Chart & Mask Questions

[mcsheltie]

At some point I'll stop posting so much (I hope!) There is just so much to learn. And a lot of it makes no sense to me!

Why are there two lines on the Leak Rate chart?

From 1:40:05 to 1:40:15 it looks to me like I wasn't breathing. Why isn't this time period flagged? What is a pressure pulse? There were five of them last night.




Why is this flagged as an RERA? It doesn't look any different to me than what occurred before and after.



This is the results from last night.



I turned CFlex and AFlex off. Neither seems to sync with my breathing. Both of the OAs woke me up.

Mask leaks are driving me crazy. I've given this mask five days. I wake up constantly and move around all night. Now I have to add mask-fixing to all of that. I have learned a quick way to do it, but every time I rollover I have to make a conscious effort to stop a leak. And that makes it that much harder to get back to sleep.

The night before I took a sleeping pill, I was just so sick of waking up all the time I needed one night of relief. Because I wasn't fixing it every time I moved, the leak rate was really high. The mask is comfortable and it doesn't leak at all if I could sleep on my back all night. But that would cripple me. As soon as I turn on my side it leaks under my nose, out the side or sometimes in my eye.

Any advice on what to try next? Whatever it is, it needs to stay put as I roll around all night.

[Lourens1190]

Hi mcsheltie!

Instead of answering your questions, I'll add one.
I see your 95% pressure was 10 for the night and your max pressure is set to 10.
Even though you have excellent stats, you should perhaps experiment with changing max to 11 or 12 and see how that works out for you. How often do you have your 95% and max the same?

[Crimson Nape]

In order for an event to flagged, it has to last 10 seconds or longer. In your case it appears that you were on the time limit threshold. I believe that the pressure pulse is a way for your CPAP to test for a Clear or Obstructed event. . .kind of like sonar. It sends a pulse of air and if it comes back, then there is an obstruction, otherwise it is a clear airway event.

[robysue]

At some point I'll stop posting so much (I hope!) There is just so much to learn. And a lot of it makes no sense to me!

Why are there two lines on the Leak Rate chart?

You are using a PR machine. The leak data that the machine records is the Total Leak Rate which includes both the intentional mask leak designed to prevent your rebreathing CO2.

In SleepyHead, the top graph in the Leak Rate chart is the graph of the Total Leak Rate data. Any official Large Leak flags are based on the Total Leak Rate data, but PR does not tell us exactly what criteria are used to determine when the leaks are high enough to be considered an official Large Leak.

The bottom graph in the SleepyHead Leak Rate chart is Sleepy Head's estimate of your Unintentional Leak Rate. The Unintentional Leak is the "bad" kind of leaking---this is any leak that is over and above the intentional mask leak for the mask you use and the pressure you use.

If you go into the SleepyHead Preferences and click the CPAP tab, there is a spot on the left side of the window that says Calculate Unintentional Leaks When Not Present. If the box in front of this is checked, SH estimates the unintentional leak rate. The box is checked by default. Underneath the line that reads Calculate Unintentional Leaks When Not Present there are two slider bars, one marked 4cm and one marked 20cm. You should compare the values where the slider on each of these bars to the Intentional Leak Rate chart that should be included in the user manual for your mask. The default values are some kind of averages for a whole bunch of nasal and nasal pillows masks as I recall. If you use a full face mask, you really need to look at those numbers and make sure they're set correctly so that SH can accurately estimate your Unintentional Leak Rate.

From 1:40:05 to 1:40:15 it looks to me like I wasn't breathing. Why isn't this time period flagged?

In eyeballing it, it looks like this event may have barely missed the 10 second rule. The scoring algorithms are good, but they're not infallible. Sometimes they miss events. Sometimes they score an event that should not be scored. In the grand scheme of things, it kind of evens out in the end.

You can, however, set up "user flags" in SH to flag things like this.

How much you should worry about them is another thing. In general if these "almost" apneas are not very many and are not tightly clustered together, they may not be worth worrying to much about.

