First time therapy, settings and progress

[Schernenk]

I had good mouth taping going on last night, leaks have some spikes but never get above a rate of 13, and must be caused from the mask, I can turn the minimum pressure down again.  Flow rate continues to look spiky and I feel quite tired this morning, lot's of CA events registered last night too which I know isn't always accurate.  I am getting good full nights of having the mask on, but last night did feel somewhat restless.  I will likely turn the baseline back down to 8, continue to mouth tape and see how the next few nights go.

[UnicornRider]

You should be able to begin eliminating the Ramp and Smart Start features by incrementally increasing the Ramp pressure to match your minimum pressure, then turn them off. They provide no therapeutic action during the time Smart Start and Ramp are active.

The CA Events from 0045 to 0100 appear to be clustered and may be indicative of positional apnea. At 0445 there is an Hypopnea next to a CA event, there again possibly positional &/or REM related?

The Flow Rate graph looked pretty smooth at ~9 cmH2O until the dream stages kicked in. Rather than reduce pressure minimum, let it ride for a few days and see if the clustered events can be corrected.

[Schernenk]

I wasn't going to post for a few days while I rode the new settings out but last night I had a troubling experience.  Right around 1:45 am (give or take) I woke up from what felt like a decent sleep.  I was taped and my nose pillows were on, but it felt like I was trying to breathe through a straw.  It was a bit panicky, with the mouth tape on too, but I calmed myself and laid there for a bit to gather myself, the machine was at 9 for pressure. I figured I would go back to sleep but just couldn't shake the feeling like something was off, I was really having a hard time drawing an easy breath, I had a bit of a headache and could feel a bit of tightness in my chest. 

I thought maybe it was normal, but after laying there trying to pull air with so much effort I realized there was no way.   I started fiddling with my nose pillows, feeling around in the dark, and didn't readily notice anything that seemed super off so I pulled them away from my nose for a second and could feel air coming from them, blowing on my face.  The machine was running and there was air so I'm thinking ok what the heck. But as soon as I put them back on it was instantly better AND the machine suddenly ramped up to 11-12 and I could breath again, like a normal flood of air on each intake of breath.  It's hard to describe but it almost felt like a "vapour lock" or a kinked hose, though the hose wasn't kinked.  

Maybe the pillows had moved but I would assume that would result in a leak, not difficulty with air flow, and around that time my chart shows very little leaking until about 1:55 where I start to fiddle.  My OSCAR charts are wild too, with lot's of reported CA events.  I wonder what I am missing, something faulty with the machine?  Side laying and compressing one side of the tube (and air flow) to the nose pillow?  Or something else.  I have felt that sort of tightness and a bit of a headache once or twice before during this process and wonder if this has happened without me realizing it before.  I was pretty much awake from 2 am on with some dosing between 3 and 4 am until I removed the mask, during that time flow was good and I felt a good volume of air filling my lungs, and I'm guessing those events in that time are from my being in and out of sleep.  I assume it's not the machine and there is something funky happening with the nose pillow but it seemed like it was my face ok at the time. I am not quite sure what to do.

[BoxcarPete]

I've had that happen before, though not so bad as you're describing here.

I'd guess that's from having the wrong pad for your nose. I don't use the dreamwear, but if it's anything like the p30i mask, there is a little cradle with holes in it that pushes against your nose. It's possible that your nostrils were misaligned to the holes causing them to be mostly covered up, but still no leak path to the outside air. That's my guess. Might be fixable by trying a different mask or if you have the fit pack for your mask, trying a different size cradle.

[Schernenk]

Thanks Boxcar, that tracks.  

It was a not very nice feeling and with the mouth tape on to boot it felt pretty panicky.  Of course at 1:45 am fumbling in the dark half asleep, it is hard to figure out what is going on.  All I know is I pulled the mask off and put it back on and it was good, so that makes sense. The likely hood of a fault with the machine is super low I imagine.  

Again, the brick and mortar place did the mask fitting and I was surprised that I am on a medium from the fit pack but she said it was the best fit so I have just gone along with that.  My own stupidity, I should have at least tried the large, even while sitting on the couch. There is only so much you can glean from a fitting in 2 minutes sitting in an office chair.  More proof that the extra cost to go there really didn't amount to much help.

That has to be it though, I bet the nose pieces were bunched up and not allowing flow but still sealed....I wonder how many times that has happened to me, could relate to some of my weird past OSCAR's too maybe?

Here is how those nose pillows look.

     

[Schernenk]

I just did some playing around, I may try the "medium wide" tonight and see if that works better, I imagine there will be some trial and error.  Is there a favourite nose pillow among the crew?  

She also gave me medium head gear, which i questioned at the time and she said it was fine (I have a very large head).  Upon reading the fitment instructions again though, the hose should sit at the top of the head, the medium sits quite a bit forward towards my forehead and if I pull it back to the correct position it actually tightens everything up so much that it constricts flow, that could be what happened last night too.

At any rate, onward and upward, perhaps my mask fit wasn't as good as I thought.

[BoxcarPete]

I'm actually glad to hear that you're having mask fit issues. Every problem you can identify is a problem you can eliminate. Keep climbing that learning curve!

[UnicornRider]

Unfortunately DME representatives are not always knowledgeable in all aspects of PAP therapy and fitment.  
On the fortunate side, Amazon does sell DreamWear components at a reasonable price.
I encourage people to get the "Fit Pack" with different size mask/pillows, when being given the opportunity to try mask. Even though you may measure a given size in actuality a size up or down may fit & function better. Then again weight change can make a difference in mask/pillow size requirement.

I encourage people to utilize the "Notes" tab of the Daily view in OSCAR to record events that later may be of significance, this may be an event that down the road you may benefit from having recorded.

[Schernenk]

In the last few days I think I have come to the realization that I likely chronic sinusitis.  I have a meeting with my doctor today but I do take a nasal steroid and realized it I don't think it is working for me.  I didn't realize how bad it was (likely have had it for years) until I compared my nose breathing with some other folks in my life and then bought some Dristan spray as a little test, seems my normal was still pretty bad.  Hardly scientific but long story short I think this could be part or all of my trouble getting results from a nose pillow, the feeling like I couldn't draw enough air etc etc.  

Regardless I started on a full face last night and it feels like I am starting all over again but I hope I can start to see some progress eventually with the full face. Maybe one day I can get the sinus issue addressed and go back to nose pillows but for the time being here I am.  It's the full face "version" of my nose pillow and I will continue to experiment with it, I have another style coming in a few days too, all ordered online for less then half of the cost of the brick and mortar place.  Anyway, here is my OSCAR from last night, fairly bad leak rate with a 30 minute chunk where it must have been pushed to the side and a massive cluster of CA events around 3:15 am, could be positional but I believe I was pretty much on my side most of the night.  I will try and tighten up the mask a bit tonight and if that doesn't work try a different size from the fit pak.  If I continue to have issues the other mask is on the way, it is the one I test fit at the brick and mortar and felt like a good fit, it was $369 Canadian there, I got online for $150 but have to wait a few more days for it to arrive.

[BoxcarPete]

Tighter is not always better. The mask has a silicone flange around your face, this should be floating on a cushion of pressurized air from the machine if that visualization makes sense. The straps are to prevent the mask from flying off your face instead of floating on the cushion.