What is my problem? Noobie needs settings advices

General Discussion on any topic relating to CPAP and/or Sleep Apnea.
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Miss Emerita
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Re: What is my problem? Noobie needs settings advices

Post by Miss Emerita » Tue May 24, 2022 11:09 pm

To follow up on ozij’s post, some of your leaks may be from your mouth. It might be worth trying tape, just as an experiment. In the US, Somnifix strips are available;i don’t know whether you can get them in France. Mouth strips are often marketed to prevent snoring. If strips help, you can get less expensive tape in rolls.
Oscar software is available at https://www.sleepfiles.com/OSCAR/

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ozij
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Re: What is my problem? Noobie needs settings advices

Post by ozij » Wed May 25, 2022 1:40 am

I'm a terrible mouth leaker - through my lips. Sometimes, when I relax, the seal between my nasal cavity and mouth relaxes as well, and cpap air simply whooshes out. Which is why for a person like me, Sominfix wouldn't work: it has a slit in the middle, that would let the air simply whoosh out.

Two good videos about mouth taping:
https://youtu.be/IG007EFmk8w -- 3 Reasons to MUST Tape Your Mouth with CPAP. OSCAR Data Tutorial
https://youtu.be/HgSdfsGe7zk -- Problems with FIXING your CPAP Mouthleak?

The tape which I use presently is called "BSN Medical Cover Roll Stretch, 4" x 10 yds, Single Roll, White - 50423 " in the US, available in Europe (amazon.de and amazon.fr) as "FIXOMULL stretch 10 m x 5 cm". Its adhesive is much gentler than the "Micropore" I used to use.

I find I can use half the width; but it's porous, and sometime I have to add a second layer on top of the first.

Remember to fold in a corner, which you can then use to the remove the tape.

And I always lubricate my lips first.

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Xantat
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Re: What is my problem? Noobie needs settings advices

Post by Xantat » Wed May 25, 2022 1:48 am

I think I should maybe ask for a more in depht sleep study at the hospital (it's "free" in France).

I have indeed seen improvement on my headaches. Now, if I sleep for like 8-9h, I usually don't have headaches, whereas it was 100% without CPAP!

On my sleep study, O2 was on average 96% with a min at 89% (for 15 seconds). Does not seem so bad... My only 2 symptoms were headaches and never feeling rested after sleeping. While I feel less headaches, I feel way more tired with CPAP than before I think.

So last night I thought I'd tape my mouth to see if it helped with the leaks (I have almost the same tape as you ozij), here are the results:
Capture d’écran 2022-05-25 à 09.51.49.png
Capture d’écran 2022-05-25 à 09.51.49.png (235.52 KiB) Viewed 506 times
No headache when I woke up, but I felt really tired. I must say though that I had a 3h climbing session yesterday. I usually climb 2-3h on mondays, thursdays and saturdays.

Now it seems pretty clear that my main leaks are mouth leaks right? For the rest, I'm not sure if those are still mouth leaks from the tape (I leave a small gap on my lips just in case), or mask leaks. I'll try without the gap tonight to test this.

Thanks everyone for the tips!

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Pugsy
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Re: What is my problem? Noobie needs settings advices

Post by Pugsy » Wed May 25, 2022 7:24 am

Xantat wrote:
Wed May 25, 2022 1:48 am
I think I should maybe ask for a more in depht sleep study at the hospital (it's "free" in France).
I would agree with you in that regard. That's mainly why I suggested that you make a follow up appt if you hadn't already.
My original thoughts were make that appt and if we got lucky somehow and found a solution to your problem and reduced your unwanted symptoms to an acceptable level then the appt could always be canceled. At this point with all that is going on I still think you should keep that appt but I have a couple of additional thoughts that might be worth trying.

Your hyponeas are increased with the reduction in pressure to fixed of 6 cm. I really don't think that you are having cpap triggered real asleep centrals so I am thinking maybe try 7 cm fixed and see what happens. You are also having a fairly active FL graph and if you were allowing auto adjusting pressures the machine would try to kill those FLs and hyponeas with more pressure.. It wouldn't be impossible for those FLs to be a contributing factor in causing arousals which in turn could be leading to the false positive centrals you are having.