What is a pressure pulse? There were five of them last night.

When the PR DreamStation thinks it MIGHT need to score an apnea, it sends out a so-called "pressure pulse" or PP for short. The PP is a very short, brief "puff" of additional pressure. The machine measures how the PP affects the back pressure (the pressure at the machine end of the hose) and uses that information to decide whether your airway is obviously obstructed or is probably clear (not obstructed). If the not breathing continues on long enough to be scored as an apnea, its the PP that determines whether the machine scores an OA or a CA. If the event is quite long OR if the results from the first PP are ambiguous, the machine may send out more than one PP in a particular apnea.

The machine will also use a series of PPs if it no longer detects breathing, particularly when there is a relatively large leak.

Outside of the fact that the machine uses PPs to classify the kind of apnea, there's no clinical significance to the PPs.

Why is this flagged as an RERA? It doesn't look any different to me than what occurred before and after.

This is an example where the machine has erred on the side of "flagging" something as an event might not be a real event. There are no recovery breaths in the snippet of breathing that you showed. It's possible that the recovery breaths are after 4:51:20 mark. Or it's possible this is just an outright mistake in labeling what's going on. It's also worth pointing out that the placement of the RERA flags is "fragile" in the sense that the flag is often not right at the end of the event.

It is surprising to me that the machine did NOT label some flow limitations here. These inhalations look flow limited in my opinion, and it really is a bit surprising that the machine chose to label this as RERA instead of a FL. However, the fact that it labeled this stretch of breathing as a RERA does explain why it's not labeled as a FL.

In the hierarchy of labeling:

• A FL only needs distorted inhalations. How distorted and how long the distorted inhalations have to last are not documented in the information that is readily available about the PR's algorithms
  
• A RERA requires a sequence of flow limited breaths typically followed by one or more "recovery breaths". The recovery breaths are missing here, and it's not clear why the machine scored this as a RERA.
  
• An H requires the flow rate into/out of the lungs to be reduced by 50-80% from the running baseline AND the reduced airflow must last at least 10 seconds. The running baseline is calculated over the course of the last 5-10 minutes of breathing as I recall.
  
• An OA requires the flow rate to be reduced by at least 80% from the running baseline AND the reduced airflow must last at least 10 seconds AND the PP test must show there is a high probability that the airway is obstructed during the event.
  
• A CA requires the flow rate to be reduced by at least 80% from the running baseline AND the reduced airflow must last at least 10 seconds AND the PP test must show there is a high probability that the airway is clear (unobstructed) during the event.
  

There are numerous scenarios where a given stretch of breathing can be somewhat ambiguous when we look at the flow rate data.

I turned CFlex and AFlex off. Neither seems to sync with my breathing.

They are comfort features and if they bug you, it's best to just turn them off.

Both of the OAs woke me up.

Why do you think the OAs woke you up? And how many times do you think you woke up?

There is some evidence that the hypopnea scored around 23:30 woke you up---even at this scale, you can see evidence of "recovery breaths" right after that event. Recovery breaths can indicate an awakening or an arousal. The OA scored at 23:21 looks more like it might be a sleep transition event---the breathing settles down right after that event is over as compared to the breathing before that event.

You may have awoken very briefly after the OA scored just before 5:00---there are some recovery breaths there and the breathing doesn't settle down afterwords. Were you restless for a long time between a wake around 5:00AM and 6:25 when you finally turned the machine off and back on?

If you really want to track when the wakes are so that you can try to figure out whether a particular event or event cluster is the culprit, you can try turning the machine off and back on any time you find yourself awake enough to know that you are awake in the middle of the night.

Mask leaks are driving me crazy. I've given this mask five days. I wake up constantly and move around all night. Now I have to add mask-fixing to all of that. I have learned a quick way to do it, but every time I rollover I have to make a conscious effort to stop a leak. And that makes it that much harder to get back to sleep.

