Help required - snoring with a full face mask

[Gekko]

Hi Everyone,

I've done some searching on these forums but haven't found anything on point.

I'm about 3 weeks into CPAP treatment - I'm using a Respironics System One A-Flex Machine (in CPAP mode, C-flex is turned off, pressure is 14). I am using a full face mask (Mirage Quattro). Most nights, when I put on the mask, I wash my face, wash the cushion and adjust the straps. I seem to get a good seal (sometimes if I purposely move my jaw around a lot, I get a small leak, but generally a little bit of further tightening sorts it out).

I'm now at the point where the mask is no longer hurting my nose, it seems to fit well, and to the best of my knowledge, I have no leaks (my partner agrees that I don't seem to have any leaks).

However, my partner tells me that I still snore. Admittedly, she says that I don't stop breathing like I did before (no pauses and spluttering, just continuous snoring), and also, in terms of volume level, if I was a 10 out of 10 before, now I'm a 5 out of 10. I also used to wake up with a dry mouth, but turning the humidity from 2 to 4 solved the dry mouth problem.

Just to complete the picture, I had a history of allergies as a child and developed huge polyps in my nose (one nostril completely blocked, the other 60% blocked). I was a mouth breather for many years. About 6 years ago, I had surgery to remove the polyps, straighten a deviated septum and reduce my turbinates. I now breathe easily through my nose but I do know that years of mouth breathing means that as soon as I fall asleep, I lapse back to mouth breathing.

According to the machine readout (I don't have the software), my AHI is sitting around 5-6 most nights (that is, the 7 day average seems to float between 5-6).

So, would you recommend that I buy a chin strap, increase pressure...? How will my doctor feel about me fiddling with pressure? I know that the equipment supplier is very reluctant to deviate from the prescription. Any advice keenly sought.

[roster]

What is your pressure setting and Flex setting? Did you have any central apneas in your study?

What are the chances you could buy a card reader and the Encore software to go with your machine? It is a very helpful tool in fine tuning your settings and therapy.

How about putting your equipment in the profile.

[Gekko]

Roster,

All good questions. As I said in my post, my pressure is 14. I had c-flex turned on for a couple of nights but I found it disturbed my sleep. I have since turned it off.

The reason I haven't bought the software is because this is a rental machine and while it is working OK for me, I want a smaller, more portable machine for travelling, so I will be buying a F&P Icon Premo when my two months rental is up.

As for the proportion of central apneas, I can't tell you that as it was not mentioned after my sleep study and I didn't ask the question at the time.

As for your last suggestion, I will put my equipment into the "equipment section". In fact, I'll do it now

Cheers.

[roster]

If you were at a pressure of 8, I would say bump it to 10. However, a pressure of 14 is getting near uncomfortably high, so let's try something different.

Do you know about positional sleep apnea (PSA)? What position do you sleep in? Sides/tummy/back?

[roster]

....I will be buying a F&P Icon Premo when my two months rental is up.

....

See:

The product range spans three models; Auto, Premo and Novo. The Auto detects interruptions to normal breathing and provides the appropriate positive airway pressure to meet the breath-by-breath needs of the patient with full efficacy and compliance reporting. The Premo model provides fixed pressure therapy with efficacy and compliance reporting, while the Novo provides basic compliance reporting.

A couple of things. First, you should go for the Auto instead of the Premo unless there is a large price difference. I don't know if there is a size difference, so check that too.

Second, you need to resolve your pressure requirements before you purchase a machine.

Do you know how to read the data on the current machine you have and clear it every day after you put the night's data in a log? If not ask for help and someone should post the instructions.

[Gekko]

Do you know about positional sleep apnea (PSA)? What position do you sleep in? Sides/tummy/back?

I know from experience that I tend to have fewer apneas and less snoring on my side (I was told that after my sleep study and previous partners have also told me!). I try to sleep on my side, but during the night, I always seem to end up on my back. However, in this case, I have been told that there is a little snoring still happening on my side (if my "back" snoring is 5 out of 10, my "side" snoring is a 1-2 out of 10). I may have to try the old tennis ball trick.

[Gekko]

A couple of things. First, you should go for the Auto instead of the Premo unless there is a large price difference. I don't know if there is a size difference, so check that too.

Second, you need to resolve your pressure requirements before you purchase a machine.

Do you know how to read the data on the current machine you have and clear it every day after you put the night's data in a log? If not ask for help and someone should post the instructions.

I was thinking about the Auto, but both my doctor and the provider think it is unnecessary. I will quiz them further when I have my next consultation.

I have a consultation in a month so I will raise the snoring if I cannot resolve it in the meantime.

I know how to read the data on the machine, but I must admit, I'm not keeping a log. My understanding is that the provider will download the data for me on request and produce a report. I intend to do that once I've done a little experimenting. However, I like your idea of keeping a log, so that I can see how my daily experience matches up with the data.

[roster]

Tennis balls are good, I actually use a small backpack.

You may not need an Auto. But you can set an Auto at straight CPAP pressure if that works well for you.

If you buy a CPAP, you will not be able to experiment with Auto settings. So how will you ever know that an Auto is not best for you?

I would get great joy out of kicking some doctors and DMEs in their asses with steel-toed boots.

[Gekko]

I would get great joy out of kicking some doctors and DMEs in their asses with steel-toed boots.

I don't want to have a go at all doctors, because I understand why some of them are reluctant to let patients experiment (both for legal and medical reasons). However, I do understand your frustration, particularly since CPAP is extremely safe and very unlikely to do any harm (compared to a whole lot of other medical treatments, including pharmaceuticals). I have also come across a lot of lazy, arrogant or simply ignorant doctors/suppliers who don't want to listen and are only interested in getting your cash and pushing you out the door as quickly as possible.

It's a shame for people who don't have the capacity or the interest to do their own research and/or experimentation.