Long time struggling user looking for guidance and advice

I have experienced headaches, tiredness, grogginess and inadvertently falling asleep in undesirable situations since I was young, and I used to struggle with waking up for work. I unfortunately went undiagnosed until I was 30 years old.

I was diagnosed with mild sleep apnea via an at home sleep study whilst living in Canada in 2018. I was provided with a Resmed Airsense 10 Autoset machine and Philips Nuance Pro nasal pillow mask which I have been attempting to use with mixed results ever since.

I moved back to the UK one year ago and had an at home sleep study done via the NHS. I was again diagnosed with mild sleep apnea. However I was told that this was under the threshold required to treat my sleep apnea on the NHS. I was however referred for a custom Mandibular Advancement Device which I have now received. However, I have read some stories of scary side effects for this on the internet and have found this even more intimidating than CPAP so have not yet used the device.

I have experienced particular difficulty with falling asleep whilst wearing the machine and I am now looking to try some different approaches in order to resolve this issue. I have had periods of successful usage getting a few hours most nights but then fall into prolonged periods of failed usage where I struggle to fall asleep with the mask on or fall asleep before putting it on. Generally I have to be tired enough to put the mask on, but if I am too tired then I fall asleep.

I think my issues with CPAP is generally that I feel the air blowing too strongly and that some of that air vents from the vent on the mask and blows onto me. I have been experimenting with Pressure and ramp settings on the device myself as well as the autostart setting. I was wondering if I have autostart on and can fall asleep without activating the machine, whether it will then turn on whilst I am asleep, making it easier to fall asleep.

The sleep clinic in Canada seemed to be more interested in selling me things than helping me acclimatize and try different things. And given the NHS' judgement I find myself somewhat on my own to try and figure out the best course of action. I would appreciate any advice you could offer or any pointer to private professional advice that I could solicit.

I was using the resmed.com website to analyse my data but it seems to have stopped uploading data there since November 2024, I don't know why this happened. I am considered starting to analyse my own data via SD Card with Oscar or Sleep HQ software.

I have started fiddling with the clinical settings on the machine in the last few months, I think that these were previously set by the Canadian CPAP clinic. I don't really know what I am doing though, I upped the pressure a bit and put the ramp on.

As my mask (Philips Nuance Pro Nasal Cushion) is an old model (I did buy a replacement) and I can no longer buy nose pieces for it I am considering buying a new mask. It does feel like the nose piece falls off the mask much more than it used to, and I do wonder if it is causing leakage. I was advised by the clinic in Canada that I should use nasal pillow rather than full face masks because I have a full beard which would prevent a seal forming.

Do you have any advice on falling asleep with the CPAP mask on?
Is it a viable strategy to fall asleep with shallow breaths and not activate autostart until I am asleep?
Can you advise on what clinical settings .e.g. pressure, ramp time etc that I should be using or a process that I can use to determine the correct settings?
Can you recommend any other masks for me to try?
Can you recommend any other machines for me to try?
Can you advise on the pros/cons of giving the mandibular advancement device a go vs CPAP?

I am very grateful for anyone who made it this far or has any advice. Thank you for your time.

Get a free account at SleepHQ.com, upload the data from your machine's SD card, and post the analysis link in this thread. (SleepHQ redacts your personal information.)

thanks for the suggestion

https://sleephq.com/public/teams/share_ ... 48ca310fef

sleepyboyblue wrote: ↑

Sun Feb 16, 2025 10:18 am

Do you have any advice on falling asleep with the CPAP mask on?

Do a brief study of "good sleep hygiene" and start working on improving.

sleepyboyblue wrote: ↑

Sun Feb 16, 2025 10:18 am

Is it a viable strategy to fall asleep with shallow breaths and not activate autostart until I am asleep?

In my experience, even shallow breaths will activate AutoStart.

sleepyboyblue wrote: ↑

Sun Feb 16, 2025 10:18 am

Can you recommend any other masks for me to try?

There are masks with images, specifications, ratings and reviews here - https://www.cpap.com/ . (I discount a few negative reviews.)

sleepyboyblue wrote: ↑

Sun Feb 16, 2025 10:18 am

Can you recommend any other machines for me to try?

You have one of the best machines.

sleepyboyblue wrote: ↑

Sun Feb 16, 2025 10:18 am

Can you advise on the pros/cons of giving the mandibular advancement device a go vs CPAP?

You are too early in the process of optimizing your CPAP therapy to consider a MAD.

sleepyboyblue wrote: ↑

Sun Feb 16, 2025 10:18 am

Can you advise on what clinical settings .e.g. pressure, ramp time etc that I should be using or a process that I can use to determine the correct settings?

If I understand it correctly, besides the issue of trouble falling asleep, your big issue is,

sleepyboyblue wrote: ↑

Sun Feb 16, 2025 10:18 am

I feel the air blowing too strongly and that some of that air vents from the vent on the mask and blows onto me.

If this were my situation, I would change the mode to APAP and the minimum pressure to 10.0. My gut feel is your pressure is too high. After each change, run SleepHQ to see the results.

About the leak level, find your mask on YouTube and watch some videos on fitting and adjusting.

sleepyboyblue wrote: ↑

Sun Feb 16, 2025 10:18 am

Do you have any advice on falling asleep with the CPAP mask on?
Is it a viable strategy to fall asleep with shallow breaths and not activate autostart until I am asleep?

If you need ramp, set it to Auto. In my experience, the Resmed machine does ad job of identifying when I've fallen asleep and it only raises the pressure then. The raise in pressure is well synchronized with my Polar watch's sleep tracking,

I have a full beard and use a full face mask. Six months ago I switched to the ResMed F40 and it is sealing much better than my F10 and F20s, and others did. The others would leak terribly if I raised the pressure where it needed to be. The F40 is smaller, more flexible, and is a hybrid. It is a nasal mask until you mouth breathe. It is WAY more comfortable for me than the F others.

The way I got used to a full face mask 18 years ago was to pretend I was sleeping on a high-altitude airplane flight needing oxygen and the mask provided it. I've never been on a flight that needed oxygen but thinking I needed the mask to survive, which very well may be true due to my severe apnea, helped me accept it. The mask gave me nightmares at first. I ripped it off during sleep sometimes. It took a month or so but I do fairly well now.