AHI & CA Climbing, Mask Fit Declining, Feeling Awful

Here's my chart from last night with some new settings applied-- a tighter pressure range, plus EPR at 2 full time. Didn't seem to make a huge different. One confounding factor about narrowing down this leak issue is the following: I woke up at 4:30am to use the bathroom and my lips felt like they were glued shut with dried saliva. Very sticky, had to pull them apart to open my mouth. So I'm not entirely sure that the leak is from my mouth. What do you guys think?

My thought is that the mask may be moving around. I sleep on my side, and the flexible portion of the AirFit P10 may get pushed/pulled as I move in my sleep, which would cause the leak events. My thinking is also that since the large leak events aren't correlated to any apparent apneas/hypopneas, that it's a fit issue more than anything. I ordered a size up of the nasal pillows, which shoulda arrive tonight. I'm going to try the same settings as last night with the bigger pillows to see if I can get a better seal. There's some correlation between the large leak events and what are being recorded as CAs, but that seem to be post-arousal events.

I'd be grateful for some feedback on whether I should focus on mouth leak via taping/cervical collar, or mask fit instead.

Thanks, all.

Raise your minimum pressure to 9, don't change anything else on the machine.

Try tightening the straps on the p10, there should be clips in the package.

palerider wrote: ↑

Tue Sep 25, 2018 11:24 am

Raise your minimum pressure to 9, don't change anything else on the machine.

Try tightening the straps on the p10, there should be clips in the package.

Will do re: pressure. There were no clips in the package for the headgear, unfortunately. I will order some.

eyeheartny wrote: ↑

Tue Sep 25, 2018 12:25 pm

palerider wrote: ↑

Tue Sep 25, 2018 11:24 am

Raise your minimum pressure to 9, don't change anything else on the machine.

Try tightening the straps on the p10, there should be clips in the package.

Will do re: pressure. There were no clips in the package for the headgear, unfortunately. I will order some.

I think they're usually with the manual, in the back.

palerider wrote: ↑

Tue Sep 25, 2018 1:31 pm

I think they're usually with the manual, in the back.

Huh. My headgear hasn't come with a manual either time. I got one from my DME when I picked up my machine and it was just in a plastic baggie with nothing else. When I got myself a replacement because the old one was stretched out, it was just in a baggie as well. I ordered a set from a CPAP supplier in Texas, so it should take a few days to get to me.

eyeheartny wrote: ↑

Tue Sep 25, 2018 2:03 pm

palerider wrote: ↑

Tue Sep 25, 2018 1:31 pm

I think they're usually with the manual, in the back.

Huh. My headgear hasn't come with a manual either time. I got one from my DME when I picked up my machine and it was just in a plastic baggie with nothing else. When I got myself a replacement because the old one was stretched out, it was just in a baggie as well. I ordered a set from a CPAP supplier in Texas, so it should take a few days to get to me.

Ah, well, perhaps you're getting scammed by your DME.

As far as I know, the P10 comes with a plastic holder, manual and clips on the back, frame, strap, and three sizes of pillows, at least, that's what I've always gotten.

palerider wrote: ↑

Tue Sep 25, 2018 2:47 pm

Ah, well, perhaps you're getting scammed by your DME.

As far as I know, the P10 comes with a plastic holder, manual and clips on the back, frame, strap, and three sizes of pillows, at least, that's what I've always gotten.

Sounds about right. They only sent me home with the pillow size that they deemed appropriate, plus the frame/strap. That's why I had to order the larger pillow size myself.

What's your preferred solution for managing mouth leak? Cervical collar or mouth tape?

eyeheartny wrote: ↑

Tue Sep 25, 2018 2:48 pm

palerider wrote: ↑

Tue Sep 25, 2018 2:47 pm

Ah, well, perhaps you're getting scammed by your DME.

As far as I know, the P10 comes with a plastic holder, manual and clips on the back, frame, strap, and three sizes of pillows, at least, that's what I've always gotten.

Sounds about right. They only sent me home with the pillow size that they deemed appropriate, plus the frame/strap. That's why I had to order the larger pillow size myself.

What's your preferred solution for managing mouth leak? Cervical collar or mouth tape?

