Getting used to therapy again - several questions

[sleepy-k]

Hi all,

I've recently come back to CPAP therapy after some time off and a move to a new state or two (bad me). I had a new sleep Dr., new split-night study with a slightly higher pressure, new DME that seems reasonable, and most importantly (to me), a new mask. Previously, I was using nasal pillows, which was causing some dryness, and which provided a convenient excuse to not use my therapy. I tend to get congested easily (and I tend towards mouth-breathing), so if I couldn't breathe through my nose, I couldn't use my CPAP.

After all the logistics, I finally have gotten a full-face mask. In general, I like it, but I'm having a great deal of leaks. According to SleepyHead, last week I had 15.35% of my time above the leak rate threshold. I know that on my side, the pillow will often push the mask slightly, leading to leaks, but I also get leaks on my back. I notice that on some of my breaths in, I can feel the mask inflating, and obsessionally will have a "pop" as the pressure breaks the seal. I also note that most nights, my leak rate starts out okay, but generally gets worse throughout the night.

Pressure: 8 cm
EPR: 3 cm - so down to 5 cm pressure

Sleepyhead shots of a good night in terms of leaks and two bad nights:
https://www.dropbox.com/s/pyffc2a9ma5go ... 6.png?dl=0
https://www.dropbox.com/s/5suz7b98un94c ... 3.png?dl=0
https://www.dropbox.com/s/cd3lsydrn19w3 ... 5.png?dl=0

I'm also waking up with a dry mouth, which is mildly annoying, but not awful at this point. I have the Climate line with my hose set to 81 degrees right now. Will adjusting the humidity ultimately help here? (I don't like to go too high with the climate line, as I dislike breathing air if it gets too warm.)

I've never found my therapy to be exceptionally effective; there's certainly no "night and day" difference in my sleepiness. My AHI numbers back on the nasal pillows and with my old pressure (6 cm, with EPR down to 4 cm), were quite good - usually 0, or well under 1. Now, I'm getting AHIs in the 1-4 range with the new mask/pressure. I imagine I can't exactly trust them until I get the leaks under control, and it also seems to be recording some OAs while I'm still awake. I breathe relatively slowly when awake and going to sleep, so I think it sees some of my pauses on exhalation as OAs.

Lastly, my doctor also prescribed provigil (200mg once per day) to help keep me awake during the day. I tried it all of last week, and didn't find it terribly effective. I was still yawning during the day.

1. What can I do to reduce leaks with a full face mask?
2. Is there anything I can do to reduce dry mouth?
3. Should I be using my nasal pillows when I can and only use the full face mask when congested?
4. Anything I need to know about provigil/tips for making it more effective?
5. Other thoughts?

[OkyDoky]

1. What can I do to reduce leaks with a full face mask?
2. Is there anything I can do to reduce dry mouth?

Glad you are back and hope I can help.

I will start with these 2 questions. This link may help with mask fitting. https://maskarrayed.wordpress.com/tamin ... e-quattro/ If you are not using a liner these may help. http://www.padacheek.com/ or https://www.cpap.com/productpage/remzzz ... iners.html I prefer the PadaCheek because you put them on and they stay until you need to wash. They can be used for a long time.

On the dry mouth, I use http://www.amazon.com/ORAJEL-MOUTH-CHUR ... +mouth+gel This helps me not to wake up in the middle of the night with cotton mouth. I don't mouth breath and still get dry mouth.

[Pugsy]

2. Is there anything I can do to reduce dry mouth?

You could try changing the Climateline over to manual mode where you can adjust the humidity level delivered and the temperature of the air independent of each other.
Right now it is likely set to automatic which means 80% delivery at whatever temperature you choose. Even if you warmed up the air it won't change the 80% delivery amount.

Unfortunately for a lot of full face mask users it's the mouth breathing that is drying out the mouth simply because the humidifier can't really handle the rehydration of the oral cavity. It was really designed to rehydrate the nasal cavity which is much smaller.
So sometimes for some people (depends on how much they mouth breathe and how easily the mouth dries out) even maximum humidity isn't enough to fix the dry mouth.

