Ups and downs in Cpap therapy

I am on mask #3 and it is the Fisher & Paykel Eson. I have also tried the ResMed AirFit N10 and the Amara View. I've been on Cpap a little over a month and this forum has been invaluable to me. After downloading to SleepyHead from last night I got a message that my mask is not sealing well and I could do better. I wonder what in the world I should do. I went to see my doctor last Friday and he was very pleased with my results so far and also with my having SleepyHead to follow my progress. I was surprised by that. I guess he has not a clue about what my numbers should be because he said to use this Eson mask and go along my merry way. He also said I needed to adjust my pressures to a low of 6.6 and a high of 14. I have been going as high as 12+ since I did that. He based this on the fact that before I had a fixed pressure I was going as high as 13+. What do you all think? Any good ideas on masks? Do you think this current pressure range is good? I sure would like to get lower AHI's. Thank you!



P.S. One day later....I used the ResMed AirFit N10 mask last night to see if that would be an improvement. It was a disaster. I had huge leaks and slept terribly. My husband and I are both feeling like crap today. It's strange to me because my AHI score was one of my best. Just goes to show the AHI score doesn't always correspond to how we feel. I went in to the bathroom in the middle of the night to adjust but that was not much better. Tonight it's back to the Eson mask. Any suggestions for ones to try? I am going to order from Cpap.com

What type of mask do you seem to prefer? another nasal cushion or something else?
Are you wanting something in the nasal cushion line like the ESON?
If so you might look at the Swift FX Nano as it is similar to the ESON but with less headgear stuff. I think it still comes with free return insurance from cpap.com.
If you are wanting something totally different...try the DreamWear or the nasal pillows like I use???
If you tell us more about your preferences then maybe we might have other ideas.
In the end you have to try them yourself but maybe if we had some idea as to preferences (like nothing obstruction view) we could point you to some different ideas.

When you do your report images can you include the Events graph at the top and the flow rate graph?
You can omit mask pressure since the other pressure graphs shows more detail.

The bulk of your AHI is central/Clear Airway and we can't fix those with pressure tweaking on your machine.
I can't see where the CAs got flagged...maybe near a known awake time???

I have liked a nasal mask. I have not tried the nasal pillows. I do not want a full face mask. I am not a mouth breather. I do like minimal stuff around my head but went with the Eson because they (tech at my doctor's office) thought it would give me a better seal. I wear glasses after I take my contact lenses off (blind as a bat) so it would be nice to have the ability to wear my glasses while wearing my mask. Here is last night with the ResMed mask.



Here is night before with Eson mask.

It's hard to tell for sure because we can't see the pressure changes easily with the mask pressure graph...and you didn't include the regular pressure graph except for a small part of it but if seeing the pressures up and no centrals really being flagged at the time of the increase in pressure roughly 3:30 to 4:30 on the 7/5 report ...so I doubt the centrals are related to higher pressures.

It doesn't really matter what the maximum pressure setting is if your machine never goes there.
Now is the minimum of 6.6 good enough? Probably when just looking at the numbers of the OAs and hyponeas because that's all we can fix with pressure tweaking on your machine.

How is your sleep quality been? Are you sleeping soundly or waking often for some reason and if you are waking often...why?

I have never even seen the ESON nasal cushion mask so I can't compare it to what I have tried.
I do know that I like as little of anything on my face and head and for that reason the ESON has never interested me...just too much stuff on my face.

If you want to try a nasal pillow mask at some time in the future you might look at the AirFit P10 that I currently use. It's about as next to nothing as a mask can be and the vent noise is pretty much non existent.
In terms of nasal cushion masks...I have used the Swift FX Nano and had good results with it and the Swift FX nasal pillows can be used with the Nano headgear so all you would need would be the nasal pillow.

Mask preferences are highly individualized and what I might love you might hate so for final evaluation you simply have to try what seems to interest you and seems to fit the bulk of your needs.

I have never tried or seen the AirFit N10 nasal cushion mask...so I don't know what to tell you about it but if you don't like it...you don't like it and there's a lot of other masks out there that might work better.
Heck...I made it all of 90 minutes with the Respironics Wisp before it got discarded and I won't ever want to try it again.

I'm out of the house right now so can't post what you have asked for. I did like the ResMed AirFit N10 for comfort and felt like I was getting a good result but SleepyHead showed too much leak. I thought the Eson was even better but it is also leaking too much. Going back to the ResMed last night was terrible. Pugsy, do you buy the different masks you've tried out of pocket? I thought the nasal pillow masks might be so minimal that they might not stay in nostrils for me. Maybe I need to try them. I realize it's highly individualized but I like to see what you think.

I have tried a number of masks over the years. Some were "used" that I picked up from forum members who they didn't work out for and some I bought from cpap.com.
Cpap.com has free return insurance available at no extra costs on some masks and some masks have a return insurance that you can buy with a mask. I think most of the masks I have bought from cpap.com were the ones with free return insurance mainly because they were the only masks that I felt looked interesting to me.

