Newbie: terrible neck pain and AHI question

[Depassaro]

I've been using my new BiPAP for about a month now. My study/titration was all about finding a mask I could tolerate. All of the FF masks they tried either tended to be too large for my face and leaky, or they squished the top part of my frequently stuffy nose, making it tough to breath through my nose. I ended the night's study with the Amara View mask, which was infinitely more comfortable than any of the other masks.

Problem is, that the headgear straps tend to pull my chin towards my chest. If I loosen them enough to not strain my neck, the mask flops around all night, making farty noises that wake me up or just constantly blowing air out the bottom of the mask. I have had cervical issues in the past (pinched nerve, C5-6); enough so that I had surgery to try to alleviate the pain several years ago. After a month on my BiPAP, my neck and shoulder pain is worse than it was prior to surgery. Last night it was so bad and on the verge of becoming a migraine, that I just had to take the darn thing off and sleep without it. Of course, I'm tired and yawning all day now, but my neck does feel a little better.

I've tried adjusting the straps. I've tried sleeping on my side (I'm a back sleeper). I've tried changing pillows from a normal pillow, to my regular buckwheat husk pillow, to a towel rolled up for a neck roll, to no pillow. I really can't tape the mask down regularly as my skin is really sensitive and can only take it for a day or two at most. I've order a mask liner to see if that helps with leaks. Nothing seems to help the neck pain. I think part of the problem may be that the mask is a bit too big for my face even though I have a size small. Any suggestions? I'm at a point where I feel like I have to make some quality of life decisions regarding treatment. I know I need this plastic alien strapped to my face, but I can't live with the pain.

And, probably an easier question, once you start treatment, does the AHI go down gradually? My study clocked me in at 96. The first couple of weeks of treatment put me in the teens. This last week, the 4th week, I'm finally seeing a few single digit numbers. Nothing below 5, but getting close. Is this normal?

[LSAT]

After a month, your AHI should be at or near the 5 mark...in fact, most will be below 5.
Check out these amara view videos for help...
https://video.search.yahoo.com/search/v ... tion=click

[OkyDoky]

If the AHI is normal can depend on if all of the events are true. You describe mask issues and pain that interfere with your sleep. A lot of times when you are not sleeping well there are events that we call sleep wake junk. It is good that the AHI is coming down. You can download Sleepyhead and see what the AHI number is made up from and when they are occurring. If they are CA's close to awake times they may not need to be counted. Work on the known sleep issues and the AHI may come down. This link will help with Sleepyhead. https://sleep.tnet.com/resources/sleepyhead
And if you want to post screen shots from Sleepyhead there are other links to help.

I don't use the Amara View so I can't help there.
Are you not able to breath through your nose and use a nasal pillows mask? The P10 I use has a minimal (1 divided) strap. Some people use a soft cervical collar to help keep their chin from dropping. If mouth breathing is a problem it will not completely prevent it but the collar works as a reminder and some have learned to breath through their nose. What also helps is breathing through your nose during the day with your tongue placed at the top of your mouth just touching the back of your teeth. With your tongue in that position it blocks air from going into your mouth. Just some ideas if you don't get replies from someone with experience with your mask.

[Guest]

Problem is, that the headgear straps tend to pull my chin towards my chest.

To my knowledge no mask or headgear straps should be pulling your chin towards your chest. In fact, you should avoid having your chin come towards the chest. Some use a pillow held up under the chin while others sleep with a soft cervical collar which you may already have. Sleep with the collar on to keep your neck straight if you can.

The key is to keep your spine straight. Is there anyone who can check your spinal alignment while you adjust your pillow height? I too have used the rolled up towel when I slept on my back. Now I sleep on my side and use a folded towel to bring my pillow up if it is not high enuff.

Getting the right mask can be frustrating. If you can teach yourself to breath thru your nose you can try either a nasal mask or nasal pillows. IMO pillows are the best for treating OSA as the pressure will keep your tongue from blocking your airway. The mask manufacturers offer a FREE replacement if your mask doesn't work for you but that is within a 30 day window and many DME's will not honor it when all they have to do is some paperwork to get credit for the mask. Some will let you keep the old mask.

If your DME refuses to honor the 30 day replacement it is time to check with your insurance to see if there is another DME you can do business with. To me it only makes sense for the DME to make sure your mask is fitted correctly or you are not likely to be successful at using their equipment.

Make sure when your mask is fitted and adjusted you are laying down in your sleeping position and at your highest cpap pressure. When using an auto cpap and the pressure increases this will put stress on the straps and cause the mask to leak.

