Apnea Newbie CPAP adventures (so much yawning?)

So I have been always tired recently (past 4 years or so) but I thought it was because of the kids. (I have a 4 year old and 11month old)
This year June, I went on a trip with family friends and we rented a whole airbnb home. I went to sleep on the couch because the bed was too small for my family.
My friend who went to the kitchen to get some water middle of the night heard me stop breathing and gasping for air and took a video of it. The video shows me sleeping on my side and me stop breathing for 40 seconds then breathing 3 breaths and then stop breathing again.

This made me book an appointment with my fam doctor to do a sleep study. It took around a month for me to get the appointment and did the sleep study done. The results were sent mid August and then they booked me with a specialist in 2 days because it was urgent. Turns out by AHI from the sleep study was 103 and oxygen saturation drops to 5X% and the specialist had booked me in earliest possible.

So the same day I booked appointment with cpap retailer, bought airsense10 with heated tube and f30i full face mask and now have used it for 10 nights straight.

From the first night, when I wake up I feel totally different... like I am not dead tired and want more sleep and I am waking up only once to go to the washroom ( and when my baby is crying for a bottle middle of the night) as oppose to like every hour when it's bad.

My new AHI is for the first 3 days were between 10-14. then I had a night where the mask shift so much, it was leaking and i hadAHI of 20. Then it came down to 9, 7.7 then to 4.7!!! which is great since we are aiming for <5AHI. However, that was the only night when it was lower than 5. The next night was 19.9 because mask leaked again, and then 8 then finally 8.2 last night.

Is my AHI still high? I find my self yawning alot during the day as well.

My setting is auto adjust between 5-15 and starts at 4 with auto ramp. I have harder time falling alseep after waking up due to it being uncomfrotable but i think it's getting little better (I am getting used to it I guess).

Any insights on my AHI being still high?

At a minimum, your CPAP settings need to be optimized. You should post an OSCAR (or sleephq.com for the less technically inclined) Daily View screenshot in this thread. Instructions are near the top of this index page.

Without data, we would be guessing.

Welcome!

hungryguy wrote: ↑

Fri Sep 08, 2023 10:02 am

My friend who went to the kitchen to get some water middle of the night heard me stop breathing and gasping for air and took a video of it. The video shows me sleeping on my side and me stop breathing for 40 seconds then breathing 3 breaths and then stop breathing again.

your friend's quick thinking pretty much saved your life. kudos to them!

hungryguy wrote: ↑

Fri Sep 08, 2023 10:02 am

Any insights on my AHI being still high?

chicago granny has the right end of the stick. each of us is just that much different that there will be different approaches to therapy. you've started out fantastically! but the forum needs to see what events compose YOUR ahi so it can be improved.

here's the link she spoke of-
viewtopic/t172378/Sticky--Newbies-PLEAS ... STING.html

good luck and welcome to the zoo!

hungryguy wrote: ↑

Fri Sep 08, 2023 10:02 am

...
This made me book an appointment with my fam doctor to do a sleep study. It took around a month for me to get the appointment and did the sleep study done. The results were sent mid August and then they booked me with a specialist in 2 days because it was urgent. Turns out by AHI from the sleep study was 103 and oxygen saturation drops to 5X% and the specialist had booked me in earliest possible.

So the same day I booked appointment with cpap retailer, bought airsense10 with heated tube and f30i full face mask and now have used it for 10 nights straight.
...

How much experimentation did you do with different types of mask? I'm still working with my sleep clinic, and I've now been given 6 different types/sizes of masks to try, and none of them are ideal. It seems like they'll keep giving me new ones to try until I find the best one. Masks are so personal!

It's not clear to me what the best way to settle on a mask is - there are so many! Do folks find that their clinics are generous in giving you new masks to try, or do you just keep buying them retail until you hit on the best one?

First off, kudos to your friend*

You haven't mentioned using OSCAR (or equivalent) to get your daily AHI and events record, but I'd suggest that you do so.** (as the MyAir reporting is inadequate)

One of the things that you really need to understand is that mask leakage tends to 1) corrupt the validity of events and AHI and 2) undermines the effectiveness of your treatment.
So, a search for a mask that will prevent accidental leakage is of paramount importance.
That search for the combination of a comfortable mask (one that will not cause your sleep to be further disturbed by discomfort) and simultaneously does not leak** when under pressure can be a significant challenge, and something that you may struggle with for years. But don't give up - keep trying to find the mask that is best for you.
In the meantime, don't be discouraged when events are reported during a leaky period. In general you may want to discount those events as unreliable.