Are you experiencing any nasal congestion to speak of? If you are then we can't expect more pressure to help and instead need to deal with nasal congestion in the regular way with decongestants or nasal rinses or whatever might work for you.

If you aren't experiencing nasal congestion then I think trying to reduce the FLs and hyponeas might be worth trying and see what happens.
It's not a horribly horrible FL graph ....I have seen much, much worse but to give you a comparison this is what my FL graph looks like.
Image

Now reducing FLs and hyponeas can be accomplished in different ways....more minimum pressure and/or adding pressure support which in your machine is adding back in some EPR exhale relief.
Using EPR can cause centrals which is why we had you turn off EPR but at this point I don't know that EPR (or cpap pressure) was any factor on your central numbers either.
So my thoughts are to proceed slowly with addressing what we know we can fix with the machine...the obstructive stuff which would be the FLs (assuming no nasal congestion issues) and hyponeas (think of them as baby OAs not grown up to earn the OA flag). While hyponeas can be central in nature in some instances, they mostly are obstructive in nature.

If the bulk of your central flags are indeed arousal related...that still points to highly disrupted sleep which would of course explain the fatigue and lack of rested feeling because it means you simply didn't sleep good. Perhaps not getting the needed sleep stages in the needed amounts which was something your home study didn't measure.

So there is more than one way to skin a cat (as they say in my neck of the woods) and these are options...all with the concern about centrals in our minds...just in case.

1...try fixed 7 or 8 cm and see if FLs reduce and hyponeas reduce
2...try fixed 7 or 8 cm and add in maybe 2 cm EPR and be prepared to check the central flags for chance of being real or arousal related
3...try auto adjusting with a tight range and let the machine try to deal with the FLs....minimum 7 maximum 9 with or without EPR being added in.

All very conservative ideas and keeping one eye on the centrals because we sure don't want to cause any real ones.
The idea being that it is possible that the arousals are maybe from the FLs or hyponeas and if we can reduce them then maybe your arousals will reduce and you will sleep a little more soundly and then maybe feel a little better.

I don't know at what level of desat we can expect to reduce headaches caused by drops in oxygen. Your oxygen levels didn't drop very much and a brief drop to 89% isn't considered horrible but I don't know at what level a desat can cause headaches. So I really can't comment one way or the other about that since you didn't have huge prolonged drops like I did. I am just happy that at least the headaches ceased with cpap for you.

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Xantat
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Re: What is my problem? Noobie needs settings advices

Post by Xantat » Wed May 25, 2022 8:37 am

I need to have an appointment anyways in order to make a point with my ENT on these few months with the CPAP. Even if I was better, I'm requiered to see him.

It's true that I don't feel perfectly comfortable at 6, and I think I would breathe better at 7. I do have a fairly large deviated septum (bone spur crosses part of the right nostril), but it didn't bother me much before CPAP. However, since I started the therapy, I am permanently congested. I have 24 hours a day one or the other of the two nostrils blocked. And it's true that when I lie down with the cpap on, I feel that the air only goes through one of the nostrils. In my memories, it happened to me to wake up in the night, and to remove the mask to finish my night without because I had the feeling of suffocating due to not inspiring enough air by the nose.

I think I will try to set the pressure to 7 with EPR at 0, and see my doctor to test a nasal decongestant. Or maybe should I try a full face mask, as using a nasal decongestant long term does not seem like a viable option. What do you think?

Thanks again!

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Pugsy
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Re: What is my problem? Noobie needs settings advices

Post by Pugsy » Wed May 25, 2022 8:56 am

What setting are you using on the humidifier on your machine?

Do you find that your nose clears up a bit during and shortly after a hot steamy shower?
Xantat wrote:
Wed May 25, 2022 8:37 am
I think I will try to set the pressure to 7 with EPR at 0, and see my doctor to test a nasal decongestant. What do you think?
By all means try the 7 cm setting and see how you do. Especially since you are feeling a little air starved at 6 cm.

Interesting that your nasal congestion has worsened with cpap use. There is actually a term for this because it is so common and it's called "cpap rhinitis" which you can google and read up on it.

Some people need more moisture and some people need less moisture after being on cpap.
What your nasal mucosa is going to be needing is very individual for you. This is something that varies widely among cpap users.