I wouldn't be overly concerned about your AHI until you get all these other things under control esp. if the AHI is under 5 already. Cuz leaks and other things can cause a misleading AHI reading.

[Depassaro]

After a month, your AHI should be at or near the 5 mark...in fact, most will be below 5.
Check out these amara view videos for help...
https://video.search.yahoo.com/search/v ... tion=click

Thank you. I was pretty sure I had the mask on correctly, but was never actually shown. I watched the video and a few others and it seems that I've got it on correctly. I did notice that the mask seems to fit the models and manikins better than mine fits. Mine seems to sit far lower on my chin and a lot higher at my nose. I think sizing was one of the problems going on during my study/titration.

You can download Sleepyhead and see what the AHI number is made up from and when they are occurring. If they are CA's close to awake times they may not need to be counted. Work on the known sleep issues and the AHI may come down. This link will help with Sleepyhead. https://sleep.tnet.com/resources/sleepyhead
And if you want to post screen shots from Sleepyhead there are other links to help.

Are you not able to breath through your nose and use a nasal pillows mask? The P10 I use has a minimal (1 divided) strap. Some people use a soft cervical collar to help keep their chin from dropping. If mouth breathing is a problem it will not completely prevent it but the collar works as a reminder and some have learned to breath through their nose. What also helps is breathing through your nose during the day with your tongue placed at the top of your mouth just touching the back of your teeth.

Thank you for taking the time to reply. I appreciate it. I've sort of been left on my own to figure all of this out. This forum has been invaluable so far. I have downloaded Sleepyhead and tried to decipher all the info. Unfortunately my concentration is still poor and I still seem to have a bit of a brain fog, so understanding all the statistics has been difficult. I need to go back and reread a lot of the Sleephead posts several times. I do have CA's, so I'll have to go back to the data and see when they are occurring. Also on the list is learning how to post a screen shot. I read how to in a post, but will have to go back and find it because it is forgotten already.

I don't normally breathe through my mouth, but when I'm asleep, my jaw drops open and I apparently do. I was also told I had a fairly high pressure (18). I think this is why they told me I needed a full face mask. The only thing I can't stand more than having my mouth and nose covered, is having something near my throat. LOL I may very well have to learn to get over it and use a cervical collar. I tried a rolled up towel under my chin, but that didn't work.

[Depassaro]

To my knowledge no mask or headgear straps should be pulling your chin towards your chest. In fact, you should avoid having your chin come towards the chest. Some use a pillow held up under the chin while others sleep with a soft cervical collar which you may already have. Sleep with the collar on to keep your neck straight if you can.

I double checked the straps positions to some of the online videos and they are on correctly, I just have the bottom ones tightened as far as they'll go to stop the leaking. You're right about pulling the chin. Not only is it, quite literally, a pain in the neck, I think it's also contributing to the OSA's. I guess a collar is on the shopping list. :::sigh::: If I could learn to sleep with that hunk of plastic on my face, surely I'll be able to learn to sleep with something around my neck.

The key is to keep your spine straight. Is there anyone who can check your spinal alignment while you adjust your pillow height? I too have used the rolled up towel when I slept on my back. Now I sleep on my side and use a folded towel to bring my pillow up if it is not high enuff.

I've got a call into my chiropractor. Good idea. I'll bring my pillow and headgear and have him take a look at my alignment and see if he has some suggestions.

Getting the right mask can be frustrating. If you can teach yourself to breath thru your nose you can try either a nasal mask or nasal pillows. IMO pillows are the best for treating OSA as the pressure will keep your tongue from blocking your airway. The mask manufacturers offer a FREE replacement if your mask doesn't work for you but that is within a 30 day window and many DME's will not honor it when all they have to do is some paperwork to get credit for the mask. Some will let you keep the old mask.

It's hard to remember because I was half asleep, but I believe the sleep techs went through at least six different masks on me before they found one that worked. Some of those dainty looking nasal pillows look interesting. I'm just not sure if the pressure will blow it off my nose, or whether I can learn to keep my mouth shut while I'm asleep. I'd like to try it though. I had no idea about this 30 day window. I don't have a DME. The DME folks at the sleep center tried to swindle me. They told me the machine I needed cost $7000 (in 10 easy monthly payments of $700!), and the way the "rent to own" crap worked out between the end of the year and my gigantic deductible would mean the insurance would cover nearly none of the expense. So I went online and found the same machine, brand new, for only $1600. The online folks didn't mention a 30 day window for the mask I bought with it.

If your DME refuses to honor the 30 day replacement it is time to check with your insurance to see if there is another DME you can do business with. To me it only makes sense for the DME to make sure your mask is fitted correctly or you are not likely to be successful at using their equipment.