Lastly, try to turn off your auto-ramp (or alternatively set it for the least amount time that you can tolerate/be comfortable to get to sleep). The ramp is just a comfort feature, BUT during the ramp period the CPAP will not adjust pressures in response to events (so if you happen to have a obstructive event during ramp period, the machine ignores/ provides no treatment. OTOH, if you need the ramp (auto or timed) to assist you in getting to sleep, by all means use it. (just don't use it unnecessarily)

*while very few people die directly of obstructive sleep apnea, it is estimated that 38,000 die each year from heart attacks that are related to sleep apnea because of the long-term damaging effect of sleep apnea on the heart. So, if possible, it might be wise to also check in with a cardiologist for an assessment of your current cardiac health.

** What you are looking for are trends in OSCAR reports. So it's a good practice to look a several days with one mask or another, or several days at one pressure settings. We all can experience "bad" sleep days, some of those "bad" days can be more related to events during our awake hours, or bad dreams. In other words, don't expect that your sleep would be "representative" if you were dealing with negotiating on buying a house!

*** all masks "leak", they are designed to do so (to facilitate exhalation and limit re-breathing). What you want to do is seek to avoid leakage significantly above 35-40 l/min.

dataq1 wrote: ↑

Sat Sep 09, 2023 7:49 am

...
One of the things that you really need to understand is that mask leakage tends to 1) corrupt the validity of events and AHI and 2) undermines the effectiveness of your treatment.
So, a search for a mask that will prevent accidental leakage is of paramount importance.
That search for the combination of a comfortable mask (one that will not cause your sleep to be further disturbed by discomfort) and simultaneously does not leak** when under pressure can be a significant challenge, and something that you may struggle with for years. But don't give up - keep trying to find the mask that is best for you.
In the meantime, don't be discouraged when events are reported during a leaky period. In general you may want to discount those events as unreliable.

How do YOU - as a seasoned CPAP user - go about finding the best mask? Given that masks are considered personal hygiene items, I presume vendors are not allowed to re-sell or re-use anything that is returned as 'not working for me'. Are vendors willing to take a short-term loss (and just eat the cost of returns) in the hope of building long-term relationships, and thus, allow generous 'returns'? Or do you have to spend your own money experimenting till you find something that really works? So far, my clinic has been giving me masks to try but I suspect that will end once they prescribe a machine for me - but maybe not.

dataq1 wrote: ↑

Sat Sep 09, 2023 7:49 am

...
*** all masks "leak", they are designed to do so (to facilitate exhalation and limit re-breathing). What you want to do is seek to avoid leakage significantly above 35-40 l/min.

I've noticed that all my masks have an 'exhaust valve' on them, and a significant amount of air is always blowing out of it (during both inhale and exhale). How does the machine account for that when calculating 'leak' measurements?

Steerpike58 wrote: ↑

Sat Sep 09, 2023 9:54 am

Steerpike58

You are hijacking hungryguy's first post! It's a very important post to him!

Please start your own thread! Your topic is very important to you. It deserves its own thread.

hungryguy wrote: ↑

Fri Sep 08, 2023 10:02 am

Is my AHI still high? I find my self yawning alot during the day as well.

Yes, it's still too high, but don't let that detract from the amazing progress you've made. You'll get there in the next few weeks. Follow the really good advice above.

The good news for you is those of us with really bad sleep apnea (which you have) tend to adapt to the therapy the most easily. Don't be surprised if you sleep a ton for a couple of months as your body and brain catch up.

hungryguy wrote: ↑

Fri Sep 08, 2023 10:02 am

....then I had a night where the mask shift so much, it was leaking and i hadAHI of 20. Then it came down to 9, 7.7 then to 4.7!!! which is great since we are aiming for <5AHI. However, that was the only night when it was lower than 5. The next night was 19.9 because mask leaked again, and then 8 then finally 8.2 last night.

