Vagal Atrial Fibrillation & ResMed F20 Strap Neck

[SarcasticDave94]

Maybe I missed them. Had you included an OSCAR data shot? Your mention of position, as in side or back, makes me curious. With that 20 cmH2O pressure, I wonder if there's at least a bit of what we've called positional Apnea. The basics is like your garden hose, you kink it and water won't flow. Parallel that to your breathing and kinking your throat airway via dropping your chin towards your chest.

Want to try a simple test to see if you do have the Positional Apnea? Two things, first the physical test. Sitting upright, relax your breathing to whatever is your normal. Now slowly drop your chin and head to tilt forward, touching your chin to chest. Did breathing get difficult?

Second part. Look at OSCAR and the Events flag area. Do you see clusters of flags meaning events, one after another in a large area.

If this checks, you might need a soft cervical collar to prevent chin tuck. The bonus is you might get to turn the pressure down and you might get better to much better sleep. And the test is free.

[MoreBeers]

Hello Folks!

Just catching up with the Thread, so a group reply.

Hello JJJ!

>>I had ablation surgery and it completely cured my afib. It's a surgery that takes a lot of practice for the surgeon to get good at it, so surgeons who do ablations tend to do nothing else, and are usually found only in large hospitals.<<

My late mother-in-law had several ablations for a very fast Atrial Fibrillation/Flutter and, unfortunately, the results got worse each time and, on the last attempt, they managed to destroy her SA Node and so they had to fit a Pacemaker that time!

I'm therefore very hesitant about having any invasive cardiac treatment, unless absolutely necessary. Not that it cannot work, as I know for many it does. My problem is generating faith in who might do the procedure! Hobson's Choice for me via the NHS so, if I get a poor team, it could all go horribly wrong!

Hello mesenteria!

>>Your risk of a stroke rises the minute you begin to experience arrhythmia in the left atrium.  You needn't go for several days, just a single minute.  The reason is that there is a 'grotto' on the extreme upper left of the left atrium called, appropriately, the 'left atrial appendage'.  It acts like a backwater into which blood can flow, but remain stagnant for a time while your atrium flutters or fibrillates.  Blood can clot there inside of a few seconds.<<

Thanks for the warning, well received. In fact I am more than aware. As I may have said, this killed my late father at 65 via a Stroke, so I am very aware of the dangers.

It is sadly ironic that all of my efforts to avoid Atrial Fibrillation by controlling Sleep Apnoea, may instead have resulted in the equipment actually causing it! That's if the Vagus Nerve issue and the ResMed F20 Strap issue is to blame, as I now very strongly suspect.

>>There is a relatively new preventative measure for that for those who can't take blood thinners called the 'watchman'.  It's a small wire 'thimble' with a fine mesh around it to capture clots and prevent them from escaping and being pumped into your left ventricle and out to your heart or your brain.  The watchman is inserted into your left atrial appendage the same way they perform ablation, insertion in the groin and rinsing up with a catheter.<<

Thanks, I did see mention of that, and watched a few YouTube videos and/or web articles. Sounds like a wise precaution if the irregular rhythm and rate cannot be controlled. Certainly, if AFib is here to stay, that may well be a very wise option to go for, that's if it's available to me.

I do think it is Vagus related, so not actually a heart misfire, but a wider problem with what should control my heart beat.

Neck and Head Position and Heart Beat

This evening, I firstly noted that my heart rate changed when sitting down to eat dinner! We have a TV on the wall very close to the table, and I have to look up a little to see it well.

That position changed my heart beat!

It is also the exact same position where several of the recent AFib sessions have started!

This is recent, because I have sat there for dinner over several years without this ever happening.

So, a recent combination of diet stimulation and position, but most likely is a new Vagus damage or constriction that is now very prone to further changes if I adopt a poor head and neck position that aggravates this new problem.

Likewise, and this may be interesting, after dinner I usually move further away and sit on a sofa where I can more easily look up to see the TV, and that position has been where several of the AFib sessions have terminated!