Whatever works for you... I've heard of tape, double boil and bite mouth guard, scunchi and the collar. As far as I've been able to determine, chin straps are ineffectual.

palerider wrote: ↑

Tue Sep 25, 2018 3:03 pm

Whatever works for you... I've heard of tape, double boil and bite mouth guard, scunchi and the collar. As far as I've been able to determine, chin straps are ineffectual.

So I just called my DME provider and talked to one of their CPAP coaches about my recent issues. She recommended I see my doctor because according to her, my data looks like complex sleep apnea. She indicated that the centrals do indeed look like real centrals. What are your thoughts? I'm not sure what to think. It would suck if I have treatment-induced complex sleep apnea.

I'm tempted to skip the machine tonight just to see how I feel. I never had these kind of headaches or other issues before starting treatment and I feel like such garbage that I'm desperate for anything to help with my sleep.

eyeheartny wrote: ↑

Tue Sep 25, 2018 3:44 pm

palerider wrote: ↑

Tue Sep 25, 2018 3:03 pm

Whatever works for you... I've heard of tape, double boil and bite mouth guard, scunchi and the collar. As far as I've been able to determine, chin straps are ineffectual.

So I just called my DME provider and talked to one of their CPAP coaches about my recent issues. She recommended I see my doctor because according to her, my data looks like complex sleep apnea. She indicated that the centrals do indeed look like real centrals. What are your thoughts? I'm not sure what to think. It would suck if I have treatment-induced complex sleep apnea.

I'm tempted to skip the machine tonight just to see how I feel. I never had these kind of headaches or other issues before starting treatment and I feel like such garbage that I'm desperate for anything to help with my sleep.

Please stop posting your stuff in multiple threads, it makes it harder to keep track of what you're asking, and what you've shown.

All of the centrals you posted in the other thread look like you had some sleep disturbance before you had the central, it wasn't nice smooth breathing then the central.

If you think you have cpap induced centrals, then turn off EPR, because that exacerbates them in MANY cases.

Unless you've taken your sd card into your DME, they don't have the same data we've been looking at, because the Resmeds don't transmit the breathing flow rate data to the cloud, so they can't see the disturbances before the centrals.

palerider wrote: ↑

Tue Sep 25, 2018 5:41 pm

Please stop posting your stuff in multiple threads, it makes it harder to keep track of what you're asking, and what you've shown.

All of the centrals you posted in the other thread look like you had some sleep disturbance before you had the central, it wasn't nice smooth breathing then the central.

If you think you have cpap induced centrals, then turn off EPR, because that exacerbates them in MANY cases.

Unless you've taken your sd card into your DME, they don't have the same data we've been looking at, because the Resmeds don't transmit the breathing flow rate data to the cloud, so they can't see the disturbances before the centrals.

Got it, thanks. I'll delete the other thread.

I haven't taken the card in. I'm seeing my doctor on Thursday and will bring my SD card and laptop with SH on it to show her the data.

Here's an example of what looks like normal-ish sleep.


And here's what looks like a central.

But then here's what's confusing, if I zoom in, it seems like it is a true central.

Zoomed in clear breathing:
Zoomed in CA:

It looks in the zoomed-in version like I just stopped breathing, whereas in the zoomed out one, it's less clear what's happening. These are the same event at different zoom settings and it's really hard to understand what I'm seeing.

Look at the breath shapes in the first of your last two pics.

Look at the breath shapes before the 'central' in the second pic.

See the difference? You weren't asleep when you had the central.

You can see the disturbance in your breathing *before* the 'central' if you move back a few seconds, you can see it in the somewhat more zoomed out version you posted before.

It's a central, in that you stopped breathing, and you weren't trying to breathe, but it's not central *sleep* apnea.

palerider wrote: ↑

Tue Sep 25, 2018 6:04 pm

Look at the breath shapes in the first of your last two pics.

Look at the breath shapes before the 'central' in the second pic.

See the difference? You weren't asleep when you had the central.

You can see the disturbance in your breathing *before* the 'central' if you move back a few seconds, you can see it in the somewhat more zoomed out version you posted before.

It's a central, in that you stopped breathing, and you weren't trying to breathe, but it's not central *sleep* apnea.

I see what you're saying, and I see the difference in waveforms on the chart. I guess the question now is why I keep getting disturbances and what I can do about it. It'll be a topic for my doctor's appointment on Thursday for sure. Combined with the leak issue I feel like I have no idea what direction to go in to improve things.