Newbie Needing Help w/ Sleepyhead ?

[FoggyBrain24]

First night back in my bed after a long flight delay, but I think I may have made some significant progress on leaks! I also reduced the VS2 a bunch!

https://imgur.com/a/uTG9u

Last night was my first night with the under the nose Dreamwear while also in my own bed. I also used an Ace bandage as a chin strap, which kept my mouth closed and appears to have fully eliminate the large leaks. The pressure stayed much more consistent, basically between 9-12.5 rather than getting up to 19-20.
VS2 went down a bunch as well.

I've felt pretty good with the brain fog the last few days, I've felt a good amount of energy and my anxiety (usually fatigue driven) has went down a lot, even though I've woken up a fair amount the last few nights. Last night, I believe I woke up once but fell right back asleep.

What do you think??

[TedVPAP]

Your numbers are much better.
I think you should continue to work on decreasing leaking. Not only can it defeat treatment and cause pressure to increase, but it can also disturb your sleeping. I wakeup when I start to leak.

[Pugsy]

Your numbers are improved but more importantly....you are feeling better.

Leaks are a war we never totally ever win. About the best we can hope for is to win more battles than the leaks.

If the leaks don't wake you up...don't worry about them. The machine can compensate for them. You had no large leaks last night. Yeah, not a real pretty leak line but still within the machine's ability to compensate.
Don't cause more sleep issues by trying to perfect that leak line if doing something extra causes discomfort or causes sleep disruption...meaning don't trade poor sleep for a perfect leak line.

Now if they wake you up...they need worked on but because they are disturbing your sleep.
And don't get bummed out if you have a bad leaky night every now and then. It happens to the best of us.

Besides some of that leak line movement is pressure related and not leak related...more pressure causes more vent rate so that top leak line will increase just from the increase in pressure.
APAP mode leak lines on Respironics machine that move around much always look worse than they really are.

[FoggyBrain24]

Hello all,

Thanks again for all the feedback. Based on the last few nights of data, I've done better with large leaks and the vibratory snores, although they are still there and I did have a small large leak last night. I also had a much higher pressure range last night as well, which was the first time in a few nights. I feel like I got a good night sleep last night with actually falling asleep, but a few of the other nights were a little less restful. My brain has felt better for the most part, but I know there is definitely some room to improve. On bad days, I seem to suffer this "fatigued, I cannot think straight" / trapped in my head feelings. Anxiety starts and it feels like I'm unsure whether I will make it through the day without sneaking in a nap. On good days, I feel back to my old self, fitting in the gym, meeting up with friends, always upbeat, and back to being the last person to fall asleep. More than anything, I know sleep apnea has taken a significantly toll on my life. I've felt like I was walking around in a fog for the better part of 2-4 years, never sure of myself and getting in my own head (due to fatigue, which has led to anxiety for me). I can tell even now in the way I feel, on bad days, I seem to be prone to emotional outbursts and feeling unsure of myself, almost like I am a child. On good days, I feel like I am kind of the world and can do anything. My optimism returns as does my zest for life and wanting to cram as much into each day as I can. I'm hopeful that these "bad days" will become a thing of the last with consistent treatment.

Last night - I slept with the Dreamwear under the nose mask, as well as chin strap and an eye mask. Not as bad as I thought, although the chin strap wasn't as tight as the ace bandage I had been using. I felt pretty comfortable. Since it was the weekend, I did not feel like I was in a rush to fall asleep and I could relax with a movie and fall asleep when the time came. I did feel like I woke up sometime earlier this AM and I sort of "refused" to remove my eye mask or look at the time. This led to my waking up @ 9 AM to an alarm.

My mouth wasn't as dry as usual, but the water chamber was completely empty, which doesn't happen often in my own bed, but I do think 9+ hours may be part of that.

https://imgur.com/a/uTG9u

[Pugsy]

My mouth wasn't as dry as usual, but the water chamber was completely empty, which doesn't happen often in my own bed, but I do think 9+ hours may be part of that.

https://imgur.com/a/uTG9u

For you a decent report. You know I still don't like the VS2 snores but I don't know what to do about them...they don't respond to more pressure.

More importantly you are having some good days... it's better than not having them.
Your report still isn't real pretty but it's a lot better than it has been. We can take not so pretty if you are sleeping and feeling decent.

The water chamber being empty.
Water consumption is tied to several things.
1...obviously the humidity setting
2...the ambient humidity in the bedroom
3...pressures used..more pressure uses more water
4...Leaks...large leaks will cause more water to be used because the machine tries to fix the leak with more flow
5...finally hours of sleep...With the right combination of all the above you will run out of water sooner.

I often will use up all the water with 8 hours of sleep and the next night use up half the water with same hours of sleep.
Ambient humidity does it for me...if it rains or humidity is really high the machine won't need to use much water but if the air is drier the machine has to use all the water to give me my desired humidity.

[FoggyBrain24]

If I can eliminate the large leaks and keep the vs2's to 8-10 and under, what else about the report jumps out at you?

I think the only large leak last night came from knocking the mask off a bit and I stayed asleep, so I think it worked itself out.

As far as the water, I agree, I think it has to do with my room temp. I have a small bedroom, and most nights, I will turn on the AC 30-60 minutes before going in to go to bed. Last night, I turned it on as I went into my room. I can always play around with that.

Any other suggestions?

[Pugsy]

Leaks are a war we never totally win. Sometimes I get to claim the battle and sometimes the leak claims the battle.
As long as they don't wake me up I don't spend a lot of time worrying about leaks unless they are really, really bad and last a really, really long time and are happening every night.

