New User - thank you for your help!

[SleepViking]

First, I'd like to thank you all for this amazing community. I spent few days reading and catching up without realizing the depth of expertise needed to navigate this - and so much is on the board already!

I'm relatively new to the journey being in it for about 2 months. The first month I was getting adjusted to sleeping with something on my face. I'm now at a point where I think I can start 

Some background:
1) Diagnosed with severe sleep apnea. AHI>40.
2) I am a mouth breather. I need a humidifier refilled every night or I wake up with a VERY dry mouth. 
3) Running AirSense 11 with F&P Evora Full Face Mask
4) At this point, no issues sleeping with the full mask and open to trying nose pillows, etc. (given point #2)

Some issues:
1) Occasionally, I wake up because the pression in the mask feels extremely high.
2) Every so often, I will have droplets of water in my mask that will wake me up. 
3) I don't know if it's an issue but I've been extra sleepy once I got my mask under control. Feels like my body is trying to catch up on all the missed sleep over the years. It could be my imagination. 

Results:
1) I definitely feel A LOT better. No more mid-day fatigue, can focus, etc. 
2) My reported AHI has been as low as 0.4 and usually stays sub 5. 

Questions:
1) My pressure seems to oscillate wildly along with leak rates. Is that function of the mask?
2) If I use full mask, is mouth breathing an issue I need to start addressing? 
3) Any recommendations on improving my numbers?

***Ignore some of the breaks. We have a newborn and I have to take the mask off when she wakes up at night. 

thank you, all!

[G. Szabo]

I would suggest setting your minimum pressure to 7 cm. It can help to avoid the frequent pressure adjustments.
Also, try to sleep on your side. This can reduce obstructions.
Irrespective of the full face mask, you might want to tape your mouth if you can tolerate it. This can reduce obstructions and decrease your pressure.
Overly moisturized air was not a problem for me, not even with some condensation. The too-dry air was more problematic.

[PeaceLoveAndPizza]

(Note: Saw that G.Szabo commented whilst I was writing this. I agree with what he said, I am just filling in some of the details.)

Some comments…

It sounds like you need humidity, but the level 5 is too much. Managing humidity is a balance between room humidity and temperature, and the humidity and temperature settings of the CPAP. Typically setting climate control and temp on auto works well for most, but if you want to go manual try setting the hose temp 81 degrees F (27 C) and humidity to 4. As you increase humidity you may need to increase hose temp, all depending on the room humidity and temp.

The mask is the biggest challenge. Your leaks are likely from the mask jostling against your pillow as you move around during sleep. We all tend to over-tighten masks, not matter what type we use. There are some good videos on YouTube from LankyLefty27 on properly fitting masks, well worth the time to view. When I use a full-face mask I get it in the proper position resting gently on my skin, then when pressure is applied it inflates the silicon sealing against my face. I do use a CPAP pillow which has a divot for the mask, so that when I move around the mask is not pushed around. You can do the same with almost any pillow if you get your head to the edge so that your mask just hangs off it. 

You could try a soft cervical collar as well with the FFM as it helps keep your airway open. Not essential, but an inexpensive way of testing it.

For pressure you are too low. Try the following:

Mode APAP
Min pressure 9
Max pressure 14
EPR 3 full-time
No ramp (preferred, but if you need it leave it as is)
SmartStart off (with a newborn if remembering to hit the button to turn off the pressure is difficult given your lack of sleep, just leave it on)

So what is the result of all that? By managing the humidity and temp you should not have any water droplet issues. By increasing your minimum pressure and reducing the maximum, your swings will be constrained. Using a flatter or CPAP pillow (and possibly a SCC) should help with keeping the airway open and reduce the pressure swing tollercoaster (“toller” as in it takes a toll on your sleep quality). 

BTW, sleep debt is a real thing. Especially difficult with a wee bairn. 

For your questions…

1. The pressure oscillates due to flow limitations as it tries to stop hypopnoea and obstructive events. It also has to increase pressure from the CPAP to make up for the leaks.
2. With a FFM mouth breathing is not an issue. Unless your lower lip drops below the mask bottom (I have the habit of doing this so use a SCC).
3. See all the above

Lots there to digest. Let us know how things go with whatever changes you decide to try out. We are here to help.

[Phaleronic]

Welcome to the forum SleepViking

Good advice in the posts from Szabo and PeaceLove-please follow them, but also rainout can be controlled by moving the machine lower than your sleeping position, mine is on the bottom shelf of an open nightstand, and by adding a hose cover (search on amazon).

[staceyburke]

Welcome!  The Resmed machine raises pressure because of flow limits.  flow limits are apnea also but not long enough to classify them as H or O events.  They have to last a min of 10 seconds to be classified so if they only last 9 seconds or less they are flow limits.  Look at your flow limit chart, it is quite high and needs to be addressed.

We use EPR to reduce flow limits.  And to use EPR your min must be high enough to all EPR to work (Exhale Pressure Relief).  The absolute lowest any cpap can go is 4 and that is what you have it set to and it has to be raised.

I would suggest min 8

That would give you an inhale of 8 
and an exhale pressure of 5 (8-3=5)

[SleepViking]

Thank you for such detailed information. I'm going to try to address these individually so I can baseline and adjust as needed starting with pressure and working my way to humidity. I will keep the group posted and again, huge thank you! 

This is such an incredible board and wealth of information is fantastic!

I laid out some overall goals: 1) Optimize numbers as much as I can with face mask 2) Figure out best humidity settings and 3) start trying different types of masks (pillows, etc.)

I started by doing this:
Mode APAP
Min pressure 9 8 (I started with 9 but it was too much and I struggled to fall asleep. I dialed this down to 8 for now)
Max pressure 14
EPR 3 full-time
No ramp (preferred, but if you need it leave it as is)
SmartStart of





2 days into what I expect to be a long and, more or less, continuous journey. I won't post graphs just yet because the little one caused few breaks in the sleep so I don't have a good representation. Overall, no changes in my routine which I take is positive. 
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