newbie frustration

[Catnapper]

As an aside to the chronic sinus infection issue, I generally had multiple sinus infections every year, sometimes almost never being without one. Since starting with CPAP therapy just over 2 years ago, I have not had a single sinus infection. I believe that the air flowing through dries up whatever is there and leaves nowhere for infections to grow. I might also have benefited from the sinus surgery I had back in 1995 which opened up all the sinus cavities.

There are times when I feel like one side is clogged, but the other side works. The sides take turns somehow, and the problem is gone when I am awake.

Although there are many wonderful side effects to using CPAP, this is one I value highly on a daily basis.

I also recommend the nasal rinse. Immediately after I had sinus surgery, the doctor wanted me to use a sinus rinse of water that had been boiled then cooled, with the addition of salt and baking soda. It was effective in clearing my sinuses of the gunk from surgery and I was surprised to discover that it made me feel better. You should ask your doctor if you are concerned about using it. I think my doctor now uses a combination similar to the one Birdshell discussed.


Good luck. The folks here helped me through the dreaded newbie stuff. They know what they are doing.

Catnapper - Joanie

[reefdreamer]

Ok here is my results from last night, I have not a clue what this all means-
therapy usage-7.42hrs
session-1
system leak-32.4 l/m
AHI-8.8

I just wonder if the mouth breathing is still occluding the airway. I had to get up 3 times and wipe drool out of the mask. I don't think it was from humidity because I only had it on 2 and my mouth and thoat are bone dry this morning. My nose of course is all clogged up when I get up and mouth wide open to breath. I have rinsed it with saline, used nasonex, nasocort, just about everything but a rotorouter but it still gets clogged. help please!
Jen

[Wulfman]

Probably the dme company is going to kill me for messing with these settings but gosh it is nice to know if the therapy is working. Is it possible to still have apnea episodes if I mouth breath (with ffm)?
Jen

Regarding your fear of your DME, you can always tell them that it's YOUR therapy and you want to make sure it's as good as it can get.
To your question about apneas......"Yes", but they would be more likely to be caused by your pressure not being sufficient rather than having to do with a full face mask.
There's no way that we can eliminate ALL apneas and hypopneas......but if we can eliminate as many as possible, that's what we try to strive for......and still get a good night's sleep.

Den

This is the first time ever I'm going to disagree with Den, so here goes:
The reason that xPAP is normally used through a nasal interface is that the airway is more likely to be opened up through the nasal pathway rather than through the oral pathway. That leads me to believe that at the same (correct, nasal) pressure, it might not be effective enough for all events if you're only breathing through your mouth. On the other hand, of course if your pressure is incorrect, which as Den says is more likely, then that would be a more likely reason for having a high AHI.

What is your AHI like now? Are you able to get the stats like Den explained?

You might want to try a Liberty or Hybrid. They have separate nasal prongs and mouth interfaces, and won't rub your nose bridge raw. In fact you could even plug the nasal output and just use it as a mouth mask!

One thing that helped me with leaking was to use a chin strap. I have been having congestion issues lately so I also can't breath too well through my nose, but I use the chinstrap to keep my mouth from moving, rather than to keep it completely closed. This avoids that my mouth drops completely open, which is what causes the horrible leaks for me on the UMFF. Actually I'm using the pap-cap, I didn;t like the way normal chin straps work.

Also on the UMFF, check that the angle of the forehead piece is correctly positioned. If I move it just one notch back or forward, it starts leaking like crazy.

I'm not sure what part of what I said, that you're disagreeing with.
The question I was specifically addressing was whether there could still be apnea events while mouth-breathing in a full face mask.
Do you think that ALL apneas and hypopneas can be eliminated? I don't.....especially when mouth-breathing.
Nasal congestion can make this therapy very difficult and any way to get air flowing through the nasal passages is "good".

