New User, Looking for Input / Direction

[luciferin]

Hello everyone! I'm new here, I've been reading through a lot for the past few weeks to try to determine what adjustments I should make to my therapy, and AHI seems to be trending down day after day. There are oddball nights where I just sleep terribly, but so far none have been as bad as what I experienced before treatment. I look forward to sleeping more than I have in years. With that said, I'm posting with the hope of gettin some help and direction on my treatment, and where I should focus my adjustments if any are needed.
I was diagnosed about a month ago from WatchPAT with AHI ~10 when I'm on my sides and back, and oxygen de-saturation hitting a minimum of 82. I was under 2 AHI on my stomach, but that was a good night for me. No morning headache, decent energy when I woke up, so I figured despite it being mild, I should have it treated. I bought the ResMed 10 Auto and the n30i mask. I took to the n30i right away, wearing it for 2 hours before going to sleep, then making it the whole night with the mask on. But, from day 1 I've been getting high leaks reported for a large portion of the night. I tried the AirTouch F20, but I have a full beard so the mask fit test failed. I have an AirFit F20 that I tried for an hour or two, but it woke me up so much I went back to the n30i. I'm going to try the full mask for an hour or two before going to sleep tonight to see if I can get used to it, with the thinking it will help my leak rate significantly.

I'm not sure if this is the preferred way to share information or not. If screenshots of OSCAR are preferred feel free to comments that and I'll get them uploaded somewhere. If specific data from SleepHQ would be more helpful let me know that.
SleepHQ Links
Range chart set
Dashboard 8/29/22
Dashboard 8/28/22
Dashboard 8/27/22

Should I focus any energy I have on trying different masks to see if I can reduce leak that way? Should I stick with the mask I find comfortable (n30i) and try chin straps/cervical collar/pillows instead or try to reduce mouth leak? Should any adjustments be made to pressure to see if it's ideal for me? Any pressure over 12 seems to wake me up pretty quickly, which is why I had lowered the max pressure to 12, but I raised it last night figuring maybe it's better if I wake up instead of experiencing potential oxygen de-saturation. I'm worried I am getting lost in the weeds a little bit, but convinced myself I'm 'dialing in' my therapy.

[ozij]

The only dashboard share that worked is this for the 29th. Looks like the others are not public.

It looks like some of the leaks are waking you up - see how the stop abruptly and your regular breathing changes.

[luciferin]

Sorry about that, I fixed the broken links in my original comment.

Thank you, I totally see what you mean now on the charts. I think they're 'small' mouth leaks, it must be waking me just a little because I only remember one or two a night at most. I tried taping with some 'surgical tape' but did not see a change in the numbers, so I gave up after a couple of nights.

[Pugsy]

tried taping with some 'surgical tape' but did not see a change in the numbers, so I gave up after a couple of nights.

Which numbers? Leaks numbers or something else?

When we tape our mouths and the tape doesn't come loose and is still stuck in the morning and we still see leak numbers higher than we want then that only leaves mask movement as the culprit.

We can have both mouth opening leaks and mask movement leaks...or one or the other.

[ozij]

You may be taken out of sleep by those leaks, without remembering that you woke up. Those "unremembered awakenings" are called arousals - and they may have an impact on how refreshed you feel, not on the AHI.

[luciferin]

Which numbers? Leaks numbers or something else?

When we tape our mouths and the tape doesn't come loose and is still stuck in the morning and we still see leak numbers higher than we want then that only leaves mask movement as the culprit.

We can have both mouth opening leaks and mask movement leaks...or one or the other.

The leak numbers specifically. Every time I've taped the tape has at least been loose and wet in the morning. To the point where I can purse my lips and feel air coming out of my mouth. More often than not it's come off completely. Is it at all common to be this unsuccessful with mouth taping?

[Pugsy]

Every time I've taped the tape has at least been loose and wet in the morning. To the point where I can purse my lips and feel air coming out of my mouth. More often than not it's come off completely. Is it at all common to be this unsuccessful with mouth taping?

Yep. Unsuccessful mouth taping if it comes loose or off.
Until the tape stays put all night or at least enough of the night you know where it came loose you can't really distinguish between mouth opening leaks and mask movement leaks.

