Therapy thread - a few weeks into CPAP

[tamaton15]

Ah I see, thanks for the detailed clarification with pictures about the awake breathing.

The reminder about sleep hygiene and not worrying too much about the numbers was helpful too, I spent more time relaxing last night in dim light. When I did wake up during the night (about 3 times), I went to another room to relax for a bit instead of staying in my bed. My sleep being fragmented is still a thing I need to work on.

Yeah, I think leak management will be key going forward. Some days I’ve had really good seals, so that’s why I haven’t tried another mask yet. How would you recommend trying to approach new masks? (In terms of how much time you give a new mask to gel or workout, whether to progress incrementally in how bulky the mask is, etc.)

If I had to guess, I think it’s probably turning from side to side or my face and mask rubbing against the pillow that results in the leaks.

[Pugsy]

How would you recommend trying to approach new masks? (In terms of how much time you give a new mask to gel or workout, whether to progress incrementally in how bulky the mask is, etc.)

In general if a mask looks interesting to me then I am game to try it. Now sometimes my mask experiments have been successes but sometimes they have been dismal failures and I don't waste much time trying something that I have problems with. I have been known to try on a mask and hate it so bad that I don't even hook it up to the cpap machine.

The P10...I have used it...it's not the most stable mask in the world as its straps move around a bit too easily and there's always the risk of the mouth opening leaks as well. It is still my number 2 in mask preferences though despite the moving around. The leaks don't wake me up so I don't really care and I really like the minimal headgear. You are going to find that there is a trade off with any mask out there...some good stuff and some bad stuff and you have to decide how important the good might outweigh the bad.
And everyone has different preferences.....me...I prefer minimal to nothing in terms of headgear (that's why I prefer as number 1 mask the Bleep/Eclipse) and I am willing to let minor stability problems slide but other people find that stability is critically important to them.

Once you have tried several masks you will get a feel for what your own personal preferences, wants and needs are going to be.

[zonker]

If I had to guess, I think it’s probably turning from side to side or my face and mask rubbing against the pillow that results in the leaks.

had that problem myself when i first started with the p10. what i did to eliminate the problem was to sleep at the very edge of the pillow. so much so that the mask (such as it is) would hang off the edge. it was NOT easy to train myself to do it but now, six years later, it's second nature.

[tamaton15]

The P10...I have used it...it's not the most stable mask in the world as its straps move around a bit too easily and there's always the risk of the mouth opening leaks as well. It is still my number 2 in mask preferences though despite the moving around. The leaks don't wake me up so I don't really care and I really like the minimal headgear. You are going to find that there is a trade off with any mask out there...some good stuff and some bad stuff and you have to decide how important the good might outweigh the bad.

Thanks, it's good to know how to evaluate a mask. As for leaking: is it fair to say that as long as the leaks are below the large leak rate (the machine can compensate for them) and the leaks are not waking me up (which I can correlate in OSCAR with change of pressure and arousal breathing), then the mask is suitable for me in terms of leaks?

If I had to guess, I think it’s probably turning from side to side or my face and mask rubbing against the pillow that results in the leaks.

had that problem myself when i first started with the p10. what i did to eliminate the problem was to sleep at the very edge of the pillow. so much so that the mask (such as it is) would hang off the edge. it was NOT easy to train myself to do it but now, six years later, it's second nature.

That's a good point! Will see if I can make that work for me.

[Pugsy]

As for leaking: is it fair to say that as long as the leaks are below the large leak rate (the machine can compensate for them) and the leaks are not waking me up (which I can correlate in OSCAR with change of pressure and arousal breathing), then the mask is suitable for me in terms of leaks?

You probably need to understand where I come from in my own experience to have an understanding of how I deal with things or decide if I need to deal with something.

Any leak no matter how big or small that wakes us up is unwanted. Anything that disturbs or messes with our sleep is unwanted.
Unwanted stuff needs to be fixed. No matter what it is.

First of all sleep has always been my primary goal because if I don't sleep....doesn't matter much how effective my cpap therapy is. We gotta sleep first and foremost for any of this to matter. I have had problems sleeping for years and it isn't related so much to OSA as it is related to other health problems. I have been on cpap 13 plus years now and while the machine has been effective against the OSA sleep related problems it hasn't been able to deal with my sleep problems (mainly a pain issue from really bad arthritis) because the machine can only fix problems related to the airway/OSA and it can't do anything for any other health problems. I Wish fixing the sleep problem was as easy as fixing the OSA problem but unfortunately it isn't. Getting good quality sleep can be a challenge for lots of people for lots of various reasons as evidenced by the multi billion dollar sleep industry and all the gadgets and stuff and ideas that are out there to "help us sleep" by various means.

