Amazing life changer! :) (Better late than never)

[sleepysurgeon]

Hi all!
Greetings from the south of India on a hot, humid and sultry day!

First of all, I am ashamed to tell you that I am a medical professional who has had sleep apnoea for years and did nothing about it!

For a long time, I have been waking up feeling unrested, getting tired by the afternoon, needing to nap a couple of hours in the afternoon to get through the day, snoring as loud as an express train everynight, drooling lakes on my pillow , having a high blood pressure not responding to medical treatment - even with three drugs....
You get the picture.....

For a while I attributed it to a severe GERD and got by by raising my head level, sleeping on my side and GERD medication.

Over the last couple of years, its been so bad that I used to fall asleep if I was not actively doing a task in the day.

Finally, last week I did my first sleep study which showed my AHI as 54, Desaturation to below 70 and nearly 511 apnoeic/hypopnoeic episodes in 7 hours sleep.

I got a trial ResMed S9 Autoset from the dealer (Fortunately in India all this is not prescription based!) and felt rested after just 6 hours sleep for the first time in years, no snoring, no drooling and almost no GERD.

I joined this board to relate my experience as well as to learn from other members.

First question:
I tried two masks:
Swift FX - AHI 7, leak rate less than 6%
Airfit P10 - AHI 4, leak rate 14%
I did not try any nasal masks as yet.

Which should I be using?

[Julie]

They're both popular, the Airfit P10 newer, but the fit is so individual (and must be tried lying down of course) that your comfort level will matter - small leaks can be improved with Padacheek.com's liners. There are also very many other masks of course, and you need to be sure you're not a mouth breather when sleeping because a full face mask would then be needed... look at what's available on Cpap.com as they have the best variety and prices, though will not ship ResMed equipment out of the US (even if they're made in Australia!). What's available to you there you'll have to look into, but what some people do is register with Reship.com who 'accept' pkgs in the US, then send them on to wherever you like. I'm not sure, however, what would happen to ResMed stuff in terms of legality, customs, duty, etc, but everything sent by Cpap.com e.g. to me (in Canada) is exempt from duty as it's stamped "Medical device" (or something to that effect), tho' I still cannot get ResMed things except from Canadian dealers who, of course, charge more for them.

[Pugsy]

Use the mask that is more comfortable and lets you sleep the best.

About the AHI...it's best to evaluate the event category breakdown when trying to determine if the therapy is effective or not.
Especially with people new to this therapy the AHI can vary widely because they spend a good bit of time awake with the mask and machine on and often a lot of centrals get flagged while awake and those centrals will cause the AHI to go up.
So when comparing the AHI of 7 to the AHI of 4...how much of it is central? how much is obstructive apnea? how much is hyponea.

The leak rate is within acceptable limits with either mask. Stay below 24 L/min (not % BTW) and the machine will be able to compensate quite nicely. Unless you are waking often because of small leaks I wouldn't worry about these leak numbers.. If off the machine that is the 95% number which means that you were at OR BELOW that number for 95% of the night. People tend to forget the "or below" part of the definition and worry needlessly. The 95% number is easily elevated or skewed by just a small time with a bit larger leak and often can make things look worse than they really are.
Now leaks that wake us up need to be worked on because they are disturbing our sleep...so even if it is a tiny leak and it wakes us up we need to work on it but because it's disturbing sleep and not because it is causing the therapy to go in the toilet.

The masks are so similar that the AHI shouldn't really change between the masks unless one of them is less comfortable and maybe keeping you awake and some awake breathing irregularities are getting flagged by mistake.
I prefer the P10 now because I just like as little on my face and head as possible but I used the Swift FX for years until the P10 came out. Both are good masks. Use the one that feels the best because feeling the best makes it more likely we will sleep the best.

Welcome to the forum.

[chunkyfrog]

I have been on my dentist's case for several years, as he was a cpap drop-out.
Thankfully, he has donned the mask once again, and is using it regularly.
Medical professionals succeed or fail for the same reasons as everyone else.
Attaboy for giving it another go. I wish you well.

[bwexler]

One week is not enough time to properly evaluate one mask, let alone two, unless the mask is so uncomfortable you just can't sleep with it. Then one hour may be enough.
Think of finding the right mask like a woman shopping for a pair of shoes. The right one for me has nothing to do with the right one for you. Your pressure requirement can also make a big difference. I found when my pressure exceeded 20 cm H2O my current favorite mask would not work at all.

I also recommend you download and learn to use Sleepyhead software, it is free, but extremely enlightening.

[Slats]

Good for you that you are doing cpap. I love love my Airfit P10. I use paper tape on my lips and place my tongue behind my upper
front teeth and voila- a life long mouth breather has learnt to breath through my nose. It is so lite and quiet and I find that the needed pressure is quite low-9.
I look forward to putting it on at bedtime ! Truly has transformed my moods dramatically .

[Sir NoddinOff]

Nasal Pillows I don't have much to say about but I liked the the nasal mask called the Wisp back when I tried it a few years ago. The mask itself never leaked, however mouth breathing demanded I use a full face mask (FFM). The Wisp is very dependent on the size and shape of your nose, like most nasal masks, so may not be for everyone.