A while back I had a chance a try a brand new mask. I think it was the DreamWear under the nose cushion model so my mouth wasn't part of the closed circuit. I was seeing some massive leaks but they weren't waking me up so I couldn't really isolate a cause...mouth opening or mask movement.
So I taped my mouth shut and made sure it stuck all night so that I could see if the leaks were still present or not.
They were definitely still present and still massive and the tape was secure so that told me mask movement leaks.
Didn't surprise me....I had a feeling that the frame that came with the DreamWear (size medium) was going to be too big for my small head. I ended up eventually having to use the small frame and with padding around things to snug it up to keep it from moving.

My point is that you need to try to figure out the for sure cause of the leaks first before you can go about fixing them.
Chances are the leaks are mouth opening leaks but until you know for sure you could be spinning your wheels because the fix for mouth opening leaks is going to be totally different from mask movement leaks and to fix any problem you first have to identify the problem.

I do understand that having facial hair also makes for it to be more difficult to tape the mouth shut. The tape just doesn't like to stick to hair.

[luciferin]

I do understand that having facial hair also makes for it to be more difficult to tape the mouth shut. The tape just doesn't like to stick to hair.

Thank you, Pugsy! I have somewhere to focus my efforts to improve my treatment.

My wife has been very supportive and helpful with my treatment so far, but I think she might leave me if I shave my beard too

[Pugsy]

My wife has been very supportive and helpful with my treatment so far, but I think she might leave me if I shave my beard too

I totally understand. My husband wears a not so short goatee and he is under the penalty of death if he messes with it.

There are people who will tell you that for mouth opening issues that you should shave and go with a full face mask but I am not one of those people unless we have tried everything under the sun to fix the problem and had zero success and we know for sure that mouth opening is the culprit.

Like I said...it might not be mouth opening anyway. I would sure hate to see you get a divorce for shaving and mouth opening wasn't the problem anyway.

We can't tell just by looking at the leak line itself for sure whether we are looking at mask movement issues or mouth opening issues. I wish it were that easy but it just isn't.

[zonker]

I do understand that having facial hair also makes for it to be more difficult to tape the mouth shut. The tape just doesn't like to stick to hair.

Thank you, Pugsy! I have somewhere to focus my efforts to improve my treatment.

My wife has been very supportive and helpful with my treatment so far, but I think she might leave me if I shave my beard too

i'm a full bearded fella myself and this is how i cope with mouth breathing-viewtopic.php?p=1089718&f=1&t=112758&p= ... s#p1086296

i modified it a bit, but it's basically what i've been using for years.

[luciferin]

i'm a full bearded fella myself and this is how i cope with mouth breathing-viewtopic.php?p=1089718&f=1&t=112758&p= ... s#p1086296

Thank you for this! I've got some on order now, so I can at least figure out of it's the mouth leak, or mask leak. I'd love to you use the n30i because it's so comfortable, but maybe I just think that because my therapy is not as effective with it right now


Full facemask seems to have been the answer for now! Here's my numbers from last night: Dashboard 8/30/22

I can't thank you all enough for helping.
Looking at the data, I think my pressure must be set too low. Could anyone recommend a level to raise it to?

[Pugsy]

Looking at the data, I think my pressure must be set too low. Could anyone recommend a level to raise it to?

So what makes you think the pressure is too low with the current minimum?
Are you having very many wake ups for some reason or another? I see a couple of starts and stops of the machine...any special reason?

Roughly one third of your already low AHI is going to be central/clear airway apneas...and more pressure won't fix or reduce those types of events.

Is your goal AHI 0.0? If so...get that idea right out of your head.

Your first flagged event the hyponea....you weren't asleep when it was flagged.
The second flagged even again a hyponea...it's iffy as for being asleep or not but just to be extra cautious lets put it in the asleep basket.
The 3rd flagged event an OA....you weren't asleep.
The 4th flagged event was a central/clear airway event...you weren't sound asleep....and even if you were more pressure wouldn't fix it.
The 5th flagged event was another hyponea....it appears to be a real asleep event.
The 6th flagged event was an OA...it's iffy but to be extra cautious we can put it in the "real asleep" basket.
The 7th flagged event was another OA...really iffy because it occurs in the middle of some irregular breathing where I doubt you were asleep but afterwards some really irregular breathing so again maybe real and the event caused a bigger arousal.
The 8th flagged event...another OA....you weren't asleep.
The 9th flagged event...Central/clear airway and again irregular breathing so I am not so sure you were asleep.
The 10th flagged event....same as the 9th.