The VS2 snores...I already explained that they bug me but I don't know what to do about them.

Otherwise...when it comes to numbers and reports the main question I always ask anyone is how is the sleep and how do you feel?
The prettiest reports and best numbers in the world don't mean a damn thing if we aren't sleeping well and feel like crap.

I get some really ugly reports sometimes...like one night about a month ago I had an AHI of 10.2...go figure that one.
I slept great and felt great (or about as great as I normally feel...remember I have other issues that mess with how I feel that are unrelated to sleep apnea) so I just shrug my shoulders and move on. I don't expend any energy worrying about last night's results when they are the rarity. Can't fix last night anyway once it is last night.

[TedVPAP]

Your leak rate tracks with pressure. So as the machine is changing pressure, your leak rate changes as does the noise. That would really bother me.
Have you ever tried a nasal pillow mask? Unlike all the other mask type, they are "positive seal". My leak rate is essentially zero, and due to mouth leaking.
For example:

[FoggyBrain24]

Thanks Pugsy. I feel like I am making positive adjustments each day. I have been sleeping pretty well, falling asleep quickly, but I have been waking up early most days.

https://imgur.com/a/uTG9u

TedVPAP - I have not tried a nasal pillow mask, but am using the Dreamwear Under the Nose Mask, which seems relatively close. I have been using a chinstrap the last few nights, which seems to have cut the leaks a great deal, but nothing like your chart. Do you think I should push my DME to try a nasal pillow? I think I will need the chin strap or other apparatus for a bit, but hopefully, that will not be needed once I do adjust to it.

Any other advice?

[TedVPAP]

Thanks Pugsy. I feel like I am making positive adjustments each day. I have been sleeping pretty well, falling asleep quickly, but I have been waking up early most days.

https://imgur.com/a/uTG9u

TedVPAP - I have not tried a nasal pillow mask, but am using the Dreamwear Under the Nose Mask, which seems relatively close. I have been using a chinstrap the last few nights, which seems to have cut the leaks a great deal, but nothing like your chart. Do you think I should push my DME to try a nasal pillow? I think I will need the chin strap or other apparatus for a bit, but hopefully, that will not be needed once I do adjust to it.

Any other advice?

I can't tell whether your leaking is from the mask seal or your mouth. Since you said the chin strap is helping, then you must have some amount of mouth leaking. My suggestion is that you try to eliminate mouth leaking by taping (with a chin strap) so that you can conclude how well the mask is sealing. If the mask seals well, then you need to explore options for mouth leakers (FFM, taping, Ultimate Chin Strap). If it is the mask leaking, then try pillows as they are positive seal.

At some point you should try raising your minimum pressure to see if it helps your AHI but I would not attempt that until your leaking is better controlled.

[Pugsy]

The only way to know for 100% sure if a leak is mouth breathing or mask movement is to tape the mouth and see if that fixes the leak or not.

See this large leak in my report below...this is with the DreamWear Gel pillows...and it's all mask movement because I taped my mouth and the tape was in place the next morning.

It's impossible to know for sure if we are mouth breathing or not unless you fix up something to totally eliminate the chance of it being mouth breathing leak and the only way to for sure do that is taping the lips.
Now if a chin strap happens to work and the leaks reduce...you may have your answer but if you wear a chin strap there's no guarantee that leaks seen aren't mask movement.

[FoggyBrain24]

OK, so next step is to tape my mouth? What type of tape and just across your lips?
I looked @ the Ultimate Chin Strap, seems to basically be a surgeon mask fixed with a normal chin strap. I could also use the ace bandage to wrap around my mouth as well.

I don't believe it's the mask that's leaking @ this point, but will see how this helps.

[Pugsy]

What type of tape and just across your lips?

Yes...horizontally just across the lips.
Use whatever tape you have handy that will stick.
You are only going to be doing it for 1 night right now...it's just an experiment to make sure the leaks you see aren't mask movement leaks.

If your mouth is taped and leaks are still ugly..mask movement
If your mouth is taped and the leaks don't happen...then what you are seeing now is likely mouth leaking.
FWIW...if the leaks (no matter what the cause) don't wake you up (even if mouth breathing) and you are sleeping through the leaks, feeling better and sleeping better...I don't worry about some brief random large leaks. Mine are rarely ever very "pretty"....and I often hit large leak territory but just briefly and I sleep through it so I don't care.

I used blue painters tape because I had it handy left over from a paint job.

[FoggyBrain24]

Tried out the tape last night, used painter's tape, which didn't have a ton of adhesive. Woke up with the tape barely stuck to my shoulder. I recall it stayed on for the first part of the night (I had the machine on while laying down and watching TV). Not really sure if I should feel 100% confident in that test but if anything, it does indicate I am still mouth breathing a little (unless it came off just from opening my mouth once). I do have a beard, so not sure I can tape with duct tape or something stronger, but I can try.

Still using the chin strap, which isn't nearly as restrictive as when I was using the ace bandage. Thinking I may have wanted a smaller size, but it was one size fits all. I woke up without dry mouth, but not sure how true a test that is.

AHI seems good. Pressure seems to level off a bit, sticking between 9-13. That seems to be usually be a good sign for me sleeping more soundly.
Leak % and VS2 seem to be the 2 issues that remain. My thought is to try to use another form of tape and test out again tonight.

I could also use the ace bandage again and see if the leak percentage chains again (based on snugness as that seems to keep my mouth closed).

My other option would be to try to swap out the under the nose mask for the full face, although to be honest, I think the under the nose has been better than the Wisp mask I was using.

https://imgur.com/a/uTG9u

[Julie]

You could also try 3M micropore tape from a pharmacy... many use that.