I usually tell people either/or
1....if not using the humidifier use it....start with middle of the road setting
2....if using added moisture at relatively low setting....increase the setting and try more moisture.
3....if using added moisture at relatively high setting....decrease the setting and try less moisture.
4....if using a median sort of setting for humidity....toss a coin but I always lean to increasing because "most" people will do better with more added moisture. If a hot steamy shower helps at all....you have your answer right there.

Try playing with humidity first before going with other measures like decongestants...most oral decongestants come with sleep disturbing baggage/side effects or they make us feel a bit groggy during the day....or can mess with our sleep a bit and cause some trouble staying asleep and you already have a big enough problem in that regard.

Here in the US there is an OTC spray available that used to be available only by prescription. I don't know what it is called in France or if it is OTC or prescription only.....Flonase...google it and see what it is called in France and if you can get it easily or not. Worth trying if you can to help with whatever it is that is causing your congestion.

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Re: What is my problem? Noobie needs settings advices

Post by Xantat » Wed May 25, 2022 9:41 am

You are a well of knowledge, that's impressive! You can't imagine what a relief it is to have that kind of support.

I'm currently using humidifier at 5 right now, I have tried more but it was creating bubbles in the hose if I remember correctly. I will try 6 tonight and see how it goes!

To be honnest, I'm not sure about the effect of shower on my congestion. I have tried to boil water in a pan and inhale the steam, it worked like a charm. The problem is, I had to blow my nose regularly, and I'm unsure of what will happen in the mask!

There is a possibility that my congestion has not increased, but I just notice it more. I'll read on this anyways!

I've checked, Flosane is available in France but by prescription only too.

Do you think a full face mask would be a potential solution if I can't get rid of congestion with the humidifier?

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Pugsy
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Re: What is my problem? Noobie needs settings advices

Post by Pugsy » Wed May 25, 2022 10:53 am

No, the full face mask is unlikely going to help with congestion relief because all it does is let you breathe through your mouth if you need to because of congestion but it can't stop the congestion itself.
Your mouth leaking...isn't enough to warrant a full face mask IMHO unless those rather minor leaks are a disturbing factor to sleep quality meaning causing some of those arousals. It's not enough leak to negatively impact therapy itself but it could be impacting sleep itself.
And full face masks come with their own baggage. There's a real good reason why I don't own one and why Ozji prefers to tape her mouth over using a full face mask for her mouth breathing issues. :lol:

Increased humidity setting does increase the chance of condensation /rain out in the hose or mask or both.
There are ways to combat it though.
See this thread and posts number 2 and 3 for various options on how to combat condensation in the hose or mask or both.
http://www.cpaptalk.com/viewtopic/t9403 ... -road.html

I use a setting of 8 for humidity and a heated hose set to maximum 86 degrees F. Plus I prefer a cool ambient bedroom temp and all that means I always fight condensation somewhere and fairly often.
I took my mask off this morning and dropped the long hose and about 2 TBS of water ran out on my bed. Condensation is annoying but it won't kill you. If I don't use max or near max humidity then I get horrible congestion and allergy like symptoms during the day and it's nothing more than cpap rhinitis from my nasal mucosa being too dry. To keep those symptoms away I learned a long time ago that a little condensation is the price I pay. Annoying as hell but the sneezing, itchy nose, congestion, etc....is even more annoying.

BTW....if the congestion is cpap related it may take more than one day for the mucosa to return to normal and congestion abate....so if you make a change in the humidity setting one way or the other one night might not fix the issue.
A long time ago I tried the setting of 1 for one night only....bad mistake...I had horrible symptoms that lasted 3 days.

Best option for condensation prevention...heated hose so you can warm the air in the hose and mask up.
Second best if no heated hose available is to insulate the long hose and/or short hose to the mask with some sort of hose covers. Explained in that thread above. I used socks over the hoses many years ago back before heated hoses were integrated into the machines. When I started cpap therapy in 2009 the only heated hose available was from Australia and cost $150 US. Socks are a whole lot cheaper.

Gotta run...doctor's appt in a couple of hours.

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Iamstumped
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Re: What is my problem? Noobie needs settings advices

Post by Iamstumped » Wed May 25, 2022 2:06 pm

You are a well of knowledge, that's impressive! You can't imagine what a relief it is to have that kind of support.

