New CPAP User - Nasal Pillow Mask Anxiety

[xhwmikey]

Greetings,

I've been using my new Resmed Airsense 10 Autoset for three nights now.  I have an AirFit F20 Full Facemask left over from my PSG, and I ordered an AirFit P30i with the machine.

I like using the P30i, but the second night using it, I woke up kind of panicky - REALLY wanting to take some breaths through my mouth.  I switched over to my F20, and I've been reasonably happy with that for the remainder of the previous night and last night as well.

I REALLY want to use the P30i because it allows me more degrees of freedom with regard to sleep positions (I like to sleep on my stomached side sometimes).  It is also pretty comfortable.  Moreover, in reading through a lot of threads here, it seems as though "mouth breathing" is discouraged.  I mostly breath through my nose, but there are times that I like (need?) to breath through my mouth...

So I have some questions:

1) Should I work on not mouth breathing at all?

2) Has anyone had the same experience with the nasal pillow style masks and worked through the anxiety/panic?  If so, what did you do that helped you to overcome the anxiety with the mask?  Should I just get on with it?

3) Am I overthinking this whole thing and just use what works?

Thanks for any wisdom y'all provide!

Mikey

[SarcasticDave94]

My answers to questions
1. You can try to not mouth breathe. You can practice tongue suck sealing if you want. Must you do anything? No. Do what's most comfortable.
2. I've used nasal and pillows masks a bit, but nowhere near exclusively. I don't think I had anxiety. I just tend to mouth breathe while asleep and hadn't trained myself the tongue suck truck to keep it in place.
3. It's fine to just use full face if that's what works best.

Most folks do normally breathe through the nose unless things like exercising requires more air. Some do need more air than nasal only breathing. I do have to mouth breathe awake or sleeping. Likely because of my COPD I guess.

I do wonder though, your description of using nasal masks sounds like you may not be getting enough air. What does your OSCAR shot look like?

[KeepingItSimple]

I’m quite new to this as well (30 nights and counting).

If you’re using nasal or pillow masks, you don’t want your mouth open, for breathing or otherwise. There is a lot of advice regarding methods to keep your mouth closed on this forum. Some include soft cervical collars (which also prevent another possible issue of chin tucking which also can cause problems) and chin straps; I think there is tape that can be used as well. I’m sure others will chime in.

I started with the N30i but due to leakage I switched to the P30i pillow mask. I had issues with the pillow mask at first, including some anxiety. I discovered that it’s easy to collapse one or both of the pillows when first putting it on; that was impeding airflow so my anxiety was understandable. I practiced in front of a mirror until I became accustomed to the right “feel” with the pillows sitting under my nostrils, not in them. Also, the initial feel of my nose being sealed by the pillows took some getting used to. Breathing through them without attaching to the machine eased that.

You’re not overthinking it. Adherence to treatment is hugely dependent upon feeling as comfortable as possible. If you find the P30i just won’t work for you I strongly encourage you to find a mask that better suits you. Much as I love the P30i, I’m not wild about the headgear because it slides up my abundant but very fine, silky hair at night so I’m going to try something else, too.

You’ll figure it out, one way or another!

[xhwmikey]

Thanks for the replies!

What I found odd was that night one of the P30i was pretty good - slightly uncomfortable but eased as the night went on.  Then good to start on the second night, only to wake up kinda panicky...The switchover to the F20 went well.

I learned (quickly) that opening my mouth when using the P30i was not the best thing to do, and for the most part I was able to achieve closed mouth nasal breathing.  I think what happened was mostly "in my head", so I'm just wondering if my experience is odd - or - it's just something to get past.

Interestingly, few if any CA events with the P30i, then a bunch with the F20. Odd.

I wouldn't say this is a big deal, just something I'm curious about.

Thanks again!

I've attached the OSCAR screenshot of the night with 1/2 P30i and F20.

[attachment=38167]

[SarcasticDave94]

Although your question was about nasal masks, I do have to mention there's a little much on the Central Apnea in that OSCAR shot. You might want to try EPR 1 to get them down.

[xhwmikey]

Thanks Dave,

I was wondering about all the centrals…I’ll give EPR @1 a go tonight.  Thanks!

Just curious - why does less EPR help centrals?

Mikey

[SarcasticDave94]

Primarily, lowering EPR reduces CO2 flushing because of the differential between pressure and EPR leverages higher ventilation. Dropping CO2 diminishes the signal to breathe, and that breath pause over 10 seconds it's Central Apnea.

Secondary, lowering pressure fluctuation can reduce CA as well.

[plakky]

I’m quite new to this as well (30 nights and counting).
Much as I love the P30i, I’m not wild about the headgear because it slides up my abundant but very fine, silky hair at night so I’m going to try something else, too.

This is an aside to the main topic of this thread; apologies if that is not kosher:

I wanted to point out to KeepingItSimple that many people who have issues with the P30i headgear sliding up (myself included) have replaced that headgear with the Dreamwear Headgear with Arms (which can be purchased separately).  You can do a search for posts on the  Dreamwear headgear hack on this site, and also look for YouTube videos showing that the Dreamwear headgear does fit nicely onto the P30i mask and stays in place much better.  Since you say you love the P30i,  it's definitely worth trying!

[CorruptAlligator]

Thanks Dave,

I was wondering about all the centrals…I’ll give EPR @1 a go tonight.  Thanks!

Just curious - why does less EPR help centrals?

Mikey

It's easier to breath out with greater EPR since your pressure is reduced to greater degree during the exhale phase when EPR is applied.  Easier breath out means, greater CO2 is expelled, which means body doesn't detect enough level of CO2, and thus decides not to breath for a duration until the CO2 level required is met.  

This happens for people new to therapy because their body has been so used to higher level of CO2 for a long time.  So, over time, body will gradually get used to lower level of CO2 from CPAP therapy. Our low oxygen saturation level is of concern due to apneas, and the low oxygen saturation level would mean higher CO2 level, and this is what our body was used to until CPAP therapy that changes that.

[xhwmikey]

Dave and CorruptAlligator,

Thanks for the explanation of why lower EPR can lead to lowered centrals...

I changed my EPR value to 1 last night, and I'm not sure I've seen much (if any) of an impact.  I used the F20 mask to keep some of the variables the same.  I've attached a screenshot from last night.

When going through some of my OSCAR results, I noticed significantly reduced centrals when using the P30i mask.  I'm thinking to retry that mask tonight to see if the centrals drop.  What do you all think?  Kinda sucks because I feel like I'm becoming "one" with the F20 

Anyway, thanks for all the information!

Mikey

[attachment=38184]