More Newbie Questions

[DoninOrlando]

I am still new, being on Cpap about 3-4 weeks. I have made a lot of progress, thanks mostly to tips from this board. I have gotten used to wearing the mask and sleeping with the pressure. I lowered leaks drastically by learning to tape. I also discovered on my own using breath right strips with my nasal pillows allows me to move around more with fewer leaks. The fit without the strips is good, but each time I moved I had to adjust the mask to stop new leaks. It seems to self seal with the breathe right strips. My current issues are I have increased the pressure slightly and it seems to have increased the leakage, mostly through my mouth. Although I tape nightly, by morning the tape is lose enough to leak. I have a mustache and outline beard so it does not tape perfectly. Also, my AHI index is averaging 5 although I have had a few 4 nights since increasing pressure from 10 to 11 so I don't want to back it down. I have tried a few full face masks and cannot get used to them. My questions are:

Is anyone else using a Remstar Pro M series, with Swift LT pillows ? If so, what is your best LPM rate ? The website says 31-32 at my pressure but my best night has been 35 and still avg 40. Only 2-3 nights below 40 and 1 below 37. Anyone getting the 31-32 ?

Any other suggestions for improving leaks ? I have used several chinstraps as I think the only possible leak is from my mouth. When I go to sleep, all is well but frequently wake up to dry mouth or exhaling from mouth slightly. Would the Cpap cap with chin strap help ? I cannot stand the very wide or tight chinstraps I have tried. I cannot sleep at all with them.

Should I keep working on reducing LPM or is leakage average 40 ok when 32 is perfect ? Like I said AHI is now 4-5. When pressure was 10 AHI was always slightly above 5. If I can solve leaks I might increase pressure more but no point if I can't stop leaks.

What is the favorite Hybrid out there with pillows ? My only other issue is Afrin addiction but I am working on that too. I have tried neti pot, humidifier, nasal inhaler, Sudafed, Veramyst, Saline sprays, and more. I have it down to a single spray each nostril once nightly. I was spraying 2 each twice daily but cannot breath yet without it. Will probably have to change to FF or hybrid to stop and I hate ff masks. I thought I would use a hybrid long enough to break afrin addiction and go back to Swift LT mask. What is the most widely used Hybrid ? Seems like the one with inside the mouth grip would still allow leaks from mouth. Does it ?

Thank you all for your help so far.

[Irene P.]

Wow, so many questions.

I have a Resmed machine, so can't comment on specific questions about your machine. But it sounds to me like your AHI is pretty good. We always want better numbers, but I'm finding I really need to be patient. I've got the software now, and I'm starting to see some trends that may help me to figure out how to get better numbers.

If you decide to get a FF mask, be sure to use the sizing helps on cpap.com. I recently got a Quattro, and I found it hard to believe, according to my measurements and cpap.com, that I needed an extra small, but I got it and it fits perfectly.

Good luck figuring things out.

[jweeks]

Don,

Welcome to the forum. These are great questions. I use a Swift LT with a BiPAP with pressures of 20/13.5. I see an average leak of 35 or so. I find that using Lansinoh on the pillows helps them to seal. I use a chin strap, but I notice that my gag reflex is getting more sensitive over time, and the pressure on the skin under my jaw sometimes bothers me. I am looking for alternatives.

Waking up with dry mouth is a sign of mouth breathing. That is bad. You need to find a way to prevent it. Note that AHI is not going to be accurate when you have leaks. Also, you might not be getting the best therapy in the presence of leaks. However, a leak of 40 doesn't sound that bad to me. Has it been getting worse over time? The reason I ask is that the pillows on the Swift LT seem to wear out quickly. I replace mine about every 6 weeks. If you are 4 weeks in, you could be due if your fit wasn't great to start with.

-john-

[Pugsy]

Don, you have the software. Look at the daily detail graph for leaks. Sometimes the overall average can be a bit high because of a couple of bad leak spikes or even a large leak. Meaning most of the night the leak was actually very good but a couple of bad times may have given the impression the leak was larger overall when it really wasn't.

I use the Swift LT. Right now I am using a very narrow pressure window of 10-13. Last night I average 31 L/min but you can see I had a few bumps. Some nights I have more larger bumps and the average does show it. I do believe the machine can compensate for these smaller bumps so I trust the accuracy. I rested well last night. Feel pretty decent other than the crippled up back from painting a ceiling yesterday. Got to do more today

I sometimes have a bit of a dry mouth from mouth leaking. Probably happened at that leak that shows right after hour 1. Might have rolled onto my back. I have it on good authority that I tend to open my mouth a bit on my back but keep it shut when on my side. If you have enough large leaks it can impact your therapy as well as the overall average.

