Relatively new cpap user looking for any advice

[williegeez]

I started on 6/9, moved from a pillow P10 to a nasal N20 on 7/9. About the same time added a body pillow and neck brace, as I was a longtime back sleeper and really longtime mouth breather. I have pretty well learned the tongue trick while awake (so I can open my mouth and not disturb my nasal breathing). The last few nights my AHI are well under control. I still show a good deal of leak rate but rarely when I'm aware of it. I could guess that when sleeping I at times open my mouth ? My mask seems secure now and I seem to wake always on my side as I started. 

I near automatically stop and start cpap so that I'm sure in the morning of being aware of when I woke. I pretty religiously wake an hour after falling asleep, most of the time for no apparent reason and am generally able to drift back to sleep. This is not any different than how I was before CPAP. But I can tell I'm dreaming more now and in the morning feel better, just doesn't last long,  because I don't have the energy to persist going back to sleep. So somedays I need multiple naps. I was using CPAP for a few naps as I was getting used to the machine, but have stopped doing that. I am ending the night at times by trying to sleep with everything off (which can give me another hour or two if I have the patience). I guess not using CPAP might be counter-productive.    

I don't know what more to do about the leaks, so I'm pretty much ignoring them as long as I am getting some quality sleep.
I went back to taking 6 mg of melatonin with L-Theonine which seems to allow me to drift off pretty quickly. I was on 900 mg of gabapentin nightly for sciatica but physical therapy helped me get off of that (that also helped me sleep. but only an hour at a time); I've been off completely for a couple of months now.  

I'm appreciative of any advice, especially anything one can see from the graphs, I don't have enough focus to see that myself.

[Narcil]

Sadly you cannot ignore such high leaks. it is above the threshold the machine can handle (24L/min red line) for almost 50% of the night. mask primer wiki may help but you need to do something about the mouth leaks. maybe a chin strap or soft cervical collar? the machine cannot deliver adequate therapy while the leaks are above the red line and your AHI is also most likely underestimated because of the leaks.

[OpalRose]

Your low AHI readings may not accurate at all due to the high leak rate. As Narcil stated, this is something you can't ignore.
I assume you have a very dry mouth when you wake up? This can be really bad for your teeth and gums.

Try the soft cervical collar as stated. I don't particularly like chin straps as most tend to pull the jaw back. You would have to be sure it pulled the jaw/chin area up.

The other thing to try is mouth taping. You'll find a lot of threads on that subject.

If you can't overcome the leaking, a full face mask may be order. Try a Hybrid mask, where it sits under and seals the nose, and still covers the mouth.

[williegeez]

I've only been using the nasal mask for a week. I'm not going to overreact to a small sample size when the mask has been such an improvement over the pillows, which both gave me congested nose and dry mouth. Last night was my first time on the nasal mask with a dry mouth. I tried the chin strap early and it did no good whatsoever. I am using a soft cervical collar (just started Tuesday). I think I took it off for the last session (I had taken everything off and I think I dozed off and awoke and just started the CPAP again). I have bouts with claustrophobia so I'd be hesitant to go full face mask , but I felt the same way about trying the nasal mask until the pillow mask was clearly not cutting it. For now, I feel like I've made progress avoiding mouth breathing just as I've made progress not holding my breath when awake, so I'm inclined to persist in trying to retrain myself, or trying a chin strap again (perhaps in combination with wearing my dentures for a night) , since I've made some progress.

[Deborah K.]

For a while, I needed a soft cervical collar for positional apnea, but for me, it did not stop the mouth breathing at all.  I need and use mouth tape.  Even with that, I have to use 2-inch wide tape, cut to about 5-1/2 inches long or I still leak.  I thought mouth tape would be claustrophobic, but it isn't at all.  I even used it straight through a bad bout of Covid with no problem.

Anyway, good luck with finding a good solution!  

[williegeez]

Posting last night's chart which was much improved.
I adjusted my pressure slightly (from 7/13 to 6/12) for no significant reason (I had not past 12 anyway). 
The night was my best yet, leaks under the red line at 95%, no snoring, 3 wake ups over 5 hrs and some change.
I'm pretty sure I took off the cervical collar at 12:30, I had woke with a badly itching nose and the mask and brace got 
gotten entangled some, so I took it all off and then slept another hour, I think I also turned off the music then. I tried for 20 minutes to go to sleep and gave up.

All off, I then slept for 2 more hours (don't remember if I woke or not). 

I'm curious if the charts with no leakage to speak of suggest anything to those who know about them.

My only inclination tonight would be to try to keep the collar on throughout. And perhaps to give a better try to keep the cpap on throughout. I do not remember really anything about the last 20 minutes last night. 

This is 3 straight nights with sleep at least as good as pre-CPAP. I'm sure the change to side sleeping has helped and the collar as well and perhaps I'm getting some cumulative impact. My start time is inching out intentionally, as I'm not so exhausted and have a real desire to sleep till light.

[OpalRose]

Nice improvement. The leaking mostly occurred during the latter part of the morning between the 1 and 2 hrs.

I agree with lowering the maximum pressure to 12, simply due to the flow Limitation. FL will cause pressure swings.
Also, line up your leak graph with the FL graph. See a correlation?

However, I'd like to see you keep the minimum pressure at 7cm if you're able, so that the EPR of 3 has room to work. You can inch up to 7 slowly. Try moving it to 6.2, 6.4, etc., and gauge the difference.

I would stay the course for a while yet and keep working on the collar use.

[williegeez]

Ahh, I see on the mininum, since the machine won't go lower than 4. My initial pressure was 5-8. I moved to 6-9 by myself and then 7-10 when I started with the disk and went as high as 7-13 to see when CPAP would stop anyway. 

And I see the relation of Flow Rate to Leak Rate (even early evening when not quite leak red-lined). And I see the pressure rising as leak continued, which I assume is the machine reacting. But you don't want an extreme pressure caused by a leak (which is why you said dropping to 12 was good ?). And you're suggesting small increments up now since I may have managed (a bit by chance) to get closer to a good setting ? Whereas my mathematic me would lean toward a quick binary search. So I think I'll settle on 6.4 for tonight. And keep the collar on. 

Appreciate your help !

[OpalRose]

You're a quick learner!

Always take it slow and if the results don't look positive, it can be reversed.

[williegeez]

This was a good night up to the hour.  95% leak rate fine, no snoring. Still relatively waking on the hour.

In the last hour, I was trying to get one last session in and just seemingly could not fall asleep. But I kept realizing I was holding my breath and then trying to get into a breathing rhythm. I was intent on trying till 5 but I finally gave up as it was getting hard to catch my breath.  I did keep the neck collar on the whole night.  

I can tell that my tongue is getting used to latching on to the roof of my mouth, like a good mask fit. I was aware of the couple of large leaks in the middle of the night; my mouth had accumulated some air and it was dribbling out until it gave up.  I'm greatly encouraged. Woke once with a dry mouth to which I just took a sip of water.

My bigger problem is my nose gets itchy, pretty much with every wake up. So I've started taking my mask off for a minute or too and giving it a bit of a massage because it is like it was sweating, and do some focused breathing. I suspect I might need to loosen the mask just a little, I've been leery of trying that since it took me a while to get to a good fit, comfortable but no leaks around the edges. I doubt that is waking me up, since pre-cpap I was waking up hourly most always. I've stopped worrying when I wake about disrupting getting back to sleep if I do much, but seems better now if I take a few minutes to regroup before getting back to it. 

Every session start, the pressure rises quickly (again I'm ignoring the last sessions). I'm inclined to go from 6.4 to 7 now.