Hi from new member (tried taping my mask)

Isn't it "lovely" when everything starts coming together?

This sounds like real progress. It starts with a change in focus and then is realized with hard work and change.

With your airway stinted open and decent report results it really doesn't matter if you sleep on your back or not. If your numbers change, then you may have to change your sleep position or up your pressure but until then dream away on your back.

HoseCrusher wrote:Isn't it "lovely" when everything starts coming together?

This sounds like real progress. It starts with a change in focus and then is realized with hard work and change.

With your airway stinted open and decent report results it really doesn't matter if you sleep on your back or not. If your numbers change, then you may have to change your sleep position or up your pressure but until then dream away on your back.

Thanks! I think a bit part of getting this to work has been really understanding that the CPAP machine is indeed holding your airway open. The stent analogy is great.

I know it's kind of sad to be celebrating that but...



Only a short recording as I woke up on the night an, in the fog, did not put mask back on.

I talked with my sleep tech yesterday about the leaks, and he recommended trying a nose mask. He gave me a loaner but when I tried using it, the machine made kind of a roaring noise and it felt really weird. The most disconcerting thing was that, if I opened my mouth, it became almost impossible to breathe - as if some kind of suction was exerted into my mouth. This would be a great enhanced interrogation technique, but was not going to work for sleep. I then realized I probably need to change the mask setting on the DreamStation. Turns out this is locked, and would require more power cycling and menu diving that I had energy for at bed time.

I don't think that the Resistance setting would make that big of a difference between the 2 masks.
Which nasal cushion mask did you try?
You need to go into that clinical setup area and unlock everything.... that's a load of crap to have the mask setting locked...it's not THAT important anyway. Geez. Talk about control freaks.

You are supposed to keep the mouth shut with a nasal mask...not supposed to breathe with it on
But...believe it or not with time and experience you can learn to talk and yawn and have the mouth open and it not cause a big tornado to exit the mouth.

Pugsy wrote:I don't think that the Resistance setting would make that big of a difference between the 2 masks.
Which nasal cushion mask did you try?
You need to go into that clinical setup area and unlock everything.... that's a load of crap to have the mask setting locked...it's not THAT important anyway. Geez. Talk about control freaks.

You are supposed to keep the mouth shut with a nasal mask...not supposed to breathe with it on
But...believe it or not with time and experience you can learn to talk and yawn and have the mouth open and it not cause a big tornado to exit the mouth.

Thanks Pugsy,

This is the mask:

It's a F & P mask...I am not all that familiar with F & P masks...maybe it is the Zest...

At any rate...the only mask setting that Respironics machines offer is the Resistance control setting and the only masks that have an actual stated setting are the Respironics masks..
When using non Respironics masks we normally just turn Resistance setting to 0 which is the off position.
You were already using a non Respironics mask so it most likely was set to 0 anyway.

The Resistance Control setting doesn't affect leak calculations like the mask selection feature in the ResMed machines. My own opinion about it..mostly hype and my own experiments with it at various settings...couldn't tell it did anything.

To be able to set the Resistance control setting accurately you need to be using a Respironics mask and even then I don't think that it is a make it or break it setting.

I saw your back sleeping question thread. While some people find they need higher pressures on their backs..it's not always a given that they will. I did an experiment once where I built a wall and made absolutely sure that I stayed on my side because I was seeing some rather dramatic pressure increases in probable REM sleep. My goal was to see if sleeping on my back seemed to lower those times I saw 18 cm...it didn't seem to make any difference. In REM when sleeping on my side I just needed a lot more pressure.
So since I have zero control over REM and I was going to end up needing higher pressures anyway I decided to not worry about supine sleeping and let the machine do its job.
Unless it is proven that supine sleeping is the only cause for higher pressure needs and those higher pressures are causing a problem...I think just set the apap in a range that takes care of both REM and supine sleeping and let the machine sort it out. Now if doing that creates a problem we try to dig deeper and fix the problem with maybe some sort of compromise but if it doesn't create a problem...sleep in any position you want.
There's no guarantee that side sleeping will lower the pressure requirements...you might be like me and it not make any difference what position you are in and it might be just REM that is causing the higher pressures.

Pugsy wrote:It's a F & P mask...I am not all that familiar with F & P masks...maybe it is the Zest...

At any rate...the only mask setting that Respironics machines offer is the Resistance control setting and the only masks that have an actual stated setting are the Respironics masks..
When using non Respironics masks we normally just turn Resistance setting to 0 which is the off position.
You were already using a non Respironics mask so it most likely was set to 0 anyway.

The Resistance Control setting doesn't affect leak calculations like the mask selection feature in the ResMed machines. My own opinion about it..mostly hype and my own experiments with it at various settings...couldn't tell it did anything.

To be able to set the Resistance control setting accurately you need to be using a Respironics mask and even then I don't think that it is a make it or break it setting.

