To increase pressure or not, with detailed data Part II

[Perrybucsdad]

Cude... can you post the Pressure data?

[Cuda]

Straight CPAP mode 13cm with EPR 1.

[Jay Aitchsee]

Cuda, I haven't read all your post, so forgive me if this doesn't apply. Back when I was chasing my AHI and going ever higher on the pressure. A sleep doctor gave me some good advice - Go lower. I think a couple things happen when you do, you give your body a chance to adjust and you get to adjust to the mask. Also, it seems to me new masks and seals require a little break-in period before they comfortably fit to your face. Lower pressures allow that to take place without blowing them off.
What I did was set my pressure down about 4 from where I'd been, run there for a few days, and then increase by .5 or so and run there for a few days, and so on. Eventually, I went thru a dip in AHI and I started back down toward that dip, till I narrowed in on what I felt was the best CPAP pressure. This was before I had ResScan and Auto. Once I got those, I set up the apap to auto titrate around the pressure I had found earlier with a 4 spread. The auto titrate pressure median turned out to be just slightly higher than the one I had determined manually.
If you think you're having positional apneas you might try time lapse video. Here's a thread: viewtopic.php?f=1&t=65101&p=607701#p607701
For those sores on the bridge of the nose I find those small (about the size of nickle), round, sheer bandages helpful without causing leaks.

Jay

[Cuda]

AHI 1.1 Leak median 4.8, 95% 18. Pressure 15cm EPR 1

Nose damage, I think what happened was not the mask being too tight but rather I rolled over pushing the mask into my face. No problems last night with soreness.

I actually increased my pressure to 15cm and did not change the mask straps or anything so I guess thats also the same as tightening the straps (hence why I think I just rolled over or otherwise applied pressure to my mask the night before), I had some decent leakage but most of that was after waking up for a glass of water and I started to fall asleep without my mask, thankfully the wife asked me to put it back on and I did and I fell back asleep!

The 15cm with the same strap settings actually seemed more comfortable. EPR is now 1. In a way I did go back down until comfortable, when I breath at 13cm I felt like I could handle more so I tried 15cm. Not sure what to make of it until I try it for a few more days and not sure how the leaks are affecting me, I seem to have higher AHI with zero leaks, I guess the machine is more accurate in its reporting with a super tight seal.

My question is, as long as the leak rate is under the 24L/M, while the reporting may be off its my understanding the machine compensates and I am still getting my 15cm right? Anyway here is the chart:

[Pugsy]

My question is, as long as the leak rate is under the 24L/M, while the reporting may be off its my understanding the machine compensates and I am still getting my 15cm right?

That is my understanding also. I would trust the results. Last night looks pretty good and even the one ugly leak hour is within acceptable parameters and I doubt it has missed scoring any events.

[Cuda]

Good, its a lot easier to fit for comfort if I allow for some leakage.

[Pugsy]

Good, its a lot easier to fit for comfort if I allow for some leakage.

The best numbers in the world don't mean squat if you have pain or discomfort from mask and thus highly fragmented sleep. Gotta get those hours of sleep and uninterrupted as best we can. Sometimes compromises have to be met.
Of course leaks can wake up a person to...so fine line to walk sometimes.

I would sacrifice a little leak any day of the week to have mask comfort so I could sleep uninterrupted from mask pain.
I have had worse leak lines than what you had last night and count the overall night a success. I don't sacrifice comfort for a zero leak...

[Cuda]

Well I would add zero leaks are important as far as full face masks that use air cushioning and silicone or whatever that material is. Slight leakage is ok if it does not wake you up seems to be the consensus but without a mask liner those slight leaks created the dreaded "face farts" which actually wake me up. The plastic/skin seal also gets moist and becomes uncomfortable and seems to causes these leaks. I also have to clean the mask every day. I would say the mask liner (pad-a-cheek or home made from a t-shirt) helps in all these areas. It feels better on the skin, leaks to do not wake (which is a good thing as long as the leaks are not ruining therapy), I do not have to wash the silicone mask liner as the pad-a-cheek takes all the damage and that's easier to wash once a week. I have to say the mask liner from pad-a-cheek really does make the mask.

I agree about the compromise. My results are not perfect but as some of you know that have followed my journey I am doing much better now than a few weeks ago. Progress is all I need to stay motivated, thanks to you guys I get through the daily setbacks that occur from time to time.

[Cuda]

Third night at 15cm EPR 1. I am getting use to the pressure but it seems its not enough to deal with REM.

[Perrybucsdad]

Cuda... maybe I missed it in your posts, but what mask are you using and getting these results now? The Quattro FX?

[Cuda]

Yes. Quattro FX with pad-a-cheek liner.

[Perrybucsdad]

Are you useing the padacheek anti leak head strap? Just looking to fix some of my leak issues as well.

[Cuda]

I purchased that but my head is too small so I gave up on it. As you can see with my charts I still get leakage but its under the 24L/M so I guess I will just live with it. I can clamp down hard enough to get zero leaks but its not worth the pain. I might adjust the anti-leak strap and try again later, seems it would be useful keeping the headgear from sliding around as I am a side sleeper. What helped is when I sleep on my side I was moving the gear which moved the mask so instead of putting my arm and hand under the pillow and resting my head on the pillow I now rest my head on my hand and have it on top of the pillow sleeping on my side. Seems to help.

Not sure how to adjust the strap, I thought about cutting the velcro section off the end and have the wife sew it back on so the strap is two inches shorter. If not suffering from "small head" syndrome I think the strap would help. It seems to apply pressure more to the center.

[Cuda]

Perry, if you are not using the mask liner I highly recommend it. Before the liner the mask sealed fine but after 3 hours I would have leaks I could not fix. The mask seal with my skin would get moist and that seemed to cause the problem, I also would have some red marks from time to time from the skin being wet and not able to breath. You can make one with a t-shirt I am told but the pad-a-cheek liner feels so much better than the silicone or whatever it is on the mask. You also do not have to clean your mask every day. I just wash my face every night and once a week put some laundry detergent on the mask and wash in warm water in the sink and air dry the liner. Now I can get 6-7 hours of sleep. So for the liner I would say go for it.

[Perrybucsdad]

...suffering from "small head" syndrome ...

TMI and sounds like a personal problem.

Also, did you try a homemade liner? Did it work at all?