Husband....New to CPAP....help, please

[Taz]

My husband has just started CPAP therapy, now on day 10. He has the same machine I have, S9 Autoset but he’s using the F10 FF mask. He’s having problems with leaks and I’m not much help since I’ve never used a FF mask. The first couple of nights were rough…pulled the mask off a few times, in his sleep but now seems to be adjusting. He admits he’s awakened several times during the night because of leaks and I just don’t know what to suggests, except…. keep adjusting the mask. He’s averaging 7hrs a night and for the past two nights has actually gotten his AHI down to 5.0 or a little less. His leak rate is at 24.0 much of the time and of course goes over a few times but is much, much better than the first 3-4 nights so he is making progress.

We both have different insurance plans. I have the insurance compliance hanging over my head but he has no compliance requirements, at all. The DME delivered his machine & mask, gave very brief instructions and more or less said, good luck and call us in 3 months, if you need supplies. His sleep study indicates he falls in the mild range. At this point, he does not feel he is experiencing any benefits from CPAP. I know he is because his ultra-loud snoring has stopped. But….he’s also comparing himself to me and my case is different. I fall in the very severe range and my symptoms were much more apparent. He says he’s OK with the mask and doesn't see a reason to make a change. Ha….that’s the only mask the DME brought and the only one he has ever tried on.

I check his Sleepy Head data, daily and I keep telling him he is improving. He doesn't seem too happy because the masks is disrupting his sleep, although he’s being very good about keeping it on, regardless so he really is trying. Now, his Sleepy Head data is concerning me and I’m not sure if I really need to be concerned. His OA events are minimal but his “central” events are more than 75% of all the combined events. Is this normal for a newbie with a FF mask? I do notice that many of these centrals happen when he is just waking up but they are also happening throughout the night. Any suggestions on what I can do to help him?

Taz

[The Latinist]

Can you tell us what exact name & model # of machine he has and what mask?

She already said he had an S9 Autoset and an AirFit F10 FFM.

[Janknitz]

The centrals may have more to do with his disrupted sleep than an apnea issue--we all tend to have centrals when coming awake.

Have him read my blog post below called "Taming the Mirage Quattro". I know it's a different mask, but the principal is the same. And if none of those suggestions work, it's time to call the DME to try other masks. You can also go to the website for the mask manufacturer and print out a fitting template--check to make sure that the mask is fit correctly. If the DME brought out only one mask, it's as likely that the sizing is wrong as anything else.

[library lady]

I use AirFit F10 mask... the FF masks tend to leak more because of the larger footprint on the face. I had a lot of trouble with leaks in the beginning. Do have hubby read the "Taming the Mirage Quattro" blog mentioned by Janknitz, it is very helpful, and her other suggestions are good too. Is he using mask liners? They were a game changer for me after I tried the sizing issue, and now leaks rarely wake me. There are several he could try, Pad-A-Cheek is one, RemZzzzs is another. Many here use on or the other of these, and there's another I haven't tried... out of the Twin Cities, I forget the name of it but look for my post "I discovered another mask liner maker" and you'll find the name of it... and the other day someone posted a review of that one. RemZzzzs usually available at your DME or you can get them from our hosts, cpap.com.

[The Latinist]

One thing you need to keep in mind with the F10 or the QuattroAir is that over tightening -- especially at the top -- can exacerbate leaks. The cushion needs to float on the face and be inflated by the air pressure. Also make sure that he thoroughly cleans both the cushion daily and cleans his face before bed. I found the mask very susceptible to oils.

[robysue]

I check his Sleepy Head data, daily and I keep telling him he is improving. He doesn't seem too happy because the masks is disrupting his sleep, although he’s being very good about keeping it on, regardless so he really is trying. Now, his Sleepy Head data is concerning me and I’m not sure if I really need to be concerned. His OA events are minimal but his “central” events are more than 75% of all the combined events.

75% of what total number for the AHI?

If you're talking about 75% of an AHI = 3, that's one thing. If you're talking about 75% of an AHI = 12, that's something else altogether.

In general if the CAI < 5, a sleep doc is likely to say: It takes time. Some newbies do have some problems with centrals when they first start out, but usually the problem resolves itself in a few weeks. If the CAI > 5 after a month or two, it's well worth investigating if there's a real reason to be concerned.

Is this normal for a newbie with a FF mask? I do notice that many of these centrals happen when he is just waking up but they are also happening throughout the night. Any suggestions on what I can do to help him?

Sleep transition centrals and centrals scored during wake breathing are not something to worry excessively about.

It might help us help you if you could post a picture of what the Daily Detailed data looks like on a typical night.

[Taz]

The centrals may have more to do with his disrupted sleep than an apnea issue--we all tend to have centrals when coming awake.

Have him read my blog post below called "Taming the Mirage Quattro". I know it's a different mask, but the principal is the same. And if none of those suggestions work, it's time to call the DME to try other masks. You can also go to the website for the mask manufacturer and print out a fitting template--check to make sure that the mask is fit correctly. If the DME brought out only one mask, it's as likely that the sizing is wrong as anything else.

