This newbie is a problem child

Less than stellar results. Generally worse at the point of mask leaking, but still not good even when I didn't have the leaking. The leaking I believe is primarily out my mouth as I am using a nasal mask and woke with severe dry mouth several times overnight.

Is there a solution to reduce the time I am on my back? I must be on my back more than I think. At least that is what I suspect. The times when I have been half asleep that I have been aware that my airway has collapsed has always been when I have been on my back. So no doubt regardless of mask leakage or not, if laying on my back closes my airway, avoiding the supine position may be the key to success here.

What do you think?

When you have time please review this thread for report formatting.
viewtopic/t158560/How-to-post-images-for-review.html
You are making more work for yourself by posting 2 images...you can get all that we need on one screen shot with just a little manipulation of the graphs (they can be resized).
Also hide the calendar and turn off the pie chart (Preferences/Appearance tab, remove check mark for show pie chart).

There may be sort of a REM pattern to those clusters. Google "sleep stages" and look at normal hypnograms and see when we would normally expect to be in REM.
My OSA is documented to be about 5 times worse in REM than non REM but supine sleeping for me doesn't seem to change the OSA...REM sure does though.

The 2 most common reasons for OSA worsening and/or needing more pressure....supine sleeping or REM stage sleep..sometimes maybe even made worse when on our backs and in REM at the same time.

We can't do anything about REM but we can try to do something about supine sleeping. Not easy for sure but we can try.
I don't hold to the belief to try stuff to make us stay off our backs by causing us to wake up from pain. Like the old tennis balls in the T Shirt or wearing anything that causes discomfort and wakes us up so we get off our backs. Last thing I want to be doing is something that wakes me up more. That totally messes with sleep architecture and we will end up feeling like crap from poor sleep even if the AHI gets down to a nice low number.

Now I have tried various things to keep me off my back because when I end up on my back I wake up because of bad back pain.
Sleeping on my back causes a lot of pain because of my back issues.
I had the best results when I was able to build sort of a wall for the back to lean against that was comfortable but yet let me stay on my side or maybe at a 45 degree angle and didn't wake me up.
It's hard though because a lot things we try to build a comfortable wall will end up sliding out from underneath us. Most bed pillows don't have enough weight and if we put them behind our backs and roll onto them they either will collapse or slide out from under us.

I had my best success with a buckwheat hull pillow up against my lower back. It's comfortable if I lean on it as it supports my back and has enough weight it won't slide out from under me. I did try wedge foam things but again not enough weight to keep it from sliding and big and awkward in the bed. So probably some experimentation will be needed to figure out what works best for you and doesn't disrupt your sleep when it does it.

If your clusters are REM related...we can't do much except keep increasing the EPAP/IPAP pressures until we can break up the ugly clusters.

Unfortunately we are fast running out of room in terms of available settings for you to try. IPAP 25 is as high as the machine will go and with current PS of 5 that means EPAP of 20 is as high as it will go. You are going to need some really high pressures and it's going to make leak management more of a challenge for sure.
You are starting to have more centrals than I want to see but they may be more arousal related than pressure related...not alarming but I would want to keep one eye on them and maybe adjust PS down a notch and see what happens.

I want you to go here and watch the videos and learn to figure out if the flagged events are real asleep events or arousal/awake related.
http://freecpapadvice.com/sleepyhead-free-software
Bear in mind that while it is talking mainly about arousal related central apneas (CAs on the software) we can have false positive events flagged in any category. It's not limited to centrals. The machine has zero way to know if you are asleep or not though and it treats everything it senses as an asleep event including increasing the pressures.

So...options
1....work on staying off your back
2....work on leaks which is a never ending war
3....try more EPAP.....and this time change a couple of things. Minimum EPAP 16 and reduce PS to 4 and keep max IPAP at 25. The reduction in PS is just to see if the centrals change in numbers

all this assuming that you have looked at the flagged events and you are thinking you were asleep when they were flagged.

I made a couple changes to my view on sleepyhead. Took a shot of a 30 minute period to compare a bit. Tons of apneas in the first approximate half with a very good seal and at near max pressures, then fewer events with a good leak. So my question is, when there is leaking, does the machine just fail to record apneas properly or can the data in this sequence be pretty reliable across the board?
Thank you for the tips on a back pillow of some sort. Not sure how I might be able to make something work short of having it attached to me. I'm likely to just shove anything behind me out of the way. I like the idea of laying at 45 degrees. That seems like something I might be able to trick my out of my mind sleeping fog self adapt to.

To best identify awake vs asleep breathing flow rate one needs to view more zoomed in....like 3 to 5 minute segments so each breath is more easily seen. A 30 minute segment still scrunches things together too much.

Here's an example below

I circled the asleep breathing in red. Both are the same but one is more zoomed in on than the other so you can get an idea.
Asleep breathing is very regular and smooth. Awake breathing is very irregular. Awake flagged events don't count.
You have to look for evidence of sleep first. Now a cluster of real asleep events could very well disturb sleep and cause subsequent false positives. So that can happen as well. This person below....was asleep...then had an arousal from something but not related to the airway and everything flagged are false positives. Evidence of crappy sleep for sure but not from apnea issues.