It may be time to say goodbye to this mask and try another one.

What are the best features of this mask---the ones you'd like to keep in the next mask you try?

Other than nasty problems with leaks, what are the worst features of this mask?

Also, what are you doing for hose management?

Some people find hanging the hose helps with both minimizing leaks AND in increasing the ease of rolling over. If you've not tried hanging the hose, that's worth doing.

If you already ARE hanging the hose, it may be time to try something like running the hose under the covers and holding onto it at night. That way you don't have to fumble to find the hose when you turn over---it's already in your hands. And if you can better manage the hose when turning over, it's less likely to pull the mask off your face triggering a leak that must be fixed.

The night before I took a sleeping pill, I was just so sick of waking up all the time I needed one night of relief. Because I wasn't fixing it every time I moved, the leak rate was really high. The mask is comfortable and it doesn't leak at all if I could sleep on my back all night. But that would cripple me. As soon as I turn on my side it leaks under my nose, out the side or sometimes in my eye.

What was your favorite sleeping position before starting CPAP? If you were a side sleeper, which side? Right or Left? And which side are you on if you lie down in bed on your side and you are facing the CPAP?

All of that information may help us help you figure out a comfortable sleeping position for you.

Any advice on what to try next? Whatever it is, it needs to stay put as I roll around all night.

Have you tried a CPAP-pillow that has cutouts for the mask to hang into when you are sleeping on your side?

You might also want to try sleeping with your head at the very edge of the pillow so the mask can hang over the edge when you are sleeping on your side.

[robysue]

Hi mcsheltie!

Instead of answering your questions, I'll add one.
I see your 95% pressure was 10 for the night and your max pressure is set to 10.
Even though you have excellent stats, you should perhaps experiment with changing max to 11 or 12 and see how that works out for you. How often do you have your 95% and max the same?

Why increase the pressure?

The events are well controlled, but the leaks are NOT well controlled. And comfort is a significant issue for mcsheltie.

She's not having clusters of events and there's nothing a priori wrong with the 95% pressure level hitting the max pressure setting when there's no evidence that a higher max pressure is warranted.

In mcsheltie's case, it's FL that are mainly driving the pressure increases. Now, some people are sensitive to FL and their FL do respond to additional pressure by going away. But FL can be caused by things other than sleep disordered breathing, and if the FL are not actually sleep disordered breathing related, increasing the max pressure is not going to fix the FL. (I've learned that the hard way in my own data.)

Also her median pressure level is at her minimum pressure level. That means for at least 50% of the night, the machine saw no good reason to increase the pressure.

At this point mcsheltie needs to focus on fixing the leak problems so that she can actually get a decent night's sleep. Now it's true that her leaks are small enough to not adversely affect the efficacy of her therapy, but they are annoying enough to make her wake up every time she wants to turn over. Until the leaks that are keeping her from sleeping well are addressed, not much else really matters.

[mcsheltie]

Hi mcsheltie!

Instead of answering your questions, I'll add one.
I see your 95% pressure was 10 for the night and your max pressure is set to 10.
Even though you have excellent stats, you should perhaps experiment with changing max to 11 or 12 and see how that works out for you. How often do you have your 95% and max the same?

Actually last night was the first that 95% was at 10. Usually it is around 8. My script is for 7 fixed and my AHI was always around 3.50. I changed it to auto so I would get a Flow Rate chart on SH. I decided to up the max pressure a bit just for the heck of it and my AHI is now constantly around 0.5 - 0.7. So it seems the random change was for the good.

[mcsheltie]

First, thank you (and thanks to everyone else that replied!) for a great reply. I really appreciate it!