I saw your back sleeping question thread. While some people find they need higher pressures on their backs..it's not always a given that they will. I did an experiment once where I built a wall and made absolutely sure that I stayed on my side because I was seeing some rather dramatic pressure increases in probable REM sleep. My goal was to see if sleeping on my back seemed to lower those times I saw 18 cm...it didn't seem to make any difference. In REM when sleeping on my side I just needed a lot more pressure.
So since I have zero control over REM and I was going to end up needing higher pressures anyway I decided to not worry about supine sleeping and let the machine do its job.
Unless it is proven that supine sleeping is the only cause for higher pressure needs and those higher pressures are causing a problem...I think just set the apap in a range that takes care of both REM and supine sleeping and let the machine sort it out. Now if doing that creates a problem we try to dig deeper and fix the problem with maybe some sort of compromise but if it doesn't create a problem...sleep in any position you want.
There's no guarantee that side sleeping will lower the pressure requirements...you might be like me and it not make any difference what position you are in and it might be just REM that is causing the higher pressures.

Thanks Pugsy,

That's very helpful - I think I'm not going to stress too much about back vs. side sleeping. I've continued to exercise more, and find that I need to shift positions in bed anyway to help alleviate muscle fatigue.

I also had kind of a Eureka Moment relating to my mask fit issues - as I'd mentioned I took a couple of weeks off work to catch up on a number of personal issues, mainly my health but also other things. During this period, I went up to two days without shaving at several points. My beard tends to grow quite fast (and I have really coarse hair), and I suspect that the heavy leak nights corresponded to nights when I had 3 mm of very bristly stubble interfering with the otherwise phenomenal seal of these masks. I skipped shaving Saturday and Sunday mornings, and had quite a bad leakage night last night and finally it clicked that the stubble is not good for the seal of these masks!

I even think I've had some nights where the seal got worse during the night due to a nocturnal beard growth spurt. Sounds silly, but have always taken ribbing from my barber about how fast my hair grows and how thick my stubble is (destroys razors etc). I feel dumb not to have clued into this earlier, but think I might start shaving before going to bed to see if it will help.

All the best,

L

FWIW here are the last three nights, with progressive beard growth (last time I shaved was Friday morning).

Friday night (first night of beard growth; AHI 5.41)



Saturday night (second night of beard growth; AHI 6.57):



Sunday night (third night of beard growth; AHI 15.2):



In addition to raising my AHI, I suspect that the beard also considerably degrades my sleep because the leaks are very noisy. The sound of air pushing past the soft mask rubber propped up by 3 mm bristles is somewhere between a harmonica and a saxophone, with a bit of kazoo thrown in.

I guess this is really a sign that I'd better pay more attention to my personal grooming habits... (yes, I did *shower* on those days)

Full face masks aren't very forgiving when it comes to the least little thing impacting the seal. There's just too much real estate involved.
There are people with full beards who successfully use a full face mask but I suspect that their beards have "softened" up a bit and the texture is more conducive to keeping the seal.

So now you learned another cpap lesson.
It's probably a good thing that I do well with nasal pillows...if I had to shave every day or night just to use a full face mask I don't know that I would get it done. I know that I am a lazy sot already.

Thanks Pugsy!

So there might be something to this "shaving" thing... I took a shower and shaved as well as I could just before going to bed, and lo and behold I snagged an all time low AHI of 4.93!! That's actually below the magic threshold of five everyone keeps talking about. I'm sure there were numerous nights during my off-time and weekends when my bristles were holding the mask off my face. I think I'm going to change my routine to shower and shave *before* bed.

If I can keep this down, and actually work on the duration of sleep, it'll be great! I am feeling pretty good this morning, even though it was only 4:51 of sleep.

Showered and shaved right before bed, and had another sub-5 night!



The mask leaks are insane though - it's really noisy and I was kept half-awake by that. I wonder if backing the pressure back down might be worth a try given the stubble/seal issue.

I definitely feel better this morning, although I still also feel like someone who had a kazoo playing in their ear half the night.

You went WAY into large leak territory...so far deep that the machine didn't raise the pressure at all and it was sitting there clueless blowing that minimum pressure for the entire time of the large leak. Your nice low AHI is because your machine was clueless for a majority of the night. Reducing the maximum wouldn't have helped last night...it never really moved off the minimum.

Maybe it wasn't the stubble that was the problem. How long have you been using this cushion? Maybe it is getting tired and needs replacing. Maybe you simply need another different type/model of mask.

This amount of leak simply has to be fixed in some manner...not only does it cause sleep problems...it's causing significant therapy problems as well. I don't expect perfection and will often let a little leak slide but leaks of this magnitude I can't let slide.

Do you use mask liners? Maybe slippery smooth shaven cheeks are a different problem for the mask.

BlackSpinner wrote:Do you use mask liners? Maybe slippery smooth shaven cheeks are a different problem for the mask.

+1 call Karen at Padacheek.com.

Thanks guys - I wondered if the numbers might not be too good to be true. Leak was indeed bad last night, so hard to imagine the numbers are meaningful.

I am still clueless about the algorithm this machine follows - would probably help to understand that.