RE: High Pressure required

[tltan]

Newbie here. Hope to learn more from the experts here!

I started with the CPAP after a sleep test diagnosing me with AHI of 84 (crazy high).

It has been about a week with my Dreamstation Auto CPAP and Dreamwear FF mask (because I am a mouth breather).

Somehow the auto-titration has been shown that I require almost a max of 20 pressure. Even with that, I am still having AHI between 5-10 nightly.

Hoping to ask a few questions:
(1) Is the high pressure normal? There tend to be some leakages in the morning and I will try to re-adjust it. The noise wakes me up since it is pumping at 20 pressure....
(2) Will all CPAP user eventually reduce their AHI to <5 which is ideal. Was told it should typically be below 2.
(3) I am having some allergy due to the headgear, perhaps due to the tightness around the scalp. The given "wraps" works for the cheek area which I am ok with, so wonder if you face that.

Thanks a lot! Please find attached my Oscar report (if I managed to upload it...)

[Pugsy]

Welcome to the forum.

As you already know your machine goes up to the maximum and pretty much stays there.
I suspect you would do better with a machine that would/could go over 20 cm pressure but there are some things you could maybe try now to see if you can reduce your pressure needs.

If you are spending much time on your back and you can stay on your side....that might reduce the pressure needs.

A soft cervical collar might help reduce the pressure needs a bit...it helps hold the airway open with less chance of collapsing so much.

I doubt that the obstructive stuff you see (OAs and hyponeas) will reduce much with just time unless they are false positive awake flags showing up and once you sleep better less chance of awake false positive flags.
The first cluster of OAs at the beginning of the night...you might have been awake for those...does it normally take you very long to fall asleep?

[tltan]

Thanks a lot Pugsy for the super fast reply!

I did not know there is a machine that goes beyond 20...I am also hoping to stay on my side as it seems to allow me to breathe better (without CPAP) and lesser snoring. However, the Dreamwear FF mask doesn't seem to do well with that....

I will find out more about the soft cervical collar.

Currently, I fall asleep quite fast as I am really short of sleep. With the past week treatment, even with AHI 5-10, I am really feeling better rested and doesn't wake up multiple times a night going to the bathroom! Perhaps could be a placebo effect from spending cash on the CPAP and mask =p but I am loving it so far. Just went straight onto it the first night I got the CPAP.

I am plugged in straight to the machine as the humidity here is in the 90%...is it necessary to use the humidifier (I do have mild dryness of the mouth every morning but nothing as bad as when I was without CPAP).

[Pugsy]

With your ambient humidity rather high the machine probably isn't using much water.
May not really need it but it hurts nothing to keep it there handy for when the ambient humidity isn't maybe so high.
Unless you are sleeping with the windows open the ambient humidity in your bedroom probably isn't that high anyway.

Unless you are having problems with humidity like nasal congestion...I would use the humidifier.
It may not totally relieve the dry mouth but it will help.
The dry mouth is from mouth breathing....and the humidifier can't always add enough moisture to hydrate the oral cavity well.
It was originally designed to help hydrate the nasal cavity which is much smaller.
If you can reduce your mouth breathing that will also help with the dry mouth.

And sometimes dry mouth is from medications...not much you can do about that.

Why a full face mask? Do you have a lot of chronic nasal congestion that forces you to mouth breathe?

The DreamWear Full Face Mask can be used when sleeping on one's side....all masks can.
It just can be more of a challenge but it can be done.

[Pugsy]

Yes, there are machines that will go above 20 cm...some to even 30 cm but those are high end very specialty machines.

What you probably need is just essentially what I call a plain bilevel which means a bilevel that doesn't do the fancy high end stuff (which you don't need anyway) except for the higher than 20 cm option.
Essentially they are like what you are using but with a few more options and the higher pressure being one of them...they will go to 25 cm.
They also offer more exhale relief which can come in very handy when people need the pressures you are needing...more comfortable to exhale with.

[tltan]

Yes, I will try to use the humidifier once I get my hands on distilled water...and Yes, I do sleep with the windows open most days.

I decided to purchase a full face mask knowing I mouth breathe due to the reasons below:
Suffered from Allergic Rhinitis my whole life until last year when I started on the Avamys (fluticasone furoate), it relieves the symptoms (runny nose, sneezing, sensitivity etc) but according to the ENT, the nasal passage was still inflamed (I keep one puff/nostril/day for maintenance as I am not keen to pop zyrtecs daily). Most times, I can only breathe through 1 nostril if I lie on my side (changes when I lie on the other side), which I believe is a deviated septum, but was told otherwise (if I sit upright, I kind of can feel breathing through 1.5 nostrils haha)...so I am not sure what is the condition.

Due to the long years of allergy, I think my body acclimatised to mouth breathing which is not easy to rectify. If I do nose alone, I feel like I am out of breath really fast. Read somewhere that mouth breathers on CPAP tend to register high AHIs and also require higher pressure?

[tltan]

Yes, there are machines that will go above 20 cm...some to even 30 cm but those are high end very specialty machines.

What you probably need is just essentially what I call a plain bilevel which means a bilevel that doesn't do the fancy high end stuff (which you don't need anyway) except for the higher than 20 cm option.
Essentially they are like what you are using but with a few more options and the higher pressure being one of them...they will go to 25 cm.
They also offer more exhale relief which can come in very handy when people need the pressures you are needing...more comfortable to exhale with.

I will probably sit on this first. Just spent money on the Dreamstation & mask. Will see what the ENT advises when I bring in the reports.

