[CPAP] Blocked nose and face mask, how to adjust?

[Lynandra]

Hello everyone!

I'm brand new here, and I have to say your forum saved me already! By browsing it, I figured out how to finally sleep again. 
What I mean by that is that I recently had major surgery around the face... as a consequence my nose mask was a total no-go: the silicon wouldn't seal around the bandages and any pressure on the nosebridge was entirely forbidden.

Thanks to your site & forum I found out about the ResMed F30i! It covers the nose from below, and the mouth, which is amazing. So thanks again for that :

However I'm still getting my bearings with it. While I sleep *somewhat*, it's not really amazing quality sleep (it's a 2/10 at best). For context: I recently had major surgery as I mentioned, and a consequence of it - a perfectly normal one - is that my nose is 95% blocked. It will remain so for an undeterminate duration. Thus... even if I could have worn a nose mask, it wouldn't have done much. 

Now the f30i covers the mouth too, so that helps a lot and I can breathe through the mouth at night! However, I often end up failing to fall asleep, or waking up altogether, because of various weird phenomenon... I'm not sure which can be attributed to the change in mask, to the surgical condition, or to the "mouth breathing" thing (I know, mouth breathing is bad but I have no choice   ). Add on top of that the fact that I can only sleep up straight (sitting or leaned upwards), and not on the side, and you have a cocktail of what-the-hell that becomes quite complex!

That's why, since you are experts and I'm not, I wondered if anyone here had good solid "noob tips" for someone who'd: 
- Be using a face mask for the first time?
- Be sleeping upright?
- Be only able to breathe through the mouth?

Generally, what wakes me up are instances when I suddenly take a deep, almost panicked breath from my mouth, filling my lungs by reflex, out of nowhere, with a jolt of surprise/anxiety. No clue why, the journal doesn't show any apnea... the AHI is only at 1.6 lol, I don't know if I wake up fast enough for the software to miss it? I'd need to try Oscar but I don't even have a card reader on my PC so there's that.

Anyhow! There's that! Thanks a lot for your help there and for this site, it was SO great and helpful ^^

[Sleeprider]

Lynandra, your post-surgical situation is challenging, and especially that you are sleeping in an upright or sitting position can cause what we call positional apnea. It would be very helpful if you would download and install the free OSCAR software so you can actually see, and post useful information on your therapy. Getting back to Positional Apnea, it is actually caused by chin-tucking which will be more difficult to avoid when sleeping upright. You could use a travel pillow or soft cervical collar to support your chin to prevent that problem which is probably why you awaken with a panicked breath. You are probably tucking your chin and causing airway obstruction that machine pressure cannot overcome. This kind of obstruction causes your body to react with adrenaline and arousal, and the sense of panic.

This is a very common problem, but in your case is caused by your sleep position. If you get OSCAR, this pattern can be recognized and confirmed. Please read our positional apnea wiki: http://www.apneaboard.com/wiki/index.php...onal_Apnea and how a Soft Cervical Collar can help: http://www.apneaboard.com/wiki/index.php...cal_Collar

[Lynandra]

Hey SleepRider

Oh damn! Thanks a ton for the reply and info! I hadn't even remotely considered positional apnea, at all. But now that I read the way it's described... it's pretty bang on. Especially the "is typically overcome through arousal and/or mouth breathing": indeed, the only way I can manage it is by waking up, then taking the deepest possible breath in that I can through my mouth as if I was sighing, then resuming normal breathing.
To make it even more amusing... part of the post-surgical care requires me to wear a sort of very tight face hood ("Press-lift") that STRONGLY presses against my throat and below my chin. Meaning: it also props my tongue sliiiightly up ^^'  

I would love to confirm this with OSCAR (I'm a data girl, I like me some nice numbers and graphs :p ) but I don't have any SD card reader, like an idiot haha. Hence... I can't put the card into my PC currently! I'll try and grab one later down the line, since those are like a buck a piece

But already, this will give me a LOT to work with, because the way Positional Apnea is described (symptoms+how it occurs) looks VERY close to my situation. Luckily, I'm at D+10 post-op which means I'm no longer required to wear the tight hood at night + no longer required to sleep upright. Let you know what goes!

