CPAPtalk.com

Yes I fall asleep pretty quickly and the ramp is just set where its set. I haven't messed with it, and only used it that one night when I had to get up once. I will adjust it or just turn it off.

So I will stick with the Rx min pressure of 10cm and then set a high upper threshold to see where it goes.

Thx

OK I was a little bit in data overload at the beginning but am starting to realize this isn't that complicated, just trying to isolate a few things that work and get some good sleep. I am posting one more night's of data below and here is what I am currently thinking:

1. The FFM is losing its luster. Its great for my mouth breathing tendency, but when the pressure gets high enough for it to be effective at preventing apneas, it starts to leak and wakes me up. I took the whole thing off last night after only 5 hours.
2. The AHI graph is a lagging indicator. I have all my OAs and H's then it shows my "mountain" in the chart the next hour. The apap mode isn't able to catch up with the AHI so I am still getting the sleep disruption, then having to deal with the higher pressure later and sleep disruption associated with that.
3. There seems to be a "mountain or 2" of AHI each night. Guessing this is in the deeper sleep episodes, but could be back sleeping too. Either way, I am not going to be able to tolerate the pressure high enough to keep those from happening with a FFM. See #1 above. I've got a week's worth of data showing that even when the apap pressure titrates up to the high teens I am still getting the apneas. Seems crazy to be chasing this ever higher pressure just to make the FFM work. I can;t see tolerating some pressure in the 20+ range to get ahead of it.


Feels like pushing the FFM is the wrong way to go. I have 5-6 nights of data showing that with the nasal mask and a pressure of only 7, I can get in the low single digit AHIs (1-3). I just need to find out how to tolerate the nasal mask and keep the mouth breathing from occurring and waking me up.

So now my questions:

A. Is any of the stuff above totally wrong and am I jumping to the wrong conclusions here? Am I running away from the FFM too soon?
B. What are some suggestions for a better nasal mask/pillows that are QUIET and comfortable? Stay on well when you turn from side to side. ( I know things work differently for everyone, but there has to be some consensus)
C. How do you deal with the mouth breathing? I have a chin strap, do I just keep at it with that?

Thanks as always, T

Here is a chart from a couple of weeks ago with the nasal mask. Shouldn't I just be trying to make this work? Looks pretty good...right?

I going to give my 2 cents here and I'm very interested in what others think of my observation.

It would appear that at around 00:40 you either turn on your back or, more than likely you have entered a deeper level of sleep. This would increase the relaxation of your muscles causing your airway to become obstructed. The machine ramps up the pressure to address the OA and starts causing pressure induced CA's. Seeing more CA's as the pressure escalates would make me think about reducing the upper limit to try and reign in this apparent pressure/CA run-away. It seems that when the pressure drops back to around 14 that you are good to go.

Good Luck!

OK to support this line of thinking, here's a night where I tried capping it a 14cm. range was 10-14.

Can you turn off the AHI graph and give us the leak graph instead?
To turn off AHI graph go to Preferences/Graphs and remove the check mark. The AHI graph is just redundant information as I can see the clusters easily in the Events graph. The leak graph is much more important than the AHI graph at this point.

donewithbeingtired wrote:Here is a chart from a couple of weeks ago with the nasal mask. Shouldn't I just be trying to make this work? Looks pretty good...right?

Looks pretty darn good to me and unless the leaks are massive this is what I would be trying to use. From the statistics it doesn't look like the leaks are massive anyway...so if you are mouth breathing it sure isn't very much.

I do have a hint about using auto mode but keeping the pressure more or less fixed so that we don't lose FL reporting (it's turned off in cpap mode).

Okay...so I went back and tried to read through the past pages and you went from a nasal mask to a full face mask because of comfort issues? Is that correct? Which nasal mask were you using? Perhaps maybe a different nasal mask would be a better option than full face and the pressures it seems to need? It's not unusual to need more pressure with a full face mask than a nasal mask.

What was the comfort problem with the nasal mask? Some are better than others and maybe just a different nasal mask would be a better option than dealing with varying pressures and a full face mask.

So exactly which model(s) of nasal masks have you tried and what was the problem?

shots w/o AHI and adding leak.

Nasal mask is a REpsironics "wisp" That's all I know from looking at it. Packaging is long gone.

The issues are noise (it seems louder than the FFM), the mouth effect, and its tendency to move around when I roll over, etc. Having my lips pop open from the air when I relax. That leads to the chin strap which helps keep my house closed, but is uncomfortable. I tried some nasal pillows very early on but the wisp seemed more comfortable at the time.

I am willing to try other options, but need some help on the mouth breathing thing. Seems like that needs to be fixed for any of this to work.

Thanks, T

Thanks for answering my questions. It appears, based on your last chart, that you do better on a straight pressure rather than a variable one.

SGearhart wrote:Thanks for answering my questions. It appears, based on your last chart, that you do better on a straight pressure rather than a variable one.

+1

And, they apparently "nailed" your correct pressure, too.


Den

.

Okay. Mouth dropping open and air rushing out is of course unwanted even if it is brief if it wakes a person up.
Unfortunately this is always a potential problem with any sort of nasal interface mask....and I know from my own personal experience that chin straps can be annoying also. The tongue needs to stay in place so it blocks the door and prevents the air going up the nose and down the airway from trying to exit prematurely through the mouth. Easy to do while awake but when we go to sleep the tongue gets lazy and drops down and lets the door open and we get a mouthful of air that wants to exit through the lips.

