Introduction to group and need general advice.

[robysue]

Will post more charts on the weekend but have a question to ask now.

I'm on my third mask & am still having what Sleepyhead categorizes as major leaks.

Where is SH are you seeing the report of "major leaks"?

SleepyHead uses the Resmed RedLine of 24 L/min for determining "Sleepy Head large leaks." In other words, when the SleepyHead leak graph (not the total leak graph) gets above 24 L/min, SleepyHead will report this as a "large leak", even though the PR DreamStation you are using does not necessarily flag it as a "Large Leak."

The thing is that with all 3 masks I haven't found any leaks between the mask and my face. The leakage is from the vent or the swivel connector. 

The leakage from the vent is normal.

But you are fitting the mask at the beginning of the night at low pressure.  What happens is that as the night goes on, your face relaxes and the pressure goes up.  That combination is causing the mask seal to break. And then you get the larger than expected leaks.

One fix: Try to fit your mask at your full pressure, not the beginning (ramp) pressure. FFM are harder to seal properly at 15cm than they are at 10cm and they're harder to seal at 10cm than they are at 5cm.

It is the Airfit F20 I'm using at the moment.

You may be right but I feel like there's some other reason.

I am a mouth breather - often my nose is blocked but seems to clear while I'm sleeping.

Breathing filtered air at night often helps clear the nose, especially if you have a lot of nasal allergies.

I generally sleep on my right side & pre starting to use CPAP I was constantly rolling around & kicking the covers off.

Now I am not rolling around or kicking & constantly am in that same position when I wake.

This is common. A lot of people with untreated OSA are very restless sleepers---essentially your body is moving around both in reaction to the apnea events and in an unconscious effort to find a position to minimize those apnea events.  With CPAP, the apnea events don't happen, so the body doesn't need to move around as much.

I have had instances when my F20 mask has crept up to where the bottom part of the cushion is partially in my mouth but without air escaping.

Facial relaxation can explain how the mask crept up ...

But it is a surprise that this didn't cause a larger than expected leak.

Feeling frustrated but know I need to just be patient - listen to the advice I receive here & continue to try different masks.

I still like the feel of the Amara View - will ask my rental supplier what size they gave me - have printed the sizing chart & am a medium.

Looking at the ratings from supplier 1 I'm thinking about trying the F&P Simplus - but feel it may be the first mask my supplier gave me that I had problems with as well.

Masks are in the nose of the beholder.

What I mean by that: A mask that is well beloved by many may just not work for you.  A mask that is hated by most may become your favorite mask.  It all depends on the shape of your nose, face, and chin, along with what things decrease your particular comfort in using a mask.

 

That's another thing that has frustrated me - my supplier not telling me what's what. I accept that I'm more to blame than them - in that I haven't asked - but that was because I had put my trust in them to look after me & not knowing zilch about CPAP. Now - especially after having my eyes opened here to their obvious need for profit - realise that me being ignorant is what they want.

The American profit system works this way: Most DMEs, like most businesses in general, care more about their bottom line than their patients/customers.

[Gazza59]

Will post more charts on the weekend but have a question to ask now.

I'm on my third mask & am still having what Sleepyhead categorizes as major leaks.

Where is SH are you seeing the report of "major leaks"?

SleepyHead uses the Resmed RedLine of 24 L/min for determining "Sleepy Head large leaks." In other words, when the SleepyHead leak graph (not the total leak graph) gets above 24 L/min, SleepyHead will report this as a "large leak", even though the PR DreamStation you are using does not necessarily flag it as a "Large Leak."

The thing is that with all 3 masks I haven't found any leaks between the mask and my face. The leakage is from the vent or the swivel connector. 

The leakage from the vent is normal.

But you are fitting the mask at the beginning of the night at low pressure.  What happens is that as the night goes on, your face relaxes and the pressure goes up.  That combination is causing the mask seal to break. And then you get the larger than expected leaks.