Den

[Wulfman]

Ok here is my results from last night, I have not a clue what this all means-
therapy usage-7.42hrs
session-1
system leak-32.4 l/m
AHI-8.8

I just wonder if the mouth breathing is still occluding the airway. I had to get up 3 times and wipe drool out of the mask. I don't think it was from humidity because I only had it on 2 and my mouth and thoat are bone dry this morning. My nose of course is all clogged up when I get up and mouth wide open to breath. I have rinsed it with saline, used nasonex, nasocort, just about everything but a rotorouter but it still gets clogged. help please!
Jen

Your AHI is still high, but your leak rate doesn't sound too bad. What pressure is the machine set to?

Therapy usage is how many hours you slept.
Session means the number of nights that are being shown
System leak is the amount of leakage was detected. All masks have a stated "Vent Flow Rate" at various pressures, which should be listed in a chart in the user's manual that came with the mask. An amount of leakage above the stated "Vent Flow Rate" would then be actual "leakage".
AHI is your Apnea/Hypopnea Index. That's the total number of A/H events divided by the number of hours of usage. If you multiply those two numbers, you'll get the approximate total number of A/H events that occurred.....about 65 in that time period.
An AHI of 5.0 or less is considered "normal"......but the lower the better.

Den

[reefdreamer]

The pressure is set at 7 as according to the sleep study and I was mouth breathing during the sleep study. I guess I should try to nose breath more and maybe that would help. I think I have to contact the dme to change the pressure since my insurance is paying for the machine.
Jen

[Wulfman]

The pressure is set at 7 as according to the sleep study and I was mouth breathing during the sleep study. I guess I should try to nose breath more and maybe that would help. I think I have to contact the dme to change the pressure since my insurance is paying for the machine.
Jen

You have the instructions......
Remember, it's YOUR therapy......not theirs.
I'd try going to 8 cm. for at least three nights and see what the numbers look like.

Den

[echo]

I'm not sure what part of what I said, that you're disagreeing with.
The question I was specifically addressing was whether there could still be apnea events while mouth-breathing in a full face mask.
Do you think that ALL apneas and hypopneas can be eliminated? I don't.....especially when mouth-breathing.

I guess I was trying to say that at the same pressure, therapy through the mouth will be less effective than nasally, due to the fact that xPAP works better nasally than orally. Since reefdreamer is not able to get any therapy nasally, that could be an issue. I do agree with you that not all events will be eliminated, especially when mouth-breathing.
I also agree with you that probably the wrong pressure to begin with can be more of a problem. But once that is solved, you still have the previous issue. So which one is reefdreamer's problem? I dunno.
I must have misunderstood what you were saying, Den.

As for changing pressure, personally I think it's better to go up by 0.5cm increments rather than 1.0.

[reefdreamer]

What should the leak rate be anyway...is it according to the machine or mask or both. Thanks,
Jen

[Wulfman]

What should the leak rate be anyway...is it according to the machine or mask or both. Thanks,
Jen

Jen,

Here's a link to some of the mask Vent Flow Rates aka "leak rates". It's according to the mask and pressure, as you will see.
Your leak rate is really close for the pressure you're using.

http://www.internetage.com/cpapinfo/leak-rates-1.html


Den

[deerslayer]

Good Luck Jen ! it only keeps getting easier because of the kind generous folks on here like Wulfman & others . Stick with it , you will be rewarded !! tim

[goose]

I would have to agree with Den on the "set it to 8 and see what the numbers look like"....I would leave it there for a week though and check the numbers every day -- if something is realllllly out of whack then change it again, but my general rule of thumb is leave it for at least a week....Just me.

Once the numbers start coming into the range you want -- AHI below 5, then I would take echo's advice about making changes in 0.5cm increments. If the numbers are a bit out as yours seem to be at the moment then changing by half a cm at a time can be maddening!!!! Both pieces of advice are excellent!!!!

