I almost couldn't wake up today

[dexter_go]

Dear Friends,


I slept at around 12 last night. My RESMED MIRAGE ACTIVA face mask was a little bit tight the past few nights and I have been getting very low AHI of below 5. So last night I decided to loosen it just a little bit.

From what I can remember, I woke up several times last night where my mouth was open and the air was coming out through it. Of course this was not a pleasant experience as the blowing of the air of my RESMED S8 AUTOSET II causes me to wake up.

I remember I had to get up at around 7:45 this morning because I had to go to the bathroom. I decided to remove my mask and continue sleep without it. I went back to sleep because I normally wake up at 9:00. But I kept on sleeping from there on until 1:00 pm. I should have gotten up at 9:00 and go to work but I felt so sleepy.

When I woke up I checked my machine's clinical results and here is what I got:

Pressure = 10, Leak = 0.20 L/S, AHI = 13.2, AI=3.1, HI=10.1

My doctor's prescribed pressure is 8. And I set my machine pressure to be lowest at 6 and highest at 15.

This is the only time that I have been using my RESMED for 3 weeks that I felt so sleepy that I couldn't get up even when I was on the machine.

Questions:
1.) Is the reason why I got so sleepy is because my AHI was too high?
2.) I'm on my RESMED so why was I still so sleepy that I woke up almost 1 pm?
3.) During the night, when I woke up and air was coming out of my mouth, are those sleep apnea events?
4.) Is the 0.20 L/S low or high? What is the acceptable leak/second?
5.) I took off the mask and did not use the machine at around 7:30 am and I went back to sleep. Is it possible that when I went back to sleep I was experiencing sleep apnea and this made me drowsy to sleep until 1:00 pm?

Thanks in advance for all your help.


Dexter

[Julie]

Hi, you got so sleepy because you slept without your mask, allowing many apneas to take place, and you slept so long because you were not getting any rest from the sleep but your body kept trying. If air comes out of your mouth, and you're not wearing a "full face" mask that would allow it to go into your lungs instead of the room, then that air is lost in terms of being therapeutic. But they are not apneas, they're just occurrences of air coming out of your mouth. Apneas occur when you're asleep (only) and are specific events of air not being able to pass down your throat to your lungs because the tissues in the area are loose (and flutter against each other with each breath), or are being pushed together because of possible fatty deposits in the area, or just a general anatomical narrowness. I cannot believe no one has explained that to you yet! Leak rates generally relate to how well your mask fits, but the ratio isn't always easy to appreciate as other factors are involved, so maybe wait a while before you worry too much about them now, just be sure that while you don't overtighten your mask (uncomfortably so), you also are not blatantly aware of big gaps between the mask and yourself. But if you are a mouth breather and don't have a full face mask, you really should look into getting one. I would suggest, however, that you might have your pressure range too wide open, and possibly try narrowing it a bit, e.g. 7-11 rather than 6-15.

[tattooyu]

Julie's right. Any help you had when you had your mask on was undone by sleeping without it.

Get the mask so it is just snug enough. It's a finesse game, but you'll find where the right tension is going to be for you.

If you don't like the sound of a full face mask, or can't afford one, you might consider a good chinstrap to help keep your jaw shut. However, that may not prevent all air leaks coming out your lips. It does for me but not for everyone.

[dexter_go]

Thanks Julie,


I take off my mask at around 7:30 am thinking since I'm going to sleep for just another hour and a half, it would be ok to do so. Is an hour and a half of sleep without the mask make me harder to wake up by the time it would be 9:00 a.m.

The reason why I did not set my minimum pressure at 7 is because during settling time I find it quite strong. I use 15 mins. settling time. I will try 7 tonight again and see what happens.

I know I am nose breather. But I notice when I am really tired there are times that I wake up because the air is blowing through my mouth. I am really annoyed by this because I am awakened. And I all do is just close my mouth and I'm back to sleep in a second. Do you have any explanation why there are times, I open my mouth?

Lastly, what is an acceptable leak rate?

[dexter_go]

Thanks tattooyu,


I started with the Mirage Activa Mask for a month now. I just ordered the RESMED SWIFT LT which should arrive to me by next week. I want to try which one is better.

Do you have a link where I can buy the chin strap. I really hate it when I wake up because of the air coming out of my mouth.

[Julie]

Hi, it seems you have confused a couple of things. Your prescribed pressure, the one given by the doctor, would be either a fixed number (like 10) that you use for a machine set to deliver Cpap therapy, or else a range (like 8-12, with 10 being the average) that you would use if on (Apap), which is self adjusting to whatever your needs are while asleep. Now, there is ALSO a setting for the Ramp, or the timed (up to about 20 minutes) gradual rise in pressure when you first go to bed, up to the prescribed pressure (whether that's 10, or 8-12 -sample numbers for now) to help you adjust to the higher pressure of the air blowing in. That setting is not the same as the "eventual" and prescribed pressure your doctor gave you, it's just a "comfort" thing (and most of us seem not to bother with it at all after a very short time, but just put on the mask, turn on the machine and let the prescribed pressure start up right away. OK, that's one thing... the other is that you may try a chin strap, but as mentioned, they're not really very effective, and a "full face' mask (doesn't actually cover your whole face of course!) is usually much better for dealing with mouth breathing problems when you're asleep. Popular ones are the Ultramirage (which I use), the Quattro, the Hybrid and the Liberty (look them up on Cpap.com). If you're losing all your air out your mouth, there's no point in using Cpap/Apap (with a nasal mask), it's a waste of time and money and sleep. And not using your mask at all is really a waste and a danger! Read my first note again so you understand the point of therapy, and why every time you do not use the mask you'll feel worse.