This evening, I was sitting down on the sofa again after dinner and, as now seems to happen, my heart rate slows a little, and the AFib sees a better mixture of slower beats and faster beats, with more slower beats when in that position.

I then had a go at massaging my RH Vagus Nerve, both just under the RH ear, and further down closer to the RH rear "L" of my yaw bone...and at one point I temporarily went into Sinus Rhythm! This seemed to be directly related to massaging around by my RH Vagus Nerve.

It didn't stay in Sinus but, there did seem to be a cause and effect just by massaging my Vagus Nerve!

So, it does look like there is some battle going on between my Sympathetic system and Parasympathetic system, with one wanting to increase heart rate, and the other wanting to lower it, but the latter is miss-firing, possibly because of a recent constriction or other damage in my neck caused by the ResMed Strap.

Indeed, the lower Strap Marks on my face this morning went right across and over that exact spot on both sides of my face.

I'm still in AFib, now heading for my 9th Day. But, it's getting a little slower more often, but just isn't dropping to Sinus.

Hello SarcasticDave94!

>>Maybe I missed them. Had you included an OSCAR data shot? Your mention of position, as in side or back, makes me curious. With that 20 cmH2O pressure, I wonder if there's at least a bit of what we've called positional Apnea. The basics is like your garden hose, you kink it and water won't flow. Parallel that to your breathing and kinking your throat airway via dropping your chin towards your chest.<<

I have not yet added any OSCAR images, but will see if I can add one this Post. It is indeed Positional Apnoea, that's definitely the problem. This is greatly exacerbated by my lower limb disabilities and osteoarthritis, which means I struggle to get comfortable in bed, so just cannot stay in the best position for CPAP.

I cannot not roll onto my back at some stage, as I often wake in agony from the hip and knee, so I just don't have the option to stay on my RH side all night.

I worked this out fairly early on, even before I found these Forums, and so bought a Foam Neck Brace which I wear back to front to stop chin tucking. That greatly improved the CPAP efficacy, and that arrangement now only struggles when I am flat on my back.

I also added a large triangular foam pillow slope, which I think helps, but I tend to slide down that in the night, and end up on my back at the bottom of it!

Apologies for repeating myself, as I covered this a few Posts back, but I start sleeping on my RH side, and that is absolutely perfect for CPAP. In that position I get almost no drops and a nice steady O2 reading. But, sadly, that position eventually makes my hip and knee hurt a lot (usually once I am asleep).

So, what usually happens is, sometime later, I unconsciously end up on my back, which is more comfortable for the injuries, but is by far the worst for CPAP and Sleep Apnoea. That's when I need every cm of pressure, and that's where even 20cm H2O is not usually enough.

I then get a tight nest of Apnoeas of all kinds showing via OSCAR but, they are effectively all Obstructives, albeit reported as a mix of all three (Obstructives, Hypopneas, with some arguably wrongly diagnosed Centrals mixed in). It's definitely positional.

If I then wake up because of that, or if my wife wakes me up to say I am on my back, I change position back onto my RH side, and all is well again on the CPAP scores!

I think I have managed to attach a Screen Shot from last night, which shows everything fine until one part when I end up on my back, and AHI goes from almost zero to 22.00, then back to almost zero when I roll onto my side. My Oxygen scores also dip at that point, but I have yet to get around to Importing that Data into Oscar, so I view that via other software.

>>If this checks, you might need a soft cervical collar to prevent chin tuck. The bonus is you might get to turn the pressure down and you might get better to much better sleep. And the test is free.<<

Sadly, as explained above, I have already covered that!

The Pressure is fine, it does not bother me at all and, as you can hopefully see, for 90% of the night, nothing happens provided I am in a good position for CPAP.

But once on my back, even 20 cm H2O doesn't hack it, even with a Foam Collar stopping chin tucking. Albeit I may need to look at getting a firmer one as an option to stop that issue even more. The balance is being able to get to sleep, if the collar is too restrictive, it makes sleep harder, so the one I have is about right in being comfortable, supportive, and in most cases it does reduce my airway being closed by chin tucking.

