This high pressure is sucking my face off and making my mask leaky. Help

[elmerphud]

Hello everyone! During my sleep study, I had continual mask leaks. I am not sure what percentage (like OSCAR and the DreamMapper software give me), but it was clear because the tech tried two mask and kept coming in to adjust mine to try and reduce the leaks. I am wondering if it is possible that my pressures were over titrated because I was not really receiving the pressure anyway. When I went for my appointment with the Nurse Practitioner for my results, she said I stopped breathing 51 times and hour (is this same as AHI?) and that was all the info she gave me. I did not know to ask for breakdown of OSA, hypopnea, clear airway (is that same as central apneas?), or RERAs. They sent me home with EPAP 19 IPAP 23. To vent for a second, they did not explain much to me, and rushed me into selecting the mask.

I am noticing on my 2 days of OSCAR data that although my AHI has reduced to 9.09 first night and 4.99 the second night, 70%+ of my events are clear airway events. From the 4.99 night, 4.04 were clear airway events.
I have 3 masks. The two they tried during my 2 night study and the one they sent me home with when I got my machine. I had a large leak, according to OSCAR, 60% of the time. According to DreamMapper my mask fit for last night was only 36%. I am set on BiFlex 3. The pressure is intense, which also makes it easier for leaks to happen. I also feel like I cannot exhale. I extended my RAMP time to 45 minutes on my second session last night and noticed that I tolerated IPAP below 20 with no leaks and no pressure discomfort. I feel like crap and have not rested well the past two nights. Woke up sleepy. I have learned how to access the Therapy menu on my machine. Considering adding an oximeter to collect more data.

Here are my questions:

1. Should I try to reduce my pressure myself? It seems that my OSAs and hypopneas are really low, but I am having clear airway ones. I have read a couple of research articles on consensus titration protocol standards, and I have watched LankLefty's video on bilevel titrations. My followup apt is 6 weeks away.

2. What is difference between BiLevel and Auto B setting on Mode setting?

3. Any recommendations for masks for such hi pressure? Nurse said nasal only would be too much pressure and not sure if I am mouth breather or not. I have my eye on the AirFit F30. The 3 I have now are F&P Simplus, an F&P Vitera, and a ResMed Mirage Quattro. Should I go back to med equipment co that gave me my first mask, or enter my insurance info with online retailer? They said insurance allowed me to say this one did not work within the first 30 days.

4. Should I shave my goatee to help stop leaks? Oh the horror of the double chin.

5. I noticed water was all gone in my humidifier after just 4ish hours. I refilled it when I went to the bathroom. Humidifier is set to adaptive with a heat level of 5. Should I reduce the level?

6. My med equipment provider said they would use the cell modem in the machine to upload data. I activated the bluetooth too to get in on my phone, even though they said to not activate bluetooth. Can they get the info via modem while bluetooth is enabled? Both show enabled.

I am committed to this treatment and to losing weight, but right now this machine and leaky mask are kicking my arse. I realize it is just day 2, but this sucks. Thanks in advance! Forums rock!

[Okie bipap]

Welcome to the forum. I will try to answer some of your questions. I don't know a lot about your particular machine since I have always used a ResMed machine.

Should I try to reduce my pressure myself?

Most of us here have taken charge of our own treatment and adjust our own pressure. That said, we do not recommend adjusting pressure based on only one or two nights, especially the first few nights. Your brain is trying to learn to cope with that strange thing on yor face while you are sleeping.

Any recommendations for masks for such hi pressure?

Just about any mask can be used with high pressure. It is a little more difficult to get full face masks to seal with high pressure, but it can be done.

Nurse said nasal only would be too much pressure and not sure if I am mouth breather or not.

Many people have used nasal pillows and nasal masks with high pressure.

My med equipment provider said they would use the cell modem in the machine to upload data. I activated the bluetooth too to get in on my phone, even though they said to not activate bluetooth. Can they get the info via modem while bluetooth is enabled? Both show enabled.

The machine will work as designed with both enabled.

[Julie]

Your machine has an exhale pressure relief feature (not sure what it's called on that one) that you can set a level for... see if you can find it to try out tonight at a low level to start with and it should help - you can always raise the level later on. And if you can stand it I'd shave for sure - it can make a difference and others have had trouble (plus double chins can be seen from the sides anyway ).

[elmerphud]

Thanks Okie & Julie! That's a big help.

[Pugsy]

2. What is difference between BiLevel and Auto B setting on Mode setting?

Bilevel....that's a fixed bilevel mode....pressures stay the same with inhale and exhale.
Auto B...that's auto bilevel mode.....pressures can auto adjust within a range depending on setting parameters.

Bilevel means 2 distinct pressures...one for inhale and another one for exhale.

Nurse said nasal only would be too much pressure and not sure if I am mouth breather or not.

Hogwash...people use nasal pillows or nasal cushion masks all the time with pressures exceeding 20 cm all night long without any problems and in fact since they typically have less surface area touching the skin they are often easier to keep sealed at the higher pressures.

And you don't have to go shaving immediately....there are people using all sorts of masks including full face masks with big full beards and they can get them sealed. Yes, there are going to be issues but being clean shaven doesn't mean people don't have issues either.

BiFlex at 3...that's the exhale relief setting. 3 is as high as it will go.