I had similar issues when I first started therapy and I went through chin straps, denture adhesive and taping in an effort to keep my lips closed. I settled on taping as it was less of an annoyance than the other stuff but I understand if someone is opposed to taping.
After about 2 months of taping I started getting lazy and forgetting to apply the tape....found out that my leaks from mouth opening had greatly decreased. So I simply quit doing anything because for the most part the mouth opening issues were rare and brief.

Do you have any nasal congestion issues that you may have noticed when using the Wisp and your mouth dropped open? Like was it maybe nasal congestion causing the need for the mouth to be open?

The Wisp is a nice mask and I have tried it but it just didn't work out well for me. I don't remember it being hugely loud though...but then I only lasted a short while with it.

Are you where you can maybe try a different nasal mask? I hear the F & P Eson has that vent diffuser to help reduce the noise level? I have never tried it though.
In terms of quiet the ResMed P 10 nasal pillows is the quietest I have ever used.

If you wish to continue with a full face mask...you are going to need to use more pressure than your current apap settings...maybe try 12 cpap or if apap mode try minimum to 12 and maximum to 12 so that Flow limitation flags are still available.
While I know that in theory X amount of pressure should be equal no matter which mask is used...in real life I have seen it often where someone needs more pressure with a full face mask than they used with a nasal mask to obtain the same results.

You have to decide which mask lets you sleep the best and work from there with the pressure adjustments.
Which is the lessor of the 2 evils...wake ups from mouth opening or leaks from a mask that is harder to get a seal and keep it and causes wake ups.
Decide which mask type you prefer and experiment with the various brands and models within that mask type.

OK thanks, I think I understand the options better now.

I am going to get a nasal pillow mask and try that in addition to some more nights with the wisp.

I have the chin strap to play with, but what about taping? Is that as easy as it sounds? Get a piece and put it on my lips? Tips, hints, tricks on that?

Try to get the ResMed AifFit P10 nasal pillow mask if you can...trust me...it's practically silent and I can't even feel the vented air unless my hand is about an inch from the vent holes and even then just barely.

Taping..yeah it's pretty much as simple as it sounds even though some people so seem to make a big production about it.

Lots of information in these various threads
viewtopic.php?t=8011

I opted to try easy, cheap and something I already had on hand so no need to buy anything else....blue painters tape left over from when I painted my mom's kitchen. It suited my needs.
You can do horizontal or vertical...I did horizontal after I experimented a bit with just how much force it took to actually open my lips if I had to. It's far from like cement. The idea is a gentle reminder to keep the lips closed..not cement them shut.
Do NOT do it if you often have nasal congestion issues that require mouth breathing out of physical necessity.

Try it while awake and just play with it and try opening your mouth to see if you can if you had to and how much force is needed.
It really takes minimal force...a good yawn will break the seal.

donewithbeingtired wrote:I have the chin strap to play with, but what about taping? Is that as easy as it sounds? Get a piece and put it on my lips? Tips, hints, tricks on that?

Yes, taping is easy if you understand the conditions that preclude it and accept that you are comfortable with it and understand the risks. Do a search on posts from Sleepydc for a really detailed description.

I would start with a 1 inch strip of 3M Transpore medical tape (available on Amazon). This is a perforated, plastic medical grade tape. 3M Nexcare is similar and can be found in most pharmacy/chain stores. It adheres well and is relatively easy to remove. The perforations allow some air to pass through.

Place the strip vertically from just under the nose to just under the chin. This helps some with jaw drop. Only press the tape down above your lip and below your lips. This allows your lips some freedom of movement and is more comfortable than sticking the tape firmly on the lips. You should find that you can talk, breath, and force open your mouth if needed with this arrangement. Thus, it doesn't result in much aprehension.

Try this for one night and see what your leaks look like. Also, note if your mouth is really dry or if the leaks wake you up. If all is well and no wake ups, you are good. If you need to do more, you can use the 2 inch version of the same tape. You may find that you can progress to more tape after getting comfortable with this arrangement. My results were so good that I find it comfortable to tape, and it realy eases my mind. My theapy is much better, and I get to use any interface I like.

I found to get my leaks good that I use the 1 inch strip as described plus I add another small piece of the same tape to each corner of my mouth for more coverage. When I still leaked through the perforations, I covered this arrangement with one piece of 2 inch 3M Micropore paper medical tape placed horizontal over the already taped lips. Micropore is less breathable and can be used for any of these lengths or steps if one prefers. Please note that it is much harder to remove quickly and in the morning from bare skin. This is why I use it over Transpore.

Of course, there are chin straps, ace bandages, cervical collars, tongue placement, and many other methods to explore. You will also find all kinds of different taping methods and preferred tapes among those of us that tape. It's really up to you. I agree with Pugsy that it's easier for me than the other methods at the moment, but others strongly prefer the other solutions. I simply tried it at first with a ffm because I read Sleepydc's posts, and I had a roll under the sink! You can use a power failure alarm and/or battery back-up solution if you choose to tape long-term and want an added safety margin.

Best of luck,

Mike