CPAP Newbie - Waking All Night With Mask Leaks

[coutherino]

Hi, I just read through your thread. I'm sorry to hear you're having so many issues with CPAP. I understand how difficult it can be as I have gone through many of these same struggles. I understand what it feels like to have conflicting information coming at you from all sides, with no real clear answers or solutions. Especially from people who are supposed to deal with this stuff for their job. As a few other people in this thread have already said, you are going to have to take your therapy into your own hands. Most doctors, most respiratory therapists, do not truly understand what they're talking about when it comes to PAP therapy.

This may be a long reply, so apologies in advance, but there is a lot of stuff I feel the need to address.

First, the notion of being a "mouth breather" is an unfortunate misconception that most new CPAP users have. Unless you have a deviated septum, chronic congestion, or some other condition that legitimately prevents you from breathing out of your nose, you should almost certainly be using a nasal mask. The reason most people come to believe they are a mouth breather is because they wake up with a dry throat/mouth, they wake up gasping for air through their mouth, or people tell them they're doing it while they're sleeping. The reason this happens is BECAUSE you have sleep apnea. If your airway is collapsing, your body is naturally going to take as much air in as it possibly can, by any means necessary. This means breathing through your mouth. Once you have something capable of stabilizing your airway when you sleep (CPAP) the need for this goes away, and you can breathe how you're supposed to: through your nose. I was under the same misconception for weeks, and was told by a respiratory therapist that I should be using a full face mask since I'm a "mouth breather." I tried everything I could to get used to get used to it. My therapy changed drastically once I made the switch.

APAP. This is the mode that your CPAP is currently in. It's what's responsible for it auto adjusting throughout the night, in response to respiratory events it flags, based on an algorithm. APAP is horrid, and any good sleep tech will tell you that. I will spare you the fine details for now, but there are plenty of videos on YouTube that go in depth as to why it's not good. It misses apneas, false flags apneas, under adjusts, over adjusts etc. Conceptually it is flawed, as it exists in a reactive state, not a proactive. It will only adjust AFTER you've already had an event, ones that it flags at least. It is not the "solution" most people in the sleep industry will have you believe, and I highly recommend turning it off in favor of CPAP, under the "mode" menu in your clinical menu. It will no longer auto adjust, and you'll likely have to be at a slightly higher average pressure—one that can stabilize your airway throughout the night—but the pressure changes are what often wake people up, which is likely what's happening in your case. 

The setting your respiratory therapist changed was likely something called EPR, which stands for expiratory pressure relief. It aims to make it easier for you to breathe out against the pressure, by physically lowering it every time it senses you breathe out. It appears to be on level 3 now, meaning if your normal pressure is on 10, you will only be breathing out against 7. 

As for your respiratory therapist claiming the wakeups throughout the night are just something you will have to get used to... I really don't know what to say. CPAP should, and can be comfortable. You should not be waking up MORE than you did before using CPAP. As someone who woke up multiple times a night before CPAP, and woke up even more after starting it, it is possible to sleep through the entire night with it. I promise. It is possible to get there, and it is the goal.

I know you want specific settings, and I'm going to give you my recommendations. But I'm sure by now you understand that this is a process, often a long one. I'm trying to prioritize comfort for now, so you can hopefully get through a whole night without being woken up constantly. Someone has already told you how to access your clinical menu, so here they are.

Mode: CPAP

Pressure: 8

Ramp Time: Off

EPR: Off

If you have any further questions, or want to understand more about why these are my recommendations, feel free to ask. This response has already gotten long enough so I'll just leave it at that. Hope this helps.

[Embeeous]

> if you tell me EXACTLY how to get back to my current settings in the event that they don’t work out

There are two settings menus. One is intended for patients and can be accessed from the main screen, and then you can access the clinical menu in the way that SarcasticDave94 said. You can take pictures of those settings so you know what they are. Better yet, take a video as you change the settings, and then if you want to revert the settings, you can go through the same steps again. Also, if you google "how to change airsense 11 settings", you'll find YouTube videos on this.

Have some confidence. You can learn to understand your treatment and your machine well. Most of the people here aren't professionals either, just people who've learned enough to improve our own sleep. I've never had any help from my supplier since they gave me the machine.

> Btw, ramp was Off, one therapist changed it to 45 mins, second one changed it to Auto, you’re saying just turn it off, correct?