If you go into the SleepyHead Preferences and click the CPAP tab, there is a spot on the left side of the window that says Calculate Unintentional Leaks When Not Present. If the box in front of this is checked, SH estimates the unintentional leak rate. The box is checked by default. Underneath the line that reads Calculate Unintentional Leaks When Not Present there are two slider bars, one marked 4cm and one marked 20cm. You should compare the values where the slider on each of these bars to the Intentional Leak Rate chart that should be included in the user manual for your mask. The default values are some kind of averages for a whole bunch of nasal and nasal pillows masks as I recall. If you use a full face mask, you really need to look at those numbers and make sure they're set correctly so that SH can accurately estimate your Unintentional Leak Rate.

The values are set at 20.1 & 48.3. The rate for my mask at the pressure I'm using is approx 26%. Is this where they should be?

This still doesn't make sense to me. How can you calculate something that isn't present? I obviously don't understand what the term means!

Both of the OAs woke me up.

Why do you think the OAs woke you up? And how many times do you think you woke up?

Because I remember waking up and looking at the clock at exactly those times last night. Last night I woke up at least six times, possibly more. My usual sleeping pattern is about 90 minutes and then something wakes my up almost every hour.

There is some evidence that the hypopnea scored around 23:30 woke you up---even at this scale, you can see evidence of "recovery breaths" right after that event. Recovery breaths can indicate an awakening or an arousal. The OA scored at 23:21 looks more like it might be a sleep transition event---the breathing settles down right after that event is over as compared to the breathing before that event.

I feel asleep watching TV. I woke up at 23:30-ish turned the TV off and went back to sleep.

You may have awoken very briefly after the OA scored just before 5:00---there are some recovery breaths there and the breathing doesn't settle down afterwords. Were you restless for a long time between a wake around 5:00AM and 6:25 when you finally turned the machine off and back on?

Yes, I finally got up and went to the bathroom.

If you really want to track when the wakes are so that you can try to figure out whether a particular event or event cluster is the culprit, you can try turning the machine off and back on any time you find yourself awake enough to know that you are awake in the middle of the night.

I will do that tonight. Sometimes it is hot flashes and restless leg (though that is getting better) waking me up too. To go back to sleep I turn on a boring YouTube vid (just the sound) to keep from thinking. So I can gauge how many times I was really awake by how many times I turned the vid back on. If I don't have something to occupy my mind I won't go back to sleep.

Mask leaks are driving me crazy. I've given this mask five days. I wake up constantly and move around all night. Now I have to add mask-fixing to all of that. I have learned a quick way to do it, but every time I rollover I have to make a conscious effort to stop a leak. And that makes it that much harder to get back to sleep.

It may be time to say goodbye to this mask and try another one.

What are the best features of this mask---the ones you'd like to keep in the next mask you try?

I like the open concept, minimal headgear and face contact. My face is completely open. I also like the that the hose comes off the top of my head so it is never in the way. I never notice it at all.

Other than nasty problems with leaks, what are the worst features of this mask?

The air comes through tubes coming down the side. So when I side sleep it unseats the nasal thingy.

Also, what are you doing for hose management?

I don't need any. The hose coming off the top keeps it out of the way of everything. It is a total non-issue. That is the best part of the mask!

What was your favorite sleeping position before starting CPAP? If you were a side sleeper, which side? Right or Left? And which side are you on if you lie down in bed on your side and you are facing the CPAP?

Right side and stomach (I HAVE to stretch my back and legs during the night) are my favorite positions. To face the machine I would lay on my left side.

All of that information may help us help you figure out a comfortable sleeping position for you.

Any advice on what to try next? Whatever it is, it needs to stay put as I roll around all night.

Have you tried a CPAP-pillow that has cutouts for the mask to hang into when you are sleeping on your side? You might also want to try sleeping with your head at the very edge of the pillow so the mask can hang over the edge when you are sleeping on your side.
[/quote]

I have tried a CPAP pillow. The tubes the air goes through are right by my ears so I can't get them off any kind of pillow. My pillow doesn't touch the nasal thingy itself.