[sleepysurgeon]

Thanks for all the helpful replies.

Julie: There is no problem buying the equipment here in India. There are quite a few dealers and the prices are just over 20% more than the US online prices. So it works out equivalent to US prices + Shipping charges to India.

Pugsy: I find the Airfit P10 more comfortable and quality of sleep is better no matter the higher AHI reported by the machine. I tried with and without the humidifier and my perception of comfort is better without the humidifier. My mouth tends to sag when I am in stage 3 to 4 sleep with consequent leak rates of 24 to 30 L/min (thanks for the correction!) The major leaks tend to wake me up gasping for breath because of the air flow through my mouth.
I am hesitant to try chin straps or full face masks due to my GERD (in case I choke on the reflux)

chunkyfrog: Thanks for the support. I feel I lost a couple of years of quality life due to my sleep apnoea related problems.

bwexler: My pressures range from 6 to 18 on the cpap through the night. The maximum on the ResMed S9 is 20. I hope I will not need higher pressures than that.

Slats/SirNoddinOff: I am afraid to manually shut my mouth or use a full face mask due to my GERD reflux choking phobia as I mentioned earlier.

[Sheffey]

My mouth tends to sag when I am in stage 3 to 4 sleep with consequent leak rates of 24 to 30 L/min (thanks for the correction!) The major leaks tend to wake me up gasping for breath because of the air flow through my mouth.

Many of us use full face masks (FFMs - https://www.cpap.com/cpap-masks/full-face-cpap-mask.php). FFMs cover the nose and the mouth. If the mouth opens at times during the night, the FFM will maintain the therapeutic pressure.

If the mouth opens with a nasal-only interface, the pressure may drop and apneas will be experienced.

Many good masks of both types are available. But it can be challenging to find the one that works best for you.

Good luck.

[knothead]

Thanks for all the helpful replies.

Julie: There is no problem buying the equipment here in India. There are quite a few dealers and the prices are just over 20% more than the US online prices. So it works out equivalent to US prices + Shipping charges to India.

Pugsy: I find the Airfit P10 more comfortable and quality of sleep is better no matter the higher AHI reported by the machine. I tried with and without the humidifier and my perception of comfort is better without the humidifier. My mouth tends to sag when I am in stage 3 to 4 sleep with consequent leak rates of 24 to 30 L/min (thanks for the correction!) The major leaks tend to wake me up gasping for breath because of the air flow through my mouth.
I am hesitant to try chin straps or full face masks due to my GERD (in case I choke on the reflux)

chunkyfrog: Thanks for the support. I feel I lost a couple of years of quality life due to my sleep apnoea related problems.

bwexler: My pressures range from 6 to 18 on the cpap through the night. The maximum on the ResMed S9 is 20. I hope I will not need higher pressures than that.

Slats/SirNoddinOff: I am afraid to manually shut my mouth or use a full face mask due to my GERD reflux choking phobia as I mentioned earlier.

SS, I have GERD also and sleep very well with a FFM by ResMed, The thought never enters my mind about choking, I have tried the nasal masks and they just dont work for me. The FFM actually helps me keep my mouth closed and I sleep like a dead dog...lol. Try a ffm, it may be just what the Doc ordered...lol

[poppi2]

I am fortunate in that my GERD disappeared after I started CPAP therapy.

[Julie]

Any problem taking half a TUMS before bed? More can create a backlash effect, but they can really help with GERD and don't have all the potential side FX PPI's, etc. have.

[kteague]

...My mouth tends to sag when I am in stage 3 to 4 sleep with consequent leak rates of 24 to 30 L/min (thanks for the correction!) The major leaks tend to wake me up gasping for breath because of the air flow through my mouth. I am hesitant to try chin straps or full face masks due to my GERD (in case I choke on the reflux)... My pressures range from 6 to 18 on the cpap through the night. The maximum on the ResMed S9 is 20... I am afraid to manually shut my mouth or use a full face mask due to my GERD reflux choking phobia as I mentioned earlier.

If the jaw relaxing is why you end up mouth breathing, please know that some of the means to keep your chin up can be non-restrictive and allow the mouth to open easily if intentional in a time of need. Maybe try a C-shaped pillow worn under your chin, or even a cervical collar. If the chin straps on the market are too restrictive for you, make your own that works for you. Early on I used stretchy cotton headbands and sports sweatbands. Making the tongue suction up against the roof of your mouth against the back of the teeth could help too. Took me a while, but at some point I quit needing the aids.

If your pressure is blowing open your mouth, that may be another story. And about that pressure - if your machine is running higher because of the mouth leaks, most of your issues could improve by conquering this one hiccup in your treatment. About GERD, I am not the only one on here whose GERD improved or resolved with effective CPAP treatment. Seems logical to me that the struggle to breathe could push stomach acids up. Remove that element and see how much reflux remains.

Sounds like you could benefit from a good look at your data. If you really do need pressure in the high teens, your starting pressure seems low. Sounds like you've got enough things you can work on to be optimistic about your treatment becoming even better. Good luck.