So the bulk of the AHI is NOT related to asleep events but instead related to awake irregular breathing flagged events.
These machines only measure air flow. They have zero way to know if we are asleep or not. Our awake/semi awake breathing can be very irregular when compared to asleep breathing and these machines can and will flag the awake breathing irregularity as some sort of apnea event. They also respond to these awake flagged events like they were asleep events because again the machine doesn't know if we are awake or asleep. They only measure air flow or lack of.

I do see lots of prolonged irregular breathing which makes me think that the sleep quality was less than optimal.
You may or may not remember the arousals associated with this irregular breathing.
You are brand new to cpap therapy and having arousals just from the newness of everything wouldn't be out of the ordinary.
Heck, when I first started therapy it took my brain about 3 months just to quit waking me up to tell me "hey, dude, do you know that there is an alien plastered to your nose and blowing air up your nose" and I had zero problems with mask comfort or fit. The brain just hadn't come to grips with the fact that the alien was its new best friend.

Now there is a lot of movement of the pressure up and down but a lot of that movement is the machine responding to those awake breathing irregularities so I don't know just how much stock we can put in that movement right now.
Would you sleep better with a little more minimum??? We don't know if you would or not but it might be worth trying at some point.

If you are looking to maybe increasing that minimum pressure....I would suggest looking at the median average and not so much the 95% number. Maybe something around the 8 ish minimum but I don't think it is a critical need at this point.
Your AHI is relatively low...and 1/3 of it appears to be central apneas which more pressure won't help anyway.
A few central apneas are normal anyway and an occasion OA/hyponea isn't cause for alarm either. If you were thinking that your goal would be AHI 0.0....that's an unrealistic expectation and it will drive you crazy trying to get there.

Instead trying to work on overall sleep quality so that you sleep more soundly is what I would be looking at.
Do you find yourself waking often during the night and if you do...why?

[luciferin]

I was thinking it needed to be raised because the pressure level was so high above my minimum all night long. That said your analysis that I was awake for most of it makes lots of sense to me. I had very poor sleep last night, which I attribute to the newness of this mask. I'm not looking for an AHI of 0, I understand that's not possible. I'm just looking to optimize my treatment, and I can't thank you enough for helping me with that.

The starts and stops were mostly because I was uncomfortable in the mask, which I fully expect since I haven't adjusted to it at all. The full face mask gave me the sensation that I couldn't breathe through my nose, which I don't usually have with the nasal mask, probably because it directs the air straight into my nostrils. I was fairly conjested last night, but that is not unusual for me at all.

I don't usually wake up this much, it's at most once or twice a night on a normal night that I can remember. I never really remember what wakes me up, though. A lot of the time pre-treatment I would attribute it to nightmares, which I have come to understand might have been me having apneas for years. When that happens I'll often get up to use the bathroom since I'm awake anyway. But that's comparing me before treatment to now. I definitely don't remember being awake as often as the breathing patter shows, but I'm honestly exhausted this morning, so hearing that I had poor sleep is not a surprise.

I will take all of your advice, I may try to get the pressure more comfortable to breath through my nose, but will give myself more time to adjust to the full face mask before I make any large adjustments.

[clownbell]

Pugsy makes excellent points as always. May I add my 2 cents regarding taping. I've tried several different types of tape. Some come loose during the night, so those are out. Some are super stick and seal well but are VERY tough on my 77-year-old skin when removing in the morning. It seems the silicone tapes are better than the cloth tapes. I have had good success with "3M Nexcare strong hold pain free removal tape" and will try a couple others too. The nice thing is if you tape and it sticks and the leaks stop, then you know that it was a mouth leak. If you tape and the leaks persist, that points toward a ask leak. Dealing with leaks can be tough, and I wish you well.