This newbie is a problem child

[The_Boaphile]

Hello. I admit it. I am a problem child. Ten weeks ago I acquired a Resmed Aircurve 10 VAuto machine and a Resmed Airfit F20 full face mask with the memory foam seal.

So I had an in home sleep study finding out I had 72 events per hour. High right? Well, I sleep like a rock. The on-line Doctor basically did not believe me when I told him I slept well saying I "denied" having any problems with my sleep. He set my Max IPAP at 20 and my Min EPAP at 10. I had problems getting my mask to seal. No matter how tight I went, sealing was constantly an issue. Converting to using the machine was a piece of cake from day one. I roll on my left side and I'm out. Dead to the world and oblivious to the ball and chain that is going to "change my life". Right?

I have tried two nasal style masks, but am awakened frequently by an exceedingly dry mouth. So I am sure I am a mouth breather.

The moment I lay down, my sinus feels stuffy at least. After strapping on the mask, it only becomes worse. So I have concluded that a full face mask is probably going to be a must. The Airfit F20 full face mask does the least in terms of additional blockage of my breathing. But the seal is terrible. I have the older style without the memory foam on order.

So now fast forward ten weeks. I still have unending challenges with my mask seal. I have had the best results with a ResMed AirFit F30i Full Face Mask I have had for about 3 weeks. It does seem to obstruct my nose breathing a little bit. I am currently running Max IPAP at 19 and Min EPEP at 10. My seal results are not super consistent but pretty decent. My events are still near 20 per hour.

I know I need to provide detail imaging using Oscar. I have a SD card reader on the way here hopefully tomorrow from Amazon.

I will post results when I can and hope that there is hope for me. Not that I have any trouble sleeping. I don't. I just know that reducing these events will be beneficial to my well being regardless.

Additionally, I use a finger oxygen meter and I do see MASSIVE improvement in terms of reduced incident of very real oxygen level drops. I do seem to mentally be more aware sooner in the AM than I was before I started this.

Thank you.

Jeff

[Julie]

Look into Padacheek.com - their liners help with leaks.

[The_Boaphile]

Look into Padacheek.com - their liners help with leaks.

Thank you. Just ordered some.

[The_Boaphile]

As I mentioned earlier, I do have leaking issues. I have ordered a "liner" to try to help with leakage. I have also ordered a Resmed Airfit F20 full face mask WITHOUT the memory foam to see if that enables a better seal. Given my results, does anyone have any suggestions for me? Thank you! Jeff

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[The_Boaphile]

Well my new Airfit T20 mask with the original seal, vs the memory foam, has not gotten here yet. Knowing that the Resmed AirFit N20 Nasal mask has been the best mask for me in terms of leakage around the mask itself, I decided to simply try to think thoughts of keeping my mouth shut at night while I am awake during the day. I'm hoping that helps. I am only aware of waking with a dry mouth one time. Likely happened more than that, but I only remember it happening one time. So my AHI of 12.55 is as good a reading as I have had except when I had really bad leakage.

I still have the Airfit T20 coming next week as well as mask liners which I will try. I have no clue what will work best for me.

In general, I am oblivious to the pressure. Perhaps higher pressure makes mouth leaks more likely. I am not sure about that. But it does seem like if the pressure could remain higher throughout the night instead of dropping down, that I might see better results. I just don't know.

I have changed my pressure to max out at 25 for tonight to see what results that gives me.

So here is my latest chart using the nasal mask and I believe keeping my mouth shut most of the night.

What do you think?

[Pugsy]

So why did you reduce the minimum EPAP to 4 cm when you increased the max IPAP to 23?

Your EPAP minimum is going to be your most critical setting. It does the bulk of the work holding the airway open and preventing the airway collapses.

[The_Boaphile]

So why did you reduce the minimum EPAP to 4 cm when you increased the max IPAP to 23?

Your EPAP minimum is going to be your most critical setting. It does the bulk of the work holding the airway open and preventing the airway collapses.

What EPAP would you suggest?

Thank you!

[Pugsy]

What EPAP would you suggest?

Well....assuming you were asleep with all the OA clustering with 10 minimum EPAP...more than 10 cm.
Probably 12 to 14 cm minimum and maybe even more. It's hard to pinpoint because you never really got the clusters broken up.
If 10 cm minimum didn't do a good job then going down in EPAP sure isn't the way to go.

Do you sleep on your back a lot?
You might be a good candidate for side sleeping or a soft cervical collar to help prevent chin tuck (assuming you are maybe tucking the chin which narrows the airway more).

[The_Boaphile]

The OAs seem to occur when the pressure drops down between 12-14. Then pressure goes up and those OAs mostly drop off while the pressure is up above 16 only to resume again when it drops down.

I sleep almost entirely on my side. I did just try the cervical neck brace last night for about half an hour. I could feel the stress in my neck building. I guess I'd say I am prone to neck related issues without the collar and have been for years. So I took it off and went right to sleep. I bought and tried about 8 different pillows before I found the one that works best for me. It's a medium thickness and pretty firm. Using this pillow AND the collar really press on my neck.