Go here and request the clinical manual for your machine....sounds like you have the DreamStation BiPap Auto.
https://www.apneaboard.com/adjust-cpap- ... tup-manual
It's going to contain more information than the user manual.
Read it and then come back with any questions that you have that might need clarification.

Should I try to reduce my pressure myself? It seems that my OSAs and hypopneas are really low, but I am having clear airway ones.

If you do reduce the pressure then some OAs and hyponeas might pop up....so just be aware of that. I can't advise changing anything without seeing some reports and I wouldn't go doing much of anything with only 2 nights of crappy sleep data to look at.

You probably aren't sleeping well at all....is that correct?

[palerider]

I am wondering if it is possible that my pressures were over titrated because I was not really receiving the pressure anyway.

Doubtful that would have had anything to do with it.

When I went for my appointment with the Nurse Practitioner for my results, she said I stopped breathing 51 times and hour (is this same as AHI?)

It's part of the AHI, the A part.

clear airway (is that same as central apneas?),

'clear airway' is a term made up by Philips Respironics because for some unknown reason, they didn't want to say 'central' like everybody else does.

1. Should I try to reduce my pressure myself? It seems that my OSAs and hypopneas are really low, but I am having clear airway ones. I have read a couple of research articles on consensus titration protocol standards, and I have watched LankLefty's video on bilevel titrations. My followup apt is 6 weeks away.

No, your centrals aren't high enough to worry about.

2. What is difference between BiLevel and Auto B setting on Mode setting?

One's not auto, the other is.

3. Any recommendations for masks for such hi pressure? Nurse said nasal only would be too much pressure and not sure if I am mouth breather or not. I have my eye on the AirFit F30. The 3 I have now are F&P Simplus, an F&P Vitera, and a ResMed Mirage Quattro. Should I go back to med equipment co that gave me my first mask, or enter my insurance info with online retailer? They said insurance allowed me to say this one did not work within the first 30 days.

The smaller the mask, the less force is required to keep it attached to your face... something that DMEs don't seem to understand.

4. Should I shave my goatee to help stop leaks? Oh the horror of the double chin.

If you're using a full face mask, probably.

5. I noticed water was all gone in my humidifier after just 4ish hours. I refilled it when I went to the bathroom. Humidifier is set to adaptive with a heat level of 5. Should I reduce the level?

If you've got a lot of leaking, which it sounds like you do, you'll burn through a lot of water.

I'm still confused at how pressure can suck your face off.

[chunkyfrog]

Bluetooth?

[palerider]

Bluetooth?

There's a bluetooth module you can add to the dreamstations.

[Miss Emerita]

Welcome! Can you download Oscar and post a chart? That would help the experts advise you about your pressure settings.

[jimbud]

Nurse said nasal only would be too much pressure and not sure if I am mouth breather or not.

Hogwash...people use nasal pillows or nasal cushion masks all the time with pressures exceeding 20 cm all night long without any problems and in fact since they typically have less surface area touching the skin they are often easier to keep sealed at the higher pressures.

Hogwash! And Hogwash again! I do not have a bilevel, but I do have a full beard and have been able to get an acceptable seal and acceptable leak rate with every mask I have tried (with my machine).
Pillow masks and full face masks. You just have to creative sometimes. And really want to keep the beard.

Of course everyone is different and your experience may differ.

JPB

[elmerphud]

sleeping well at all....is that correct?

Yes, that is correct. I am still sleepy even after being in bed for 7-8 hours.

[elmerphud]

I'm still confused at how pressure can suck your face off.

Okay, maybe a little hyperbolic. However, it does feel like my eyes are about to pop out because of the pressure behind them in my sinus cavity(?).

[Pugsy]

Well...negative pressure can suck out but positive pressure doesn't suck out. CPAP is positive pressure...so it can't suck out.

But cpap in general does take some time for the body to adjust and perhaps even a lot more so when using pressures that you are using.

Being in bed doesn't always mean we have actually slept well. We might wake often for any number of reasons and this is especially true when first starting this cpap therapy. It's just not normal and feels weird and the body will wake up often just because of the weirdness of it all.
So lots of wake ups during 8 hours is going to mean we don't feel so great despite the 8 hours because it wasn't good quality sound sleep.

It's only been a couple of nights...give yourself some time.
It took me probably 3 months for my brain to quit waking me up a dozen times a night just to tell me that something weird was stuck on my face.

Use the mask and machine while awake and under no pressure to be asleep so the brain can get used to its new best friend.

[elmerphud]

It's only been a couple of nights...give yourself some time.

Use the mask and machine while awake and under no pressure to be asleep so the brain can get used to its new best friend.

Thanks Pugsy! Great advice!

[elmerphud]

Good news is I got my large leak rate (according to Oscar) down to 26% (60% previous night)! Thanks to everyone for your help. I will keep this updated. You all have kept me from losing my mind these first few days. I think I am going back to my DME tomorrow and try either a mouth with nasal pillow mask or a nasal pillow only mask. Ideally, I would like to bring home both for a week and see which is best. I know I am supposed to take my machine in with me, so maybe they will let me try them out in their "store."

And yes my machine has the bluetooth module and I am using Oscar with the memory card. I'll post some Oscar data when I have settled on a mask for a few days.