At a bit of crossroads, need some advice

Hey Folks,

I need some advice. I've been using a CPAP for almost a year now. The first month was the best. I was using a ComfortGel Nasal and feeling a lot better. But, it gave me the dreaded red mark at the bridge and I switched to the LT. I began mouth-leaking and between taping, chinstraps, and trying various other masks, have only felt a little better. One night with a Mirage Micro went particularly well but it irritated my face. I tried a UMFF and felt pretty decent but after a couple of weeks, went back to feeling foggy and having headaches upon walking up. In addition, I found it difficult to sleep on my side with the UMFF due to leaks and the airflow blowing across my arm.

My new puppy chewed up the UMMF and hose so I had to go without the my CPAP for a couple of nights since I didn't have a back up. My apnea is positional so I focused on sleeping on my side. The second night was better as I taped a ball to the back of my shirt. Here's the thing; I woke up feeling better without the CPAP than with. No puffy eyes, headache, or foggy feeling. I felt sleepy but not groggy. So the Activa came. I get a good seal (leak of .04L/s)though I have some irritation at the bottom of nose. I've gone through a couple of different settings. AHI's have been low, as low as 1.4 with no AI's. Despite this, I still wake up feeling with puffiness under the eyes and a groggy feeling.

I just don't get it. My doc suggested doing some oximetry readings for a couple of nights. Besides that, I'm kind of at a loss. Is my pressure too high? I've set it just a bit higher than my titrated pressure; originally 11.0 but I've set it at 11.6. The first night I got the Activa, I had an AHI of 8.3. With 11.6, it dropped to 1.4. I felt marginally better. EPR doesn't help. Blech...I'm not sure what to do...

I'm open to recommendations.

mdintx wrote: I'm open to recommendations.

Quattro

probably a stupid question, but did you change the mask settings on the cpap each time you switched masks? I have found cpap doesn't work as well for me if i don't do this.

otherwise, i have no useful suggestion. sounds odd. perhaps those wiser than me will chime in to assist you! hope it works out!

I've tried the Quattro. I can't get a seal with the Quattro and it irritates the bridge of nose within minutes.

And yeah SleepyT, I make sure the change the mask settings.

mdintx wrote:I've tried the Quattro. I can't get a seal with the Quattro and it irritates the bridge of nose within minutes.

And yeah SleepyT, I make sure the change the mask settings.

I got a sore nose too at first due to over tightening, but not within minutes, do you think you have a allergic reaction to the seal silicon material? or maybe you just have it too tight and need to loosen the dial clamp. Either way pad-a-cheek has a pad for the nose bridge you might want to try seeing as you already have the mask.

Uncle_Bob wrote:

mdintx wrote:I've tried the Quattro. I can't get a seal with the Quattro and it irritates the bridge of nose within minutes.

And yeah SleepyT, I make sure the change the mask settings.

I got a sore nose too at first due to over tightening, but not within minutes, do you think you have a allergic reaction to the seal silicon material? or maybe you just have it too tight and need to loosen the dial clamp. Either way pad-a-cheek has a pad for the nose bridge you might want to try seeing as you already have the mask.

I think it's just the shape of it. At various levels of tension, it leaks at the eyes and at the corners of the mouth. I've confirmed that it's the right size as well. Every time I've tried, it just didn't work regardless of fiddling I've tried. The bridge of my nose has tolerated the UMFF, Micro, and Activa without problems. So, I'm reticent to purchase something for it. But thanks for the suggestion.

have you tried the hybrid masks?

Uncle_Bob wrote:have you tried the hybrid masks?

Yep, both of 'em. The Hybrid tore up my nares and the Liberty wouldn't seal

F&P Forma

I think you need to back the bus up so to speak, why are you talking masks at this point? You already have fantastic numbers with a low leak rate.
If you are still feeling fatigued then maybe you need to look into the many other causes of fatigue of which sleep apnea is only one.
If you google "causes for fatigue" the results are plentiful.
Good luck.

mdintx wrote:I've confirmed that it's the right size as well.

How did you confirm that?

If I use the guides/templates, I need a large.
I use a small.

The proof is in the pudding.

mdintx wrote:I've tried the Quattro. I can't get a seal with the Quattro and it irritates the bridge of nose within minutes.

Back in the beginning ( when cpaps were Australian vacuum machines connected to the blowing side) they used glue the masks on. Have you tried ?

I'm not sure what kind of glue they used.

Uncle_Bob wrote:I think you need to back the bus up so to speak, why are you talking masks at this point? You already have fantastic numbers with a low leak rate.
If you are still feeling fatigued then maybe you need to look into the many other causes of fatigue of which sleep apnea is only one.
If you google "causes for fatigue" the results are plentiful.
Good luck.

I agree, I'm wondering why I don't feel good despite having great numbers. I assumed it was the mask. But now I'm finding that even with other masks that give me good numbers, I feel the same way. Then to have a couple of nights without CPAP and not have the fogginess really has me wondering what's going on.

mdintx wrote:I just don't get it. My doc suggested doing some oximetry readings for a couple of nights. Besides that, I'm kind of at a loss. Is my pressure too high? I've set it just a bit higher than my titrated pressure; originally 11.0 but I've set it at 11.6. The first night I got the Activa, I had an AHI of 8.3. With 11.6, it dropped to 1.4. I felt marginally better. EPR doesn't help.

Hi,

Too high? No, I think it is still too low. When you went from 11.0 to 11.6, your AHI dropped from 8.3 down to 1.4 and you felt better. Consider moving it to 13, and maybe you will knock out the rest of the events and feel even better after a few days. It might be that you are one of the population that is very, very sensitive to any events. It would be useful to see a graph of a typical night. Can you post one?

I also think that spending a night with a recording oximeter is a great idea. Low blood oxygen can cause real damage. If that is still happening despite having reasonable treatment, then you have a pretty good lead on what the issue might be. I suspect that is a pretty good suggestion for a next step on the part of your MD.

-john-

mdintx wrote:I agree, I'm wondering why I don't feel good despite having great numbers. I assumed it was the mask. But now I'm finding that even with other masks that give me good numbers, I feel the same way. Then to have a couple of nights without CPAP and not have the fogginess really has me wondering what's going on.

First of all, never lose site of the fact that the therapy is doing more than making you feel good. It's to save our life. So everytime you mask up, you are helping yourself.

I think feeling good may be a bit overrated. Especially if you're a natural skeptic and pessimist as I am.

You might want to consider something like the Respironics Fitlife FF mask as it doesn't touch the bridge at all. I have some chin issues with it, but I use this mask to give my bridge a rest. I find the Fisher & Paykel Flexfit 432 Full Face Mask to rub less against the bridge than Quattro or Comfort Gel.

So don't give up. You're on a journey. And it takes some of us longer than others. Keep trying. And remember, CPAP is more than feeling good. Its a life saver.