In summary, if I could get hold of a ResMed AirCurve that could go to 25 cmH2O, that may improve the situation when on my back. Such as setting it to variable pressure, but with that safety overhead of an extra 5 cmH2O to play with, if needed, which should give me 22-23 cm H2O when needed, even with some pressure lost if Mask leaks a little at that pressure.

I am sure the current AFib is Vagus Nerve related, so I will see what I can do in terms of self-help to work on my neck to see if I can somehow try neck exercises to free up any nerve entrapment. I will also try to improve the rear pad on my ResMed F20 Strap, to better spread the load.

Ideally, the strap should only exert rear pressure upon the skull, it should not go near the Vagus Nerve, and should not exert pressure to the rear of the neck, as that is asking for problems with the upper three vertebrae, which can trap and/or compromise not only the Left and Right Vagus Nerves. It can also cause a poor head to neck misalignment over time, as the strap does exert enough force to cause pain, and sometimes headaches. In my case, it did cause really acute pain that seems to be the day it set this all off.

MoreBeers

   

[SarcasticDave94]

It seems you and I are discussing the 2 differing types of positional Apnea. You're referring to the version doctors use during sleep studies. This includes supine, side, prone. I'm referring solely to your neck being kinked with your chin pointed towards your chest or a drastic bend to either side. Not yet seeing data, it's a guess at this time. I think you'd mentioned using a collar of some sort, but wearing it backwards as a cushion for the too tight mask straps. And what I'm referring to is using a soft collar to prevent your airway from getting kinked.

soft cervical collar

[MoreBeers]

Hello SarcasticDave94!

Apologies if I wasn't clear, we are indeed on the same page!

I wear a foam neck collar specifically to stop my airway from closing via the old chin tuck position. The collar I wear is similar, just intended more for sleep when on a train, so if worn normally, it has a lot of padding at the rear, and is secured at the front.

I just wear that back to font, so it's secured at the rear, with the main padding at the front. That makes it hard for my head to roll forwards, so is doing the same job just isn't exactly like the traditional collar. This is a snug fit, and is not slack or loose, so my chin cannot slide below the padding and evade this measure.

To stress, I do not wear that to stop any Mask Strap issues, it does not impact the lower strap areas which are a little above the collar. It is worn solely to stop my airway from closing and, in most positions, it does a good job.

It is only when on my back that everything struggles, and a poor combination when asleep can see a nest of Apnoeas (see last Post's OSCAR screenshot).

I do have both, but found I was getting better results with the reversed sleeping collar than with the medical collar.

In all other positions, if the Mask is tight with no leaks, then the pressure settings of CPAP 20cm H2O and EPR 3 do manage to keep almost all Apnoeas away. Then if in Sinus Rhythm my Oxygen levels are stable, there is no cardiac stress, my heart relaxes and settles on a steady beat, and that's when I can manage a good mix of Light, REM and some Deep Sleep...unless limb pain rats that all up, in which case the sleep patterns are not so good, even when CPAP is doing all that it should.

Right now, most bets are off because of the on-going disruption caused by the mix of Atrial Fibrillation and what looks like either straight Tachycardia, or could be Atrial Flutter (my little ECG cannot really show if there is a saw tooth pattern between the QRS Complex).

Last Night's Sleep

I was trying various Vagus Nerve massage techniques before bed, and seemed to get the Atrial Fibrillation to slow down, and was seeing ECG based rates around 112 bpm, which on the ECG Trace was a mixture of long and faster heart beats.

By the time I went to bed, I seemed to have a lowering heart rate, although still in Atrial Fibrillation (always above 100 bpm).

But from the Viatom Oximetry, it looks like once I strapped myself into the ResMed F20 and settled down to read before sleep, I went from that almost straight to Tachycardia at around 141 bpm (so a regular fast beat, not irregular). The optical Viatom can count heart rate when in a regular rhythm, like all such devices, it just struggles when the rate is variable.