Hi Janknitz,

I had my husband read "Taming of the Mirage Quattro" and he said it made good sense, he'll give it a try. I tried the fitting template, his mask is a large, the template indicated he might be closer to a medium but he didn't agree. He thinks the mask size is not the problem. We'll see.......

Taz

[Taz]

I use AirFit F10 mask... the FF masks tend to leak more because of the larger footprint on the face. I had a lot of trouble with leaks in the beginning. Do have hubby read the "Taming the Mirage Quattro" blog mentioned by Janknitz, it is very helpful, and her other suggestions are good too. Is he using mask liners? They were a game changer for me after I tried the sizing issue, and now leaks rarely wake me. There are several he could try, Pad-A-Cheek is one, RemZzzzs is another. Many here use on or the other of these, and there's another I haven't tried... out of the Twin Cities, I forget the name of it but look for my post "I discovered another mask liner maker" and you'll find the name of it... and the other day someone posted a review of that one. RemZzzzs usually available at your DME or you can get them from our hosts, cpap.com.

Hi library lady,

Thanks for the info, I went to cpap.com and ordered the RemZzzzs.

Taz

[Taz]

One thing you need to keep in mind with the F10 or the QuattroAir is that over tightening -- especially at the top -- can exacerbate leaks. The cushion needs to float on the face and be inflated by the air pressure. Also make sure that he thoroughly cleans both the cushion daily and cleans his face before bed. I found the mask very susceptible to oils.

Hi Latinist,

I had my hubby read your post. He said he would begin washing his face before putting on the mask.

Thanks for posting your suggestion.

Taz

[chunkyfrog]

If he is being awakened by mask farts, you could try a mask liner.
(DIY, cut a gasket out of an old t-shirt--cloth quiets the facial razzberries.)

[Taz]

I check his Sleepy Head data, daily and I keep telling him he is improving. He doesn't seem too happy because the masks is disrupting his sleep, although he’s being very good about keeping it on, regardless so he really is trying. Now, his Sleepy Head data is concerning me and I’m not sure if I really need to be concerned. His OA events are minimal but his “central” events are more than 75% of all the combined events.

75% of what total number for the AHI?

If you're talking about 75% of an AHI = 3, that's one thing. If you're talking about 75% of an AHI = 12, that's something else altogether.

In general if the CAI < 5, a sleep doc is likely to say: It takes time. Some newbies do have some problems with centrals when they first start out, but usually the problem resolves itself in a few weeks. If the CAI > 5 after a month or two, it's well worth investigating if there's a real reason to be concerned.

Is this normal for a newbie with a FF mask? I do notice that many of these centrals happen when he is just waking up but they are also happening throughout the night. Any suggestions on what I can do to help him?

Sleep transition centrals and centrals scored during wake breathing are not something to worry excessively about.

It might help us help you if you could post a picture of what the Daily Detailed data looks like on a typical night.

Hi Robysue,

Here's his data from Sunday, 6/29....I haven't uploaded, last nights, yet. I'll get back with that.....

[Pugsy]

Any chance he was awake or semi awake around that 4 AM mark?
Robysue will probably ask so thought I would save a bit of time and ask now.

[Taz]

Any chance he was awake or semi awake around that 4 AM mark?
Robysue will probably ask so thought I would save a bit of time and ask now.

Pugsy, it's possible. His alarm goes off at 4:50am and this indicates he may have gotten up before the clock went off. He's having a rough time sleeping with the mask and has mentioned that some days he just "gives up" and gets up early.

Taz

[Pugsy]

I have my grandson visiting for a couple of weeks so my time on the forum is hit or miss.
When I see large blocks of not much of anything and then a block or 2 of a bunch of centrals especially around wake up times I have to wonder about the machine maybe picking up on awake/semi awake breathing irregularities by mistake.
Also if we look at the pressure line after 4 AM...it isn't doing much of anything and certainly has been higher so I really doubt that these centrals are related to pressure. The machine can and will flag SWJ (Sleep/Wake/Junk) as some sort of apnea event and centrals are flagged often. When this happens we just sort of have to sit back and try not to worry about the centrals because they aren't the kind that we should or would worry about. I know they look ugly but other than the fact that the sleep quality itself is probably in the toilet...it doesn't mean something horribly bad is going on.

It's especially common to see this SWJ in newbies who are having difficulties staying asleep with the mask on. They lay there tossing and turning and sighing and wishing they were asleep.
The machine senses breathing irregularities and since it doesn't know if a person is awake or asleep it just calls them like it sees them.

Things look really good until around 3:15 or so and then at 4 AM. My first suspect would be SWJ.
You might be able to zoom in on some of the individual breaths to see if they look irregular and Robysue might like to see some of those. I am not the greatest in evaluating SWJ on a breath by breath evaluation unless it is so obvious a blind person can see it.

[The Latinist]

Any chance he was awake or semi awake around that 4 AM mark?

My first thought, too. His report looks like a lot of mine, where clusters of centrals start in the the couple of hours before my alarm goes off. My doctor thinks it's SWJ.