[CPAP] New CPAP User Help

[MichaelC]

Hi

I started using my ResMed AirSense 10 4 weeks ago following a home sleep study (NHS).My sleep study showed AHI of 55 and the reason i sought help was due to my loud snoring. I only had a short telephone call with the doctor and all he told me was that my AHI was 55 and that i needed CPAP.

I am using a Philips DreamWear mask and most nights I am being woken up by leaks. I contacted my provider (Baywater) and after looking at photographs of me wearing the mask they suggested I use the small frame instead of medium. Unfortunately this hasn't helped and I have to wear the mask so tightly it is leaving dents in my face in a morning. I only managed 4:45 sleep last night before I had to take the mask of because of the leaks.
When the technician visited me at home to install the equipment she said this mask would be best because I sleep on my front and breath through my mouth.
Are there any other masks that would be suitable for me?

I am also concerened that my AHI is still fairly high when using CPAP and because I am new to all this I don't really understand the data in OSCAR. Could someone look at my stats attached?

[Phaleronic]

Welcome to the forum MichaelC

They set you up on too low of a min pressure (4cm is for children)-please raise this to 7.6cm and set EPR to fulltime and 2 for now-that should knock down your OA/H events. You may need a chin strap or mouth tape if you have high leak rates down the road too (I couldn't use nasal pillow systems because I open my mouth and cannot use a clinstrap or mouthtape. If you need more EPR you can set it to 3 but I would like to see how you do on 2 and if your CAs clear up on the new settings.

[PeaceLoveAndPizza]

Far too many sleep professionals just leave the machine they provide on the default settings assuming the it will titrate properly and magically find the proper pressure. In most cases it will find a pressure that works, but it will also not help with sleep quality as it must cycle up and down repeatedly until it locks in on what will actually work for you, creating a rather unpleasant nights rest.

Fair play to the lass who tried to help with the mask. Unfortunately a single visit is not sufficient to get it right without a serious amount of luck.

Let’s focus on the mask. Sadly, it takes a bit of trial-and-error plus luck to find one that truly works. Masks similar to the Dreamwear are the ResMed F30, F30i. F40, and the Fisher and Paykel Evora. All are fine masks which you will need to experiment with to find the one that works for you. As Phaleronic said, nasal pillows may be worth trying, but if you are a mouth breather you may need help from a chinstrap, mouth tape, or soft cervical collar to help keep your mouth closed properly. Personally I prefer a soft cervical collar with nasal pillows, but it is your choice if you want to try it.

Watch some YouTube videos from LankyLefty27 on fitting any of those masks properly. The thing to learn is how to keep it just barely touching your face so that when the silicone inflates it seals against your face. Too tight and you get leaks, too loose and you get leaks. If you have a beard then it makes it more difficult with a full-face mask, but memory foam cushions help. I have a fairly large bushy beard and no longer can use a full-face mask without some large leaks, but on the occasions I use one I know what will happen so just ignore it.

Try a flatter pillow as well to help with the neck kinking. You show some positional apnoea, which is likely happening from chin-tucking. A flatter pillow and if needed a soft cervical collar will help immensely with that.

Regarding the pressure, try the following:

Mode APAP
Min pressure 10
Max pressure 16
EPR 3 full-time
No ramp

It will take some time to hone in on your proper range, so patience is needed. Once you get some time on those settings, the fine-tuning process can begin.

[MichaelC]

Thank you for the replies. I will change the settings and see how things go

[HalfAsleep]

If you're sleeping on your face, you need to be careful! Full face masks have an out-valve. You cannot block this without being at risk of suffocation. Locate yours, and be sure it's not buried in pillows.

FWIW the F40 has an out-valve right up against the mask. This is not a model you'd want to be wearing if your face is buried in pillows.

[MichaelC]

Much better AHI score last night but I still only managed less than 5 hours due to a mask leak waking me up.

I phoned my provider today again about the mask leaking and they said that Myair was only showing a small leak rate and made me feel as though I was lying.
I explained that the leaks are small and tend to be around the nose which is causing air to blow in my eyes. Apparently someone will call me back.

[MichaelC]

If you're sleeping on your face, you need to be careful! Full face masks have an out-valve. You cannot block this without being at risk of suffocation. Locate yours, and be sure it's not buried in pillows.

FWIW the F40 has an out-valve right up against the mask. This is not a model you'd want to be wearing if your face is buried in pillows.

Thanks for the warning!

[PeaceLoveAndPizza]

Try a few nights with your min pressure set to 12 and max pressure at 16. That should help with the pressure swings. 

The mask leaks are frustrating, but it does take time to find the proper setup with it just resting against the face, so that when pressure is applied the silicone inflates and seals against your face. If you have a beard or mustache that affects how well it seals. For some of us with bushy beards full-face masks can prove dodgy at best.

Do you feel congested at all? The flow limitations are more than we like to see, but as you are already at max EPR there is nothing further we can do with the machine settings other than increasing or decreasing pressure. Consider trying a flatter pillow and a soft cervical collar to help keep the airway open, maybe some OTC nasal spray like Flonase will help as well.