If you switch to manual mode you could set the humidity to "5" which is maximum and then adjust the temperature more to your comfort...you may or may not have a greater chance for rain out at these settings depending on your bedroom air temperature.
It's worth trying...maybe you will get lucky and have some relief of the dry mouth.
Otherwise adding something to rehydrate the mouth (like the various products available for dry mouth) is pretty much the only other option.
Remember some meds make the tendency for a person to have dry mouth worse.
Remember that sometimes dry mouth can be caused by other things and while it is a common sign of mouth breathing...people have dry mouth that don't mouth breathe.
Also remember that sometimes the dry mouth from mouth breathing is because the nose gets congested and forces the mouth breathing so if there is nasal congestion involved...try to reduce the nasal congestion.

3. Should I be using my nasal pillows when I can and only use the full face mask when congested?

Up to you and what lets you sleep the best.
Sometimes a small amount of mouth breathing leak is preferable to fighting a full face mask all night in terms of leaks, face farts and general comfort. I don't own a full face mask and wouldn't use one if I did. I probably do experience some mouth breathing on occasion (usually spotted on the leak graph) but for me 15 to 30 minutes of big leak (if it even makes it to big leak because often it doesn't go to large leak territory) that I sleep through is better than 50 wake ups throughout the night because of various issues with a full face mask.

[sleepy-k]

I will start with these 2 questions. This link may help with mask fitting. https://maskarrayed.wordpress.com/tamin ... e-quattro/ If you are not using a liner these may help. http://www.padacheek.com/ or https://www.cpap.com/productpage/remzzzs ... iners.html I prefer the PadaCheek because you put them on and they stay until you need to wash. They can be used for a long time.

Thanks for the link; I definitely did not follow those guidelines for fitting the mask, so hopefully I can try to refit it tonight. For the PadACheek liners, are you suggesting the ones that fully line the mask or just the cheek straps? I'm surprised ones that line the mask wouldn't lead to more leaks.

As for the orajel, I'm willing to try it, though I admit to some hesitation about it!

[sleepy-k]

2. Is there anything I can do to reduce dry mouth?

You could try changing the Climateline over to manual mode where you can adjust the humidity level delivered and the temperature of the air independent of each other.
Right now it is likely set to automatic which means 80% delivery at whatever temperature you choose. Even if you warmed up the air it won't change the 80% delivery amount.

I didn't know that was an option! Thanks for this - it's definitely worth a shot.

As for the face mask - I don't generally find it uncomfortable, but I have woken up a few times in the morning to find that I took it off in the middle of the night, so that must be telling me something.

[OkyDoky]

I will start with these 2 questions. This link may help with mask fitting. https://maskarrayed.wordpress.com/tamin ... e-quattro/ If you are not using a liner these may help. http://www.padacheek.com/ or https://www.cpap.com/productpage/remzzzs ... iners.html I prefer the PadaCheek because you put them on and they stay until you need to wash. They can be used for a long time.

Thanks for the link; I definitely did not follow those guidelines for fitting the mask, so hopefully I can try to refit it tonight. For the PadACheek liners, are you suggesting the ones that fully line the mask or just the cheek straps? I'm surprised ones that line the mask wouldn't lead to more leaks.

As for the orajel, I'm willing to try it, though I admit to some hesitation about it!

The cheek straps can help with comfort but I was talking about the ones that line the mask. I used one on my N10 when I was ready to get rid of it because of skin irritation and leaking into my eyes. For me the Padacheek stopped the leaks and others have had leaks stopped with them but as always it is an individual thing and they don't work for some. If you want to try a DIY one first you can take an old soft cotton tee shirt and cut a home made liner to cover the part of your mask that touches your face. Just make it a little bigger so it's extending outside your mask a little.

With the Oragel I just use a little and rub it between my gums and cheek. Try the humidity changes first but if you find you still have dry mouth keep it in mind.