So my heart rate was bobbing up and down in a lower level of Atrial Fibrillation but, once the ResMed F20 Straps kicked in, I went straight to a higher regular beat, more or less fixed at 141 bpm. It stayed like that all night but when I changed position upon partial awakening, then the heart changed from a steady fast beat, and back to a variable beat.

It looks like left unchecked, my Sympathetic system wants to be at 141 bpm, but when the Vagal Parasympathetic mechanism kicks in a little, the rate comes down, so then there is a mini-battle as the dominant side keeps pushing things up, and the faulty dampening side fails to bring things down.

I am wondering if, say, anyone's cardiac Vagal Mechanism was to be disabled for any reason, would their heart rate shoot up?

Is the body always poised to increase heart rate, that is normally kept in check by the dampening effect of the Vagal system? So, in effect, when the body needs the heart to beat faster to deal with physical demand, does this work by the Sympathetic System requesting an increase, such that it is the Vagal system which back off the dampening effect, to increase heart rate that way, rather than the Sympathetic System actually increasing it directly?

Either way, either something is driving my heart rate up when I fit the ResMed F20 Mask, which my Vagal System is not managing to dampen, or the natural rate is higher when all Vagal dampening is disabled or compromised via, perhaps, nerve constriction or external pressure. Such as when I strap into the ResMed F20 and that tight pressure in several wrong places, inhibits the dampening effect. Or that exacerbates damaged caused around 3rd January when I had that severe lower rear neck pain after waking up after a night with bad strap pain.

Since playing with my Vagal Nerve location yesterday, there does seem to have been linked changes to my heart rate.

Conclusion

I must make up a new rear pad for the ResMed F20 Straps today, and see if I can remove any strap pressure effect, if at all possible.

I have a plan to cut a suitable piece from a thick 10mm foam Yoga Mat we never use, one that will cover the rear of my head, rear of my neck, that will also pass under the lower straps as they go under my ears and over where the Vagus Nerves exit the skull.

That should also, hopefully, remove pressure from the back of my neck as well, which may have been pushing my C1-C3 Vertebrae out of alignment and so crimping the Vagus Nerves. We took images of my head this morning with Mask on, and Mask off, so we can see the route of the deep Strap marks do go right over where the Vagus Nerves exit the skull.

As a temporary measure, I could secure that to the ResMed Strap with tie-wraps, so the new Pad stays in place and doesn't slide out. We can enhance the design and method of affixation once the basic principle has been tested.

Then see if tonight that helps at all.

There does seem to be a definite link between the on-going AFib issue and my Vagus Nerves. I will also try doing gentle neck exercises today, to see if working on the articulation of my neck may help.

MoreBeers

[MoreBeers]

Hello SevereApnea!

My apologies, I had overlooked your Reply when I drafted the group Reply to other Posters.

My wife would say my not being very risk averse has led me here! Indeed, I think she puts it rather differently less politely, using words like bloody, and idiot!

>>Your bad fats and palm oil connections are fascinating. We have progressed from moving/walking/farming and producing our own food to a sedentary lifestyle where we are dependant on others to produce our food for us in a way that they control what goes in the food rather than we. Too bad most of don't have access to allotment or vege patch these days!<<

Absolutely, we did once have a Farm, and we miss that greatly. So now we are also at the mercy of industrialised food production, although because we still live in a fairly rural area and have friends who are still Farming and who own things like butchers, we are still fortunate to have access to traditional food suppliers. Our basic rule now is to make as much as we can from natural ingredients, cut seed oils, and do our level best to avoid anything processed where at all possible.

We stepped that up a gear this year, after the Atrial Fibrillation went haywire. So, we are now far more ruthless in avoiding the purchase of anything food related that might contain anything nasty. I do try to get good Olive Oil, but finding any that is not adulterated or fraudulent, is hard. I use a Green Laser to test anything new, as that should turn Red if shone through genuine Extra Virgin Olive Oil, because the chlorophyll and other vegetable matter should filter out the Green. This seems to work as a basic test. Things like, say, Rapeseed Oil, turn the Green beam a milky white. Fake Olive Oil does not change the Green Laser at all, and it stays Green!