So when it comes to leaks I have adopted an attitude that as long as a leak doesn't wake me up I don't worry so much about leaks....even if the leak is large enough to register as large leak as long as it isn't deep into large leak territory and prolonged in large leak territory. These machines can compensate fairly well for more leaks than we think they can. ResMed machines are ultra conservative IMHO when it comes to flagging large leaks. ResMed's line in the sand is 24 L/min excess leak for the beginning of large leak territory. In terms of therapy itself we want to minimize leaks because we don't want to go so far into large leak territory that the machine can't sense, respond and record apnea events. We need to be able to trust the data reported....if the AHI is nice and low we have to trust that the machine wasn't missing events because the leak was so bad the machine was clueless. ResMed machines will usually start flagging UAs...unknown apneas...when facing large leaks before they progress into the clueless state and just miss stuff. From my own personal experience the ResMed machine doesn't really start running into trouble sensing stuff until the excess leak hits around 35 L/min.

I don't even bat an eyelash about the leak until until I hit 30 or 35 L/min and then if I do I then evaluate how long was I in that large leak territory (again assuming it doesn't wake me up) because in terms of effectiveness 5 minutes at leak level of 40 L/min isn't the end of the world....now if someone spends 50 minutes continuous at 40 L/min then we look more closely and decide on what to do if we see it happen often. If I see a large prolonged leak only once every 2 weeks....I really don't get all that excited. If I see it every night or I spend half the night deep into large leak territory then I will think about what I should do.

All this is of course assuming that the leaks aren't disturbing my sleep and for me I can sleep through some pretty big leaks.
Now some people are much more sensitive to leaks and they might find that a little 10 L/min excess leak causes a sleep disruption and those people have to work harder on leak control. Everybody is different on what works the best for each person and different in how they react to things.

ResMed uses the 24 L/min line in the sand and you still get Mr Smiley face on the machine for leak management until you spend 30% or more of the night above that ultra conservative line in the sand. It takes a lot of prolonged leaks to reach 30 % and I have seen Mr Frowny face on a rare occasion...not often though. Most of the time my large leaks fall below the 30 L/min threshold...so maybe above 24 but below 30 L/min. As long as I am sleeping soundly for the most part and feeling decent then I don't worry about short excursions into large leak territory.

Leak management doesn't have to be 100% perfect (again assuming leaks aren't disturbing sleep) to be successful. We have some wiggle room there.
So I have this criteria for myself
1...are the leaks disturbing my sleep....if they are disturbing my sleep then they need to be fixed no matter how big or little the leak is.
2...just how deep did I go into large leak territory....I don't even bother looking at the leak graphs unless I hit 30 L/min.
3...then I evaluate just how deep into large leak territory did I go...was it maybe 29 L/min which isn't worth worrying about...or was it 50 L/min
4...then I look at how long was I deep into large leak territory....5 minutes or 50 minutes or half the night. 5 minutes is nothing and I shrug my shoulders and move on. 50 minutes or longer I will look more deeply and consider is this a one off bad night or is this something I see often kind of thing.

I used the P10 last night. Woke up this morning with that back strap riding up on top of my head right next to the top/front strap. I am sure there was some leaking but it wasn't what woke me up and I haven't looked at the data yet to see how much leak was going on.
The P10 does that to me most of the time with the back strap sliding up. If I crank it down it doesn't really help that back strap issue I have but it sure crams those pillows in my nose and that isn't comfortable and that sure messes with my sleep. It hurts my nose.

No mask is going to be "perfect". They all come with a few negatives for some people. A negative for me might not be a negative for you.
It is the life of a mask.

FWIW when I first started therapy I was numbers driven everywhere ....I wanted 0 AHI and 0 leak all night long and I tried all sorts of stuff to attain those unrealistic goals. I tried stuff that messed with my sleep more than the leaks might have caused a problem. Sometimes the cure is worse than the disease kind of thing. Didn't take me long to re-evaluate those unrealistic goals and change my goals to ....sleep is the most important thing and then I worry about the other stuff.