Of course, will try side sleeping as well as the most difficult part: lose weight and better sleep hygiene.

[Pugsy]

If you aren't using water right now in the humidifier....you can use tap water or bottled water.
The worse thing that will happen is you might get a little mineral build up in the water chamber but that is easily removed with a little vinegar or lemon juice soak (I mention lemon juice because I personally hate the smell of vinegar and for me no amount of rinsing seems to get rid of it).
It all depends on how hard your tap water is as to how much mineral deposit you might get.

People using full face masks often find that they can use a little less pressure with a nasal mask.
I think it is because of the airway position that full face masks and those lower straps end up doing to the airway....they tend to draw the chin back which narrows the airway a bit and makes it harder to keep it open to prevent apneas from happening...so more pressure is needed.

At some point...I suggest at least trying a nasal mask. I had to just about twist this guy's arm off to get him to try it but read what Perrybucsdad says.
viewtopic/p663440/Mouth-Breathers.html#p663440
he was able to shave off 3 cm on his minimum pressure.

You need more minimum than 4 cm but the machine is increasing quickly and stays up there pretty much all night.
So you are getting more minimum anyway...I doubt that increasing just the minimum will be the solution to your problem but you could try it if you wish. Once it goes up it stays up and it goes up fast...now if you were seeing large variances...more minimum might reduce your AHI.
More minimum pressure would definitely help with any air starved feelings you might get if you tried a nasal interface mask.

So just a thought to put on the back burner...maybe try a nasal mask. You might find that the added moisture helps with the congestion and it might work out. They are definitely easier to get and keep a good seal in any position...simply less surface area to have to touch the skin to seal.
Much easier to side sleep with also.

[tltan]

Thanks Pugsy.

Great suggestions for new CPAP user like myself!

I am actually already planning to purchase the nasal mask in due course since it is adaptable to the Dreamwear FF mask setup as well. Just need to get the right nasal mask as well as the respective headgear. Don't need to twist my arm for that! As I am not based in the States, getting parts are more troublesome..they tend to sell me the entire mask which is costly (way marked up due to Tax) over my end. =(

[tltan]

If you aren't using water right now in the humidifier....you can use tap water or bottled water.
The worse thing that will happen is you might get a little mineral build up in the water chamber but that is easily removed with a little vinegar or lemon juice soak (I mention lemon juice because I personally hate the smell of vinegar and for me no amount of rinsing seems to get rid of it).
It all depends on how hard your tap water is as to how much mineral deposit you might get.

People using full face masks often find that they can use a little less pressure with a nasal mask.
I think it is because of the airway position that full face masks and those lower straps end up doing to the airway....they tend to draw the chin back which narrows the airway a bit and makes it harder to keep it open to prevent apneas from happening...so more pressure is needed.

At some point...I suggest at least trying a nasal mask. I had to just about twist this guy's arm off to get him to try it but read what Perrybucsdad says.
viewtopic/p663440/Mouth-Breathers.html#p663440
he was able to shave off 3 cm on his minimum pressure.

You need more minimum than 4 cm but the machine is increasing quickly and stays up there pretty much all night.
So you are getting more minimum anyway...I doubt that increasing just the minimum will be the solution to your problem but you could try it if you wish. Once it goes up it stays up and it goes up fast...now if you were seeing large variances...more minimum might reduce your AHI.
More minimum pressure would definitely help with any air starved feelings you might get if you tried a nasal interface mask.

So just a thought to put on the back burner...maybe try a nasal mask. You might find that the added moisture helps with the congestion and it might work out. They are definitely easier to get and keep a good seal in any position...simply less surface area to have to touch the skin to seal.
Much easier to side sleep with also.

Oh I forgot to share. My dream station starts at pressure of 11.5 cm the last few days! With 4, I still snore badly.

[Pugsy]

The software is showing a setting of 4 cm for that minimum...that's where I was getting the 4 cm from.
Sometimes the software settings are wrong though.
It's showing min 4 and max of 20.

It's also showing a time over red line for leak that is probably a bit incorrect. I don't see 15% of the night in large leak.
That would be well over an hour in large leak and I count maybe 25 minutes or so.

That's because the software is using a ResMed red line leak threshold and your Respironics machine doesn't use the same red line.
The software defaults to Resmed's 24 L/min red line...and Respironics machines don't have a fixed red line. It varies with the pressure and the mask...but probably up around 80 L/min.
You might just turn that statistic off or set the red line to something closer to what yours is with your pressure.
Preferences/CPAP tab...change the 24 to maybe 80 and that statistic will be a little more accurate.

[Pugsy]

Where are you located?

I might have one of the DreamWear nasal products that you could just have. I don't think I have the headgear though.
I would need to look. I have a big box of stuff that people have donated...gently used and sometimes brand new...they don't want it to go to waste but don't want it in their house anymore.

[babydinosnoreless]

Pugsy talked me into trying the nasal route and it is so much better. The filtered air blowing in my nose, for me, helps to keep the passages open.

[palerider]

Yes, I will try to use the humidifier once I get my hands on distilled water...

In much of the rest of the world, the cpap instructions clearly state "fill humidifier with water", no mention whatsoever of distilled.

[kteague]

If you find you can side sleep even with the 1 side plugged, look up some of the cpap pillows to see how they are cut out on the sides. You could experiment with cutting out a cheap foam pillow and see if it helps keep your mask in place, then decide if it would be a worthwhile purchase. And a firm flat pillow that does not allow your head to sink in might help. Sinking into the pillow is one of the common causes of mask displacement.