Seemingly Sudden Increase in Leaks

[TheManseHen]

Greetings Fellow Pap-ers.

I have been using the same model machine and same model mask for a year and a half now, and have gotten decent enough results. (I have mixed obstructive and central apneas while on cpap and typically at a 50 50 ratio but my AHI is still far better treated than not) I have always managed to control any mouth breathing by doing tongue seal and I also tuck blanket over my mouth as a reminder as I fall to sleep. I have not needed to use a chin strap.

Anyway, I had a machine that got damaged in March and the DME replaced it with the same machine (except newer one counts RERA's yay) and mask etc.

Ever since then I've had what appears to be an overall higher rate of large leaks on most nights, leading to a slightly higher AHI on avg as well.

I find myself waking with the lip flaps...Do we have an official term for these? I sleep on my stomach or side, never back. And I wake from the air escaping my lips on exhale, not a full open mouth snore, just my jaw shut and lips letting air out like involuntary horse lips. I also feel like I'm being slammed with pressure more often than I used to. I assume this is from the increased pressure to compensate for the leaks, which I feel when I shut my mouth. Maybe I have a vicious circle going on here.

I put the new machine on same settings. I did have one premolar taken out this spring so it is possible that before it was helping seal air in better. (I am nearly needing a lower partial but even when I get one, one isn't expected to sleep in them (does anyone here have comments on that as a side issue?)

I have had the EPR at 2 this past few weeks, and sometimes since march had it at 3 but don't see any tight correlation.

I have had lots of allergies this spring, I am taking benadryl, but that isn't so unusual over prior spring.

Thoughts? Anything I can try to stop the lip flaps? (Not interested in total taping of mouth)

I feel refreshed-ish but not the quality of sleep I had been used to.

ANy ideas why a new machine, could be behaving differently? Think I should rule it out as cause? Should I have it tested? HELP----

Thanks in advance....
The Manse Hen

[green wings]

Hi, Manse Hen. It sounds like you've got a complicated problem going on. My condolences on the "involuntary horse lips".

I have had that happen, so I know just what you're talking about.

Do you know if your median and 95% pressures have changed since you started using the new machine? Just wondering.

Also, I am wondering if your new machine has the option of two algorithms. Some people say that their A10 AutoSet machines do - a regular algorithm and a second one called "For Her" or "gentle". I was thinking that if the "gentle" algorithm is available, you might try it.

How long have you had your mask? How often do you usually replace it? I think I'd start trying new masks - maybe a new one of the same type at first and then explore further if that doesn't help. Or you could try a chin strap, if you can use that. Not fun.

[FrankNichols]

Hmm, first thought is do you set your own pressure settings? Maybe the new machine was setup differently and at a higher pressure? I see a serious increase in leaks at a certain pressure - 1 above or below it makes major different. I see you are using Pillows, I would also look into humidity settings, if your nasal passages are getting dry you may be mount creating to relieve that.

Just suggestions, I have no idea what i am talking about

[TheManseHen]

Thanks Frank and Green,
I shall check my median. Yes I do my own settings, and so after they gave me the new machine I put them back to where they are. I don't think I have the option for a gentler algorithm but I'll double check. It is not a 'for her" machine but who knows, it has Rera's the old one didn't.

I will try moving it down one and see what happens. I hate horse lips.

Susan
Open to more idea's if anyone else responds.

[PaytonA]

The horse lips are because your tongue seal is not being completely reliable. The only suggestion that I can make is to practice the tongue seal more and harder. You might try some chin straps or a soft neck brace.

You could try a slightly lower pressure for a while and then try sneaking the pressure back up to where it was.

Maybe the way that the new mask positions itself directs the airflow in a manner that makes it more difficult to seal off. Try doing a critical comparison between your old mask and the new one.

I am making a lot of guesses here. If I think of any other possibilities I will let you know.

Best regards,

PaytonA

[chill]

No idea, but I can commiserate. I am not sure it is nasal stuffiness (horrible allegory season up here too!) or an increase in pressure. I have never had a problem maintain a tongue seal before, but the last week I have been waking up with flapping lips and a very dry mouth. As I go back to sleep, I can notice my tongue seal sometimes relaxing. Darn!