New CPAP, new thread

[midwestguy]

Midwestguy, you can update your profile information on the Apnea Board site by going to the user control panel (CP) here http://www.apneaboard.com/forums/usercp.php  

Looks like you are right back to the old high level of AHI, clustered positional obstructive apnea, crazy leaks and poor sleep.  Sorry to see this.

Thanks Sleeprider. Updated.

Yeah, all of that stuff. Have to get the hang of this mask.
No pun intended.

Best,

Harv

[Geer1]

You can see how there are no leaks at the beginning of each session and the leaks don't start until after apnea has already been occurring for a while. The apnea is probably causing you to pull on the mask causing the leaks more so than just a bad mask fit. If you can fix the apnea it will probably fix the leaks.

This apnea looks positional in nature. Are you still using the cervical collar and sleeping with a single pillow etc in a position that helps keep airway open? If you have the lower straps too tight they could be pulling your chin back/down as well exaggerating this.

[midwestguy]

You can see how there are no leaks at the beginning of each session and the leaks don't start until after apnea has already been occurring for a while. The apnea is probably causing you to pull on the mask causing the leaks more so than just a bad mask fit. If you can fix the apnea it will probably fix the leaks.

This apnea looks positional in nature. Are you still using the cervical collar and sleeping with a single pillow etc in a position that helps keep airway open? If you have the lower straps too tight they could be pulling your chin back/down as well exaggerating this.

You think I'm pulling on the mask in my sleep? I know I reached inside to
scratch an itch. That's murder!

I am using the collar. It seems to keep my chin off my chest.

I sleep on a wedge-shaped pillow to keep stomach acid where it belongs.
(LPRD, a cousin to GERD.)

I did try tightening the lower straps to stop the leaks.

I'm hoping Dave's procedure will fix this. (Dave: no pressure! )

Best,

Harv

[Geer1]

Your leaks are very large, It seems more likely that you are pulling the mask half out of place. Most leaks are caused by people changing positions, pulling on mask/hose etc. I do sometimes get leaks if my mouth opens and chin falls down/back, your collar should be stopping that from happening though if it is fit right.

When using a wedge pillow you need to make sure you are staying up high on it and not sliding down or sleeping at the base of it as that angle can put a kink in neck/airway.

I would focus on trying to fine tune positional and mask leak aspects a few more nights. If sleep continues to be poor and apnea high might have to go back to the nasal mask at least for a bit. Some people struggle with FFMs but I was hoping that wouldn't be the case for you and that it would solve mouth breathing/leak issue. Mouth breathing/leak is better than high apnea and large leaks though.

[midwestguy]

Funny thing is, I was never”asleep.”  I was flat on my back, collar on, 
at the top,of the wedge, eyes closed.

So I didn’t shift the mask in my sleep.

It could be that the medium cushion isn’t the right size.

F&P says this combination fits 97% of users. Maybe I’m in the 3%.

Yeah, I’m going back to the nasal pillows. Can’t take another
night on the Vitera. Will try another cushion size, later.

Thanks, geer1.

Harv

[SarcasticDave94]

BTW maybe this helps on the wedge aspect. See if you can place it below the mattress. Mine was wide enough to support a mattress so I did that for mine when I used one.

As for the Vitera mask, it should work but if the steps are tight it'll crush the cushion and instant leaks all over. And if you move it about you need to reset it by pulling it off your face to allow it to pop back into shape.

[midwestguy]

Here's the nap result.

   

Harv

[midwestguy]

BTW maybe this helps on the wedge aspect. See if you can place it below the mattress. Mine was wide enough to support a mattress so I did that for mine when I used one.

As for the Vitera mask, it should work but if the steps are tight it'll crush the cushion and instant leaks all over. And if you move it about you need to reset it by pulling it off your face to allow it to pop back into shape.

Dave,

My mattress is a California King, heavy as the devil. The wedge is barely one person wide.
I'll try it, but not optimistic.

Best,

Harv

[Sleeprider]

A wedge could be done with a piece of plywood supported on blocks under the mattress.

Harv, I don't recall, have we tried a lower pressure range? Can you post the prescription history (Statistics) for review?

[Geer1]

He was using 8 min before but with the nasal mask. Flow rate chart showed periods of restrictions, mostly apnea free. Many of the reduced flow rates are due to mouth breathing and had associated leaks, potentially mouth breathing because of discomfort breathing against the machine.

Tried bumping him up to 11 min with nasal mask to see if that would help. Flow rate chart looked improved overall but still had moments of mouth breathing and the higher pressure made leaks noticeably worse during those periods.

Wanted to see what his results would look like without mouth breathing/leaks. He doesn't want to try tape or a chin strap. Talked into trying the FFM but so far has had poor results, the FFM appearing to aggravate his positional apnea as we have noticed it does in some members.

With nasal mask his pressure only increased slightly, probably due to apnea, flow limitation and snore not being recorded or reacted to due to him mouth breathing when those restrictions were present. Now with the FFM his pressure has been maxing out likely due to the machine now seeing and reacting to all his restrictions.

Trying the FFM with lower pressure settings would be an interesting test. A test that would either be successful by easing breathing or a failure by allowing rampant positional/obstructive apnea. If he is interested in trying it I would use 8 cm min, 8 cm max.