I changed my settings because I think the EPAP setting was so high I stressed out my body with the unatural forced exhaling I had to do. I had gotten in a new F20 full face mask and did the mask pressure test. The past 4 days or so my back has been hurting while I'm still in bed. This just never happens to me. Recently my EPAP setting has been higher. It took me about 5 minutes to do the test. I realized my back pain was much worse while doing the test and immediately afterward. So that is why I believed my recent increased back pain was related to the higher EPAP pressure.

So I adjusted my pressure settings to 10/25 with a PS of 10.

I also tried a home made simple device to keep me on my sides to avoid back sleep.This is simply a length of pool "floaty" foam stick I cut the length of the width of my body. I ran a soft rope through it and tied it around my waist with the floaty behind me. This was very effective keeping me off my back. My back pain was pretty significant all night. I first thought that was because of the difficulty in changing position because of the floaty. But I can't really be certain if it was or the pressures and forced exhale I had to engage in.

So last nights graph includes my mask test time at around 4PM with a gap before I went to bed to sleep. It appears my pressures were still maxed out much of the time still not making much difference in my OA events. My OA numbers have not taken any real noticeable reduction.

Last night my CA reading is off the chart! I have zero idea why that would be. I posted my graph from last night. I also posted a graph showing all my numbers going back to when I started to show my CA reading was nothing like last night. No idea of this was a fluke, wrong reading or what.

So right now I feel like I have not made any real improvement from the beginning. Plus believing I am having additional back pain issues because my body isn't used to this effort required to exhale at these higher pressures. ;-(

The attachments posted were incorrect. I'm going to try to fix this now.

These are the correct attachments. The editing feature would not allow me to delete the two I had mistakenly posted.

Your central apneas are too high because the PS is 10 which is way too high.
Goes back to what I said earlier about sometimes PS will cause centrals. It's essentially causing hyperventilation and too much wash out of carbon dioxide and your blood levels don't get high enough for the brain to know it needs to breathe...so it doesn't and you get a central.
It's carbon dioxide in your own blood that is the driving force for the brain to know it needs to send the breathe signal to the body.

You gave yourself complex sleep apnea with too much PS.

It's not a fluke. If you had told us that you were planning to use 10 PS....I would have bet my last dollar that this would have been the result.

Pugsy wrote: ↑

Wed Oct 14, 2020 8:39 am

Your central apneas are too high because the PS is 10 which is way too high.
Goes back to what I said earlier about sometimes PS will cause centrals. It's essentially causing hyperventilation and too much wash out of carbon dioxide and your blood levels don't get high enough for the brain to know it needs to breathe...so it doesn't and you get a central.
It's carbon dioxide in your own blood that is the driving force for the brain to know it needs to send the breathe signal to the body.

You gave yourself complex sleep apnea with too much PS.

It's not a fluke. If you had told us that you were planning to use 10 PS....I would have bet my last dollar that this would have been the result.

If this was easy, there wouldn't be a need for a forum like this. Thanks you for the more mild rebuke than I deserved.

OK. So, Given a couple things what should I do next?

1. I found yesterday that I can in fact for the first time, use this new F20 full face mask, which I far and away prefer over a nasal mask for many reasons, produced minimal mask leakage.

2. I am having these back pain issued that I think may be caused by the high pressure during exhaling. No way to be certain yet, but I think so.

So where do you think I should go from here? 15/25 with a PS of 5? Or drop it back a bit? Keep in mind the possible back issue plus the previous nasal mask leakage issues I have had, along with the discomfort of the dry mouth over and over again over night from opening my mouth.

Thanks for the help. I hope I am not asking you to beat a dead horse over and over again.

You need EPAP to deal with the obstructive stuff... and yes more EPAP can be difficult to exhale against.

I suspect some of your discomfort might be chest wall muscles just getting a harder work out due to the increased EPAP. It's no different than taking on a new exercise regiment at the gym and having new sore muscles because of the extra/different work out.
It's fairly common with cpap therapy but eventually fades as the muscles get more used to the extra work.
I don't know if that is what your back pain is...I can't see you from here and don't know when you are getting it and/or how it manifests itself.
Chest wall muscle discomfort....sort of like Costochondritis
https://www.healthline.com/health/costochondritis
It can range from mild to quite painful.
Again I don't know that your back pain is this chest wall pain but it might be.

Obviously no more high PS but if you feel like high PS help with the exhaling....maybe try 6 PS and see if that triggers centrals or not.

PS causing centrals...it varies with people and there's no way to know where the line is (if there is a line) without trying it.
I have a friend who gets about 20 centrals per hour with a PS of 4 but essentially none with a PS of 3. I have another friend who regularly used PS of 6 and gets essentially no centrals.

So maybe a little more PS will make your exhaling against the EPAP you need but maybe not so much PS.

And you don't have to make big changes all at once. It's okay to take small steps so that your body will have a chance to get used to the new settings.
Maybe try 15 EPAP and increase PS to 6 (watch the central count) and max at 25 IPAP. It won't roam around much because at those settings there's simply not much room to roam but it is what it is.

