noobie first post

[NoseKnows]

Lurking noobie’s first post – and report.

I'm not really posting for advice, since it's easy to find threads on every question or problem I've ever had.

Really this post says thanks to all of you for your hard work and dedication.

Also, thanks to jedimark and his team, without SleepyHead I would have been flying blind. Or sleeping blind? For those not familiar with open source software, but sure to contribute to his project if you are using SleepyHead and enjoying it. I've actually saved money, you can spend 50 bucks pretty easy on little things that aren't going to work.

I’m also willing to contribute to forum upkeep – but I don’t see an obvious link to do that.

On to the report. I tried to keep it simple but this isn't simple. So first I’ll lay down my immediate problems and then comes the novella, for those of you having trouble sleeping.

Immediate:

The current big problem is, I've got to reach at least 15cm. With all your help, I can do OK at 11cm pressure, but that isn't effective.

I’m a mouth breather so I need a full face or hybrid mask. The strap pressure required for a seal at 15cm collapses the silicon cushion on the ResMed AirFit 10. And my long narrow face doesn't match the contour of the hard plastic mask shape. I had a similar problem with the Respironics Amara View hybrid mask, it also bottomed out before I got a good seal.

So I'm going to try fabricating my own seal with harder foam. Wish me luck.

As a side-note there's the heartbreak of aerophagia. But hey, I’m a guy, sleep farting is in my nature. But at 15cm it wakes me up sometimes.

Novella:

I’ve known for many years that I would snore myself awake when sleeping on my back. So I always slept on my stomach and sides. Maybe 10 years ago, shoulder problems made side sleeping painful, so that left stomach only. Then mid-2016 due to neck problems my orthopedist said no more stomach sleeping.

Having no choice, I started sleeping on my back again. After a few nights I dreamt a ghost was attacking my chest, stopping my breathing. This went on for a while. When I woke up what do you know, I wasn’t breathing. Pretty scary.

I scheduled a split sleep study/CPAP titration. Pricey but I'd already hit my out-of-pocket maximum. It was suddenly free like all the rest of my doctoring end of last year. During the study I purposely slept on my back, and the result was 40 events/hour with my lowest oxygenation at 83%.

The tech got me up to 11cm with a nose mask, at which point I woke up blowing raspberries. I got a prescription for 11cm and they gave me a ResMed AirSense 10 AutoSet with humidifier and the ClimateLineAir heated hose. I asked the DME for a full-face mask and they gave me the AirFit F10. Pretty good rig, I think.

The AirSense has an Expiration Pressure Relief (EPR) mode, and it was initially set up for 11cm inhale; 8cm exhale – and a ramp-up time of 45min. I found the EPR mode to be annoying, if felt like someone was breathing for me. The ramp only helps at first and I always wake up and then what? So I set it to a pressure and go for it.

Well, that was almost 3 months ago. My first night I torqued the straps down for fear of leakage and woke up with bruises and open wounds. Some of you know how that is. The DME has been good and they sent me the AirFit P10 nasal pillows and a chin strap. The seal is great and I found it comfortable (with Lanolin and Pad-a-Cheek), but I couldn't strap my mouth closed. I tried mouth taping, but my cheeks would blow up with puffer fish syndrome.

I also tried the Phillips Respironics Amara View but with my long narrow face couldn’t get it to seal.

Meanwhile, my face healed up, and I found a thread saying you eventually toughen up enough to use the full-face mask. It’s true, then I got a Pad-a-Cheek liner and that really did the trick. Well, it was livable at 11cm.

As far as treatment though, not so good. On one night at 11cm, SleepyHead showed 45 minutes of obstructive hell, culminating in a full minute without a breath. That time I was in an airline baggage compartment, the door popped open, all the bags were flying out around me, and there was no air to breathe. For a long time.

I learned the two-finger salute for clinician mode and pushed myself up to 12cm with no better results. By this time, I was close to my specialist appointment so I decided to wait before going further.

I kind of gave up and tried sleeping on my side again. My orthopedist said my shoulders were better and he saw no physical reason that I couldn’t. It’s still uncomfortable so I wake up after an hour and roll over, but no apnea events and the dreams are more pleasant. Still, that's not going to get me through the full sleep cycle that we all need. Plus I sometimes stop the roll before reaching the other side, fall asleep on my back, and then those dreams ...

Finally, I had my appointment with the specialist, and she was impressed. She said to step it up to 15cm and see how it goes. I like her, she said that CPAP forum users were more qualified to advise on mask fit and general CPAP use than she would ever be. So here I am.

