Help for a new "very tired' CPAP user: questions about nasal masks (resmed)

[italyhound]

Hi All -

Coming up on first few weeks of use now and I have hit some snags in my adjustment. Hopefully someone can give me some tips - I am exhausted!  Please excuse any grammar or spelling goofs!  

Some basics:  I am using the airsense 10 on auto starting on 5 cm and looking at oscar it averages about 5.8 or so through the night - I dont snore anymore according to my wife and the data oscar look good but I am so so so tired.  I have no facial hair and my hair isnt long.  The headgear is a fine fit.  Its the masks that are problematic.

Initially, I was sent a full face mask hose over chest but that wasn't comfortable and I am not a mouth breather so I quickly swapped it out for a resmed over the top hose nasal mask.

My experience was first with the nasal cushion N30i.  That was a bit cumbersome over the nose but was 'ok'.  Even though when you remove the cushion you hear a real WHOOSH of air, i felt like I could use more air flow to make me feel more comfortable (like the sense of air coming in easily vs my actively working and drawing it in if that makes sense).

I was then given a Dreamwear over the top headgear with nasal pillow.  That made too much of a noise at the vent hole for me.  I ditched it.

So I ordered a p30i nasal pillow for the resmed headgear.  That sense of stronger airflow was instantly more comfortable for me (although can be better imho).  The problem I am having is that I swap positions from back to left side to right side.  While a looser strap setting is fine for back sleep, when I turn to my side it easily dislodges and I can hear the leaking.  So I need to tighten the straps to allow for side turning.  That however is causing discomfort for my nose and it's waking me up.  (The other thing that wakes me up is when the top of the vent hole hits the headboard it generates that hissing noise which wakes me too.).  The dislodging of the pillow when loose wakes me up too.

So I have been waking up repeatedly during the night.  I thought about going back to the N30 cushion but that airflow is reduced so it's not comfortable.

So..... questions:

1.  I am a bit confused why there is so much airflow when the nasal piece is dislodged but that doesnt translate to a feeling of better airflow into my nose.  Would jacking up the base pressure help this feel better for me?

2.  Is there a way I can reconcile the issue with my p30i so that it doesnt press and hurt my nose but still stays put on my side?  It's 10a and I am at work and its still a bit sore under the base of my nose.

3.  I can't see a fix but any way to modify the top vent hole so it doesnt squeal when against a headboard?

Any and ALL help is warmly welcome and appreciated!

[Sleeprider]

First, you sound like a candidate for the Resmed Airfit P10 nasal pillows mask. The mask flows a lot of air directly to the nostrils and is absolutely silent from the exhaust vent. It is an inexpensive mask that is perhaps the most minimal weight and size of any on the market. It typically comes with 3 nasal cushion S, M and L, and most users find they end up using a size larger than they thought they would need. This will resolve your discomfort with the bridge of your nose, and eliminate the vent noise.

The whoosh you hear when removing any mask is the large leak. The flow generator tries to maintain pressure, and when the circuit is open it flows a lot of air. If you're using EasyStart, it will quickly turn off when it detects the mask is removed.

Your pressure is set to a wide range, and you will be more comfortable when that is optimized to provide the pressure you need and not fluctuate through the night. Those pressure changes are disruptive to most people. In addition, your machine provides a bilevel pressure for inhale and exhale that can be very comfortable, but is not as effective below 7-cm minimum pressure. If you post a typical detail chart from OSCAR, we can certainly help you find a comfortable and effective pressure range and comfort settings.

[italyhound]

Thank you.  The vent noise was an issue on the dreamwear nasal pillow but is fine with the resmed nasal pillow and cushion.  I can look into the p10 although the over the head hose is really nice for me.  I can see the over the chest hose torturing me as I swap positions overnight?

I can definitely post some data when I get home from work this evening.

[snorybob]

Check on amazon for the'' CPAP hose buddy ''. That could solve your problem. It did for a lot of people! 


                      sb.

[mesenteria]

Have you considered ear plugs?  My wife and I both use them, and they help a lot.  We use the soft gel silicone ones available at pharmacies.  They come four to a clear plastic box.  My ear canals are smallish, so I can pinch one in half and use a half in each ear quite effectively.  They are reusable for a period, often a couple of weeks.

There's never going to be a PAP system that is entirely unobtrusive; something about each of them will ping off any one wearer.  So, sometimes it falls to other ideas, ideas other than trying to find the perfect mask/hose/vent/sleeping position which will likely lead us to diminishing returns.  In my case, it was resorting to hearing attenuation.  And, my wife commencing to use a cervical foam collar to ward off her snoring.

[italyhound]

Thanks for posting.

I had not thought about plugs for whooshing noises; that is a thought.

I suspect the p30i is not for me since I am not sure how to balance fit and comfort - maybe its just my noggin shape that is the issue.

I will post and get a better sense of a set pressure to use - maybe that will help with the airflow comfort coming off AUTO.  Maybe in that case the n30 may be best once again.  If not I will definitely try out the P10 with the hose buddy.  These are great suggestions for a very sleepy dude like me!

[Sleeprider]

Thank you.  The vent noise was an issue on the dreamwear nasal pillow but is fine with the resmed nasal pillow and cushion.  I can look into the p10 although the over the head hose is really nice for me.  I can see the over the chest hose torturing me as I swap positions overnight?

I can definitely post some data when I get home from work this evening.

I suspend the tube from the headboard using a lanyard and hook. The Hose Buddy is another alternative. I sleep side to side and on my back so over 10 years the tube has not rested on my chest and not been in the way. It’s not perfect, but keep working with it.

[italyhound]

Here are the last two data sets from full nights sleep and the overall statistics from Oscar.  Some were really interrupted so I left them out but from my viewpoint the statistics tend to be pretty even.  Hopefully I uploaded these so they are viewable.

I tested with an AHI of 18.2

If you see something that may make my experience more comfortable - let me know.  Maybe bump up the minimum pressure to 6?



   

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[Sleeprider]

What if you set the minimum pressure to 7.0 and left everything else the same. I bet you would have almost no pressure swings, and EPR would be consistent throughout the night. As far as maximum pressure, you're not going to hit 10, so whatever you want to set...speakng of which, what happened at 05:00?

[italyhound]

...speakng of which, what happened at 05:00?

From 4-5a I took the mask off but can’t recall specifics now.  Whether I did it semiconsciously or knowingly for comfort and put it back on would be the two possibilities.   Why pressure was so high at 5a no idea.   Maybe I fell back asleep stat and it ramped up hard!