[robysue]

Mcheltie,

My answers are in blue

If you go into the SleepyHead Preferences and click the CPAP tab, there is a spot on the left side of the window that says Calculate Unintentional Leaks When Not Present. If the box in front of this is checked, SH estimates the unintentional leak rate. The box is checked by default. Underneath the line that reads Calculate Unintentional Leaks When Not Present there are two slider bars, one marked 4cm and one marked 20cm. You should compare the values where the slider on each of these bars to the Intentional Leak Rate chart that should be included in the user manual for your mask. The default values are some kind of averages for a whole bunch of nasal and nasal pillows masks as I recall. If you use a full face mask, you really need to look at those numbers and make sure they're set correctly so that SH can accurately estimate your Unintentional Leak Rate.

The values are set at 20.1 & 48.3. The rate for my mask at the pressure I'm using is approx 26%. Is this where they should be?

I don't know what you mean when you say the rate should be approximately 26%. Do you mean 26 L/min?

What does the owners manual for your mask say the intentional leak should be at 4cm of pressure? What is the intentional leak at 20cm of pressure

This still doesn't make sense to me. How can you calculate something that isn't present? I obviously don't understand what the term means!
This is GEEK speak. Some machines calculate the unintentional leak rate. Some machines (including yours) calculate the total leak rate. If the machine does NOT calculate the unintentional leak rate then the unintentional leak rate data is missing.

The unintentional leak rate is the difference between the total leak rate and the intentional leak rate. Your machine does not record the unintentional leak rate, but SleepyHead can calculate the unintentional leak rate for you.

Both of the OAs woke me up.

Why do you think the OAs woke you up? And how many times do you think you woke up?

Because I remember waking up and looking at the clock at exactly those times last night. Last night I woke up at least six times, possibly more. My usual sleeping pattern is about 90 minutes and then something wakes my up almost every hour.
So you usually get a full sleep cycle in between the wakes. Post-REM wakes are pretty normal, but most people don't remember them in the morning because a person with normal sleep typically wakes up for no more than a minute or two, determines there's nothing wrong and goes right back to sleep. And because the post-REM wake is less than 5 minutes long, the person doesn't even remember it in the morning.

If you can keep consistently get about 90 minutes of sleep between the wakes and get back to sleep quickly after them, then the best thing may be to not worry too much about them.

There is some evidence that the hypopnea scored around 23:30 woke you up---even at this scale, you can see evidence of "recovery breaths" right after that event. Recovery breaths can indicate an awakening or an arousal. The OA scored at 23:21 looks more like it might be a sleep transition event---the breathing settles down right after that event is over as compared to the breathing before that event.

I feel asleep watching TV. I woke up at 23:30-ish turned the TV off and went back to sleep.
Are you sleeping in a recliner? Or is there a tv in the bedroom with a remote control?

If the frequent wakes continue to be a problem, you may want to move the tv out of the bedroom if you've got it in there.

You may have awoken very briefly after the OA scored just before 5:00---there are some recovery breaths there and the breathing doesn't settle down afterwords. Were you restless for a long time between a wake around 5:00AM and 6:25 when you finally turned the machine off and back on?

Yes, I finally got up and went to the bathroom.
What did you do between the wake at 5:00AM and when you finally got out of bed around 6:25? Were you tossing and turning the whole time fighting with the mask? Or did you get some sleep?

If you really want to track when the wakes are so that you can try to figure out whether a particular event or event cluster is the culprit, you can try turning the machine off and back on any time you find yourself awake enough to know that you are awake in the middle of the night.

I will do that tonight. Sometimes it is hot flashes and restless leg (though that is getting better) waking me up too. To go back to sleep I turn on a boring YouTube vid (just the sound) to keep from thinking. So I can gauge how many times I was really awake by how many times I turned the vid back on. If I don't have something to occupy my mind I won't go back to sleep.

I understand the need for something to distract your mind so that you can get back to sleep, but using the number of times you have to turn the vid back on to gauge how many times you were really awake is a very bad idea. You are reinforcing worrying about being awake when you are trying to get to sleep.