One fix: Try to fit your mask at your full pressure, not the beginning (ramp) pressure. FFM are harder to seal properly at 15cm than they are at 10cm and they're harder to seal at 10cm than they are at 5cm.

It is the Airfit F20 I'm using at the moment.

You may be right but I feel like there's some other reason.

I am a mouth breather - often my nose is blocked but seems to clear while I'm sleeping.

Breathing filtered air at night often helps clear the nose, especially if you have a lot of nasal allergies.

I generally sleep on my right side & pre starting to use CPAP I was constantly rolling around & kicking the covers off.

Now I am not rolling around or kicking & constantly am in that same position when I wake.

This is common. A lot of people with untreated OSA are very restless sleepers---essentially your body is moving around both in reaction to the apnea events and in an unconscious effort to find a position to minimize those apnea events.  With CPAP, the apnea events don't happen, so the body doesn't need to move around as much.

I have had instances when my F20 mask has crept up to where the bottom part of the cushion is partially in my mouth but without air escaping.

Facial relaxation can explain how the mask crept up ...

But it is a surprise that this didn't cause a larger than expected leak.

Feeling frustrated but know I need to just be patient - listen to the advice I receive here & continue to try different masks.

I still like the feel of the Amara View - will ask my rental supplier what size they gave me - have printed the sizing chart & am a medium.

Looking at the ratings from supplier 1 I'm thinking about trying the F&P Simplus - but feel it may be the first mask my supplier gave me that I had problems with as well.

Masks are in the nose of the beholder.

What I mean by that: A mask that is well beloved by many may just not work for you.  A mask that is hated by most may become your favorite mask.  It all depends on the shape of your nose, face, and chin, along with what things decrease your particular comfort in using a mask.

 

That's another thing that has frustrated me - my supplier not telling me what's what. I accept that I'm more to blame than them - in that I haven't asked - but that was because I had put my trust in them to look after me & not knowing zilch about CPAP. Now - especially after having my eyes opened here to their obvious need for profit - realise that me being ignorant is what they want.

The American profit system works this way: Most DMEs, like most businesses in general, care more about their bottom line than their patients/customers.

[Gazza59]

OK - My last 7 daily reports + my Stats Sheet - finally worked out how to do it - just follow the "5 easy steps" to the letter.

These results have actually been the worst since starting - not going to express a view because I don't know enough - I'll just wait to see what the experience here has to say. Saying that I still feel great compared with how I was. I had changed my low pressure from 10 to 12 just before these results as per advice here & I did reinstate the V12 as well.

I have ordered a CPAP pillow - won't be able to pick it up until this Saturday - hoping it will help.

Thanks again to all that have shared their advice.

Still deciding on what mask to buy.

[quiescence at last]

OK - My last 7 daily reports + my Stats Sheet - finally worked out how to do it - just follow the "5 easy steps" to the letter.

These results have actually been the worst since starting - not going to express a view because I don't know enough - I'll just wait to see what the experience here has to say. Saying that I still feel great compared with how I was. I had changed my low pressure from 10 to 12 just before these results as per advice here & I did reinstate the V12 as well.

I have ordered a CPAP pillow - won't be able to pick it up until this Saturday - hoping it will help.

Thanks again to all that have shared their advice.

Still deciding on what mask to buy.

https://i.imgur.com/b4Upjxk.png
https://i.imgur.com/XCVU6WH.png
https://i.imgur.com/4wM5siY.png
https://i.imgur.com/xrv2rvS.png
https://i.imgur.com/sS5uNbX.png
https://i.imgur.com/xAeNrWR.png
https://i.imgur.com/VhiZWPh.png
https://i.imgur.com/woS9kTC.png

you have widely varying nights results, so one thought is there is value in adding the cervical collar mentioned lately. 

also some consistencies exist worth noting, as follows: (1) clear airway events are not happening - that is great!  (2) flow limitations tend to stay well above 0.50 which indicates that a higher minimum pressure would make breathing easier and sleep more restful. (3) RERA is still significant (over 1.0) most nights, meaning you are awakened by increased effort to breathe.