Pugsy wrote: ↑

Wed Oct 14, 2020 12:10 pm

You need EPAP to deal with the obstructive stuff... and yes more EPAP can be difficult to exhale against.

I suspect some of your discomfort might be chest wall muscles just getting a harder work out due to the increased EPAP. It's no different than taking on a new exercise regiment at the gym and having new sore muscles because of the extra/different work out.
It's fairly common with cpap therapy but eventually fades as the muscles get more used to the extra work.
I don't know if that is what your back pain is...I can't see you from here and don't know when you are getting it and/or how it manifests itself.
Chest wall muscle discomfort....sort of like Costochondritis
https://www.healthline.com/health/costochondritis
It can range from mild to quite painful.
Again I don't know that your back pain is this chest wall pain but it might be.

Obviously no more high PS but if you feel like high PS help with the exhaling....maybe try 6 PS and see if that triggers centrals or not.

PS causing centrals...it varies with people and there's no way to know where the line is (if there is a line) without trying it.
I have a friend who gets about 20 centrals per hour with a PS of 4 but essentially none with a PS of 3. I have another friend who regularly used PS of 6 and gets essentially no centrals.

So maybe a little more PS will make your exhaling against the EPAP you need but maybe not so much PS.

And you don't have to make big changes all at once. It's okay to take small steps so that your body will have a chance to get used to the new settings.
Maybe try 15 EPAP and increase PS to 6 (watch the central count) and max at 25 IPAP. It won't roam around much because at those settings there's simply not much room to roam but it is what it is.

Thank you.

I will try 15/25 and a PS of 6 and see what happens.

Am I reading this correctly? If I didn't have any mask leakage, I may have had a pretty decent night. ?

No....not a decent night even without the mask leakage. The UAs...during the large leaks...something happened during those times but the machine couldn't put a label on them because of the leak. My best guess based on your past reports....those were central apneas.
I am thinking that 6 PS causes more centrals for you but I of course can't prove it.

Obviously crappy sleep so there's a good chance of a lot SWJ flagging (sleep/wake/junk) false positives muddying up the evaluation process.
If you aren't asleep they don't count.
Did I ever give you this link to look at the videos to help figure out awake vs asleep breathing?
http://freecpapadvice.com/sleepyhead-free-software

I'm struggling with mask leakage. It's frustrating that I simply can't "test" for mask leakage in a meaningful way other than spending the night sleeping with the rig all set up. At my high pressure settings, I have to have it really tight. Not a lot of fun but once I'm asleep I am oblivious to it. Plus when I awaken, it seems to be slightly less tight on my face. Not sure if the head gear stretches or the rubber on the mask looses some of it's original push back.

I am using the F20 full face mask. 3 nights so far. The first night I had a really great seal ( PS 10.0 over 10-25). The second night, after adjusting pressures to PS 6.0 over 16-25 I had a lot of leakage. Last night, leaving the settings on the machine the same, I tried adding a "mask liner" hoping that would help with the leak. That was apparently a disaster as my results show.
So tonight I will see if I can get a better seal. If I can't get a reliable good seal, it seems like I am going to have difficulty moving toward the best result possible for me.

So I'll try again tonight. :-I

I assume you are using the mask fit feature on your machine???? It gives you full pressure as opposed to the pressure you start with when using the ramp feature.

Maybe the F20 simply isn't a good choice for you.
Also something I hesitated to mention....when going from a nasal interface mask to a full face mask people often need more pressure to hold the airway open which compounds your problem.

Do you have facial hair of any kind?

Pugsy wrote: ↑

Fri Oct 16, 2020 12:10 pm

I assume you are using the mask fit feature on your machine???? It gives you full pressure as opposed to the pressure you start with when using the ramp feature.

What do you mean by this? Do I select "Full Face Mask" on the Resmed machine as the mask I am using? Yes. Something else?

Pugsy wrote: ↑

Fri Oct 16, 2020 12:10 pm

Maybe the F20 simply isn't a good choice for you.
Also something I hesitated to mention....when going from a nasal interface mask to a full face mask people often need more pressure to hold the airway open which compounds your problem.

I tried the ResMed AirFit F30i Full Face Mask. In order to reduce the leakage, I had to clamp that puppy so tight that it even more severely restricted breathing through my nose. It tends to mash my face in around my nose and restricts my breathing.

I have tried nasal masks. I am a mouth breather. The nasal mask leaves me many sections of time where the leaking, apparently from my mouth, is really bad. Leaving me leak readings and a very dry mouth that wakes me over and over overnight requiring that I drink water to rehydrate everything. My sinus seems to near instantly feel more blocked as soon as I lay down. So I really need my mouth to breath. Otherwise I have to do this really labored inhale and exhale to breathe.

Pugsy wrote: ↑

Fri Oct 16, 2020 12:10 pm

Do you have facial hair of any kind?

Yup. Full beard for 30 years.

The F20 did work the first night in terms of leakage. If I can replicate whatever I did when I put that rig on, I feel like I can make it work.

I am aware that whiskers make this more challenging.

This is me.