Newbie Starting out!

Hello everyone!

Finally got my cpap setup at home a handful of nights ago (night 3 was last night, just woke up!) and I'm still in the adjustment phase. I've lurked the forum's quietly for different tips and ideas (and AHI's to hit) and wanted to show my info for a few days of sleep to see if there are any area's I can optimize or improve. My questions/concerns are my high leak numbers I'm aware of and ways to handle my pressure (16 cm). It's gotten alot easier with an afternoon of reading with the mask on but it's still a bit of a pain. I'm additionally trying to find that sweet spot of the mask (Dreamwear full face with the different size cushions, using M now) of being just tight enough to minimize the leak but not so tight I'll look beet red in the morning.

So my primary issue is are my leaks looking really bad and is my pressure going to be an issue as well? I have been reseating the mask a handful of times before finally going to sleep I have a "30 day guarantee" on my first mask so I felt if the first week stays as bad as the data looked I'd try another mask. My issue is it's been great for me as a side sleeper with the tube on top but the semi dry throat is bugging me but not extreme yet. I've also noticed last night my right nostril felt...weird not irritated but weird when I was inhaling. The center of my chest has been feeling odd but no sharp or serious pain pain, and I've been burping into the mask alot the past few nights when I've had no food that could cause that really. Some light headaches have been occurring but I feel that's a mind over matter or other issues as I've been trying to lose weight, cold cut most sugars, etc. Not necessarily the CPAP, to my knowledge of course.

My second issue is if any numbers that look out of place, worrisome, or if if serious improvements are needed. I recall the last few nights fairly well (my first nights data would be awful as I was constantly ramping and waking up due to not being used to the pressure) so I can mostly tell if I was awake or not. I felt a bit sleepy on the 19th (image 1's night) but this morning (image 2's night) i feel pretty well. But any help is greatly appreciated! Let me know if I need to tidy up the images or not! Apologies if I missed a step in the Newbie post and thanks again all!

Sorry if my opening post is kinda all over the place. I can clarify if needed!

theikeeffect wrote: ↑

Fri Mar 20, 2020 9:04 am

Hello everyone!

welcome to the zoo!

while we are waiting for knowledgeable folk to come along, i have a couple of things.

do you know why you are at a fixed pressure?

when you get the chance, go to your equipment profile and fill it in. that way your machine and mask will show up at the bottom of each post, as mine does below.

chart presentation looks to be formatted correctly. however, you don't need the snore chart.

i'm going to follow this with interest. i'm not clever enough to figure out why, at a fixed pressure, your pressure dips to 4, according to oscar. hoping someone can come by and explain that.

good luck!

zonker wrote: ↑

Fri Mar 20, 2020 10:50 am

why, at a fixed pressure, your pressure dips to 4, according to oscar. hoping someone can come by and explain that.

Either the machine was turned off briefly and then back on or the person was awake in the middle of the night and just pushes the ramp button.

Respironics machines will allow you to push the ramp button and have the machine drop the pressure without having to actually turn the machine off to start the ramp again.

Pugsy wrote: ↑

Fri Mar 20, 2020 10:56 am

zonker wrote: ↑

Fri Mar 20, 2020 10:50 am

why, at a fixed pressure, your pressure dips to 4, according to oscar. hoping someone can come by and explain that.

Either the machine was turned off briefly and then back on or the person was awake in the middle of the night and just pushes the ramp button.

Respironics machines will allow you to push the ramp button and have the machine drop the pressure without having to actually turn the machine off to start the ramp again.

thank you. that makes sense. i keep forgetting the differences between remed and respironics.

Yes! That is exactly it. I am hitting the ramp button as the pressure is a bit rough. I was set to 16 flat by my doctor after my sleep study with the mask. The ramp was setup by the DME people. I'll work on the profile request now!

Edit: The info is in my profile but I'm not properly seeing an option to show it. So I'll copy and past here!

DreamStation CPAP Machine with Heated Humidifier and Heated TubeMask:
DreamWear Full Face CPAP Mask with Headgear - Fit Pack (S, M, MW, L Cushions with Medium Frame)
Humidifier: DreamStation Heated Humidifier

Obviously you aren't sleeping well and spend a lot of time awake with the mask and machine on.
Anything special that you can say is the cause of being awake? Leaks? Pressure uncomfortable? Mask uncomfortable?

