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I'm using ResMed Airfit P10 Nasal Pillows. So I have now dialled in my settings more and about 2 weeks into CPAP usage. It's comfortable going to sleep, and I can get to sleep. What has helped the most has been very high trigger, and increasing the pressure.
Two problems I'm facing still:
1) Waking up after a few hours at a time with it on (doesn't happen without the mask, and also good sleep hygeine already)
2) Slight mouth leak - Waking up or like semi-sleeping and realising air is coming out of the edge of my mouth.
I am using the following already: full mouthtape end-to-end on lips, Knightsbridge Dual Chinstrap. Without these, the mouth leaking was heavy.
I also already in the day positioning my tongue in the right position and as I am getting to sleep. However I imagine once I fall asleep it changes.
Even with mouthtape, what happens is I notice the side of my mouthtape gets loose, wet, and opens up a little hole and air comes out at some point.
It's not some heavy leak, so obvious you might see on OSCAR, but I do realise it.
I'm wondering if these little leaks are what wakes me up? Because it's what I realise as I am either semi-asleep/about to fall asleep.
Seems like I've tried a lot to fix this issue already with Nasal Pillow.
Does anyone have anymore advice for me?
Do I need to test out different masks? This is the only mask I've ever tried.
What even makes a full face for example, less likely to leak and wake you up? Wouldn't it still leak out of your lips, but into the full face mask area?
Attached is last nights OSCAR. It's with waking up every few hours or so, so it's not pure sleep.
With using mouth tape as well as chinstrap that is a pretty extreme scenario that would be the last resort for someone who is completely inable to tolerate a hybrid or a full face mask.
Your exhale time is around double your inhale time. This could be a sign of building up high CO2 levels.
That 'very high' trigger time is pretty uncommon. It is causing the machine to trigger the switch to EPAP much quicker than what it is typically set to. I have yet to see very high be needed on a person. This extreme comfort setting change may be limiting your inhale time in those deeper sleep stages causing overall disruption.
I would start by trying a pressure support of 6 and having the trigger and cycle at their default medium.
I am leaning to believe that the mouth forcing itself open is a body mechanism to increase the exhalation of CO2. If you are using tape and a chinstrap with that low of maximum pressure it sounds like your jaw is forcibly opening.
You should really give a FFM a try as it may actually cause increased comfort without the need for a chinstrap and mouth tape. A FFM aims to hold the mouth shut but allows for slight openings during sleep while also containing all the pressure. A mouth leak with a nasal mask is much different than with the use of a FFM. With a nasal mask, the pressure is rushing out which reduces the PAP effectiveness while also causing discomfort. When your mouth opens slightly while you are asleep with a FFM there is no rush of air exiting your mouth at all, as it is now also contained by the pressure. So you wouldnt feel any discomfort and your mouth would be allowed to open slightly to aid expelling built up CO2.
This forum is quick to dispel the increase of pressure support but it is one of the main features of Bilevel. If you are not predespositined for central events and not showing any it should not create an adverse increase in them.
If I had a bipap I would start at 11/5 and increase ipap for hypo and epap for apnea and leave the PS at 6 unless a significant amount of centrals were seen.
I increased to very high as advised by LovePeacePizza because I was experiencing a ton of CA events. Increasing my pressure and the trigger to very high removed all those CA events. So the screenshot at the moment is the best it's been from adjustments so far (not saying it's the final level though). So I'm not sure about going back to medium since I used it for a reason. Thoughts?
Secondly, FFM could be a good idea as a test, what masks do you recommend?
Thirdly, it wouldn't just be a case of the "jaw forcing open" with a chin strap and mouth tape. It's simply where the tongue is. I can be fully relaxed, and if my tongue relaxes fully, air will start to fill my mouth and it'll go into a balloon. This is while awake, without any potential CO2 buildup. So it could be that, or it could just be because my tongue relaxes when I sleep. I dont think my jaw forces open. The air just squeaks through the edge of a mouthtape I think
I have not adjusted pressure support much yet. I decreased it to 3 before which made it hard to even fall asleep. Going back to 4 was good, and it's just been there so far
When I realized I needed mouth tape I made the mistake of buying very comfortable but wimpy tape. I eventually switched to tape that holds better, and even then I realized that I need to to use 2-inch wide tape, cut about 5-1/2 inches long. Any narrower or shorter and I still had lots of leaks. Maybe you are like that too. Lots here like Cover Roll Stretch or Hypafix tape, both of which work well. I prefer Theraband kinesiology tape as I find it much more comfortable, but it is more expensive. I hated my full-face mask, as it leaked like crazy. Nasal pillows are more comfortable and leak a lot less.
No, my cheeks don't fill up with air. Over the years that has happened a couple of times. When It did I just pulled my cheeks in and blew out hard through my nose.
As to narrow tape, I need extra coverage top and bottom or I manage to leak air. I guess I'm a forceful exhaler or something. I don't really know.