You might be better off putting on a playlist of boring music that you have no incentive to "count" the number of times you restart to "gauge" the number of wakes.

Seriously, one of the worst things you can do for the "I can't get back to sleep" problem is to work on ways to remember each and every wake. Your job when you are in bed is to NOT focus on "counting" the times you woke up during the night. Your job is to try to get back to sleep with a minimum amount of worry.

If you have to know exactly how many times you woke up and when you woke up, turn the CPAP off and back on. And then forget about trying to count that stuff in the middle of the night. When you look at the data in SleepyHead, you'll be able to figure out how many wakes and when they happen.

In general looking at the clock as soon as you wake up in the middle of the night is also a way to encourage your mind to stay awake and worry rather than encouraging it to relax and fall back asleep.

Mask leaks are driving me crazy. I've given this mask five days. I wake up constantly and move around all night. Now I have to add mask-fixing to all of that. I have learned a quick way to do it, but every time I rollover I have to make a conscious effort to stop a leak. And that makes it that much harder to get back to sleep.

It may be time to say goodbye to this mask and try another one.

What are the best features of this mask---the ones you'd like to keep in the next mask you try?

I like the open concept, minimal headgear and face contact. My face is completely open. I also like the that the hose comes off the top of my head so it is never in the way. I never notice it at all.
Ok---you like the open face. You like the hose rooted over your head, but at the same time, the way the mask is connected to the hose is what's triggering your problems with the leaks when you try to sleep on your side or when you try to turn over.

You might want to try a Resmed P10 nasal pillows mask. The headgear is as minimal as it gets and there's nothing covering your face except the pillows touching your nostrils.

But the hose is routed downwards. However you can run the hose under the covers and hug it like it was a bizarre stuffed toy. (It's easier to do if you put the hose in a hose fuzzy hose cover.) That way your face is still completely open and if you fall asleep with your hand on the hose, your hand can control the movement of the hose as you move around in bed.

Other than nasty problems with leaks, what are the worst features of this mask?

The air comes through tubes coming down the side. So when I side sleep it unseats the nasal thingy.

So while you like the fact that the hose is attached at the top of your head, you don't like the air tubes that come down the sides.

I think that may be a deal killer for you since you want to sleep on your sides and you can't seem to make this mask work. I'd suggest looking at other very minimal masks that are basically open. The Resmed P10 may be worth taking a look. If nasal pillows aren't your think you might want to look at the Nano or other micro nasal masks.

Also, what are you doing for hose management?

I don't need any. The hose coming off the top keeps it out of the way of everything. It is a total non-issue. That is the best part of the mask!

What was your favorite sleeping position before starting CPAP? If you were a side sleeper, which side? Right or Left? And which side are you on if you lie down in bed on your side and you are facing the CPAP?

Right side and stomach (I HAVE to stretch my back and legs during the night) are my favorite positions. To face the machine I would lay on my left side.

If you go with an alternate mask, you may want to switch sides of the bed so that you are facing the CPAP when you are on your side and the hose then does not have to cross your body to get to your nose. Or you may need to figure out a way to hang the hose if you try a different mask.

I do think you need to figure out a way to sleep in your favorite position while using the machine. If you can't do that with this mask, you're going to have to find a different mask.

Is it possible to sleep on your stomach with your current mask? Or does that also trigger the leaks?

My husband sleeps on his stomach with a nasal mask all the time. He also frequently turns over to his left side to curl around me. And then he'll move back onto his back. He has no trouble getting caught in the hose because he hangs it over the head of our bed.

I typically sleep on my left (facing my BiPAP) with the hose under the covers and because I hug the hose, it moves with me when I turn over. I also can sleep on my stomach if I put my head near the edge of my pillow.

Finally, have you ever told your doctor about the fact that you find yourself needing to stretch your legs a lot at night? It could be that restless leg syndrome is adding to your sleep woes. There are ways that RLS can be treated.