[Lynandra]

All that said I'm realizing, I should have added that in my original post (sorry >.>), but the potential advice for a first-time full-face mask wearer is also appreciated, if any

For example, I've been using a fixed 7 (ramp from 5.4) pressure for five years now, with a normal F&P Eson nose mask, without any problem. However: with those exact same settings, and my Resmed set for a Full-face mask, I keep having trouble exhaling (and had to turn EPR on at 1 for now). Also I get my cheeks puffed up (which is not that pleasant haha). So again, if there are specifics when it comes to face masks as opposed to nose-only, I'm very interested

[Sleeprider]

EPR is a great feature and gives you a bilevel pressure. Don't hesitate to try EPR setting of 2. I think it might help to change to Autoset mode and use a pressure range of 7.0 to 10.0 with EPR 2. That will give your machine some additional capability to respond to obstruction with higher pressure, but the EPR will actually give you a pressure reduction until you get above 9.0 cm pressure. You would start at 7/5 (inhale/exhale) and go to 10/8. Even if you set max pressure to 9.0 the most your exhale pressure would reach is 7. The data will tell the tale better than guessing, and you're correct a SD card reader is pretty cheap. I have never used a full face, so will leave that to others.

[Lynandra]

EPR is a great feature and gives you a bilevel pressure.  Don't hesitate to try EPR setting of 2. I think it might help to change to Autoset mode and use a pressure range of 7.0 to 10.0 with EPR 2.  That will give your machine some additional capability to respond to obstruction with higher pressure, but the EPR will actually give you a pressure reduction until you get above 9.0 cm pressure.  You would start at 7/5 (inhale/exhale) and go to 10/8.  Even if you set max pressure to 9.0 the most your exhale pressure would reach is 7.  The data will tell the tale better than guessing, and you're correct a SD card reader is pretty cheap.  I have never used a full face, so will leave that to others.

Well, night just ended here (it's 6:30 am) and you were BANG on for the positional apnea. Shifting my position a little and making sure my chin stayed far from my chest completely fixed the biggest "suddenly awaken" problem. Thanks so much

Regarding the AutoSet... I was wondering about it indeed! It still felt uncomfortable tonight because at times, I had the feeling the mask sent a brutal "blast" of air in my face, strong enough to wake me up. While the fixed pressure felt very comfy with the nose mask, not so much here, so... I'll try that next night, and I've ordered an SD reader! Thanks again, ^^

[Sleeprider]

It's amazing what we can guess without charts, but more amazing what we can do with them.

[Lynandra]

AND WE HAVE... DATAAAAAAAAAAAAAAAAA \o/

Not gonna lie, I'm amazed by the amount of very cool data Oscar revealed Among others, it made me realize I had a lot of LL (mouth breathing?) events before, that I didn't even realize happened. Anyhow! 


To make this digestible, I took a few caps from various charts ^^' And I tried to imitate how people post, my apologies if I don't "post" right :x I like data but as a consequence I'm at a high risk of posting data that'd be considered irrelevant ^^'

So! Intro. First of all I wanted to give a general idea of how the OSA was managed PRE-SURGERY, aka before the 22nd of December. As can be seen here, it was... kinda fine overall I'd venture? 



AHI consistently below 5, with mostly remaining CA events here and there, session times were I believe more than fine, pressure stable. 

Additionally, respiratory rates and tidal volumes were I believe rather decent? 



Now I would like to post the same two charts, except after surgery. :> I would like to show the council the following!
First one, covering AHI, Usage, Session times (yep, it's fragmented). 



And next, Respiratory rate (NOT GOOD) and Tidal Volume.



So yeah. As we can see... the pre and post are VERY wildly different. The main issue as I mentioned in the first post is... my nose is blocked, entirely blocked all the time, forcing me to mouth-breathe. And sometimes I flat-out forget that breathing is a useful thing. 

Now I attached 3 charts - a general one with global data, next is a "typical day" pre-surgery, and the last one was yesterday. Which are... a bit different :') 

And in case anyone wonders: yes, I sleep THAT little. Sleeping with a blocked nose + OSA (back of the mouth blocking) + no mouth-breathing reflex when asleep is rather miserable 

Anyhow, there it is! Sorry again if I didn't respect proper posting protocol, I'll be more than happy to add/remove/modify the posted data if necessary!   Thanks!

[Lynandra]

And I'll post a last attachment, showing one of my "typical" attempts to sleep. It's also the reason why I barely sleep: whenever I try, this is what tends to happen :p 

Enjoy o/

[quiescence at last]

Welcome. I like to review individual breaths, so that clip means a bunch to me. There is nothing I see in it that makes me think you were asleep, at least, not deep enough for any restorative sleep. While awake, you use your muscles to inhale and to exhale. When asleep you only use your muscles to inhale. The body just exhausts the inhaled air by equalizing pressure inside and outside.