Nasal Mask vs Face Mask (Newbie)

[RaydeeohMan]

I've been struggling with my new AirSense 10 AutoSet CPAP machine for about two weeks now. So far my sleep is way worse than it was with no CPAP. A big part of my problem is caused by the coronavirus shutdown. I have never had any help with fitting, in fact I had no idea that people normally meet with a sleep therapist when they are starting out. My initial appointment with my doctor was in person, back in January. For various reasons I didn’t have my all night sleep clinic visit until March 9 2020. By the time I had my follow up appointment with my sleep doctor on March 26 we were in stay-at-home mode, so it was done over the phone. He confirmed I have sleep apnea, and also REM Sleep Behavior Disorder. He said that Apria would be sending me a CPAP machine, complete with instructions and a DVD. It arrived April 5, and I set it up the next day.

The mask I was initially sent is a AirFit N20. I followed the instructions as best I could and got it setup, but I had no idea that I was supposed to be sleeping with my mouth closed. The CPAP machine was blowing extra hard because it was detecting a ‘leak’. I called Apria and they told me the problem. I told them I didn’t think I could sleep with my mouth shut, so they sent me a F20 full face mask. Trying to use that mask led to its’ own problems. The air pressure was so strong that it would literally lift the mask right off my face. After calling Apria a couple of more times, and struggling to get things to work right, I finally called my doctor. He said the problem was that the machine pressure was set to Auto, which is a range from 4-20, and that the machine was ‘getting it wrong’. He changed it remotely to a fixed setting of 7. I tried it again last night, and the pressure was much better, but I still could not get to sleep after 90 minutes. So, now I am trying to decide which mask I should use, the Nasal Mask or the Full Face Mask. I did get to a point where I can get some sleep using the Nasal Mask, but I am still dead tired the next day, from being woken up several times during the night. Whenever my mouth opens the CPAP starts blowing so hard it wakes me up.
So, my question is, which mask should I be using? Also, I ordered a chin strap, so maybe I should try using that with the Nasal Mask. Any advice will be appreciated. My age is 72, if that matters.

[LSAT]

If you can keep your mouth shut use the nasal mask...If you breathe through your mouth, all the therapy is going out your mouth instead of opening your airway..use the F20. (side note..the mask is tested to work for pressures up to 25...it won't blow off your face).
.

[Miss Emerita]

Set the machine up outside your bedroom during the day, somewhere comfortable where you can read or watch TV. Mask up and use the machine for a couple of hours. Do this as often as you can. This will help you get used to it faster.

Also, google around to find videos about fitting whichever mask you are using. Be sure you check the fir while you are lying down, as the contours of your face will shift a little compared to your upright position.

I’m disappointed to hear that your doctor told you the machine was doing something wrong. It was doing exactly what he told it to do.

Keep us posted, would you?

[RaydeeohMan]

I'm going to try the N20 for tonight, using this chin strap that I bought and see how it goes. Re blowing the mask off my face, it did blow hard enough to lift the edge of the mask up, letting the air escape. But, that was during the Mask Fit Test. In regular use, the air pressure was varied. When my doctor said the machine was doing it wrong, he meant that when the pressure was set to Auto (4 to 20) the machine sometimes will choose a pressure that is too high.
I like the idea of putting it on in the daytime, and working on the fit. I guess I can watch videos on mask fitting while I am wearing mine.
I did shave off the beard I wore for decades a few weeks back, but that had more to do with getting my N95 mask to fit, as protection against that virus.
Thanks for the advice!

[RaydeeohMan]

Ok, I opted for the Nasal Mask last night, and used my chin strap. I was able to keep it on for about 5 hours. My masks are from ResMed, and they have something called the MyAir Score, which I guess is to encourage newbies. My score for last night was 79, and it said I had the mask on for 4.52 hours, a good mask seal score of 20/20, 0 events per hour, 2 mask on/off. Usually I do have some 'events', but not last night. I think there is a disconnect between these scores and the quality of sleep though. A week ago I had a perfect score of 100 but I still felt exhausted. Another night I had 91. Every day I feel like I can barely function. Even writing this simple post is a struggle! Anyhow, I'll keep trying, I know it's supposed to take up to a couple of months for the benefits to kick.

[loggerhead12]

When my doctor said the machine was doing it wrong, he meant that when the pressure was set to Auto (4 to 20) the machine sometimes will choose a pressure that is too high.

That's wrong. The machine reacts to changing conditions in your breathing and sets the pressure accordingly. You may be able to reduce leaks by setting it to a reduced fixed pressure but that won't optimize your therapy.

You have to reconcile in your mind that most sleep docs know a lot about OSA theoretically, but when it comes to the xPAP devices, masks, and where they meet your face they know next to nothing. The companies that sell the devices and masks are slightly better, but the best advice you're going to get is right here.

What seems impossible two weeks in will suddenly start working. It will take several weeks to get it right, but you'll look back and see what was wrong. It will click and start to make sense.

[RaydeeohMan]

Actually, I did observe that the pressure changes at different times, just as you said. A few times I was wondering if it was actually turned on, so I opened my mouth to trigger a response. And every time it would start blowing hard, so I shut up again. My doctor did change something though, as I could tell that it wasn't blowing as hard. I do take notes every day so eventually I'll be able to see a pattern and make sense of it all. At this point I'm still not sure what type of mask I'll end using, full face or nasal. Whatever works, I don't care!

