Edit again- Sleep doctor visit

[raisedfist]

In S mode there is no easy breath

There is easybreathe. You can see it enabled on her settings. I've used it before as well in S mode. It's just not automatic enabled/the only option like the VAuto. Kind of weird but oh well.

[Pugsy]

Rise time isn't available if EasyBreathe is turned on.
If you turn off EasyBreathe then rise time becomes available to change.

[palerider]

In S mode there is no easy breath[e]

It's optional in S mode, but always on in VAuto mode.

[Attagirl70]

I start adjusting the mask as it ramps up. DME guy said to do it that way. Should have known that wasn’t correct. I will try adjusting at full pressure tonight and see how it goes. I was only offered two FF masks to even try (both ResMed) which were not the prescribed ones.

I am a huge mouth breather and always have been so I’m not sure about a nasal mask. I have been looking at the Amara full view face mask but not sure it will work with my crazy pressure at this point. It says it’s only rated to 20.

I have lost 10 pounds since my in clinic study was done so hopefully as I keep losing weight that will help lower my pressure.

Thank you all again.

[raisedfist]

The Simplus and the F20 are probably the best masks for high pressures in terms of ability to seal and be reasonably comfortable. We are all different though and some people have "the mask" while for someone else it doesn't work at all. At least with our host most masks have 30 day free return insurance. A bit of a pain but better than the alternative.

But yeah I mean I would fit the mask at the actual pressures you will be using for 98% of the night.

See if that helps, and then consider getting some advice on how to set up the VAuto mode to see if we can improve the comfort but keep the efficacy.

[Attagirl70]

I am attaching my in-clinic study results. Putting the mask on at full pressure didn’t work last night. I did try a much shorter ramp time at 5 minutes and once fully pressurized then adjusted the mask. Had a pretty good seal to start but it eventually blew its cork after a couple of hours and I was up trying to reseal it. I finally gave up about 4 this morning and got up.

[Attagirl70]

When trying to adjust the mask at full pressure, my ears kept popping (very annoying) and I am pretty sure I swallowed about 5 gallons of air (can you measure air in gallons? lol). This morning when I woke up at 4, I stayed up until about 7 and then tried yet again getting some sleep. After 3 hours, I woke up with a severely sore nose and strap marks that felt like they were 2 inches cut into my cheeks. Obviously, I had the mask way too tight but it did have a decent seal, only blowing and passing gas by the right side of my nose making my cheek vibrate each time (pretty sure that's what woke me up). Anyway, after getting out of bed, I felt very odd, like I was in a daze and my stomach was upset to the point I had to vomit after which made it feel a little better. My question is, could this be caused by having the mask too tight and then swallowing air like I did last night?

Good news, my padacheek order came today (a day early!) so I'm excited to try the mask liner and cushions tonight to see if they help with my ongoing mask issues.

[palerider]

blew its cork

I think the padacheek mask liner will make a huge difference for you!

[Pugsy]

Swallowing a lot of air can cause stomach distress.
I haven't had aerophagia issues very much but when I did I was extremely nauseated all day long.

[Attagirl70]

blew its cork

I think the padacheek mask liner will make a huge difference for you!

Unfortunately, it didn't. I put the liner on and it just would not seal around my nose no matter what I tried.

The two worst spots for the mask to leak are on the right side of my nose toward the bottom part of my nose. If I can manage to get the leaking stopped from going into my eyes, then the mask breaks the seal on the bottom left side below the corner of my mouth to the chin crease about halfway across my mouth width. I hope that makes sense!? If I open my mouth as wide as I can that will usually seal the bottom but then the eye area will start leaking again and I really don't want to sleep with my mouth that wide open all night. LOL

I feel like it's a never ending cycle. I can't keep buying things to try no matter how much I would like to, I just can't afford it.

I managed about an hour of sleep and three more trying to re-adjust that blasted mask. I turned my pressure down from 24/20 to 23/19,I know not enough to make a difference, but I was getting beyond frustrated. I was too scared to go lower than that.

@pugsy - I feel much better this morning, so I'm pretty sure it was all the air I swallowed the night before that caused me to feel sick to my stomach most of the day yesterday.

I'm not sure what else to do at this point.

[Pugsy]

If it were me I would change to much lower pressures and probably use auto mode and work on getting the mask to seal so I could at least get some sleep with the mask and machine.

