Problem with mask and EPR

[jomama]

I have had to take off the EPR because it was aggravating my lung problems.

Could you maybe expand on this? 

Is EPR/PS contraindicated in certain situations?

[Gideon]

IMHO SWJ is when you physically wake up. Arousals are sleep disturbances and critically disturb your sleep through the night. For example, by the definition many use, a RERA would not be an event because you were aroused. It is a series of Flow Limitations ending in arousal by definition. In other words, your sleep was disturbed by events and as such, IMHO SHOULD COUNT. You wake up for a bathroom break, answer the phone, door, change the diaper on the baby, etc. those don't count and are SWJ. My interpretation is that those count. The question a CPAP cannot answer is why a disturbance occurred.

[jomama]

IMHO SWJ is when you physically wake up.  Arousals are sleep disturbances and critically disturb your sleep through the night.  For example, by the definition many use, a RERA would not be an event because you were aroused.  It is a series of Flow Limitations ending in arousal by definition.  In other words, your sleep was disturbed by events and as such, IMHO SHOULD COUNT.  You wake up for a bathroom break, answer the phone, door, change the diaper on the baby, etc. those don't count and are SWJ.  My interpretation is that those count.  The question a CPAP cannot answer is why a disturbance occurred.

I'm with you. That's exactly what I'm trying to figure out in my case: Why disturbances occur, and if they are related to SDB or something else that a PAP machine can't address. I am seeing lots of flow limitations, so I'm trying to figure out if those are causing my arousals.

So, in that example we were looking at, if you look all the way to the left, that's the first disturbance/arousal in that section. To me, it looks like it came out of nowhere, in the sense that it was not precipitated by a flow limitation, nor can I see any SDB event that might have caused it. The disturbances to the right of that one logically would be when i'm trying to fall back asleep. So when I say that those to the right "don't necessarily count," or are SWJ, what i mean is that they are not events that happened while I was asleep and which woke me up. Does that make sense? I might be seeing it wrong...

[jomama]

Update: I just did another small test, at 8, EPR 3, and it went better. When I take small/normal, easy, more shallow breaths, the ballooning is much less of a problem, sometimes I didn't even feel it. I think that when I started again, I was breathing too heavily, kind of "panic breathing," like my body was kind of panicking at the pressure, so I was breathing deeper, trying to get more air. But as I am calming down, and getting more used to the strangeness of it, and my breaths get calmer, shorter/shallower, it's less of an issue. Of course, time will tell, and 15-30 min tests while awake/resting is not the same thing as going all night trying to sleep, but at this point I'm hopeful regarding the ballooning issue. Hopefully it's not false hope!

Not that anyone necessarily cares, but in the spirit of not having false info out there, I'm frustrated to report that, so far, it was false hope, after all. Still testing, and while I can get some breaths which don't cause ballooning, other breaths do, and those are disturbing. Given how sensitive I am when it comes to sensations and sounds and so forth when trying to fall asleep, I don't see how I'll ever "get used to it."

At this point, I suppose I'll have to just try again with EPR 2, experiment with a few pressures to see if I can tame my flow limitations, and then, well, I guess that's it, because if I can't deal with EPR 3, there's no reason to even consider a bilevel. (And this isn't even addressing the problem that my lips loosen when I relax, which lets air in my mouth, causing dry mouth. Chin strap can't help that, and taping gives me anxiety, and melts and sprays don't last all night, so, I think I'm just one of those people for whom PAP therapy just ain't gonna work. Very discouraging.)

[sheepless]

you didn't mention trying a soft cervical collar. while I don't love it, it's the only thing that reduces lip leaks for me. I hardly notice it anymore but the minor discomfort (biggest problem is it's hot in summer) is a small price for better sleep.

[Melman]

I also use a FFM (AirFit F20) with EPR 3. I've never noticed what you described but I just put it on an started the machine. I experienced what you describe but I don't find it uncomfortable or disruptive. It may just be a matter of getting accustomed to it. Hopefully you can.

Wait, I'm confused... you said you never noticed what I described, but then in the next sentence you say that you experienced what I describe. Just to satisfy my own curiosity, which is it?

Also, I'm curious, is your cushion the silicone, or foam?

Sorry for the delay. What I meant was, after reading your post I put on my mask and noticed what you describe for the first time. It's never bothered me so I never noticed it before. I use the silicone cushion.

[jaswilliams]

Just a note that the Resmed memory foam masks don’t move in the same way with EPR as the mask does not hover/float on your face in the same way as the air fit silicone masks. I only noticed the ballooning with epr the first couple of nights I soon got used to it but I can understand the concern.

With a True BiLevel machine the Pressure support can be increased in 0.2 increments maybe that would also help you get used to the mask ballooning as the rather if change can be much smaller

[jomama]

you didn't mention trying a soft cervical collar. while I don't love it, it's the only thing that reduces lip leaks for me. I hardly notice it anymore but the minor discomfort (biggest problem is it's hot in summer) is a small price for better sleep.

Hi. Thanks for the suggestion. Yeah, the problems with a cervical collar for me are that I really dislike anything around my neck. It kind of triggers a panic, which I can try to learn to get used to, but while I am trying to get used to it, my sleep is being ruined even more. I just don't think I'll be able to get used to something around my neck. But that doesn't even matter because when I am lying on my side, which is the position I fall asleep in most often, even when my mouth is closed and my chin hasn't moved down at all, my lips will relax. My jaw hasn't moved at all, it's just something that happens. A cervical collar cannot help in that situation, unfortunately.

[jomama]

I also use a FFM (AirFit F20) with EPR 3. I've never noticed what you described but I just put it on an started the machine. I experienced what you describe but I don't find it uncomfortable or disruptive. It may just be a matter of getting accustomed to it. Hopefully you can.

Wait, I'm confused... you said you never noticed what I described, but then in the next sentence you say that you experienced what I describe. Just to satisfy my own curiosity, which is it?

Also, I'm curious, is your cushion the silicone, or foam?

Sorry for the delay. What I meant was, after reading your post I put on my mask and noticed what you describe for the first time. It's never bothered me so I never noticed it before. I use the silicone cushion.

Thanks. :) Yeah, from what I've read, some people are more sensitive than others when it comes to this or that. I think I fall into the sensitive category, which I think might be a part of why I wake up so often in the night, like my nervous system is extra vigilant or something. It's also why the various disruptions of PAP therapy itself just adds extra walls between me and restful sleep, even after I am able to fall asleep with it. For example, I will spontaneously wake up (seemingly not from SDB, if I'm reading the example chart above correctly), and then it will take a lot longer for me to fall back asleep with the PAP machine than without. That might get better over time. Then again, it might not. And in the meantime, my sleep is being ruined even more, wearing me down even more, which ruins my health even more. If I had an AHI of over 30 or something and O2 concerns, and PAP therapy brought it down to below 3 and kept my O2 from falling to dangerous levels (which doesn't seem to be an issue with me), then I'd know it's making a positive difference, and it might be worth pushing through. But in my case, I have no solid reason to believe that PAP therapy is going to help me get more restful sleep. It's just a totally different animal. It makes it extremely hard to keep pushing myself to keep struggling against the, in my case, insurmountable obstacles.

[sheepless]

my problem is lip leaks rather than jaw drop & I didn't think the collar would help me either but I was wrong. fortunately, for reasons I can't explain, the collar actually does significantly reduce my lip leaks. I refuse to wear ties & turtlenecks because I hate things around my short neck coming right up to my chin but have adapted to the collar because it makes a huge difference for me. try a $20 collar with an open mind for a week or two before concluding it won't work.