[RaydeeohMan]

I'm continuing to use my CPAP every night, but so far it isn't helping at all. I have the same sleep (or non sleep) pattern I've had for years. I fall asleep in maybe 15 minutes or so, and wake up 2-4 hours later and cannot go back to sleep. The only difference so far is that now I have this annoying contraption stuck on my head! Last night I got up at 2am and then laid in bed for an hour and a half trying to go back to sleep. I finally gave up and went out to the living room to sit in the recliner and read. That's the only way I've been able to go back to sleep for years now. After an hour or so of reading I fall back asleep. When I finally got up around 9:30am I still felt very tired. My wife said I had mild shaking around 12:45am. For what it's worth, my MyAir Scor was 68. It said I had the mask on for 3.56 hours, good mask seal score 20/20, .7 events per hour, 3 mask on/off.

[Julie]

Until you download Oscar and post here we can't tell what's going on or why... would like to, but...

Probably been asked already, but are you taking any meds, and which and when?

[RaydeeohMan]

Re Oscar, I have read about it here and so installed it a couple of days ago. I just haven't imported any data into it yet. Will have to get on it. Re my meds, yeah I am taking 6mg of melatonin each night. I started that because my sleep doctor said I have REM sleep behavior disorder. I had read that melatonin may be as effective as clonazepam in treating it, and is usually well-tolerated with few side effects. Clonazepam has some side effects that I wanted to avoid if I could. My sleep doctor actually hasn't said anything about taking clonazepam, but he does know I am taking the melatonin.

[Julie]

Have you tried taking less - e.g. 3 or even 1 mg? I and others find that a lot more leaves a dopey hangover the next day.

[DreamDiver]

If you're waking up with your mouth desert dry, or you can feel air escaping from your mouth, you're getting large leak. If you're getting large leak, you're not getting therapy.

The first thing to do is to conquer large leak. In your normal sleeping position, try to relax your face muscles as much as you would during sleep. Just let everything go slack. Smile. Move your nares around. You can hear and feel large leaks as the bypass your pillows or escape through your mouth. If you can create a large leak just by slight movement, slackening your muscles or twisting your head in your mask, chances are, as soon as you're unconscious, that's what's going to happen because of Murphy's law.

If you cannot physically keep your mouth from leaking while wearing a nasal mask, you may need to use the F20. Download the sizing pdf, print it out and use it to determine whether you have the right size mask. Watch a fitting video on youtube, if that will help.

Learning about fitting masks in general from TheLankyLefty27...

Full face masks are not for breathing through your mouth. The concept is that by equalizing pressure between your mouth and nose at all pressures, it becomes easy to keep your mouth closed yet relatively slack while sleeping, allowing you to breathe exclusively through your nose with the full face mask. Your mouth doesn't dry out. Large leaks are avoided. You sleep comfortably through the night.

Even if you don't have decent numbers or long enough times to make it seem worth the while, you can use OSCAR to determine if you're pushing out large leaks too. And once you're comfortable securing your mask from large leaks and posting data from OSCAR on the forum, we'll be able to show you how to use your data.

Chris

[RaydeeohMan]

Julie, I have taken different doses of melatonin at different times. I was taking 1 mg for a few years, then I reduced it to .5mg for a year or so. When I was diagnosed with the Sleep Behavior Disorder I increased my dosage considerably, up to 10mg. I did that because I thought it better to take high dosage melatonin than clonazepam. I’ll see what my doctor says, re reducing it

Chris, I don’t seem to have dry mouth, and according to the MyAir reports I have a good mouth seal. I am slowly learning to keep my mouth shut. I do have a full face mask that I can try if I cannot adapt to the nasal mask, but for now I’m trying to use the nasal mask and try to not leak anywhere.

I just imported my data into Oscar; as soon as I figure out how to use it I’ll post here I’ll do it. Meanwhile, here is the message Oscar gave me after I did my import:

“The last time you used your ResMed AirSense 10 AutoSet...
was last night (on April 26, 2020)

You only had the mask on for 2 hours, 30 minutes and 2 seconds.
You had an AHI of 0.80, which is under your 7 day average of 3.94.
Your CPAP machine used a constant 6 cmH2O of air
Your average leaks were 1.10 L/min, which is under your 7 day average of 13.22”

Ok, so it is saying I had leaks, in spite of that the MyAir report said. I wonder if that is from my intentionally opening my mouth? I did that a couple of times just to make sure the CPA machine was on. It is pretty subtle and I wasn’t sure it was even working!

[RaydeeohMan]

Ok, here is a screenshot attachment, hope I got this right and it can be read. Another post said to just include the first 4 graphs?

[DreamDiver]

Ok, here is a screenshot attachment, hope I got this right and it can be read. Another post said to just include the first 4 graphs?

Small leaks are normal. For the AirSense 10, you'll usually see a gray swath across your event flags graph and your flow rate graph. We're not seeing this here. So you're leaks look mostly small. You might have had to scratch your nose once.

This is a good graph. The only thing I can think to say is if these were my settings, I'd stay with them for a few days to get an average of how I'm doing at this pressure regime. Try to sleep as many as 8 hours if possible. Whatever you can achieve is fine.

Chris