[dexter_go]

Thanks Julie I have a little bit better understanding now.

I use an APAP which is the RESMED S8 AUTOSET II. Now i set it at 7 min. (as you advised) and max. 15. I put the settling time to 15 minutes. Does this mean that the pressure already starts at 7 when I start the machine or slightly lower and slowly reaches 7 after 15 mins?

What is the acceptable air leak using nasal mask?

I just ordered the SWIFT LT and some Mirage Activa rubber replacements, what a waste now...

Wow I never realized that letting the air out of my mouth is wasting my APAP therapy.

I will get a full face mask and I wonder how it feels like to finally get a full nights rest and sleep....

With a full face mask, can an air leak still happen?

If I use the full face mask. Should I be getting lower AHI, etc. reading results in my machine?

Last but important question.... How do I know that the machine is effectively treating me? Can I check this by looking at my AHI results, being below 5 continuously everyday?

Thanks so much for your help.

[tattooyu]

Dexter,

I use the same machine as you do. Settling is just a time period that lets you fall asleep before the machine starts recording apnea events. On your machine, you are at 7 cm for 15 minutes, and then the AutoPAP kicks in and adjust throughout the night.

With any type of PAP therapy all the air needs to go through the hose (in or out) and not through the mouth (full face mask being the exception).

With my Swift LT and PapCAP chinstrap, I have gotten 0.00 L/s leaks every night except one, which was only 0.10 L/s.

Good luck!

[Julie]

Yes, the ramping feature of 15 minutes is just there to let you adjust slowly until your prescribed pressure setting is reached, whether that's 10 or 15 or whatever. As I said, most of us don't use it at all, just throw on the mask, and it will go straight to your prescribed pressure unless you use the ramp.

[Fredman]

The Mirage Activa is meant to be loose fitting. If air escapes from your mouth, even though you are a nose breather, you may want to use a chin strap as mentioned earlier or even a cpap cap from pursleep.com.

I wouldn't go crazy trying a whole bunch of different masks. Keep up with the Activa for a while then maybe try another mask. You can try a full face mask as you said, but a lot of people find them harder to seal around your face. Some also find them very claustrophobic.

Masks are really a personal decision and for me the Mirage Activa is the best, but you may find something that is much better for you and maybe the full face mask will be it. Try to keep your mask on. Don't sleep without it...people have died in their sleep because they stop breathing!

Good luck!

[dowen]

Hello Dexter and all

Bear with me if I am jumping in over my head here. I am a rookie and I just got my CPAP device (first one) yesterday.

Dexter - you talk about setting your machine pressure yourself and checking the machines clinical results.

We end-users can do that?

The only thing my machine provider showed me in the way of settings was the on/off switch. He made it seem like I was dependent on him to do anything else with the machine. I also have a S8 AUTOSET II.
(And I am eager to learn all its intricacies. I am a computer nerd by day.)

[Fredman]

Hello Dexter and all

Bear with me if I am jumping in over my head here. I am a rookie and I just got my CPAP device (first one) yesterday.

Dexter - you talk about setting your machine pressure yourself and checking the machines clinical results.

We end-users can do that?

The only thing my machine provider showed me in the way of settings was the on/off switch. He made it seem like I was dependent on him to do anything else with the machine. I also have a S8 AUTOSET II.
(And I am eager to learn all its intricacies. I am a computer nerd by day.)

In another recent thread Dexter, had a question about his machine being an Autopap - meaning is it adjustable. viewtopic.php?f=1&t=41317&p=362584&hili ... II#p362584

Yes your machine can be adjusted by you. Here is a link to how to:
viewtopic.php?f=1&t=39800&p=348250&hili ... et#p348250

The trick is to find out what the data means and for that you will need software and a USB card reader. I believe the S8 Autoset II is the S8 Elite II in North America. https://www.cpap.com/simple-find-cpap-p ... mit=Browse

from this machine you can pull your previous night(s) sleep data. You can then save the data as a picture file and save to a picture sharing site and the members here can give you feedback on your results.

Hope this is a start for you and if not post a new thread asking how to get started reading data from your machine. There are a good number of experienced hose heads here that will help.

[LinkC]

Dowen--

To amplify a bit. Your provider WANTS you to be dependent on him and assumes you aren't competent to make intelligent changes to the settings. (And, at this point, he's probably correct! None of us were one day into therapy...)

Knowing how to get your machine into setup mode (where changes can be made) is one thing. Knowing what changes are needed is something else altogether. You need to be able to read and interpret the data your machine collects and provides. That takes some time and effort, of course.

Proceed with caution and patience. The FIRST step is gaining the ability to access the data I don't know what that entails with a ResMed machine; but there are those skilled in that here who will be glad to assist.