I feel it's that I'm either not used to the pressure yet or the leaks. It feels like a bit too much. The leaks could also be it as I can feel the leaks pushing air against my face until I get it tight via the straps, but by that point it's too tight. So I try to loosen it to give my face a bit of relief but then I can feel or hear the air coming out from above or underneath. This may be why im awake a bit for a good period of time. Constantly shuffling and readjusting the mask has kept me awake. But when it's finally at a good spot I do fall asleep after a bit.. Other than the fitting properly/leak issue, the mask has been fine and I'm very happy it makes side sleeping easier.

I feel I should just give it time while trying to minimize leaks, but I wanted to be sure there wasn't anything else I missed yet with what little data I do have. I've had alright numbers in AHI but I don't know if the leaks are making them not as accurate. I've been feeling a bit better though, haven't had the more serious headaches all 3 days when I wake up compared to without CPAP in recent years.

Look into Padacheek.com for 'liners'. They help deal with small leaks and keep your face less marked up... designed by a member here.

Your leak levels do go up into large leak territory....those gray blocks you see and the LL line on the Events graph.
But you also have considerable time when in less than large leak territory.

Those large leak excursions are actually just barely into large leak territory for the most part and the machine is going to be fairly accurate up until around 110 L/min total leak (that top leak line). The time spent where the machine might be missing flagging something is very minimal. So your reported AHI is probably fairly accurate.

At this point though your biggest problem is sleep....you gotta get the sleep before any of this other stuff matters and if you can't sleep then we need to try to fix the reason you aren't sleeping so great if at all possible.

Your pressure needs are relatively high and it's going to be a challenge fighting the leaks at your pressure.

Couple of questions for you.
Do you just have to use a full face mask for some physical reason like a chronically congested nose that forces you to mouth breathe or did they stick you with a full face mask because they said you couldn't use anything but a full face mask at those pressures?

Would you feel comfortable doing some minor changes in the settings on your machine yourself.
I don't like CPAP fixed mode on the Respironics machines because it turns off Flow Limitation flagging and flow limitations are actually very important to know if a person is having them or not. They are a big part in the auto adjusting algorithm because they are early warning signs that the airway is trying to collapse. In cpap mode we don't know if you are having any of those warning signs or not.
Would you be comfortable changing to auto mode and minor setting adjustments to maybe make it easier for you to sleep?
Or do you prefer all changes be made by your doctor? It's easy to make the changes...just a matter of a little secret hand shake with the machine but not everyone feels comfortable doing that.
We can make auto mode work like fixed mode though...so no real change in how the machine works except we are turning on FL flagging.

The full face mask was because of the pressure. The sleep technician told me the pressures I needed are hard for nasal masks. That's what I was told mind you, I'm unsure if it's the absolute truth. I do tend to wake up with my mouth open as well which is also why they recommended it but I know that can be fixed via chinstrap, neck pillow I saw in the forum, etc.

I'm a tad uncomfortable with changing settings. But if it could help and the changes aren't drastic I don't mind giving it a whirl for a few nights for data gathering purposes! It's not like I can't undo it if my doctor gets snippy or I get anxious, and I kinda want to hit the ground running on this. Especially if we can keep it working like fixed mode as you said and can keep the ramp feature as is. It's been a godsend as I get used to the high pressure.

There are people using pressures above 20 cm all night long who can successfully use one of the nasal interface masks...either the cushion or the pillows. DMEs telling people who use higher pressures that they just have to use a full face mask because of the pressure are spreading an old wives tale.
Now if the nose is congested really badly and they can't clear it up...that's a totally different story no matter what pressure someone is using.

I mention this because often people using a nasal mask might get by with a little less pressure than they need with a full face mask.
Something for you to think about.

Right now your biggest challenge is simply sleep and this is something that should improve with time and experience.

Go here and request the clinical/provider manual for your machine via email. The manual explains the secret hand shake to get into the clinical setup menu are. It's just a combination of pushing the ramp button and the adjustment knob at the same time for 10 seconds I think it is.
https://www.apneaboard.com/adjust-cpap- ... tup-manual
I always tell everyone to get this manual even if they aren't going to go changing stuff because there's some good information in it that isn't in the typical user manual.

For now...just change it from cpap mode to auto mode. Set the minimum pressure at 16 and the maximum at 16.
This just turns on the FL flagging but the machine still functions just like it would in CPAP mode. Plus if you have events happen during your ramp time the machine will suspend the ramp and go directly to 16 much faster than it does in CPAP mode.
Right now you could be having apnea events during ramp and the machine isn't doing anything and when people use ramp often during the night then they are using a sub optimal pressure during a lot of ramp time.