I'm not the person you're responding to, but that's what I would do. Ramp is low pressure for people who can't fall asleep without it. It's a "comfort" setting. 45 minutes is crazy, in my opinion. If you turn the machine on and off a few times, that could be hours of sleeping where you're effectively untreated.

Regarding the min pressure: Your min pressure was set to 4 because it's the lowest possible number and these companies don't personalize settings at all. The thought is that the machine will figure out the right pressure. But the machine is reactive. It only raises pressure in response to problems... which means you will have those problems every night, or several times per night if you turn the machine off and on again. 4 is too low for almost any adult, and we can see it's too low for you because your OSCAR charts show you have a lot of obstructive apneas at lower pressures.

This was an extremely helpful and insightful response, thank you! I will implement some of these recommended changes along with ones made by sarcastic this evening.

---

Hi, I just read through your thread. I'm sorry to hear you're having so many issues with CPAP. I understand how difficult it can be as I have gone through many of these same struggles. I understand what it feels like to have conflicting information coming at you from all sides, with no real clear answers or solutions. Especially from people who are supposed to deal with this stuff for their job. As a few other people in this thread have already said, you are going to have to take your therapy into your own hands. Most doctors, most respiratory therapists, do not truly understand what they're talking about when it comes to PAP therapy.

This may be a long reply, so apologies in advance, but there is a lot of stuff I feel the need to address.

First, the notion of being a "mouth breather" is an unfortunate misconception that most new CPAP users have. Unless you have a deviated septum, chronic congestion, or some other condition that legitimately prevents you from breathing out of your nose, you should almost certainly be using a nasal mask. The reason most people come to believe they are a mouth breather is because they wake up with a dry throat/mouth, they wake up gasping for air through their mouth, or people tell them they're doing it while they're sleeping. The reason this happens is BECAUSE you have sleep apnea. If your airway is collapsing, your body is naturally going to take as much air in as it possibly can, by any means necessary. This means breathing through your mouth. Once you have something capable of stabilizing your airway when you sleep (CPAP) the need for this goes away, and you can breathe how you're supposed to: through your nose. I was under the same misconception for weeks, and was told by a respiratory therapist that I should be using a full face mask since I'm a "mouth breather." I tried everything I could to get used to get used to it. My therapy changed drastically once I made the switch.

APAP. This is the mode that your CPAP is currently in. It's what's responsible for it auto adjusting throughout the night, in response to respiratory events it flags, based on an algorithm. APAP is horrid, and any good sleep tech will tell you that. I will spare you the fine details for now, but there are plenty of videos on YouTube that go in depth as to why it's not good. It misses apneas, false flags apneas, under adjusts, over adjusts etc. Conceptually it is flawed, as it exists in a reactive state, not a proactive. It will only adjust AFTER you've already had an event, ones that it flags at least. It is not the "solution" most people in the sleep industry will have you believe, and I highly recommend turning it off in favor of CPAP, under the "mode" menu in your clinical menu. It will no longer auto adjust, and you'll likely have to be at a slightly higher average pressure—one that can stabilize your airway throughout the night—but the pressure changes are what often wake people up, which is likely what's happening in your case. 

The setting your respiratory therapist changed was likely something called EPR, which stands for expiratory pressure relief. It aims to make it easier for you to breathe out against the pressure, by physically lowering it every time it senses you breathe out. It appears to be on level 3 now, meaning if your normal pressure is on 10, you will only be breathing out against 7. 

As for your respiratory therapist claiming the wakeups throughout the night are just something you will have to get used to... I really don't know what to say. CPAP should, and can be comfortable. You should not be waking up MORE than you did before using CPAP. As someone who woke up multiple times a night before CPAP, and woke up even more after starting it, it is possible to sleep through the entire night with it. I promise. It is possible to get there, and it is the goal.

I know you want specific settings, and I'm going to give you my recommendations. But I'm sure by now you understand that this is a process, often a long one. I'm trying to prioritize comfort for now, so you can hopefully get through a whole night without being woken up constantly. Someone has already told you how to access your clinical menu, so here they are.

Mode: CPAP

Pressure: 8

Ramp Time: Off

EPR: Off

If you have any further questions, or want to understand more about why these are my recommendations, feel free to ask. This response has already gotten long enough so I'll just leave it at that. Hope this helps.

Omg, this was an incredibly helpful response! I am fast tracking your suggestions and will be making those changes this evening. Makes so much more sense now, especially the APAP vs CPAP comparison. THANK YOU!