Steerpike58 wrote: ↑

Sat Sep 09, 2023 9:54 am

I've noticed that all my masks have an 'exhaust valve' on them, and a significant amount of air is always blowing out of it (during both inhale and exhale). How does the machine account for that when calculating 'leak' measurements?

Hopefully this will help both hungryguy and Steerpike58

Cpap masks are designed to leak, there should be exhaust ports (small holes) that allow a constant flow of air to escape to prevent rebreathing exhaled C02. The amount of air that passes thru the exhaust ports varies with the pressure being applied (you can see graphs of pressure-flow curves in your mask users manual) and in general on the order of 20 to 50 liters per minute.
The "normal" volume of air that is actually taken into the lungs is on the order of 5 to 8 liters per minute. So you can see that the CPAP is actually generating much more air than the normal adult is consuming. This excess air flushes the exhaled air and is intended to prevent rebreathing C02.
However, if you are using a full face mask with your mouth open even if you are not breathing through your mouth this whirlwind of excess air may tend to dry your mouth. (at least that has been my experience).

According to the ApneaBoard wiki, the leakage that is reported (from OSCAR) is above and beyond the designed leakage. - So the machine does account (subtracts) the designed leakage before reporting the leakage values that you will see in your OSCAR reports. So if you were to see a leak reported , for example of 50 l/min, the actual volume of air being generated by the machine and passed to the nose and or mouth areas is on the order of 70 to 100 liters per minute. (that's a lot of air!)

In actual practice, a perfect mask seal (no leakage beyond normal exhaust) is very hard to obtain consistently. As a rule-of-thumb (from others on this forum) occasional OSCAR leaks below 30ish are not significant enough to to warrant concern. It's the "large Leaks" that will confuse the CPAP machine and lead to faulty event reporting. *

* ApneaBoard defines "large leak" as the "a leak exceeding the CPAP's ability to maintain proper therapy pressure and volume"

dataq1 wrote: ↑

Sat Sep 09, 2023 9:57 pm

Cpap masks are designed to leak

Masks are not designed to leak. They are designed to vent.

Yes of course, continuous venting is a better description of the design. That said, some users refer to that venting as “leakage”. ( note how Steerpike was wondering how devices leak values account for the ‘air continuously blowing from the mask’).
But designed venting is a better terminology; thanks for pointing that out.

Mask venting is also called intentional leak.

Pugsy wrote: ↑

Sun Sep 10, 2023 6:05 pm

intentional leak

Colloquialism

Steerpike58 wrote: ↑

Fri Sep 08, 2023 11:13 pm

hungryguy wrote: ↑

Fri Sep 08, 2023 10:02 am

...
This made me book an appointment with my fam doctor to do a sleep study. It took around a month for me to get the appointment and did the sleep study done. The results were sent mid August and then they booked me with a specialist in 2 days because it was urgent. Turns out by AHI from the sleep study was 103 and oxygen saturation drops to 5X% and the specialist had booked me in earliest possible.

So the same day I booked appointment with cpap retailer, bought airsense10 with heated tube and f30i full face mask and now have used it for 10 nights straight.
...

How much experimentation did you do with different types of mask? I'm still working with my sleep clinic, and I've now been given 6 different types/sizes of masks to try, and none of them are ideal. It seems like they'll keep giving me new ones to try until I find the best one. Masks are so personal!

It's not clear to me what the best way to settle on a mask is - there are so many! Do folks find that their clinics are generous in giving you new masks to try, or do you just keep buying them retail until you hit on the best one?

The clinic just gave me recommended mask set up, large frame with medium mask portion. Suggested that I get the full mask because if i have dry mouth I am probably breathing with my mouth during sleep.

Thanks to those who posted for taking interest in my Journey, I really appreciate everyone's inputs

Here are two screen shots from oscar.
Last night, when the baby woke me up a little past 4AM, I realized I wasn't wearing my mask, I don't remember what happened at 3:15ish but it looks like I took the mask off? First time this has happened to me during the last 2 weeks. It also looks like mask was leaking alot before I took it off.
The night before that I had the sleep with lowest AHI yet which I also have attached.

I have not tried to mess with autoramp because I was scared to change the settings, but I will try to change it tonight if someone gives me a recommendation after looking at the data below.

So far, it looks like my mask works very good when I am sleeping on my back but it seems to leak when I switch to my side