How can I tell if my mouth is open with a nasal mask while I sleep?

[evenflow]

When I started CPAP in August I got both a F30 mask and N20 mask. The velcro has (frustratingly) been failing on the F30 so I decided to try the N20 despite immediately writing it off after trying it one of my first few nights. 
 
The F30 and the N20 effectively immediately plug my nose.  I've done some things to make it so that it doesn’t happen so the N20 is usable, and I'd say I even prefer the N20. Here's my setup. If I am doing anything wrong, please let me know.  
 

• Flonase before bed. My ears can basically always be popped with the Valsalva manuever (nose+mouth shut, blow), I probably have some sinus problem. Flonase might be a placebo but it helps. I might try it without flonase. 
  
• Tube temp is 70 F 
  
• EPR set to 3. It was at 2 before with F30. 
  
• Humidity is turned off, but I fill the humidity container. This is contrary to what I thought where high humidity and high heat will open the sinus (think a steamy shower). High humidity and high heat is a recipe for rainout and a stuffy nose. If I turned off the humidity with the F30 I'm pretty sure I'd have a dry throat 
  
• No frowny face leaks 
  
• No dry throat. 
  
• Low AHI according to Resmed device (~0.3ish).  I have never seen such low AHI before.
  

 
That being said with the N20 I changed so many variables that it's hard to know what has helped, but I suspect the humidity and flonase are the biggest contributors, with EPR and tube temp I guess more for "comfort" 
 
With all of that said, a few questions: 
1) Does everything sound good with the N20 or can I still have a major leak and thus the AHI reading is false? As in, can I be tricked by the above and I am still having apnea?
2) Can I continue taking Flonase – is there any rebound congestion to be had with that? 
3) Why does my nose clog up basically immediately if I don’t take the above steps? I have no idea what contributed to helping me breathe through my nose with CPAP. For what its worth, I breathe through my nose just fine during the day....but CPAP does something to me.

[SarcasticDave94]

Welcome to Apnea Board,

The best suggestion is to use an SD card in your ResMed to save the sleep data, upload it to the always free OSCAR app. After using the CPAP with the SD in, upload the data to OSCAR then add a screenshot attachment to a reply post. There's indications that will be seen on OSCAR about leaks and such.

The standard SD card can be any brand, 2-32 GB capacity, formatted to FAT32. You don't need to write lock this SD for 10 series ResMed when inserted into your computer SD card reader. The SD slot on ResMed's is on the left side under the flap.

[evenflow]

I have historical data (non recently, but maybe from September to December-ish). I also just plugged in my card now. Is one night enough to get clear data? What would I be looking for? I haven't really used OSCAR much since I started.

[SarcasticDave94]

Non sarcastic, one night is good to start with. We can go from there in suggesting actions to asking for more or different data, etc. Leak graph is probably one thing to look for, to see the type of leaking. Data along with your description together helps a lot in getting answers.

[evenflow]

   
Please let me know if I am posting the wrong thing, but this is the top view for OSCAR from last night. I got up once, you can tell. It's one hour ahead (EST vs EDT) but that shouldnt matter.

I haven't posted OSCAR data before since I started in August, so a few questions:
1) does everything look normal?
2) does this indicate that my mouth isnt ajar, and if it is, it isnt hurting my sleep / CPAP?

I was looking at previous data with a full face and they all were like 1-3 AHI. Nasal mask has been severely lower.

[SarcasticDave94]

There's low level leaks, and some very low and constant leaking that's possibly a mask leak. This very low constant is under 3 it seems. There's a few occasions where it appears to have the arcing mouth leaks pattern. The 99.5% more or less Max level was 10.X, so not terrible.

Otherwise appears to be a decent pressure set. EPR 3 is on which can add to therapy. You don't move much past pressure Max 10.

If the leaking is a disturbance, you'll want to adjust it a slight amount. I'm basing this on that low constant flat line being based on mask leaking. It could be strap issues, less than ideal fit, etc. If it's not an issue to your well rested state, this shouldn't be at a level to hinder the CPAP therapy. However, I'd believe you'd not want it to increase much beyond this amount or then it can become an issue.

[Rich66]

Hello, I generally don't post to peoples situation unless they have the same machine I do, the ASV. But I see you're using the N20 mask, I use the same. Your graph shows a lot of leaks. I find leaks to be disturbing to my sleep because of dry throat, or the constant air coming out my mouth. I have solved that, but it was a battle, including taping my mouth shut. Thankfully, I no longer do that. I've always considered leaks to be a priority in solving.

Also, and I really don't know if it matters, but others previously pointed out that the manual for the N20 mask shows to have the machine setting at "Pillows" -- not at "Nasal". I don't know if that has changed. Excuse the pun, but I just went with the flow and keep mine on "Pillows".
May these suggestions help you. Good luck.

[BoxcarPete]

The persistent leak appears to be a setting issue, like Rich said above, try setting to Pillows and see what it does. The minimum leak on your OSCAR chart axis is actually -1.7 which means the mask is leaking less than the machine's expectation for your setup. I'd say your persistent leak is more or less zero, with some leaks around the 7-10 mark, which is really not too horrible. You can keep working on them if you have some thoughts on how to improve, but overall your chart looks good.

[Deborah K.]

Your leaks are too minimal to worry about.

[evenflow]

Oh man, I put the settings at "Nasal" - because that was the intuitive thing to do! Haha. I'll change this to Pillow right now. I assume it won't fix the leak rate, but it will change the axis I guess? I don't really know what the settings is for (full face vs nasal vs pillows), besides maybe setting a baseline...

So if we disregard OSCAR (which may be questionable) - are there like...easy ways to see if CPAP is working? Are AHI's still accurate if there's any leaks? If I mouth breathe too much during the day, my mouth can get incredibly dry so that was the first thing I thought of. I have no dry mouth. No drool. So I think the general consensus from everyone here is that my leaks are fine / might be present but not significant?

FWIW, The F30 mask was giving me an AHI of about 1 to 5 and this N20 mask is giving me a AHI reading of sub 0.5 every night. Last night I didn't even need Flonase. I really do wonder why any form of humidity just puffs up my nose....