Lots of Questions about Air/Pressure/Masks!

I've been using my machine for a little over a year now and though things are much better, I still can't crack the problem of the perfect pressure setting. I have multiple awakenings during the night from air issues of one kind or another. Recently, I'm having a lot of trouble with air that seems to want to escape through my mouth. My tongue starts off in the right place, but it either relaxes and the air pours out, or the tongue stays in place but the air finds a way around it, even with a great chinstrap. I tape my mouth, so this results in my cheeks puffing up, which wakes me up. Sometimes when I'm just dropping off to sleep, I feel a little click or sometimes something like a burp deep down my throat, near the base of my neck. Is this the air pushing my throat open? I don't know if this "burp" feeling is a portent of bad things to come or if it means that everything is working.

The funny thing is that I have very low AHI readings, almost always under 1.0. For the last week, it's been 0.0 almost every night. However, I'm waking up 4-5 times a night and not feeling like I'm really getting the best sleep. I suspect the reason my AHI is so low is that I never get deep enough in sleep to register an apnea event. I usually have 4-5 flow limitations that Sleepyhead says are in the range of (4)-(10), and usually several RERA's that can be up to (45)--does that mean seconds? For a long time, I worried that these flow limitations and RERAs meant that my pressure was too low. I guess I still don't understand how this works.

Anyway, I decided to experiment with my pressure settings. I haven't had a completely solid sleep since I started cpap, but I had moderate success with APAP min 7, max 9.5 and Cflex at 3 for a long time. I was very cautious about changing pressure settings because I'd had a lot of trouble with aerophagia when I first started Cpap and didn't want to repeat the experience. This low setting wasn't perfect, but I felt like I got adequate sleep even though I woke up two or three times a night. However, I thought if I increased the pressure gradually, I might get the good sleep I was hoping for. So, I got up to max 9, min 14, and it seemed tolerable, with no pressure problems, but then I started having trouble with my mask. I'd been using the Dreamwear gel pillows, which were really comfy, but it's sort of noisy to have air coming down through the tube from the top of your head, and this noise issue was making it even harder to get back to sleep when I woke up. I started taking melatonin, but for some reason, it made the problem worse. I decided to try the Airfit P10 pillows, and found them to be much quieter, so great. But then this air problem began, and I can't help but wonder if the P10 has something to do with it.

I've reduced my pressure down to 8 min, 14 max with Cflex at 3, but still have air coming into my mouth. I tried one night putting the machine on Apap and turned off the Cflex, just to see what would happen, but that was even worse. I don't think I got any sleep that night, so that's not the answer.

Do the P10 pillows send more air up the nose than other masks? At this point, I prefer it to the Dreamwear gel pillows, so I don't really want to go back to them. Should I keep reducing minimum pressure until the air problem goes away?

Jeanne Ellen wrote:Do the P10 pillows send more air up the nose than other masks?

Unless you've got an ASV/VAPS/ST machine, nothing sends air up your nose. The only air going up your nose is what your lungs pull in, no matter whether you're using the p10 or a dreamwear or some other mask.

As to waking up, it's *normal* to nearly wake up between sleep cycles, either awake, or just barely asleep, people that think they slept soundly throughout the night just don't remember those brief wakeup periods. Just like before you got your machine, you wouldn't remember the times your throat would close up and you'd gasp for air.

What full face masks have you tried (well fitted, for more than a night or two)? And what does Sleepyhead show (if you use it)?

Hi Julie, in answer to your question about full face masks, I've never tried one. I started out with my pressure set at min 8 max 12, and a Wisp mask, which just covered my nose, but I had a lot of problems with leaks. Then I tried the P10, which was fine, but I began to have trouble with aerophagia. That's when my doctor lowered the minimum pressure to 6 and I got a chinstrap and decided to try a Dreamwear mask with the thing that goes under (not into) your nose. The aerophagia got better, but again I had trouble with leaks, so I tried the Dreamwear gel pillows, which were great, but the noise from the air in the tube coming down from the top of my head started to bother me. So, I went back to the P10, which is super-quiet, but now I'm having this air-in-the-mouth issue.

Did you experience anything like this with nasal pillows? Is that why you use a full-face mask?

A full face mask is used when someone's mouth opens while asleep and Cpap air goes out instead of down (their airway), losing therapy. Aerophagia is often made better by lowering the min. pressure by just 1-2 cms, but you then need to be sure you're still getting adequate treatment using either Sleepyhead or some objective gauge (getting enough treated sleep to feel better, etc). A forum search for aerophagia will show you lots of info. Have you tried a soft cervical collar that would keep your head up off your chest, improve airflow and keep your mouth more closed? I haven't used 'pillows' or collar, but doubt if they'd suit me personally, but then things are working well as they stand now. If you try on full face masks, do it lying down because your face will change then and it will affect how the mask fits.