Right now you may need 24/20 but it's doing you no good at this rate what with being new to therapy and fighting all the leaks.

It's a challenge to maintain a seal at the pressures you need. It can be done but it takes a lot of fiddling and experience and patience.

I would change to auto mode and start with a pressure that is more leak friendly and easier to manage and see what happens at a lower pressure.
Let the machine go higher if it needs to. Maybe it won't need to go quite so high for the bulk of the night.

Up to you but that's what I would do. You aren't getting enough sleep as it is.
Even if you used less pressure and it was maybe not quite optimal...some therapy is better than no therapy or no sleep.

[Attagirl70]

Thanks pugsy for all your help! In your opinion, what do you think would be a good pressure to start with on auto mode? The bridge of my nose can't take much more of this high pressure. It's pretty much raw from the mask being too tight. I tried using a band-aid over it but of course that wouldn't let the mask seal.

How accurate is that ResMed My Air? I have been looking at the results of that each morning and looking at the SD card every few days.

I am willing to try just about anything to get that crazy mask to seal and get some decent sleep.

[Pugsy]

MyAir just shows pretty much what the machine is going to show on the LCD screen and the software of course shows what the machine is recording. They are all accurate in what they show.
The only real monkey wrench in things is the chance of false positive awake events getting flagged because the machine only measures air flow and doesn't know if we are asleep or not.
Plus if someone is having REALLY big large leaks for a prolonged period of time the machine might not be able to sense what is happening and in that situation it is possible for some events to happen but not get flagged...but it takes some really big leaks that are prolonged for that to happen.
The information from MyAir or on the LCD screen isn't going to let you see that detailed.

As for going rogue and changing to auto mode and what settings....it's a crap shoot because we don't know if your 20/24 recommended setting was a worse case scenario kind of thing or if you really do need that much pressure all night long.

If it were me I would start with some modest settings that should be able to get you to at least have the masked sealed at the beginning of the night and let you get at least some sleep. I would allow some range but not totally wide range because we know it's going to leak and likely wake you up.
So primary goal is leak free sleep or at least leaks that don't wake you up. Sleep is the primary goal...worry about optimizing the therapy later. Accept that the AHI might be higher than we want because we have limited the pressures a bit but any reduction in AHI from a no cpap AHI and a treated sleep AHI. Even a cut in half AHI is better than a no treatment AHI or a no sleep night.

I know it's not ideal but gotta start with getting you some sort of sleep and then we worry about the other stuff.
It's why I was wanting you to try a nasal mask...yeah, you might do some mouth breathing but probably won't be mouth breathing all night or even if you did..it might not be as bad as what you are going through right now. Not all mouth breathing equals totally worthless therapy pressures. In other words the mouth breathing you might do just might be less of a problem in terms of leaks than you are having now.

So what to start with....I think a nice modest
Auto mode
Minimum EPAP at 12
PS of 4 (like you are using now with the 20/24 settings)
and max IPAP at 20.
It's small range and probably will need to be adjusted but again....sleep and leaks not waking you up is the primary goal.
And hell...might get lucky and be enough for the bulk of the night especially if you only need higher pressures during REM or when on your back.

Some people simply can't manage full face masks for any number of reasons....no mask should cause blisters, skin abrasions, extreme pain even at high pressures. Either it's the wrong size, fitted improperly or simply not the right mask for the person's facial structure.
It's simply not acceptable to have to shrug your shoulders and accept the nose looking like hamburger.....not to mention the infection risk it poses.

[Attagirl70]

Good morning,

I readjusted the settings to what was suggested. I only "remember" waking up once around 5 this morning. I am posting my OSCAR from last night below. I did try the setting earlier in the day. Auto mode is definitely different. I think I am going to decrease my ramp time because I felt like I wasn't getting enough air in the very beginning. I didn't have to have the mask quite as tight last night to keep a seal, but my nose was still just as bad this morning.

Do you think if I can keep this lower pressure, an Amara FF may be better for me?

[Pugsy]

I think you likely could go lower with the pressures if you want to. Maybe minimum EPAP of 10.
Certainly don't need more based on this report anyway.

Did you know that if you want to use the ramp function and the starting point of 4 cm isn't comfortable that you can change that starting point?