It's becoming pretty clear I'm at a real disadvantage without a regular local DME. I need to recontact the insurance company for local DME's on their list. The online one's they gave me were again the rent to own deal, and overpriced, just not as obscenely. Again, the same problem with end of year and high deductible. It ended up cheaper for me to buy the machine from an out-of-network provider and just pretending I don't have insurance. SMH

Thank you so much for your input. It's been a tough month figuring all this stuff out.

[Okie bipap]

Your DME is wrong. Several people use a nasal pillow with high pressure like you are using. When my first mask made my nose sore, they recommended I try a nasal pillow mask. At that time, my pressure was 20 - 25 cm H2O with a pressure support of 5 cm H2O. If I could keep my mouth closed while sleeping, I would use nasal pillows. I have tried three or four different masks, but have never been able to make it work for me.

[OkyDoky]

This site will help you organize your charts,take a screen shot, and post by using Imgur. There are 3 pages so be sure and click on the links at the bottom of the page. https://sleep.tnet.com/resources/sleepyhead/shorganize

As far as the statement that you can't use pillows or nasal masks with high pressures is something untrue. My bilevel pressures are EPAP 11 and IPAP 15 and several users here use pillows with higher pressures. The closest to perfect mask is an individual thing but several individuals, that the DME directed away from nasal/pillow masks, have been able to successfully use them.
To get more replies from Amara View users you might put the mask name in your title.

[Guest]

It ended up cheaper for me to buy the machine from an out-of-network provider

That is often the case this time of year. But that doesn't mean you can't buy masks from a DME using your insurance which is prob when/where using a DME comes in handy. Call your insurance first to be sure how that will work for you. There is a billable code for a mask fitting that the sleep center can use also. Tho it is called something else that I can't remember right now. CPAP Acclimation? I think.

I was also told I had a fairly high pressure (18). I think this is why they told me I needed a full face mask.

Often a DME will say that nasal pillows can't be used at a pressure of 12cm of higher.

I started with a FFM then bravely tried a nasal mask while learning to keep my mouth shut. Liked that so much I moved to nasal pillows at a pressure of 18 cm on straight cpap.

The amazing thing is the nose will regulate how much air it allows thru AND since the sealing surface covers less area it is much easier to seal and less irritating to the face. Nasal Pillows also cover so much less of the face.

The secret is to 1st keep the mouth shut - sleeping with a sports mouth guard may help with that, it did for me.
Start using the largest size pillow in the pkg as the larger holes allow more air in. Smaller holes will often starve one for air. Plus the pillow should not enter into the nostril but seal on the surface of the nare.

[sleepychar]

If you haven't used the template to check that the mask is the right size, I would suggest that as a next step. You would print out the template. Check that it is printed in the correct size as indicated in the directions. Make sure you cut out the semi-circle in the bottom of the template. Then check the size. There is at least one YouTube video that shows how to use the sizing template. The size of the Amara View is not necessarily the same size as another face mask might be. I was comfortable with a small size in the Quattro Air mask but the small size Amara View pressed against my nose too much. After that is when I used the template to check the size and found out the recommended size Amara View for me is a medium, which is what I am now using.

The sizing guide (found on cpap.com when you look up the Amara View there) to make sure the mask is the right size for you: https://5faacd0c97cf0d23c6dc-064f3cd61b ... -guide.pdf

I use the Amara View mask and it mostly works for me. I usually get some mask leakage that SleepyHead describes as either not large leaks or not a significant number of large leaks. Occasionally, like last night, there are a significant amount of large leaks. I'm not sure what makes the difference as I think I am fitting the mask the same every night. But maybe some nights I am more restless as other nights. As long as most nights are ok and I am feeling rested, I try not to worry about it.

Here is what I have found works best for me as far as fitting the mask (once you have determined you have the right size mask in the first place). The mask should sit just below your nose, not pressing right up against the nose. When the cushion inflates with air, the mask will seal around your nose. Don't have the mask so tight that the cushion pillow can't inflate once the air flow starts. When the air flow starts, I can actually feel the cushion inflate against my face. I wear the bottom strap as low on the back of my head, just above my neck, as I can get it. I don't know if this will bother your neck or not. Also, it seems to work best for me when the bottom portion of the mask fits just into the little crease between lower lip and chin. When I have placed the lower portion of the mask further down on my chin, that is when the mask slips around a lot. I also push the top strap as far to the back of the top of my head as it will go. The mask then tilts out away from my face ever so slightly on the top. I use a mask liner for comfort but I have not found any difference in the leakage with or without the liner. My experience is that I don't find that the mask pulls my chin closer to my chest at all.