If this were my data, I would immediately set ramp to start at 9 or greater.  I would also set my minimum pressure to 13.5 which was the median pressure for the last 7 days.

QAL

[Gazza59]

Thanks Q.

Will try try the suggested settings but not so sure about the collar yet.

I start every night with a blocked nose & it tends to clear while I'm asleep but can close up again just as easily - so mouth breathing is a necessity for me.

Is it that you think I'm dropping my chin too much - suppose a collar would prevent that & be OK as long as I can open my mouth to breath.

[Gazza59]

Have bought a CPAP pillow & back to the Amara View mask.

The pillow was my idea but when I went back to my provider she pointed out that my figures with the Amara View were the best of all. I felt most comfortable with this mask as well.

[ajack]

I wouldn't count the ones when you are going to sleep, I would also think 13.5 or even a bit more is needed. the DS is a slow machine to respond.

[Gazza59]

Had my provider convince me to reset my lower limit to 10 - saying that the specialist would be put out interpreting the data.
Sticking with the advice here - 13.5  lower with 9 ramp it is.

[quiescence at last]

I start every night with a blocked nose & it tends to clear while I'm asleep but can close up again just as easily - so mouth breathing is a necessity for me.

Is it that you think I'm dropping my chin too much - suppose a collar would prevent that & be OK as long as I can open my mouth to breath.

I think you will be able to clear your blocked nose more or less in a few breaths at new starting pressure of 9 cm.  I have to tilt my head to a particular angle to gain clear nasal passages enough to breathe deeply as I fall asleep, but also sometimes shift to mouth breathing during the night.  I have a full face mask so that is not a problem.  Dry mouth occurs when that happens.

The wide difference in scores and that the events sometimes occur in big clusters all at once are suggestive of positional issues like you rolled onto your back or side for relief of discomfort.  Most often it is rolling to the back that results in gradually relaxing into a tucked chin.  I have been using a buckwheat airline pillow to provide a soft landing for my chin, but can easily untuck when I wish to open my mouth.  The cervical collar has helped many but selection appears to be fairly important, the size (length) and the softness are some things to get right, and then the tightness also need not be as great as with an injury.  I have not tried a collar myself, and best lookup those threads that discuss from those that have.

I hope your sleep specialist will not be put out, as it is hoped that they would be looking for effectiveness, and you are showing that.

Good luck.

QAL

[Sleeprider]

I will disagree with the disagreement. For most users, and ones that have compulsive tendencies towards the data results, VS2 is a distraction that is not readily addressed through machine or sleep position adjustments. Particularly in new users, it is a secondary concern and may it may be alarming to see so many events being flagged. My preference is to address in order, the issues of OA, CA, H, S and FL. If VS2 ever becomes a concern we can go there, but I personally never have. By the time we get down to difficult problem solving, I think it is better to look at the details in the flow rate, respiration rate and tidal volume graphs where I can see if snores or flow limits are present, rather than relying on recording on events. I prefer the straight-forward graphing of snores and flow limits as done by Resmed that the "guessaholic" games with Philips events, but I can live with either one.

I recently noticed that flow limitation graphing in Philips machines may be based on comparative inspiratory flow patterns rather than the actual presence or absence of flow limiting characteristics. I'm sure you have seen flow rates that are clearly flow-limited but not charted as FL events. In short, I don't find Philips Respironics charting of some of these events either predictable or treatable without going deeper into the data, so I have in many cases recommended turning off VS2, and I'm sure may recommendations to do so preceded Bonjour's. These opinions and approach to problem solving are my own and I respect your disagreement. I will however continue to suggest turning off that event marker, particularly with new users with otherwise good therapy results.