I am one of those people that has zero issue going to sleep and staying asleep. So my apnea issues are not something I have any knowledge of, or notice as they happen. It just never wakes me up. Leaky mask issues have been the foundation of my lack of success I think.

Correct me if I'm wrong, but leaky mask issues are the very foundation for failure.

So I'm going to reset my EPAP to 12 to start. I have slept with my EPAP this high on my journey before without any problem as far as pressure and sleep is concerned. After moving my EPAP to 12, will the machine maintain my pressure at a higher level than 12-14 ? Hopefully so. Seems to me that it would be nice if the machine could "learn" that my OA numbers are much better at that higher pressure and just stay there.

Thank you for the suggestion.

[Pugsy]

Seems to me that it would be nice if the machine could "learn" that my OA numbers are much better at that higher pressure and just stay there.

These machines don't learn anything or remember anything. They operate in the here and now based on whatever is happening now.

They work best by preventing the airway from collapsing in the first place and not trying to fix it after the fact. That's why the minimum pressure is the most critical setting.

[The_Boaphile]

Seems to me that it would be nice if the machine could "learn" that my OA numbers are much better at that higher pressure and just stay there.

These machines don't learn anything or remember anything. They operate in the here and now based on whatever is happening now.

They work best by preventing the airway from collapsing in the first place and not trying to fix it after the fact. That's why the minimum pressure is the most critical setting.

Gotcha. Thank you!

By the way, I'm in Missouri too. Kind of a weird day today huh? Very low hot sun today.

[Pugsy]

We need rain and lots of it. Haven't mowed the yard in 6 weeks. Pretty sad. If we don't get some grass growing I will be haying my horses in 2 weeks. Normally don't need to do that until after the first hard frost or around mid to late November.

I am unsure just how much baseline EPAP you are going to need but giving a 12 cm minimum EPAP is a good starting point.
For some reason or other your pressure needs are just higher and the 2 usual culprits are either sleeping on one's back or REM both of which can worsen OSA and/or cause a need for higher pressures. Your clusters of OAs are too numerous and too close together to be likely REM related which is why I thought maybe supine related. But unless you are rolling over onto your back and you don't realize it...can't blame it on being supine.

Nice thing about auto adjusting machines though...whatever the reason we establish a good working baseline so the machine has a better head start to get to where it needs to get to and then let the machine sort it out. I have REM worse OSA myself. Documented in the sleep study 5 times worse OSA in REM than in non REM sleep. When the baseline or minimum is too low the machine can't respond quickly enough to hold the airway open and during the airway collapse event the machine won't do anything except twiddle its little thumbs and wait until the airway is open and then it tries to do a better job preventing. It can't/won't try to blow through the obstruction. It simply can't generate enough pressure to do that. So what we want to do is better hold the airway open in the first place and prevent the collapse from ever happening. Hence the higher baseline minimum.

Let's see what 12 minimum does and then decide if we need more or not.
Also...just open the max to 25...it won't go anywhere without a good reason and with a more optimal minimum the machine might not need to go quite so high. No guarantees but a maybe there.

[The_Boaphile]

Thank you Pugsy for the additional feedback.

Well another improvement but my mask must have slipped a few times overnight. If I am reading these results correctly, my events seem to primarily jump when my mask leakage was up. I think I was able to keep my mouth mostly shut again with this nasal mask. I just am not aware of sleeping on my back very much. I suspect my AHI number would have been lower had I not had the mask leakage that I had.

Regarding REM; REM sleep is what we all want right? Isn't that the deepest most restful sleep? When I go to sleep I am dead to the world. I usually have zero arousals that I remember in the morning. I sleep like an absolute rock.

So here are two views of my graph so you can see the mask leakage. Would yo suggest I go higher than 12 with my EPAP, or stick with 12 hoping for less mask leakage? I still have a LOT of room for improvement. Like I mention before, the pressure just does not bother me. I am unaware of it really even before I fall asleep.

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[Pugsy]

Your leaks aren't that bad and if the clusters were related to leaks then I would expect to see a lot of UAs flagged and I don't see but maybe a couple.

You still need more minimum EPAP. Give 14 a try tonight.

If you notice....a lot of the time the leak stays below 30 L/min and the machine can handle that much leak easily. You do have a few spikes higher but they don't last long and actually the clusters of OAs seem to happen and then leaks happens which makes me wonder if you are struggling to breathe and then the mask is moving some.

[The_Boaphile]

Your leaks aren't that bad and if the clusters were related to leaks then I would expect to see a lot of UAs flagged and I don't see but maybe a couple.

You still need more minimum EPAP. Give 14 a try tonight.

If you notice....a lot of the time the leak stays below 30 L/min and the machine can handle that much leak easily. You do have a few spikes higher but they don't last long and actually the clusters of OAs seem to happen and then leaks happens which makes me wonder if you are struggling to breathe and then the mask is moving some.

14 it shall be. Thank you.