All of that information may help us help you figure out a comfortable sleeping position for you.

Any advice on what to try next? Whatever it is, it needs to stay put as I roll around all night.

Have you tried a CPAP-pillow that has cutouts for the mask to hang into when you are sleeping on your side? You might also want to try sleeping with your head at the very edge of the pillow so the mask can hang over the edge when you are sleeping on your side.


I have tried a CPAP pillow. The tubes the air goes through are right by my ears so I can't get them off any kind of pillow. My pillow doesn't touch the nasal thingy itself.
So the problem isn't where the mask meets your nose. The problem is that the air tube below the "down" ear gets squashed and pulls the mask off just enough to bug you? Or is the problem that lying on the tube is uncomfortable? Or is it a combination of both things?

[mcsheltie]

Mcheltie,

My answers are in blue

I'll reply in green (let's see how confusing we can get...LOL) I'll delete some of the previous answers, so hopefully that will help!


I don't know what you mean when you say the rate should be approximately 26%. Do you mean 26 L/min?

What does the owners manual for your mask say the intentional leak should be at 4cm of pressure? What is the intentional leak at 20cm of pressure

Yes, I meant L/min

It's a little hard to tell what 4cm value is. The graph they give you is small and fuzzy. I Googled it and didn't come up with anything. 5 cm is 17.7 though. 20 cm is 40.2 So I assume I should change the values to those numbers?


So you usually get a full sleep cycle in between the wakes. Post-REM wakes are pretty normal, but most people don't remember them in the morning because a person with normal sleep typically wakes up for no more than a minute or two, determines there's nothing wrong and goes right back to sleep. And because the post-REM wake is less than 5 minutes long, the person doesn't even remember it in the morning.

If you can keep consistently get about 90 minutes of sleep between the wakes and get back to sleep quickly after them, then the best thing may be to not worry too much about them.

I am sleeping for what should be a full sleep cycle when I first go to sleep. After that it is about an hour. But according to both nights during the sleep study I never ONCE got past the first stage. I didn't have any problems sleeping during the study. I stuck to the same pattern I have every night. I don't technically have insomnia as I thought. Apnea, hot flashes and/or discomfort wakes me up. The way they explained my issue is most people wake up briefly or shallowly (for lack of a better word) at those times. I completely wake up. If I don't start to think about something I can go back to sleep, even if I get up for a few minutes. They had me repeat the first night (without CPAP) because the doc couldn't believe the first night's results. First, no one expected me to have Apnea. Secondly, with as much as I slept they were shocked I never progressed through any of the sleep stages. I had to come back a third time to use the CPAP.

Are you sleeping in a recliner? Or is there a tv in the bedroom with a remote control?

If the frequent wakes continue to be a problem, you may want to move the tv out of the bedroom if you've got it in there.

Contrary to all the sleep hygiene studies, watching TV in the bedroom before I go to sleep works for me. In 50 years I have tried EVERY protocol imaginable. I don't have the TV on during the night and I never turn it on when I wake up. I put on wrap around anti-blue light glasses and about 20 minutes later when I get sleepy I turn it off and go to sleep.

What did you do between the wake at 5:00AM and when you finally got out of bed around 6:25? Were you tossing and turning the whole time fighting with the mask? Or did you get some sleep?

Tossing and turning. I need to get on my stomach periodically to stretch my legs and back a particular way and the mask kept leaking. When I couldn't make that happen, I got up.


I understand the need for something to distract your mind so that you can get back to sleep, but using the number of times you have to turn the vid back on to gauge how many times you were really awake is a very bad idea. You are reinforcing worrying about being awake when you are trying to get to sleep.

You might be better off putting on a playlist of boring music that you have no incentive to "count" the number of times you restart to "gauge" the number of wakes.

Seriously, one of the worst things you can do for the "I can't get back to sleep" problem is to work on ways to remember each and every wake. Your job when you are in bed is to NOT focus on "counting" the times you woke up during the night. Your job is to try to get back to sleep with a minimum amount of worry.

