[CPAP] AHI 7-10, desperate and leaking!

[flabberjabber]

No doubt you've all seen this a hundred times, but I could really do with someone in the know's advice. I am so tired and feel like I have dementia. Word finding is so hard. I desperately want to get on with my life. Everything is on pause because of this bloody sleep condition. I am desperate, please help!

I was diagnosed with sleep apnoea by an NHS service around six months ago. They gave me a machine (loewenstein prisma smart max) and essentially sent me on my way despite the numerous issues that have cropped up.

I thought, due to the sh**ty prisma app, that my AHI was under control for the last six months. As, it never went above 3 according to the app. Despite feeling utterly atrocious. I had begun to start to mentally blame my symptoms on other things. But, when my deep sleep started to dip to less than 10 minutes a night, I figured it was time for a closer inspection. I downloaded OSCAR and to my surprise it seems the prisma app is complete and utter fabrication and misrepresentation. I'm still getting a middling AHI, which is obviously not good!

My initial AHI was 30.4 in clinic. I'm struggling to get under 7 AHI consistently due to what appears to be leaks. I've bounced between different masks. At first, not to fix the leaks, but because I seem to be allergic to silicone and the marks the mask were leaving weren't fading over time. So I settled on an AirFit F20, which I've had to fund myself as the NHS won't, which is the only mask I've tried that doesn't produce long lasting marks my face.

I have used the Resmed template to measure my face, and I am a large. I have experimented with different tightness the straps, again nothing seems to work.

I have quite a broad nose if that's useful information to keep in mind.


Out of frustration I upped my therapy level last night from 7 to 9 and of course, upon reviewing this in OSCAR this morning, the change has just made the leaks worse.

Any input anyone has is most welcome! Thank you in advance for any help and taking the time .

[SarcasticDave94]

You have 2 things working to destroy your therapy. Leaks and Positional Apnea are working against you.

Leaks, seems to come during times of those clusters of events. The machine is trying to combat these clusters, which it can't.

The clusters are showing a Positional Apnea pattern. Check a few things. How thick is your pillow? It might be pushing your chin towards your chest, which sets up a kinking off of your airway. A visual, old Grandpa falling asleep in his big recliner with his head flopped onto his chest.

That scenario kinks your airway externally and physically. And it'll require an external, physical action or device to block the chin tuck. If the pillow is too thick, replace with a thinner option. If you side sleep, some pillow depth is acceptable to fill the space between head and shoulders. In that scenario, pull a section of the pillow to fill the gap between your chin and chest. Failing this, then you'll need to change action to getting a soft cervical collar to block the chin tuck.

There's an article on the wiki for other info.

https://www.apneaboard.com/wiki/index.ph...onal_Apnea

[flabberjabber]

Oh Dave, thank you so much for your response! 

I am a side sleeper and have really broad shoulders. My neck definitely tends to move forward at night. I'll do what you recommend tonight with a pillow and failing that look at a cervical collar. And, I think from what you've said it's time to invest in the right kind of pillow for my neck. Perhaps one of those memory foam ones that curves into your neck at the edge.

Do you think the leaks are being caused by the positional apnea as well?

Thanks again for your time Dave! Really appreciate it

[SarcasticDave94]

I myself cannot tell which was first, but they do seem related.

I tried the F20 both medium and large cushions, and in both variants of seal, the silicone AirFit and memory foam AirTouch. I used these for almost a year and never got it to stop leaking a bit too much. I went over to Fisher and Paykel masks, starting with Simplus, to Vitera, now on Evora Full hybrid. Maybe look them up.

What I liked about these F&P, nearly right seal out of the box. Slight tweaking of the straps the right order and it's low leaks and light tension, plus well built masks, to me a winning combo. I won't go elsewhere for masks now. And no I don't work for them.

[Deborah K.]

Your Positional Apnea is bad.  I think you will need to start wearing a soft cervical collar.  When I needed one I liked the Caldera Releaf Collar the best, as do a number of others here.

For leaks, keep in mind that full-face masks tend to leak the most, nasal masks less, and nasal pillows masks the least.  Because you have a lot of leaks maybe you would do better with a nasal pillows mask.  You might need to tape your mouth, but it is well worth it to stop the leaks, as they interfere with your therapy.  Just something to consider.

If you don't like that idea there's a new full-face mask that a good number of people like quite well, the ResMed F40.  You can search and read about it on this forum, as lots have written about it.  

Best of luck with getting your therapy and comfort optimized!  

[flabberjabber]

I ordered a collar earlier today. Although it's just a standard one from a healthcare website. Do you think it'll work okay? I suppose if it doesn't I'll look to getting the one you mention.

I've actually tried a nasal pillow and I really didn't get on with it. I found it claustrophobic and I could not get to sleep with it on. Unlike most with sleep apnea, I have no problems falling asleep normally. On the contrary, in fact I'm asleep in within five minutes and I sleep for too long (up to 13/14 hours occasionally but usually 10-12) (which my sleep specialist seems to think is a reaction to the apneas).

I've had a quick look at the F40. Its possible the clinic I'm with will supply it. But, considering it only comes in silicone I'm apprehensive about getting one. I think I'm going to need to stick to the non silicone based masks. I tried three different silicone masks and all of them made my face red and sore all around where the contact was. Do you know of any masks that aren't silicone that are good alternatives? 

Thanks for your input Deborah. I'm eager to learn and get this sorted! More than anything I want my mental faculties back. I feel like an idiot gliding through life most of the time!

[SarcasticDave94]

If the collar is the right size, it might be fine.

Is the silicone mask aspect an allergic reaction, or are they being adjusted tight? I've found if the mask doesn't seal with light to moderate tension, it's probably going to end up being too tight. Tightness can increase discomfort and pain, so it's not good to go there.

[flabberjabber]

I'm pretty sure it's an allergic reaction. The mask was leaving a mark uniformly all around where the contact was, not just where the mask was tending to leak. And, I tried all different tensions and it made no difference. 

Having switched to the memory foam mask, the marks have disappeared, and don't come back regardless of the tension (which I've also been experimenting with).

[SarcasticDave94]

OK. There's a few silicone free masks. I'm not coming up with names just now.

[Deborah K.]

You could also wear a mask liner which keeps the silicone from touching your skin. Lots of folks here like the products made by Supplier 31.