Living the mask life...questions

Hi all,

I just recently got back on to using my BiPap. I had an updated sleep study back in June (after not using the machine for years) and got a new machine in early July. I struggled a bit with the Respironics machine (specifically the lack of auto-start with a ramp) and decided to stick with the Resmed AirCurve10 VAuto that I had gotten previously. After trying the new AirTouch F20, I found the AirFit F30 and it was an amazing find. I'm not feeling like I can leap tall buildings yet but generally feeling a bit better and am generally comfortable with therapy but I have some questions.

1) A few times a week, I tend to wake up with a bone dry mouth. I do have the humidifier filled and set to auto, so I am not sure what might be happening here. Can anyone offer some thoughts?

2) Using the BiPap Auto, there is a low pressure and high pressure. Is there any reason I couldn't set the lower pressure down to say 6? (I use a 4 ramp for 45 minutes)? I ask because my understanding is the machine auto-adjusts to whatever pressure I need at the time. I will occasionally wake up and feel like the pressure is super high, so I wind up stopping and re-ramping. This might just be a fundamental misunderstanding on my part.

3) Looking at the numbers from last night are there any general recommendations? Can someone explain leak rate to me and at what level should I be concerned?
Thank you so much for this community, has been really helpful to motivate me to get back on to therapy and also take control of my therapy needs from my DME.

gmsmith wrote: ↑

Fri Aug 02, 2019 9:43 am

1) A few times a week, I tend to wake up with a bone dry mouth. I do have the humidifier filled and set to auto, so I am not sure what might be happening here. Can anyone offer some thoughts?

Probably mouth breathing is causing the dry mouth unless you can blame it on medication side effects or other health issues.
Common problem. The humidifier simply may not be cranking out enough extra moisture to offset the drying effects of the mouth breathing. You could try increasing the humidity setting higher than the auto (which is equal to maybe 4 or 5 manually) and see if that helps or not. Lots of people just add a oral hydrating agent of some sort to help with the dry mouth. Sometimes even with maximum humidity being cranked out the mouth is still dry....the humidifier was designed to help hydrate the nasal cavity and not the oral cavity which is much larger. Sometimes it simply can't keep up.

gmsmith wrote: ↑

Fri Aug 02, 2019 9:43 am

Is there any reason I couldn't set the lower pressure down to say 6? (I use a 4 ramp for 45 minutes)? I ask because my understanding is the machine auto-adjusts to whatever pressure I need at the time. I will occasionally wake up and feel like the pressure is super high, so I wind up stopping and re-ramping. This might just be a fundamental misunderstanding on my part.

It will auto adjust but the minimum still has to be close enough to what you need to hold the airway open to prevent the collapses.
I am afraid that if you set the minimum EPAP to 6 that you may see a significant increase in the obstructive events because the machine wouldn't be able to get to where it needs to go fast enough. These machines don't respond in the blink of an eye ...they go up slowly and come down slowly over a period of several minutes.
It can't go from 6 EPAP to 12 EPAP in a minute....and you need at least 12 or 14 all night long.
You could try it and see what happens but I don't think you will like what you see.

gmsmith wrote: ↑

Fri Aug 02, 2019 9:43 am

3) Looking at the numbers from last night are there any general recommendations? Can someone explain leak rate to me and at what level should I be concerned?

ResMed machines report excess leak only....and ResMed's line in the sand is 24 L/min where large leak territory starts.
It's an ultra conservative line in the sand...the machine can actually do a decent enough job compensation for leak up to around 30 or 35 L/min.
Obviously you didn't even make it into large leak territory on this report and unless leaks woke you up...I wouldn't give them a second thought.
Even small brief excursions into large leak territory aren't the end of the world as long as they aren't waking you up.
Anything that wakes us up is unwanted no matter how big or how little the leak might be.

You aren't getting full effective therapy with that ramp for 45 minutes and the machine doesn't flag anything during the ramp period so we have no idea what might or might not have been happening during the ramp. I would suggest shortening the ramp period if at all possible.

Thanks, Pugsy for the quick reply.

I've upped the humidifier, thank you. Not familiar with oral hydrating agents, will need to do some searching.

Thanks for the feedback on the pressure and leaks.

For the ramp, I tend to put the mask on and watch tv for a bit, so I may be actively awake for about 30 minutes before closing my eyes. I'm trying to avoid falling asleep without a mask. I definitely didn't realize it didn't flag anything during the ramp, so I'll play around with the ramp time to see if I can find something a bit less that works.

Again, thank you!!

gmsmith wrote: ↑

Fri Aug 02, 2019 10:37 am

Thanks, Pugsy for the quick reply.

I've upped the humidifier, thank you. Not familiar with oral hydrating agents, will need to do some searching.

the oral hydrating agent i use and recommend is xylimelts. it's a lozenge that your put in your mouth between teeth and cheek. it stimulates saliva for the whole night.

the side that goes against the teeth is slightly tacky so as to keep it in place.

you can generally find this product in your local drugstore or grocery store in the oral care section.

it's one of many such products you'll find there.

good luck!