Newbie struggling with mask

[Steve of Cornubia]

Hi Folks. I was diagnosed with severe sleep apnea a couple of weeks ago. I haven't had to adjust much mentally, because I knew I was a sufferer a long time ago, not least because my wife had suffered more from my condition than I, poor girl. However, a heart attack at 52yo, then a steady but steep increase in symptoms, finally drove me to a specialist. My sleep study AHI was 39. Oh and by the way, I suspect I have some sort of central apnea problem too, including during the day (albeit minor).

Anyway.......

I am now one week into a month-long CPAP/APAP trial using Resmed equipment. As I'm sure most people experience, the initial problem was simply getting used to wearing a full-face (nose and mouth) mask plus having the machine running nearby. Results so far are mixed and confusing. My AHI came down really quickly and last night was below 5. Strangely though, my best days so far have followed nights where my AHI was around 8.5 - 9.0. Having said that, the first week has been atypical (I hope!) due to much lost sleep due to grappling with the mask. I have really struggled to set the tension where it is (a) comfortable (b) doesn't slide about when I sleep on my side and (c) doesn't leak.

My other problem has been an APAP machine that won't behave, or so it seems. Until last night, the darn thing would occassionally go berserk, dialling up enough pressure to almost blow the mask off my face. Keen to understand what's going on, I have several times tried to stop the leaks using hand pressure, but it seems that the machine just refuses to back off the pressure once it is high, leading me to think it is NOT a response to pressure loss. Is this normal? I eventually have to turn the machine off, then on again.

After my first consult during the trial, the nurse suggested we set the machine to operate in CPAP mode. Apparently, I have needed pressures up to 18cm, which she said indicates I have a VERY floppy palate/throat, but she wanted to trial CPAP at 13cm initially, and see how things go. Well I had the best night so far, with my AHI down to 4.1 and more sleep than I've had in quite a while. I feel pretty good today!

This leads me to my second question (sorry!):

Given the behaviour of my machine, i.e. it goes berserk from time to time, is it possible to set a mask tight enough to cope yet without crushing your face? I feel like I have the mask about as tight as I can tolerate right now - tighter would be painful I think.

Oh and FYI, my apnea seems to be purely down to this 'floppy palate' thing. I have never been more than a few kg overweight, never smoked and never taken a sedative that didn't involve fermenting grapes I am pretty unfit though I'm hoping I can start exercising once I get my energy levels up.

Apologies for starting right out with questions!

[Pugsy]

it seems that the machine just refuses to back off the pressure once it is high, leading me to think it is NOT a response to pressure loss. Is this normal? I eventually have to turn the machine off, then on again

The machine doesn't increase the pressure in a blink of an eye and it doesn't reduce the pressure in a blink of an eye either.
It takes a few minutes...Your best bet to reduce the pressure back to a more manageable level is just to turn it off and then back on. Depending on how high it goes to it might take several minutes to get back down to your minimum pressure.
The new S9 machines don't go chasing leaks with more pressure like the older machines did...but it might chase it a little.

We would need to see the software reports to see just how wild it is going and what was going on when it decided to go wild.
Do you have the software to get the detailed reports.
SleepyHead will work with your machine and I have links for it in my signature line.
ResScan will also work. And you can find information on where to get it in UncleBob's signature line here
memberlist.php?mode=viewprofile&u=38643
Tutorial on how to use ResScan here
http://montfordhouse.com/cpap/resscan_tutorial/

Let's see just how bad the leaks are and what the pressure is doing.

These masks should never be cranked down horribly tight...if it is causing pain or abrasions or bruising...something is wrong...fit...size or maybe just not the right mask for you.

Don't know how to post images of reports so we can see what you are seeing...check out this thread
viewtopic.php?f=1&t=81072&p=737779#p737779

[Steve of Cornubia]

Hi Pugsy. Thanks for the reply. I don't have access to data or reports because the machine is a 'loaner' from the sleep clinic. I am still experimenting (or 'messing' as my wife describes it.....) with the mask and the problems could be mainly lack of experience. Part of the reason I have it tight is I can't get to sleep on my back, only my side, and if I have the mask looser, it gets pushed sideways by my pillow, causing leaks.

It's almost 8pm here and I'm still wide awake

[Viperdave]

steve,

It might be that your mask is not right for you.

What mask are you using?

I have found that the gel masks work better for me. i routinely see pressures in the 16-20 range, and i found the silicone masks have a shorter cushion and i couldnt get it tight enough without hurting. the gels seem to have a taller mask and i was able to tighten it down better. I actually sleep mostly on my side or stomach. what i found helped also was using a FIRM pillow, folded in half, but only under part of my face. when i travel i use an antileak strap to help keep the mask on in my sleep.

[Pugsy]

You can still use the software I mentioned even if the machine is a loaner.
Doesn't matter at all. If you have a little SD card in the back of that machine you can use the software.
Downloading the data from the SD card doesn't do anything to the data on the card. It's all still available for later reviewing by whomever wants to look at it.

[Janknitz]

Steve, if your mask is an air cushion mask, see my tips for "Taming the Mirage Quattro" in my signature below. Those may help, or you may need a different mask.

As for the pressure issue, when it goes really high like that and wakes you, most machines have a "ramp" button. Even if you don't have your machine set to ramp when it first starts up, you can hit that button to lower the pressure back to whatever it's set at for as a starting point (and that point can be changed). That way you don't have to turn it off and turn it on.

Getting control of the leaks will help a lot. You might look up how to make a simple mask liner (cut out a triangle of an old T-shirt until you are settled in a permanent mask) to help.

[Steve of Cornubia]

Thanks for all the advice, folks.

I will get hold of the data analysis software - I am a compulsive fiddler and I get the impression from reading this forum that the best long-term results come from optimising your equipment and understanding what's going on over the long term. Using a specialist to do that would be expensive and time-consuming.

The mask issue I suspect will be hard to address fully, but worth the effort. The treatment is already paying off in terms of reducing my apneas, but my sleep is still quite fragmented by mask leaks. If I can fix or reduce that problem, life should be sweet!