>>Even after Covid started here in Oz we were still able to trial different loan masks for a few weeks. Don't know how that works in the UK and the NHS.<<

Hobson's Choice: pick any Mask you like, so long as it's a ResMed F20!

Although they do offer it in the three sizes! They don't seem to do the foam AirTouch Cushions, only the basic silicone AirFit Cushions, although I am fine on them, and find them easy to keep clean.

That may vary depending on the NHS Clinical Commissioning Group area and local NHS Sleep Clinic. I think it's also the same with the choice of CPAP Hardware, it seems to be limited to the ResMed AirSense S10 Autoset. I don't think they offer the ResMed AirCurve units, some of which can go to 25cm H2O.

I have read that all ResMed S10 units can manage 30cm H2O, but the Firmware limits them down.

>>My wife frequents the Op Shops here a lot to find lots of unwanted treasures, all for a good cause. There are many of us here in the sleep apnea community that have surplus masks, hoses and bits and pieces. Too bad there is not a Sleep Apnea Op Shop service anywhere, where those unloved but little used items would not go to waste. I have a few F30i and DreamWear masks lying around that I am unlikely to ever use again, but with Covid around there seems to be no way to re-purpose those.<<

Sounds great. Here in the UK it's basically what you can find via eBay or Gumtree, and eBay will cancel any Sales of CPAP Hardware if listed, so you have to buy them quick before a Sale gets nuked by the Big Pharma Censors!

It's basically Commercial Censorship for profit, and all part of the Batty Flu BS!

>>I woke this morning with another cracker headache, sore right sided neck muscles and must say the Perry Nickleston trick seems to have worked somewhat. I will try that before and after sleep and see how I go. I think coming off coffee tends to aggravate my own headaches, together with some dehydration.<<

I too must watch more of his material, and I will also give his suggestions a go. I did also try the hand behind head technique to push head up and over, to try and open up the neck vertebrae, which may also have helped.

Hydration is important, I went for years neglecting that, then woke up, and once I started forcing myself to drink more water every day, I almost stopped having any headaches, when I was having them all of the time, usually controlled via Ibuprofen! Stopped needing that as well, funnily enough!

I stopped coffee at the start of this year in case that was a factor, and even gave up all alcohol too towards the end of January (not that it was a lot, just a couple of tins with the odd meal or my wife and I share a nice bottle of red).

Oddly, the AFib went nuts after stopping alcohol, but I think it was that which was keeping the Beta Blocker from doing its worst. So once the alcohol brake was removed, I then had lots of other problems kick in that were Beta Blocker side effects.

Once I worked that out, I stopped the Beta Blocker, and felt 100% better. I do not have high Blood Pressure, and had CPAP under control such that I had no Apnoea related AFib, so the Beta Blocker was only a precaution really, and it failed totally when needed. It's also contra-indicated with Vagal AFib, and has been known to make Vagal AFib worse, so I am better off without it. It has other bad effects such as reducing Selenium, and can rat up immune systems, cause Bradycardia (yes, it did that to me for sure), and a host of other nasties. Like many drugs, it is a poison, just in a small enough dose not to kill you off. Far better off taking as few drugs as one can I think.

The pain killers for my osteoarthritis do also have a cardiac effect, so I try not to take them, unless pain has got worse than usual. I have avoided taking any all of this year because of the AFib, which has thrown extra pain into the mix, which impacts sleep. But better to rule things out and bring them back in later, if needed.

MoreBeers

[SarcasticDave94]

The cluster of events starting just after 0930 is exactly what I'm referring to. This shows that despite this collar and 20 cmH2O pressure, you're getting Positional Apnea. At least that's the pattern I'm seeing. In fact, that cluster was where all the events were.