My insurance only pays for 1 complete mask every 6 months. I did use my insurance and my DME for the trial with the Wisp and it went right back to the DME since I hated it. It was the only mask that I have actually returned due to it simply being a disaster for me.

If you utilize the return insurance from cpap.com they will even send you a prepaid shipping label so that you don't even get dinged for the return shipping. See their return policy which I think means they have to have it back in their possession before the 30 days is up.

These masks are expensive experiments for sure but there are ways to get the costs down.

There are pros and cons to every mask out there....I haven't found one yet that is 100% perfect for me but what I do and have done...is learn about what I find is most important to me and work from there.
I like as little on my face and head as possible and I will give up a little stability to have next to nothing on my face and head. That's just me. Others value stability more and don't have a problem wearing a mask that has more headgear or overall larger footprint on the face. This is where trying different masks can help you learn what your own personal preferences and needs are.

If a mask interests me....I try it. If it doesn't then I don't. Sometimes all that I have learned about a mask is how bad I hate it but I always learn something about either the mask or myself.

Use the mask that is the most comfortable for you and let's you sleep the best...and if its leaks are unacceptable then maybe trying fixing the leak issues before moving on to a different mask.
Any leak that wakes us up (even if it is a tiny leak) is unwanted and if that nice comfy mask can't be adjusted so that the leaks don't wake you up or you spend way too much time in large leak territory then it's time to move on to a different mask.

I will let a little bit of large leak slide as long as I am sleeping well and the leaks aren't waking me up. It's a compromise that I just accepted some years ago because good quality sleep is my primary goal.
I don't sweat 10 or 15 minutes in large leak territory as long as I sleep well.

Nasal pillow masks are quite stable when properly fitted and sized. I see pressures up around 20 almost every night and I never know about it until I see a report. The only real instability I have with the P10 nasal pillows is that back strap....sometimes it slides up the back of my head but I had similar issues with the Swift FX nasal pillows and since it wasn't something that happened often I just decided that the other pros outweighed this one con.

If money is tight and even buying from cpap.com and using free return insurance is going to take food off the table...watch the forum for people selling their tried and failed mask experiments. Just because it didn't work for them doesn't mean it won't work for you. Sometimes forum members will even just give away a mask to get it out of their house. You can always do the same if an experiment fails.

I used to have quite a stash of unwanted mask supplies from various people's donations but my stash is pretty much depleted now so I can't help out much now with used masks.
I do have some Swift FX nasal pillows that are new and unused....if you could get your hands on the headgear and short hose assembly I could help out with the nasal pillows for free.

Thank you Pugsy for the offer. I can afford to buy another mask but am just stubborn enough to not want to. In my opinion I should be allowed to try different masks until I find one that works, especially since I was not titrated in a sleep lab. I had my sleep test at home. I spoke with the tech at the sleep clinic this afternoon and she said my leak rate is acceptable. So now I want to show you my leak rate and ask you if you agree. What part of my SleepyHead report do you need to see. Thank you, as always, for your time and expertise. You rock!

For leak evaluation I prefer the leak graph for final determination but often if the 95% leak number is really good then I already know what the leak graph will look like.
Like if your 95% leak number is 10 L/min...I don't need to look at the leak graph because it's going to be really boring.
Now if your95% leak number is up there pushing 24 L/min then maybe we need to look at the leak graph.
A few large leaks here and there aren't going to be a huge problem (assuming you sleep right through them) as long as they are brief.
So when large leaks are flagged then we look at how long did they last and how far into large leak territory did you go and for that we need the actual graph.

Sorry, but you are way above my head on what you are saying. Please allow me to post the last several days of mask leakage. Here's night before last. (Last night I went back to the ResMed AirFit and it was not a good night.



Night before:



night before that:



Well, darn! I messed that up. But two nights are available. Sorry for poor computer skills.

You spent a short amount of time in large leak territory....large leak territory begins at 24 L/min for ResMed machine users.
Looks like one night you hit around 34 L/min briefly...but if you slept through those leaks I wouldn't worry about that amount of time in large leak.
The second image shows that you went much further into large leak territory again for brief short lived time frames.

When you have time take a look at my Pugsy's Pointers thread in the top of the Announcements section.
I composed a post explaining leaks that will help you understand what I said previously as well as what you see here.

Overall though...while the leak graph isn't real pretty...I would agree with the person who told you that leaks weren't a serious problem. ResMed won't even give you a Mr Frowny face until you spend 30% or more of the night in large leak territory and I can tell by looking at the times that you were no where near 30% of the night.

Any leak that wakes a person up needs to be worked upon....even if it isn't technically a "large leak" because anything that disturbs our sleep is unwanted.
If you are sleeping well and not waking up with those leaks then I wouldn't stress out too much over them...they are within the machines ability to compensate for the bulk of the night.
10 minutes in large leak isn't the end of the world...but 60 minutes of continuous large leak could present negatively impacted therapy.

Once you go over 35 L/min the machine's ability to respond, sense and record could be seriously impacted and it might miss flagging some events...and we want the AHI data to be accurate.