She also sent me to an Ear Nose and Throat specialist who specializes in sleep problems. We talked about surgery for a deviated septum, or dental appliance, but he didn't think they would be effective for my apnea. My airway is just too narrow. He though better hydration would open my nasal passages and maybe help with the mouth breathing. That's done with a big bottle of salt water inserted in one nostril and draining out the other. Switch nostrils and repeat. Pleasant. But us CPAP'ers have to tolerate much worse than that, eh? I think it helps a little, and my nose is more comfortable.

Now, the real trouble begins. I could keep a seal on the F10 up to 13cm by increasing strap pressure. But past there it became painful. At 14cm I was seeing some results. But when I tried 15 cm I couldn't sleep at all.

One side-effect of 15cm - with more air pumping through the humidifier gets low after a few hours. Might be a problem once I can take it all night.

I think I'll work on the seal next. My theory is that the silicon bottoms out under the required strap pressure. And that exposes the hard plastic mask contour to my face contour. I might try to fabricate a new seal with a stiffer closed cell foam (e.g. ethafoam). I can cover it with the Pad-a-Cheek so it stays in place. Wish me luck.

Well that's all for now, sleep tight everyone.

[OkyDoky]

I'm not really posting for advice, since it's easy to find threads on every question or problem I've ever had.

That's how I started also. There's lots of info especially at the top of the page.

I’m also willing to contribute to forum upkeep – but I don’t see an obvious link to do that.

The forum is provided for us by CPAP.com so you can contribute by looking for them when you need supplies.

[ChicagoGranny]

The strap pressure required for a seal at 15cm

It's not necessary to use a high strap pressure to get a good seal. The FFMs available today are designed to be used with a low strap pressure. For the mask you are using, search youtube for instructional videos on fitting and adjusting.

Here are some tips on getting a good seal:

To reduce unintentional mask leak -

- Make sure the mask is fitted properly. (See mask manufacturer's video.)

- Make sure the headgear is adjusted properly (See mask manufacturer's video.)

- If you use a low ramp pressure or a low minimum pressure, you should fit and adjust your mask at the higher pressures it is operating at for most of the night. You would temporarily change the machine pressure settings while you do the fitting and adjusting. It's best to do this well before bedtime before you are tired and ready for sleep. Don't forget to change your settings back to the ones you prefer.

- Make sure to use good hose management - the hose should not pull on the mask. Notice how your hose is positioned between machine and mask. It should be positioned to minimize any pull on the mask. Hose management is an individual practice. How it is done depends on the mask, the position of the machine, your sleeping position and other factors specific to the individual.

- If you still have problems, learn from the forum what mask liners are available.

- If your mask still has excessive leak, try other masks. Many people report trying several masks before they find one that works well for them.

Note: Links to just some of the mask manufacturers' instructional videos can be found on the forum host's website - https://www.cpap.com/cpap-masks.php and https://www.youtube.com/

- CG

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I’m a mouth breather so I need a full face or hybrid mask.

I had a problem with my mouth opening at times when I first started using CPAP, and I also had very high pressure requirements (As high as 18 - 20 cm.) during REM sleep. The solution I eventually found was wearing a 4-inch firm foam collar. The collar does two things for me. First, it keeps my mouth closed most, if not all, of the night. Second, it keeps my neck/airway in the best position for airway patency - it keeps the chin up and away from the chest.

Not only does the collar keep my mouth closed and prevent dry mouth, it also made a large reduction in my pressure requirements.

Here is information on the collar that I prefer:

I like the DMI Universal Firm Foam Cervical Collars -
http://www.walmart.com/search/?query=DM ... %20Collars

The firm works better and lasts longer than the soft. There seems to be no loss in comfort with the firm over the soft.

The cells in the foam break down over time. One lasts me about four months.

Typically the 3-inch width fits a smaller person, and the 3.5-inch or 4.0-inch fits a larger person. Some may need to change the size up or down on the second order. The larger size you can wear, the more support to keep the jaw from dropping. Although I am a small person, the 4.0-inch collar works best for me.

Walmart ships free to your closest store for customer pickup.

- CG

Note: I continue to use a FFM (Innomed Hybrid) because my mouth will occasionally open during REM sleep.

[Guest]

Immediate:

The current big problem is, I've got to reach at least 15cm. With all your help, I can do OK at 11cm pressure, but that isn't effective.

I’m a mouth breather so I need a full face or hybrid mask. The strap pressure required for a seal at 15cm collapses the silicon cushion on the ResMed AirFit 10. And my long narrow face doesn't match the contour of the hard plastic mask shape. I had a similar problem with the Respironics Amara View hybrid mask, it also bottomed out before I got a good seal.

The seal is designed to be inflated with air to mold to the contour of the face. If you are compressing the seal then that is likely the problem as it will cause leaks. Straps too tight will cause leaks.

You see when using an auto cpap and the pressure increases this puts more stress on the straps stretching them.