I tried a cervical collar once and didn't like it, so that's not a good idea for me. My doctor gave me a good chinstrap that really works for keeping my mouth closed, and I'm comfortable with taping my mouth. I never thought I needed a full face mask because I don't sleep with an open mouth (normally) or wake up with a dry mouth. However, it might be worth a try to get a FF mask as an experiment. They all look terrible. I'd need one that I could wear with my glasses, since I like to read before I go to sleep. It also has to be good for side-sleeping. Are there some that have a "gentle" exhaust? The one thing I love about my P10 nasal pillows is that the exhaust doesn't blow clear across the bed and bother my husband. What are those hybrid FF masks like, by the way?

Last night I lowered the minimum pressure on my machine to 7.5 and didn't have trouble with the air coming into my mouth, so that was an improvement. I also had one hypopnea and about seven RERA events. My AHI was 0.16, which isn't bad at all. Even though I woke up a couple of times (that I remember), I felt like I finally had a decent night's sleep. Sleepyhead shows that my average pressure was 7.65 and that 90% of the time it was 8.00 or less, with max pressure at 9.00. I have the machine set to a max of 14.

I want to make sure that I'm getting the best therapy, so I may continue to play with pressure a bit. Would lowering the C-flex setting below 3 (where it is now) make any difference? Or turning it off, altogether, assuming I don't begin having air problems again, of course?

Using Flex effectively lowers the pressure upon exhale a bit so if you turn Flex off the pressure will be raised a bit since it no longer will be lowered during exhale. I am afraid that it might make your aerophagia issues return....sometimes there is a fine line between where the aerophagia monster stays away and where he comes and sets up shop.

Gentle exhaust and full face masks are an oxymoron. You won't find any that diffuse the exhaust like the P10 does especially with the requirement for being able to wear glasses and the mask. Try a full face mask if you wish but you won't find any of them nearly as comfortable as the P10....and if you want to try one look at the Respironics Amara View...it will at least let you wear your glasses and read. I have tried it and I kept it just in case I ever had to use a FFM for some reason. It's not nearly as nice as the P10 in terms of comfort or venting. The other thing is that you might end up needing more pressure with a full face mask to get the same results as you get with the P10 in terms of AHI and what you see on the reports...some people end up needing a little more pressure (some don't) and that always brings the aerophagia monster potential back into the picture.

What are you using as guidelines for the "best therapy"? What is it that you wish to accomplish with continual little tweaks?

If it were me and I had the results you had last night and I felt I slept decently....I would be leaving things alone and seeing if it continued.

Hi Pugsy--thanks for taking time to answer my questions. I guess I want to be able to say that I LOVE my cpap machine. I do love that I feel better now than before I got it, but I'm never quite sure that I know what I'm doing because my sleep pattern is so inconsistent. Sometimes I go through periods when I have one bad night after another, and I can't figure out what I did wrong. Those are the times that I decide to try something different, like get a new mask or adjust the pressure, or change my diet...or just take a sleeping pill!

Now that I've tried raising the pressure and found that my ceiling is rather low (compared to many people), I guess I'll stay here. In the meantime, I'm going to stick with my P10 mask and chinstrap.

We all have bad nights from time to time. I had one last night myself.
Mine was from condensation in the mask and hose...damn. Long story there.
I do understand wanting to try "something" sometimes....I do that because I just like to try stuff but not because I am necessarily unhappy with the results I have. I just get this curiosity itch to see what something else is like and what might happen. I am fortunate in that my experiments aren't complicated by the aerophagia monster though...if he was a regular visitor I would have to rein in some of my experiments.

Just remember that even under the best of circumstances that we don't sleep the same each night and sometimes we just have a bad night despite not even changing anything and they will happen now and then and it's not necessarily something we can really prevent or expect to do anything about.

So scratch that curiosity itch every now and then if you want to but understand your limitations and your ultimate goals.
My ultimate goal has always been to get good decent sleep and feel decent. It's never been just numbers because numbers don't mean much if you feel like crap because you sleep like crap.
And while I don't normally have the aerophagia issues some people have...I have experienced it really bad 2 times in my cpap career and it was ugly and I do understand wanting to avoid that monster. I was miserable the entire day when he came to visit. He's not a nice monster at all. He can really mess with not only our sleep quality but how we feel during the day and that's a big reason why we do this cpap therapy stuff.