Sleep quality worsens and mouth gets dry

[singhvi]

I have been using Bilevel therapy for almost 4 years now with good results.
Recently, my sleep quality has worsened significantly. I am using the S9 Resmed machine on an auto setting.
I find that the noise of the air blowing through the escape holes in the Resmed Activa mask has increased of late. This noise comes mostly during the inspiratory phase of the cycle.
I also get up with a dry mouth 2-3 times a night.
The machine has a humidifier.
Please help. What is going on over here?

[Julie]

Are you using a nasal mask or one that also covers your mouth that allows open mouth breathing when asleep but not losing therapy air? The second type of mask is called a 'full face' though is really just a nasal mask extended to also cover your mouth.

[ChicagoGranny]

Which mask are you using?

[singhvi]

I am using a nasal mask. Last four years.

[robysue]

I have been using Bilevel therapy for almost 4 years now with good results.
Recently, my sleep quality has worsened significantly. I am using the S9 Resmed machine on an auto setting.
I find that the noise of the air blowing through the escape holes in the Resmed Activa mask has increased of late. This noise comes mostly during the inspiratory phase of the cycle.
I also get up with a dry mouth 2-3 times a night.
The machine has a humidifier.
Please help. What is going on over here?

How old is the mask that you are using? How old is the mask cushion?

What's the humidifier set on?

Do you use the ClimateLine hose or an unheated hose?

What does the machine's data say about: The AHI, the distribution of events, the amount of leaking, and the pressure used throughout the night?

And finally: How has the sleep quality deteriorated? Trouble falling asleep? Trouble with too many wakes during the night? Just not waking up feeling rested, but you don't remember any wakes during the night? Lots of tossing and turning? And any new medications? Any major life changes going?

[singhvi]

The mask and cushion is 3 years old. There is no apparent leak. Using slimline tubing. I feel sleepy during the day. Do remember getting up in night. Will look up the ahi data.

[Julie]

We need all the info you can give us, including model #'s and names of equipment, plus leak rates, etc. so we can try to advise you.

[robysue]

The mask and cushion is 3 years old.

Replace the mask and cushion. These things don't last forever.

There is no apparent leak.

Are you basing this on what happens when you are awake with the mask on or are you basing this on data recorded by the machine. We can sleep through some pretty bad leaks without being consciously aware of them, but leaks (even ones that are not official "Large Leaks" can disturb our sleep.

I feel sleepy during the day. Do remember getting up in night. Will look up the ahi data.

Do look up the ahi data. And the leak data. If there are problems in the data, then that might explain a return of the OSA symptoms and it's worth consulting the sleep doc.

If the AHI is consistently less than 5.0 and the leaks are under control, then the sleep problem is probably not being caused directly by something being wrong with your current BiPAP therapy. In that case, if it's been a while since you've had a full physical exam with blood tests for thyroid and vitamin D (and possibly vitamin B) levels, you should probably start there. If you have recently started taking a new medication, it's worth talking to the prescribing doctor about whether or not the drug might be triggering the new sleep problems.

[singhvi]

Thanks. I turned on the leak alarm in the machine (Resmed S9 V Auto) and it started beeping every 30-40 min.
Over the night the AHI is reported as 36 and mask fit is .
The mask and cushion look OK on inspection, and I have today disassembled the cushion and cleaned with soap and water.
What is the normal life of a mask cushion? (Resmed Mirage Activa LT). I do have a spare pillow system and will try that out.

[mgaggie]

The life of a mask is quite subjective. 3 years is a very long time for silicone to last

[robysue]

Thanks. I turned on the leak alarm in the machine (Resmed S9 V Auto) and it started beeping every 30-40 min.
Over the night the AHI is reported as 36 and mask fit is .

Mr. Red Frowny Face shows up on the Sleep Quality Report when your unintentional leak rate is AT or ABOVE 24 L/min for at least 30% of the night. Resmed defines a unintentional leak of 24 L/min as a Large Leak.

You've got a leak problem. It could just be that the silicone in that 3 year old mask that has been used nightly is simply too worn out to handle the pressure---particularly if/when it increases up to your maximum pressure setting.

You've also got an AHI problem. If your therapy was (still) effective, that AHI would be less than 5. On a diagnostic sleep test, an untreated AHI = 36 gets you diagnosed with severe OSA. So your therapy is NOT effective. It could be the excess leaks are preventing the machine from delivering the needed pressure. It could be that your OSA has worsened through the years and you need a pressure adjustment. Can you post some data from your S9 VPAP Auto? It would be useful to see the following graphs from either SleepyHead or ResScan: The flow rate graph, the pressure graph, and the leak graph for two or three recent typical nights.

Between the leaks and the treated AHI = 36, I think we've identified why your sleep quality has worsened: If the AHI = 36 is typical of what's happening night after night, your CPAP is NO LONGER effectively managing your OSA

The mask and cushion look OK on inspection, and I have today disassembled the cushion and cleaned with soap and water.
What is the normal life of a mask cushion? (Resmed Mirage Activa LT). I do have a spare pillow system and will try that out.

Most manufacturers suggest replacing the mask at least once or twice a year. Some insurance companies authorize a new mask as frequently as every three months. The mask cushion usually wears out before the rest of the mask does. It's probably long past when this mask should have been retired. And a growing leak rate when it was fine before is often one of the signs that the mask is worn out.

[singhvi]

OK folks. Mystery solved. The machine had just come back from service. Apparently there was an air leak from inside the machine. The giveaway was the very high tidal volumes being generated. Further the problem persisted even on replacing the mask.
I sent the machine back and they just opened it and closed it back again. The air leak was from the bottom half of the unit. Once this was fixed everything is back to normal again. The AHI with the old mask is now 0.8.
I sleep well.
Thanks for all your help.

[ChicagoGranny]

Well that is good to hear. But sorry you had to experience that.