I have probably tried over 40 masks over the years. Most were tried just because I wanted to try something to help alleviate the boredom of this therapy. I try stuff just because it looks interesting or maybe a new mask was released and it looked interesting and I knew that people seemed to appreciate my experiments. I have had masks leak so bad that the leaks woke me up repeatedly during the night. Those masks didn't last long in my arsenal.
My most recent new mask experiment was the ResMed N30 which is a nasal cushion mask that is essentially a P10 pillow with an under the nose cushion instead of pillows. Same headgear as the P10 and same diffused venting system. I actually used the N30 the entire month of January of this year. It's a nice little mask...not perfect (no mask ever is perfect) and it is number 3 in my own personal list of masks I might want to use. You can crank it down more and not have it hurt the nostrils.

So don't be afraid to try new things....just realize that with any experiment you are going to have good results and bad results and you don't know about anything until you try it. I was very pleasantly surprised at the N30....I really didn't expect to like it all that much as I have never really done well with any mask except a nasal pillow mask.

One thing about experiments with anything....you will always learn something. Now sometimes all you learn might be what a bad idea that experiment was but you will learn something about yourself and about which masks seem to fit your own personal wants, needs and preferences.

Mask experiments are expensive though and insurance paying for a new mask every 6 months is limiting. Plus we don't really want to burn up an insurance paid for mask and have it be a horrible choice and a waste of money.
Back when I first started therapy there were relatively cheap ways of obtaining masks that didn't break the bank. Don't have those options so much now.
Now cpap.com offers free return insurance on all their complete mask package purchases....if you buy a mask and hate it you have 30 days to get it back to them and they will give you a refund or store credit to try another mask.
So the cheap supply of masks to be used for experiments have sort of dried up...people return the mask instead of offering it up free or cheap here at the forum.

Watch the forum....people will still offer cheap or free masks that were barely used that people can use for experimenting. They got a mask and didn't like it but didn't get around to returning it during the return window....so they will offer it up here.

Final word about masks and DMEs and insurance. In reality all the mask manufacturers offer a 30 day return policy on all their masks.
Yes..insurance only pays per the allowance schedule but DMEs could swap out masks if they would just do it. They can recoup their losses from the mask manufacturers if they would just do a little paperwork but most won't.
Some DMEs have very liberal mask swapping policies and some simply won't do it....so people need to find a DME that has a liberal mask swapping policy and then they can try more masks and not have to pay out of pocket. Those DMEs are out there but about as scarce as hens teeth. My own local DME has a 60 day swapping/return policy for all masks and it pertains to new to cpap therapy people as well as cpap veterans like myself. I have 60 days to swap out a mask if I end up hating it and I can do it multiple times within that 60 day window.
So my local DME has a generous mask swapping policy...but unfortunately they are assholes about getting me a mask that they don't carry in stock. They refused to get me my Bleep....so they no longer get my business but I could use them now to try something they did carry in stock if I wanted and I would have 60 days available to try any number of other masks.

[tamaton15]

Happy New Year's all.

Update - I tried out the Dreamwear mask with nasal pillows, and the first few nights seemed to be fairly good, with much lessened leak rates. I also have a confounding factor now that I'm taking a TCA for pain, which is making me sleepy during the day. But I do take the TCA around the same time each night.

A night after which I felt fairly good during the day:


Last night, after which I felt pretty sleepy:


Let me know if there's any places I should be zooming in on.

I had changed EPR to 2 because I was burping some air during the night, and adjusted the minimum pressure up slightly to 7.

I was also told by the ENT I met with that I had a very deviated septum, and am considering getting a septoplasty. (I was also complimented for bringing in my SD card, though they said they had a policy of not looking at them due to some IT policy...). I'm wondering if during my nasal cycle on the bad side of my nose, it's causing me to mouth breathe and increase the leak rate (which also disturbs my sleep during those times). I wonder if that has to do anything with my high amount of clear airway events.

[btbderek]

A night after which I felt fairly good during the day:


Last night, after which I felt pretty sleepy:


Let me know if there's any places I should be zooming in on.

Now I am newer around here so some others opinion may vary but if it were me, I would just highlight and zoom in on the actual recorded data of your sleeping, like on that second Oscar chart just highlight the whole chunk of data that’s in the later half of the graph if that is all sleep data and everything before it isn’t(only saw one small line of data at the beginning of the second chart), this way the data can be seen in better detail. I am still in compliance period so I wear my mask during the day, so I will only highlight and zoom in on the night time portion or “actual sleep period”. Now if I wake up in the middle of the night and don’t fall back asleep for a whole hour but keep the mask on, I just leave that in because it is easier to see the difference at least on my charts. Again, others here may disagree but that’s what I do.