If you have to know exactly how many times you woke up and when you woke up, turn the CPAP off and back on. And then forget about trying to count that stuff in the middle of the night. When you look at the data in SleepyHead, you'll be able to figure out how many wakes and when they happen.

In general looking at the clock as soon as you wake up in the middle of the night is also a way to encourage your mind to stay awake and worry rather than encouraging it to relax and fall back asleep.

Music and white noise keeps me from falling asleep (not enough to focus on) and music during the night wakes me up. Listening to the news used to work well, but now the night time news shows have a lot of panel discussions where the people end up yelling at each other. Not conducive to sleep.

Music and white noise also doesn't give my mind anything to focus on, so it goes into action. Planning or worrying. Listening to YouTube I fall back to sleep in five minutes. I pick out 15-20 minute vids before I go to bed. They turn off shortly after I go back to sleep, so there is no noise to wake me up later. If I can't go back to sleep I'm not bored, so I don't have a fit that I'm not sleeping.

I play YouTube on my phone with the screen off. It's not on the TV.

I don't have a clock in my bedroom. I don't count the number of times I turn on the vid during the night. The phone does that for me. I check that in the morning after I get up if I am trying to figure out if my sleep pattern has changed.



You might want to try a Resmed P10 nasal pillows mask. The headgear is as minimal as it gets and there's nothing covering your face except the pillows touching your nostrils.

I was also looking at the ResMed Swift LT for Her. There is a way to route it over your head if I couldn't get the hang of the hose straight off my face. Tho I doubt that would be a problem. The headgear doesn't look comfortable though.

I also wonder if the nasal masks that fit over the nose would give me the same issues as the DreamWear during my nightly marathon.


Is it possible to sleep on your stomach with your current mask? Or does that also trigger the leaks?

It triggers leaks. Any pressure changes (on the mask or on my face) can unseat the nasal thingy. It is very soft pliable silicone. That is why it so comfortable and self seals when you're on your back. Unfortunately if I sleep on my back I am crippled the next day. Years of training horses professionally... I have had more than my share of getting beat up! If I could afford an adjustable bed it might work really well. But I think a mask change would be more economical.



Finally, have you ever told your doctor about the fact that you find yourself needing to stretch your legs a lot at night? It could be that restless leg syndrome is adding to your sleep woes. There are ways that RLS can be treated.

I never had RLS until recently. My PCP put me on two different Benzos for 12 years for my "insomnia". He never did another thing to find out why I wasn't sleeping. I developed pretty nasty depression, brain fog (I left the car in drive one day and got out!!!) and SCARY memory loss. I did some research and found out Benzos cause all of those things (as can Apnea...so I got a double whammy) and you are only supposed to take Benzos for two weeks. So I slowly titrated off of them. RLS is one of the common withdrawal effects. So I assume that eventually it will go away. I looked at the drugs they prescribe for RLS, the side effects are not worth the risk and could negatively effect my Benzo withdrawal.


So the problem isn't where the mask meets your nose. The problem is that the air tube below the "down" ear gets squashed and pulls the mask off just enough to bug you? Or is the problem that lying on the tube is uncomfortable? Or is it a combination of both things?

The mask is super comfortable. And seals right away. I don't feel it at all. But when I sleep on my side the pressure on the side pieces causes the nasal thingy (it really isn't a pillow, so I don't know what to call it) to move or change shape (it is very soft silicone) and the seal breaks. When I sleep on my stomach the position change creates a different pressure on my face. So even if nothing is touching any part of the mask, the seal can break. I do think a lot of people could sleep through this. It wakes me up. This mask is a back sleeper's dream. I am a really small person, so perhaps someone normal sized might not have any of these issues.

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[mcsheltie]

Looking at the P10. I don't see any way to adjust the headband other than spreading the straps. Does that work? I have short slippery hair! Do the pillows stay in position without much help from the headgear?