Another thought is about the AHI. While an AHI of 5 or less is what we're all shooting for, don't obsess over that particular number once it's at 5 or below. The real telling thing in your treatment is how you feel!!! If your AHI is at 2.5 (like mine) and you're feeling really good -- leave it alone. If you tweak it for a zero or a one AHI you might find that you're not feeling as good as you were when the AHI was a bit higher.....
To give you a case in point, I'll use my own experience. I had my APAP machine set in CPAP mode at 10cm for nearly a year with an AHI of 2.7.....not a bad number really, but I still didn't feel all that great in the morning or during the day -- though I did feel much better than I did prior to being diagnosed and starting treatment. One day I decided to try to shoot at a better number and better feeling (listening to posts saying that it's how you feel not necessarily the AHI -- I finally decided to listen to and take that advice). So I put my APAP machine into APAP mode with a range of 11-15 to see what happened. Well not only did I feel much better, but my 90% pressure is/was 12.2cm. My AHI is still hovering around 2.5, but now I'm feeling much better in the morning and during the day.....Not being satisfied, I'm presently tweaking it back to a range of 10-15 and my 90% number has come down, BUT, that said, I don't feel as good as I did at 11-15, so that tells me I'm not going in the right direction. AHI is still around the 2.5 number....Next time I pull my data and have the card out I'll change my prescribed range back to 11-15.....

Though I sense your frustration, I also sense you have a great attitude, so you can't help but succeed. It just takes a little time and patience. I always tell myself, "I didn't get here overnight. I won't be fixed overnight".

Keep at it -- you'll nail it down!!!!!
Take care
cheers
goose

[reefdreamer]

Well last night I had the pressure on 8 and the numbers are worse (go figure)
leak-34.6 l/m
AHI-10.2

What the heck? I do feel better this morning...maybe more leak caused the problem, but actually according to my users guide at pressure of 8 the leak is actually 32 so then the leak would not be bad. I will keep trying. Also the mask made a whisling noise all night that about drove me crazy. Took out the exhaust vent and put it back in and messed with the mask all night long.
Jen

[Wulfman]

Well last night I had the pressure on 8 and the numbers are worse (go figure)
leak-34.6 l/m
AHI-10.2

What the heak? I do feel better this morning...maybe more leak caused the problem, but actually according to my users guide at pressure of 8 the leak is actually 32 so then the leak would not be bad. I will keep trying. Also the mask made a whisling noise all night that about drove me crazy. Took out the exhaust vent and put it back in and messed with the mask all night long.
Jen

The thing is, you don't know what some of the previous nights' numbers were like......only the night before. There can be a significant fluctuation in AHI numbers.

Good luck.

Den

[goose]

Feeling better is a good sign -- numbers don't look that great, but hey it's all a process....
I'd leave it at 8 for now and see how the numbers do and if the feeling in the morning remains good.....Den's right, we don't know what the previous numbers were, so you're building data.....

The leak rate seems to be pretty good....
Don't know what to say about the whistling....did it diminish when you messed with the mask??
I remember my first couple weeks -- messing with the mask to make it work. Turns out after 6 months I found out it was a size to big, but I did make it work -- just made my teeth hurt .....

Keep at it - you're doin' good!!!!
take care
cheers
goose

[echo]

I've also got that maddenning whistling noise with the UMFF sometimes. If you've taken the mask apart, when you put it back together, make sure that you place the silicon on the mask frame first, make sure it's set in there properly (the silicon has some sort of notch all the way around it, that fits onto the frame). Then very carefully slide the top firm plastic piece over the silicone, and make sure each of the 4 or 5 plastic latches click into the frame.

Water/condensation in the mask and near the vents can make the whining noise as well.

Or it's just the effect of using a higher pressure. You might try using the ramp to fall asleep at a lower pressure, if you're not already. At lower pressures the vent noise will be less.

I totally agree with goose - the numbers are there as a guide, but it's best to correlate that with how you feel.

Good luck, Keep us posted!