Before bedtime set the cpap to a higher pressure than you expect to use.
Lay down and adjust straps while in your sleeping position with the cpap ON at your max pressure.
Adj straps so that all leaks just stop. You should have enuff room between the straps and your face to slip in two fingers. Check several areas.

[NoseKnows]

Thanks all, that was helpful.

Looking back, I had OK seals at 11cm, but probably had the straps overtightened a bit. Then I panic'ed in anticipation of it getting worse at 15cm so really overtightened them.

I backed off the straps and it was good last night. I had some large leaks when sleeping on my side but that's OK from an apnea point of view.

As it turns out, I have a cervical collar that I tried with the nasal pillows so I used it with the full face last night. I think it helped but it's too small so I'll get a 4" and see how that does.

I also think the yukky nasal washing has helped unplug my nose and reduced the urge to mouth breath. These New England winters are tough.

I managed 2 hours sleep on my back, with only one hypopnea event - vs 40 events/hour, mostly obstructive. I couldn't get back to sleep on my back so flopped between sides and got a few more hours.

So that's much better and I'm very encouraged. I think I let the 4cm increase in pressure psych me out, 15cm isn't all that bad.

Two hours isn't a night's sleep, so I've still got a few things to work on. But I've never slept 10 minutes on my back without obstruction so this is a real milestone for me.

Looking back at my first post I did need some advice, eh? Thanks again.

[ChicagoGranny]

a real milestone for me

Glad to hear you are getting on the right track. For many people, learning to CPAP and getting everything set up properly is not so easy. I had bad problems at first, but Gramps was practically an expert from papping for 15 years, and he helped me in the early days.

I think it helped but it's too small so I'll get a 4" and see how that does.

I recommend "firm". I used soft foam 3.5-inch for several years, and it was a good help. But when I switched to firm foam 4-inch, the therapy became much easier, and my mouth stays closed the entire night most nights. Occasionally, my mouth will open for a short time - probably during REM sleep. For this reason, I continue to use a FFM.

[NoseKnows]

OK, second night was longer, 6 hours. There was only one 15 minute stretch with 5 obstructive events. But they were shallow breathing vs the total obstruction I've had before. I think that qualifies as treatment . Once I get a better cervical collar, I might do even better.

Now I've got a new problem, air leak through a tear duct. Of course there's a thread on that. I'll dig myself out of the snow and hit the drugstore.

viewtopic.php?f=1&t=88362&st=0&sk=t&sd= ... =tear+duct

[SoCal Guy]

"SleepyHead showed 45 minutes of obstructive hell, culminating in a full minute without a breath."

I'm new as well. I just downloaded Sleepyhead, pretty cool. But I really want to know the length of my longest breathing stoppage. Your post indicates Sleepyhead tells us that?

Does Sleepyhead tell us how long we've stopped breathing? Where do I find that figure?

Thanx!

[OkyDoky]

Does Sleepyhead tell us how long we've stopped breathing? Where do I find that figure?

Thanx!

The Flow Rate graph is your breathing. You can left click on an event and it will zoom into the event then you can see the time below the graph. You can zoom back out by right clicking.

[Okie bipap]

If you click on the events tab, it will give you the ability to see every event and the length of the event.

[OkyDoky]

If you click on the events tab, it will give you the ability to see every event and the length of the event.

Yes and this may be the easier way to see individual events. The events tab is above the AHI bar. You can also click on the colored bars on the left. When you see the individual events listed, if you click on an event it will take you to it on the graphs on the right.

[SoCal Guy]

Thanks to eveyone for tellin me how to read SH regarding how long I stopped breathing.

Flow rate, that's the one I want to focus on to see how long I stopped breathing, right?
I see "clear 10" "obstructive 19" does that mean i stopped bretahing for 10 seconds and 19 seconds respectively?

How do I post my SH data?
I tried a screen shot, then saved it to a word doc. If I could post mine then I could quickly learn how to read it, with your help;)

Thanx again!!!

[OkyDoky]

This User's guide might help you. http://sleepyhead.sourceforge.net/wiki/ ... sers_Guide

To post data this site will help. Please organize your graphs because some are more helpful than others, This link has 3 pages that will tell you how to organize, take a screen shot, and post using Imgur. There are 3 pages so please click on the link at the bottom to go to the next page. https://sleep.tnet.com/resources/sleepyhead/shorganize

The number, when you click on the events on the left,in (#) is an approximation of the time. Most of the time it is very close. You can see the actual time line on the zoomed in Flow Rate graph on the right.

[ChicagoGranny]

post my SH data

It's a good idea to post it in this thread - viewtopic.php?f=1&t=114994&st=0&sk=t&sd=a

This will allow those advising you to see your history.

[Uncle_Bob]

Lurking noobie’s first post – and report.

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