I have to agree with the OP

Xantat
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Re: What is my problem? Noobie needs settings advices

Post by Xantat » Wed May 25, 2022 2:24 pm

Got it! I'll wait for the full face mask if I can't find another solution. I actually had pretty low leaks last night with mouth taping, I'll try tonight without the hole in the center to see if I can get even less.

Regarding condensation, I will try increasing to 6 and see what happens. Because last time I did it, my girlfriend told my she heard bubbling sounds during the night, but I didn't see any water in the morning. So, maybe it was not that bad. I'll keep you updated!

In the end, if I keep using CPAP on the long run, I will buy a heated hose anyways.

Good luck for your appt! :D

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ozij
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Re: What is my problem? Noobie needs settings advices

Post by ozij » Wed May 25, 2022 9:54 pm

Xantat wrote:
Wed May 25, 2022 9:41 am
Best option for condensation prevention...heated hose so you can warm the air in the hose and mask up.
Second best if no heated hose available is to insulate the long hose and/or short hose to the mask with some sort of hose covers.
I bough my "Airsense 10" 2 years ago - it came with a heated hose, it's called "Climateline. The Airsense can adapt the hose to the ambient temp - and you can choose how humid you want the air.

One of the many many things I learned on cpaptalk is the value of "nasal irrigation". It feels wonderful.
https://www.fda.gov/consumers/consumer- ... -pots-safe

I use this type of squeeze bottle: https://www.amazon.com/NeilMed-100-Sinu ... DZFZ0?th=1.
The salt packs are convenient, but you'll find instructions on the net for making you own saline solution.

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And now here is my secret, a very simple secret; it is only with the heart that one can see rightly, what is essential is invisible to the eye.
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Xantat
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Re: What is my problem? Noobie needs settings advices

Post by Xantat » Thu May 26, 2022 2:37 am

Thanks for the advices, I'll give it a look!

Last night went almost exactly the same as the night before: as much hyp, a tiny bit less centrals. And I just feel as bad as the night before when waking up! :cry:

To be honest, the fatigue has only gotten worse and worse since I've had CPAP. I'm getting to the point where I'm wondering if I'm going to have to stop for a while to recover, because I'm really not feeling well.

Xantat
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Re: What is my problem? Noobie needs settings advices

Post by Xantat » Fri May 27, 2022 4:49 am

So last night I slept without CPAP for the first time in like 2 month. I slept in a trait, no waking up during the night. Felt better than usual. I'm wondering if I should keep using CPAP.

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ozij
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Re: What is my problem? Noobie needs settings advices

Post by ozij » Fri May 27, 2022 5:54 am

Xantat wrote:
Wed May 25, 2022 1:48 am
I think I should maybe ask for a more in depht sleep study at the hospital (it's "free" in France).
Xantat wrote:
Fri May 27, 2022 4:49 am
So last night I slept without CPAP for the first time in like 2 month. I slept in a trait, no waking up during the night. Felt better than usual. I'm wondering if I should keep using CPAP.
Could you ask your doctors what they think the idea of not using CPAP till you go through a test in the hospital?
Did you really have no headache this time?
Your girlfriend reported you woke up with the CPAP - anything to report about this night?
Basically, you're the best person to make the comparison between how you feel with CPAP and without.
And you should also take into account that CPAP use - and you've been using it for almost a month and a half - may leave residual beneficial effects.

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And now here is my secret, a very simple secret; it is only with the heart that one can see rightly, what is essential is invisible to the eye.
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Pugsy
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Re: What is my problem? Noobie needs settings advices

Post by Pugsy » Fri May 27, 2022 7:19 am

I agree with Ozij. Get in touch with your doctor about this. I realize you say you feel worse on cpap than without with the exception of the abatement of the headaches. You aren't the first person I have heard say that they feel worse on cpap (minus the headache abatement thing) and it is unfortunate for sure but get in touch with your doctor and discuss it further.
I realize it has to be a decision that only you can make with the input from your doctor.

One thought though for a sleep study done in a lab. Be sure to talk with your doctor about the problems you had sleeping even during the home study and it would also be a problem with an in lab study. In the US often doctors will prescribe a sleeping pill in an effort to make sure the person gets some sleep because it isn't so easy to sleep in the sleep lab setting.
I had to have one and I still had trouble sleeping. The environment isn't all that conducive to falling asleep and staying asleep.

Good luck to you.

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