When you fit your mask at the beginning of the night...fit it at the higher pressure...don't fit it at the ramp pressure.
I think there is a mask check or mask fit feature available on your machine where it will blow at the higher pressure for about 3 minutes and let you check the seal and then you can go to the ramp if you need it.
A mask fitted at 4 cm starting ramp pressure isn't going to seal so great at 16 cm.
So do that if you aren't already doing that.

Lay down when fitting your mask as best you can. Our faces changes when laying down as opposed to sitting up.
Don't over tighten it thinking that more snug is better...it actually is counter productive to tighten too much. These masks have to inflate to seal and too tight prevents them from inflating.

Consider a nasal mask trial. There's no reason in the world that you can't use a nasal mask just because of the pressure.
Nasal masks have much less surface area touching the skin requiring skin to mask sealing...they are actually easier to keep sealed than a full face mask at the higher pressures.

Until you can actually sleep soundly for large chunks of the night we can't really evaluate the therapy results you see on the Events graph because there's so much awake breathing stuff muddying up the waters.

If you get to the point that you feel gutsy enough to actually change the pressure more than just auto mode with settings that mimic fixed mode....minimum of 12 and max of 20 would be a good experiment to try.
You might not need that 16 cm all night...you might only need it part of the night and there's no sense in using it all night long if you maybe only need that much for 1/2 of the night or less.

Use whatever Flex setting simply feels more natural to you no matter what the setting is. Try them all including off...pick the one that you think just feels like it matches your own respiration pattern the best. When we fight the machine during exhale because of timing we aren't comfortable and without comfort we are going to have trouble sleeping.

Sleep....that's your primary goal at this point. Without sleep none of this other stuff really matters all that much.

Thank you very much for your time and insight. I send the request for the manual and I will try the auto mode and proper mask application. If it's still rocky for a week or so I'll likely use the 30 day guarantee for a nasal mask and try that for a period of time. Any of them that work for side sleepers or are they easier for other positions in general compared to face masks?

Thanks again!

Actually any mask can be used in any sleeping position.
No one mask is necessarily any better for one position over another.

The nasal pillow masks have probably the smallest footprint but some of the newer nasal cushion (that goes under the nose instead of over the nose) have a pretty small footprint as well.

The masks that have the hose attach at the top of the head are especially nice for side or stomach sleeping because the long hose isn't sticking out in front of your nose to get in the way or move when side sleeping or stomach sleeping.

Both ResMed and Respironics have nasal interface (cushion or pillows) that attach at the top of the head.

Heck, look at the mask I use...it has no headgear and is glued to the end of my nose.
You have a lot of options. I usually tell people to look at what is available and try what looks interesting to them. Maybe ask some questions about it if some questions come to mind.
Take a stroll through what is out there and available.
https://www.cpap.com/

HEy guys. Update with a new issue. (Unsure if I should've made a brand new thread since it's still on my own post)

Things were a bit better last night, however I woke up to found white gunk on my tongue.

I imagine thats a mouth leak issue as I've fouind in the thread but my question becomes what can I do to resolve until I can get a chinstrap or something similar in my home? Can't call my DME until Monday and I don't think not using it will work well but I'd like to avoid creating a colony in my mouth.

theikeeffect wrote: ↑

Sat Mar 21, 2020 6:22 am

HEy guys. Update with a new issue. (Unsure if I should've made a brand new thread since it's still on my own post)

no, you've done exactly right. while you are still new to the forum, it's best to keep all of your questions or problems in one thread. it helps folks keep track of you!

theikeeffect wrote: ↑

Sat Mar 21, 2020 6:22 am

I imagine thats a mouth leak issue as I've fouind in the thread but my question becomes what can I do to resolve until I can get a chinstrap or something similar in my home? Can't call my DME until Monday and I don't think not using it will work well but I'd like to avoid creating a colony in my mouth.

this has helped me tremendously in fighting mouth breathing-

viewtopic/p1089718/viewtopic.php?f=1&t= ... s#p1086296

however, i'm uncertain if it would work with a full face mask.

what you could also try(it will prolly work better) is a firm foam cervical collar. they can be found in the home health care section of your drugstore. that's the section with bed pans and walkers and such.

good luck!