New Member Mask fit and CSA questions

[cpapmonk]

Just getting started. 

First question: Mask fit;

They supplied me with a nasal pillow which doesn't work, not because of mouth breathing per se, but my jaw goes slack, pressure blows the lips open, game over. (With the full face troubles below, I may try a chin strap, but I am a bit claustrophobic with all the gear on my head.)

So next, resmed F30i. Seems the frame size is OK, but the cushions don't fit that comfortably because of shape. The SW seems best seal from the fit kit but it is not comfortable. I have to tighten straps such that the fit is uncomfortable both on the tip of the nose and around the mouth.

My facial features: 

-more angled than flat. i.e. from incisors rearward more like the prow of a ship. It seems the cushions are for a flatter face.

-medium length but narrow nose. the Medium cushion fits the length, but width makes for a looser seal on nostrils.

-non prominent chin. the mask wants to lift off of my lower jaw when it relaxes, so I have to tighten to discomfort to maintain a seal.

I tried using hot water to bend the hard plastic, didn't work.

Is there a mask designed for more angular faces with less prominent chin?


Second question:

My real problem needing treatment is not obstructive apnea, but sleep hypoxia which has increased hemoglobin and hematocrit. I have very little obstructive apnea. I have known I have cheyne stokes for a very long time, and the machine's API data confirms this. Is CPAP even effective for this sort of problem? I am experiencing more trouble with Central events with the extra pressure. My understanding is that hyperventilation causes respiratory alkalosis which interferes with primary CO2 breathing trigger. Not an oxygen problem itself, but a lack of CO2/carbonic acid in the blood. If the CPAP is pushing my ventilation rate and volume, CO2/blood acidity would decrease, reducing the drive to breathe. i.e. lower CO2 theoretically should CAUSE more CSA events. I feel like CPAP might be the wrong treatment. 

I'll add that i live at over 9000' elevation which does not help both in terms of CSA and high HGB/HCT. 

Appreciate any input on this one. My doctor's communication has been next to non-existent.

[Gideon]

You have the right idea in general but please post your daily charts from OSCAR. At AB we like to see the data so we can visualize what is going on, it is much more effective than guessing, even if it is educated guessing.

On mask fit, please read or review the Mask Primer. It would help. Look at the hybrid masks, they typically fit under the nose which will help with that claustrophobic feeling.

Don't give up on the pillows, you can learn how to nasal breathe, it did take meany months to do so.

[cpapmonk]

Thanks, I see you're the OSCAR Manager. respect, what a project.

but... I had a quick look at the installation and some of the user guides. Too much for me right now.

Still would appreciate any input about mask fit for this kind of face shape.

[RainbowFish]

It sounds like we have similar situations, and from one relative newbie to another:  

1) I have played around with many of the same masks and cushions.  For me, the best combo is an F30i with either a medium or small-wide cushion with a small frame.  (This is not a combination that comes as part of a set, and I was not aware the F30i even has a small frame option until I spoke with my local DME.) I thought the hybrid F30i was inherently more unstable than an F20, but it turned out that they seal equally well for me as long as the headset is analogous (small). When relaxed in sleep your mouth often falls open and can unseal the nose, so check the fit of the hybrid mask with an open mouth too.  That's why I eventually migrated to a medium rather than small-wide cushion myself.  I am also a big fan of strap covers to stabilize the mask and get rid of strap lines. 

2) I too live at high altitude, and I have mixed apnea.  My sleep study showed mild-moderate obstructive apnea, but once on APAP, the OSA is easily fixed, and the centrals are visible.  If I turn down the EPAP too much though, the obstructives reappear.  And at over 9000 feet I need to add a liter O2 as well, confirmed by my Wellue ring.  (This is one of many advantages of having OSCAR/O2 monitor feedback.  Without it, I would have been convinced my sleep study result, done at 2000 feet lower than my 7000 foot home, was missing the point or flat out wrong.) 

You are correct that initially CPAP will result in treatment emergent centrals, but these should fade, and depending on the number of centrals that remain, you may or may not need a different therapy approach.

The fine people here are a great resource, and often know far more re the capabilities of different machines than many of our providers.

[cpapmonk]

@RainbowFish, thanks for your reply.

I tried mouth taping last night with the nasal mask... no good. When I need to swallow, I don't have the skill to do so without swallowing a bunch of air.

So I went back to the F30i, the pressure seems to be ramping higher now, up to 9.6 and I can't make the mask tight enough without facial pain. It leaked a lot and the sound and feeling of air escaping kept me awake.

I have slept pretty well with the pressure reaching 8. Can I limit this on the Airsense 11 myself, or does it have to be set by the Doctor/supplier?

[RainbowFish]

Where is the mask leaking?  If it is the nose area, the key is often to position it high so the nose sinks into the pillow even with an open mouth. If it is around the mouth, it sounds like the size is off in either the cushion or the frame.  The mask should be firm against the face, but not overly tight, so the cushion can inflate with air pressure to seal itself.  Try adjusting the straps at pressure and try a firm pillow where you can hang your face/mask off the side to minimize compression on the seal when side-sleeping.  It may also be that ResMed is not the best fit for you.  The supplier list is a good resource to see what is out there.

This website has user manuals (see top banner) to give you the keys to the system. But I would strongly discourage messing with any settings without OSCAR feedback.  The OSCAR graphs do look intimidating, but you have lots of help here.  Take a look at a sample OSCAR printout for me below, the important stuff is the AHI and the first 4 graphs.

[cpapmonk]

Thanks again RainbowFish,

I am not intmidated by OSCAR's data interpretation, I just don't have time to get the software running on my computer at this time.

Re: trying other masks, yeah, I would love to try others but at $150 a pop... I need to know which would be likely candidates.

Thanks for the tip for the manuals. I also found a youtube vid showing how to access the clinician's interface. Last night was a bit better at 8.