[DoninOrlando]

Pugsy,
Thank you very much for the reply. That is exactly what I wanted to know. So you have the same machine and mask, and are averaging 31, or at least that night did. I was beginning to think the data was wrong for my mask as I never hit below 35 and average 40. Your average "straight line" is about 31 where mine is almost always 40. Mine looks similar to yours, fairly consistant, just a few smaller short duration leaks, but at 40. My biggest leaks are usually the last hour when the tape wears out and starts to leak. I have a hybrid on the way that covers the mouth. I hate to change from Swift LT as I can almost forget it is on, but I want to lower leaks and AHI. My AHI average 5 but have had a few in the 4's since increasing pressure from 10 to 11. but the leaks are increasing so I cannot increase more without another mask. May not need to either.

I did not have the dry mouth before increasing pressure, but have also had my lowest AHi and the 11 feels as confortable as 10, just leaks more. I also have a Pap Cap on order so if that chin strap works better than the last few, it may also help. I do not believe I am leaking from nasal area as it fits very well. I move around a bit and rarely have it loose seal when I use breath right strips. The tape helps, but only for the first 4-6 hours as my mustache and beard mess with it. So far I cannot get used to a chin strap as they feel too tight and constricting. Been looking for a smaller one like on football helmets but don't see one. Maybe I will try to get one from a sports store and rig it up somehow.
Thanks again for all your help.

[bdubsee]

It may be worth trying a different mask. I started with the nasal pillows as well because of my beard (and on the advise of my DME) but it doesn't quite do it for me. I switched to Respironics ComfortGel mask and used the RemZzzs http://www.remzzzs.com facial masks and I've been pretty happy. The liners fill in the space between my beard and the mask as well absorb oil (my seal was breaking at about 1.5 hours due to oil and sweat without the liner). I've had to add a chin strap because I occasionally open my mouth. I am going to to try a full mask next time with the RemZzzs.

[prestifare]

Pugsy,
Thank you very much for the reply. That is exactly what I wanted to know. So you have the same machine and mask, and are averaging 31, or at least that night did. I was beginning to think the data was wrong for my mask as I never hit below 35 and average 40. Your average "straight line" is about 31 where mine is almost always 40. Mine looks similar to yours, fairly consistant, just a few smaller short duration leaks, but at 40. My biggest leaks are usually the last hour when the tape wears out and starts to leak. I have a hybrid on the way that covers the mouth. I hate to change from Swift LT as I can almost forget it is on, but I want to lower leaks and AHI. My AHI average 5 but have had a few in the 4's since increasing pressure from 10 to 11. but the leaks are increasing so I cannot increase more without another mask. May not need to either.

I did not have the dry mouth before increasing pressure, but have also had my lowest AHi and the 11 feels as confortable as 10, just leaks more. I also have a Pap Cap on order so if that chin strap works better than the last few, it may also help. I do not believe I am leaking from nasal area as it fits very well. I move around a bit and rarely have it loose seal when I use breath right strips. The tape helps, but only for the first 4-6 hours as my mustache and beard mess with it. So far I cannot get used to a chin strap as they feel too tight and constricting. Been looking for a smaller one like on football helmets but don't see one. Maybe I will try to get one from a sports store and rig it up somehow.
Thanks again for all your help.

Just like to chip in with my $0.02 worth..

I also started out with a Swift LT. In the beginning, leaks were a huge issue, mostly due to the fact that I'm a side sleeper. The nasal pillow would get knocked out of position from movement. I eventually ended up with a taping regime that worked fairly well (even though ending looking like Darth Vader waking up the morning after a bar room brawl), but it made my bedtime routine a little too cumbersome. In addition, I really couldn't get to the pressure levels I needed with the nasal pillow. Anything above 11 made me feel like my nostrils were tearing.

Anyhoo, I decided to go for the full face mask (ResMed Mirage Quattro), along with a PureSom Ruby chinstrap. Had to go through a few different straps (including my wife's elastic hairband) before I found one that works without being too constricting or tight.

Upsides (in my case) are:

* _Significantly_ less leaks, in-sleep adjustments nd general cumber. The FF mask has a tighter fit, and isn't nearly as prone to being knocked out of position as the nasal pillow.
* Much higher pressure without trace of discomfort. The FF mask disperses the air more, "diverting" the pressure in lack of a better description. I'm currently at 14, which would have been impossible with the nasal pillow.
* Headgear is less prone to movement, much better fit (and more extensive adjustment options) than the Swift LT.

"Downsides":

* The FF mask obviously takes up more "real estate". Did take some time getting used to.
* As a result of the above, you'd need to take more precautions concerning perspiration/oil/facial hair than with the nasal pillow. The RemZzzs are very useful in this regard, as is a thin layer of talcum powder.