[Embeeous]

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I made the changes, and I am currently testing with the nasal mask and a pseudo nap as I’m typing this, so far so good. I can definitely handle the pressure at a constant of 8, and I’m betting that I can fall asleep and hopefully stay asleep with it.

The one thing that I do notice is that there is more air movement and noise around the mask. At a pressure of 4, it’s almost silent, but at 8 I can definitely hear and feel it. I’m not sensing or feeling any leaks, just more air movement outside of mask around the nasal area, and air noise. I can’t seem to make any adjustments to the mask to make it go away, but I feel like I’m getting a good supply of air. And I can create a louder clearer whooshing leak if I pull the mask slightly away from my face, so it is making a decent seal. Is all of this normal?

[Embeeous]

I made the changes, and I am currently testing with the nasal mask and a pseudo nap as I’m typing this, so far so good. I can definitely handle the pressure at a constant of 8, and I’m betting that I can fall asleep and hopefully stay asleep with it.

The one thing that I do notice is that there is more air movement and noise around the mask. At a pressure of 4, it’s almost silent, but at 8 I can definitely hear and feel it. I’m not sensing or feeling any leaks, just more air movement outside of mask around the nasal area, and air noise. I can’t seem to make any adjustments to the mask to make it go away, but I feel like I’m getting a good supply of air. And I can create a louder clearer whooshing leak if I pull the mask slightly away from my face, so it is making a decent seal. Is all of this normal?

Update - I readjusted the mask and it got a little quieter with less air movement outside the mask.

[Embeeous]

coutherino:

You suggested a pressure of 8.  Several other posts here and on another board suggest 7.  One response said that my OSCAR data showed me hovering around 7 all night, so keep it close to that value, but per your suggestion, maybe going slightly higher to 8 is a better option for some reason? I don't know. I'm not even sure how dramatic of a difference there is between 7 and 8. Yet another response on another message board said that I need to make small changes over time, and that a big jump in pressure might be difficult to tolerate, try increasing that pressure to the new target number over several nights. I'm not planning on doing that for now. I was comfortable testing out my setup this afternoon with the pressure on 8, and I do feel like I can fall asleep and hopefully stay asleep with the pressure on 8.  I think. So that is my plan for this evening, unless I hear otherwise from you or anyone else beforehand. As you mentioned earlier, there is a lot of information coming from a lot of different directions, but the increased pressure is a consistent message from just about everyone. Thank you for your incredible input and continued support. 

Embeeous

[coutherino]

Glad I could help. All of this is normal, your mask is naturally going to be a bit louder at a higher pressure. More air will be coming out through the vents, which you'll be able to feel more strongly. If you're concerned about leaks you could always do quick a test, perhaps for a few minutes, then upload your data to Oscar to make sure your baseline leak is at 0. 

One thing I forgot to mention is to make sure you change your mask setting on your CPAP to nasal. You've probably already done this but I just wanted to make sure.

As for pressure, unless I'm missing something most of the people I see recommending 7 are referring to your minimum pressure within the range. Meaning APAP, which I still struggle to recommend, even as a means to find your actual pressure. My reasoning behind 8 is that I think it's something you'll probably be able to handle comfort wise, without going too low that it doesn't control ANY of your apneas, or too low that you wake up gasping. That being said I cannot say for sure whether or not you'll be able to tolerate it, but I think it's much easier to have an entire night where you're set on 8 so we can either rule that pressure out, or try it some more. That, instead of a night where your pressure if fluctuating up and down based on a flawed algorithm, which we then take the average pressure from. Some people will probably disagree with that thought process, but that's just my recommendation.

[Embeeous]

Apologies in advance For any typos this message. Dictated to Siri.Once again, I cannot thank you enough for the quick and detailed responses. I will keep the machine set on eight for tonight. One more question… There are two settings on the machine side for nasal masks. One is nasal and the other is pillows my respiratory therapist told me to keep the setting on pillows for the ResMed N 30 I mask that I am using. Would you agree with that or would you change that to nasal instead of pillows and I am assuming that you’re talking about that one setting on the device side there’s also a setting in my air on the iPhone application side to tell the application which is nowhere near as good and helpful as Oscar but Still I keep it updated to tell that app. I’m also using a nasal mask instead of a full face.

[coutherino]

Your respiratory therapist was right, actually. I wasn't aware that the N30 is supposed to use pillows. Sorry about that. I just checked the manual and it confirmed it. And yes, I'm referring to the machine setting. 


I hope everything goes well tonight. Looking forward to hearing how it goes.