Newbie want to know if he is on the right track

[mattbth]

I have had a CPAP for several years but only recently discovered what a difference it makes to look at my own data and take control of the situation.

On a night without CPAP (or bad CPAP AHI > 4), I will wake up in a stupor and literally be walking in circles around my kitchen in the morning as my body acclimates to breathing normally.

I have worked with OSCAR and my CPAP data (Phillips Dreamstation) and found the following.

1. If my mask leaks significantly, I often take the CPAP off in my sleep.
2. On a typical 'good' night, my pressure will start at 10, go to about 18 and stay there most of the night. I set the bottom pressure to be 10 and the top pressure to 20 manually.
3. Mask tightness seems to be a significant factor in mask leakage. If I strap myself in as tight as I can, I get fewer leaks, and my AHI decreases from ranging between 3 and 4 to ranging to between 1 and 2 (for a night when I keep my mask on).
4. I must wash my face right before bed. Otherwise, the oils on my face will affect the mask's seal, and I will get a lot of leaks and/or take off my mask in the middle of the night while I am 100% unconscious.

I have attached two OSCAR screenshots. One of them was a fairly nice night of sleep but not perfect. I want to get my AHI under 1 and appreciate any advice anyone can give me.

The other is a night that I took off my CPAP mask in the middle of the night. Here, there was apparently a big leak, and I took it off immediately. Sometimes I tolerate major leaks for a while before taking my mask off.

I have 3 questions.

1. Am I on the right track here? Do you see anything incorrect about my analysis or have anything to add?
2. A lot of my problems appear to be with mask leakage. I have tried what I have said above, to some benefit. I also tried using medical tape to keep the mask on my face. The tape unfortunately did not help since I just take the mask off in my sleep anyway, tape and all. Are there any other tips people have to reduce mask leakage and/or prevent myself from taking off the mask in my sleep?
3. My AHI on a night where I don't take my mask off and strap myself in tight is about 1-2. I want to get this under 1. What more can I do to make this a reality?

Thanks a lot for your replies.

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Screenshot 2021-03-31 235601.png (104.93 KiB) Viewed 563 times

[zonker]

I have had a CPAP for several years but only recently discovered what a difference it makes to look at my own data and take control of the situation.

welcome to the zoo! you are preaching to the choir here, as i'm sure you know. the only way to make cpap therapy work for anyone is for them to take control.


you've left out an important bit of information in your introductory post...

how are you feeling? are you sleeping well and waking up refreshed? therapy is more than just getting the good numbers. more important is how you are sleeping.

good luck!

[mattbth]

Good question zonker. I have noticed that on nights when my mask stays on the whole night, when my AHI is in the 3-4 range I wake up in a daze, walking in circles in a stupor in my kitchen trying to make myself breakfast. On nights like this I feel like I've been hit by a truck. Most of those nights are gone now that I am taking all of these steps to get a better seal on the mask.

On nights when I have an AHI of 1-2 and the mask stays on the whole night, I feel 'sort of ok, but not quite.' I am a little tired when I get up, more than what I should be, but I can get up and do my day.

On nights when I take my cpap off in the middle of the night, I feel more like a truck hit me. Worse than the full night of cpap with AHI in the 3-4 range.

[Miss Emerita]

A couple of thoughts.

Don't focus quite so much on your AHI. For example, the night of the 30th you had a cluster of hypopneas within about a ten-minute interval. Outside that interval, you had blessedly few events. Your data for that night are unlikely to reflect the quality of your sleep or to provide useful information about trends.

In theory you should not have to crank down your mask to avoid leaks. If you're able to experiment with other masks, I'd recommend you give that a try. Everyone's facial contours are different, and it can take some trial and error to find the mask that will really work for you.

Are you using a full-face mask? If so, do you breathe through your nose during the day? If yes, might you consider trying a nasal pillow mask?

In addition to the tape trick, people try wearing socks or mittens on their hands and putting a cap on over their headgear, one that has ties going under the chin. To find one on line, try googling "medieval cap with ties." (Turns out that's a thing.)

[zonker]

Good question zonker.

i asked for clarification not so that i could make some sage pronouncement. rather it was to help someone with a better understanding to give some advice.

the only two things i can think of is advising you to go to youtube and search for mask fitting videos and include the mask name in the search field. one thing hanging around this forum has taught me is that it's usually NOT a good idea to have your mask ratcheted down so tightly. it needs room to move slightly so that it "floats" on your face rather than crushing down on your face.

also, vibratory snores are an indication that you prolly need more minimum pressure. but that means nothing until you can get your mask sealed properly so you can sleep through the night.

let's see what others have to say.

[mattbth]

Thank you both Miss Emerita and zonker. I do wear a full face mask. A nasal mask may work for me. I ordered a chin strap from my medical supply company because I sometimes open my mouth and my lip goes underneath the bottom of the mask. I'm hoping the strap will fix that problem and a full face mask would not be necessary.

Interesting that you both say that pressing the facemask down is not likely the way to go. So far it has seemed helpful to my rest and I could see improvement in the data. Maybe this works because I use a full face mask and there is a lot more space between my face and the "top" of the mask'??? Or is there something else I am missing?

I tried using socks last night on my hands and I did not take my mask off. That's only one data point, so I will see how that works going forward.

I will look up mask fitting videos since that is definitely a topic where I can use some education. Thanks for the suggestion.

Interesting about how vibratory may snores indicate minimum pressure too low. I set mine at 10. My doctor prescribed 4 or 5. Is a setting that is higher (like 12 or 14 or even 16) too high?

[zonker]

Interesting about how vibratory may snores indicate minimum pressure too low. I set mine at 10. My doctor prescribed 4 or 5. Is a setting that is higher (like 12 or 14 or even 16) too high?

no, there is no such thing as "too high". it's what works to prevent your events and thus lower your ahi. i myself use a minimum of 18 and a high of 20. this would have been unimaginable (not to mention impossible to tolerate!) when i first started my treatment. it's something that i worked up to gradually.

i hesitate to suggest what your minimum should be until i see a couple more of your charts. let's see some more. thursday night and friday night and so forth. what we want to see is trends rather than what happens on one single night.

as to the snores, yes, it's an indication. the purpose of cpap is to keep your airway open. snores are a result of the airway partially closing. i've found out over the years that it's the minimum setting that is doing the bulk of the work.

good luck!

[mattbth]

Thanks zonker for the offer. I have attached 3 nights worth of data. What I have noticed in my own data is that often the snores are very common while the pressure works its way up to about 18 or so and then the snores are less frequent during the night.

Any help is appreciated. I realize it's been more than a few days since my last response.

[zonker]

Thanks zonker for the offer. I have attached 3 nights worth of data. What I have noticed in my own data is that often the snores are very common while the pressure works its way up to about 18 or so and then the snores are less frequent during the night.

Any help is appreciated. I realize it's been more than a few days since my last response.

don't worry about the time lag in getting back. some people never come back at all after asking questions!

okay, so as you can see the pressure is, indeed, working it's way up to 18. see how, in your pressure graph, it goes up to 16 in the first hour? and never, ever gets back down to 10?

so i would suggest that you set that minimum pressure to higher than 10. you might want to bump your minimum to at least 14 or 15. in this case, it's the minimum pressure that is doing the bulk of the work. let it loose, man, and see what happens!

continued good luck!

[mattbth]

Thanks zonker. I will set my minimum pressure higher. I had thought that was what I was seeing in the data. It's good to get the confirmation.

[zonker]

Thanks zonker. I will set my minimum pressure higher. I had thought that was what I was seeing in the data. It's good to get the confirmation.

please keep us posted as to whether this helps or not.