is dry or you wake yourself 'puffing' out of your lips, you'll want to try a chinstrap and/or taping to be sure you have a closed 'circuit' of airflow.
Like masks, chin straps/cups are a matter of personal preference. The only 2 I've found that work are both by Respironics; the Deluxe Chinstrap and the standard. Deluxe is about 3" wide and comes with 2 straps to hold it in position, front & back. It's hot in the summer but boy does it keep your chin up. The other is the one that Slinky touts. It's only 2 straps with a chin cup that's silky and a bit bigger on one side than the other. I turn mine inside out so the sewing doesn't rub under my chin. It comes with 4 Velcro squares that you can use to attach it to either the headgear or itself. I've taken the small chin cup and the Velcro squares and a strap from the Deluxe and made a Summertime Version. It works for me.
I also have to tape and use 2-1" strips of tape that overlap. I use the Hurt Free at the top and the Gentle Paper on the bottom. They overlap about 1/4". Fold the edges over so you have a handle to take off the tape when you need to. I tape nightly and have a 0 leak rate w/Swift LT. AHI last night was 1.4. My periods of sleep are getting longer and longer. I'm up to about 6 hrs after 18 months. It's been a long road, but I've hung in there and am finally seeing marked improvement in my energy and cognizance levels.
BTW, congratulations on your upcoming wedding and may you share a long, happy life together.
All the best,
LKTNKY

[mdintx]

Thanks for all of the responses. I've used a chinstrap (respironics) and I've taped. Neither achieves that "closed circuit" and I still feel the air wanting to come out of my mouth.

I've been considering a full face but am resistant due to the potential for skin irritation to the bridge area of my nose. The doc says I have a lot of "altitude" in that area. So I've also thought about the hybrid but that gets back to my concerns about the seal at the nostril. So I don't know at this point.

[LoQ]

Just want to point out that he did say he was taping, and the problem persists even with taping.

[mdintx]

A bit of an update. I had a better night with the Swift LT. I set it to be tighter than I have in the past and used the Lanolin. I rarely felt the need to puff out air and when I did, I lightly pressed my nose into the nasal pillows and the feeling went away. I feel pretty good this morning and wanted to sleep past my alarm. My nose was a little tender when I first got up but it's fine now. So I'm wondering if that's it for me. I just need to wear the Swift a little more tightly than I have in the past.

[yardbird]

What size pillows are you using on the Swift?

Also... the "barrel" on the swift rotates. Make sure you rotate it to a position that seals against your nose. Swift pillows should not be stuffed up your nose. They should rest against the outside and as the air pressure comes on they "inflate" a little to form a seal.

Taping won't necessarily keeps your cheeks from puffing ... it just prevents air leaking out your mouth. I love nasal pillow interfaces. I have the Swift, Swift II, and Swift LT. I also have a ComfortLite 2 with pillows. I have the nasal cushion interface for the ComforLite 2 as my escape from pillows in case I get a sore spot for whatever reason.

The masks are SO adjustable. Don't be afraid to give them a tweak right after you put them on. I pull on the mask, rotate the barrel kinda... feel around where the pillows meet my nose, and then off to dream land.

[Issac]

If your are breathing or even puffing out of the mouth, you may need more than tape. Tape is a pain. When your insurance allows, usally 3 months , try a new mask. You may want to try a full face mask . If you like pillows, the Hybrid is a great mask. Lot's of options out there.

[mdintx]

Would love to say that I was checking in with good news but it's not the case. I was woken up this morning at 3:45 in the midst of an apnea episode. I'm gonna be ordering a new mask today. I hope the cpap.com staff are ready for a lengthy conversation!

[mdintx]

Thanks to this forum, I figured out how to look at some summary data.

Last night, I started off with an Activa LT. Woke up about 90 minutes later to my painful feeling on my upper lip. So I got up and put some micropore tape there and came back to bed. I could not get the Active LT to seal up again. Lots of fiddling with settings with no benefit. So I swapped out to my Swift LT and came back to bed. Woke up about 6 hours later...feeling somewhat tired with lots of air in my stomach. BTW: the machine rated both Excellent in terms of seal.

Last night's data:

Leak - .02 L/s
AHI - 2.7
AI - 0.0
HI - 2.7

For the week:

Leak - .0 L/s
AHI - 2.4
AI - 0.0
HI - 1.6

How do these numbers rate? Why am I still feeling pretty tired?

[Pugsy]

Maybe you just need more good hours of good sleep. I have seen 6 hours with really good numbers and while I feel the improvement, not nearly as much as when I get closer to 8 hours uninterrupted sleep. They say we have this sleep debt, from years of bad and no sleep, to pay off. I guess we need a little excess good sleep to work on paying off the debt. Seems reasonable and everyone is different. My "good" days vary in "good quality" despite the numbers being pretty much the same so I try not to obsess over a set of numbers and just make a mental note of possible contributing factors and then move on. Just my opinion for what its worth.

Congrats on the good numbers. I am thinking that the air in the stomach discomfort will contribute to the general overall reduction in the "good" sleep feeling despite the good numbers. I have been lucky, I haven't had any swallowing of air problem so I can't offer any suggestions on how to remedy that problem.

[lktnky]

Your numbers are excellent! And given the fact you're using a ResMed, you can cut that HI score in half then add the AI score. I would've given my firstborn away to get those scores so congratulations.
Give it some time, enjoy your honeymoon and let us know how you feel when you return. Maybe when your mind is off the subject you'll begin to feel better & more alert.
All the best,
LKTNKY

[mdintx]

Thanks for the encouragement everyone! Well, last night was a hit!

Leak - 0.0 L/s
AHI - .5
AI - 0.0
HI - .5

I used my Swift LT with a Breath Right strip, Lanolin on my nose, and Micropore tape on my mouth. I definitely feel much better today and no air in the stomach. Here's hoping this continues!