Why not bring the flow limit chart up in OSCAR next time so we see that? At some point in that session, the flow limits peaked at its 99.5% at 0.35. Typically, that's well within the range to take action to correct it. I have a feeling that the most relevant therapy info is going to be contained with in the regular, base charts of Events, Flow Rate, Pressure, Leaks, and Flow Limits. These other charts will be more useful for the advanced device therapy like ST-A and ASV.

As you say you don't have access to get other masks, I'm not sure how much better therapy gets then. I would exhaust all possible avenues to get that mask replaced with one that you don't need to torque down so tight it damages nerves.

[MoreBeers]

Hello SarcasticDave94!

>>The cluster of events starting just after 0930 is exactly what I'm referring to. This shows that despite this collar and 20 cmH2O pressure, you're getting Positional Apnea. At least that's the pattern I'm seeing. In fact, that cluster was where all the events were.<<

That's what I am seeing and why I posted that so, as far as I am aware, we are on the same page!

That is what I was trying to stress, that it is only when I end up in a bad position now, that the Apnoeas break past the preventative measures of collar and pressure. Usually the combination of the two keeps almost all of them away. I did try variable pressures, and no collar, and the results across the board were much worse, with Apnoeas all over the place.

>>Why not bring the flow limit chart up in OSCAR next time so we see that? At some point in that session, the flow limits peaked at its 99.5% at 0.35. Typically, that's well within the range to take action to correct it. I have a feeling that the most relevant therapy info is going to be contained with in the regular, base charts of Events, Flow Rate, Pressure, Leaks, and Flow Limits. These other charts will be more useful for the advanced device therapy like ST-A and ASV.<<

I will do, OSCAR is on another machine (long story, but I need to keep home and work machines apart to keep only certain applications on the work machines so nothing upsets that apple cart)! I'll fire up the home OSCAR Box tomorrow.

CPAP in terms of the air therapy is otherwise not a problem (unlike CPAP Mask Straps!), well, apart from the break through positional Apnoeas, that are hard to keep away. I don't think there is a better or more effective collar, and the pressure is already at the limit, as was Mask strap load.

>>As you say you don't have access to get other masks, I'm not sure how much better therapy gets then. I would exhaust all possible avenues to get that mask replaced with one that you don't need to torque down so tight it damages nerves.<<

I agree. I'm not really concerned with the positional Apnoeas because, most nights, I usually avoid them. That's unless I have Mask leaks or a poor night in terms of getting in bad positions for CPAP. I do usually have very low AHI and very high oximetry levels, so it was mainly the strap issue that was the problem.

The core current problem is the Mask Strap tightness needed to stop Mask leaks at 20cm H2O is very onerous, which seems to have caused pretty severe problems now with Vagal AFib.

In terms of the current AFib session, I am now heading into my 10th day of AFib, and it is getting very, very wearing. Not just on me, but on my wife who is worried sick.

Given the Stroke risks, it is partly the inevitable stress of that, plus the desire to try and find a self-help way around it in the absence of professional help from the NHS!

Fundamentally, I think the ResMed F20 strap design is flawed. The ResMed design engineers should have tested the F20 Straps at all possible working pressures and strap tightness forces, given the structural capabilities of the strap material, narrow loading and the upper limits of the Velcro grip.

The width of the strap can pose very real dangers given the maximum load that it can impose upon the neck and vertebrae. Not to mention due consideration for the effects over time, in the same way that Dentists can move teeth around with braces, using mainly a certain load over a certain time.

The same considerations apply to strap loading upon the neck over time, and what I have been feeling could easily have had the potential to move vertebrae around if a set force is applied over a set time.

If in any doubt, they should have widened the strap, or come up with a way to keep such forces working against the otherwise immoveable back of the skull, and not upon the more vulnerable neck area, let alone working against the Vagus Nerve skull exit routes either side of the neck and just aft of the jaw bone.

Modified Rear Mask Pad

To try and at least stop the above forces, I have just finished the new MKI Pad Prototype!

Please see the attached image.

We had an otherwise unused 8mm foam Yoga Mat so, I liberated that, and chopped a prodigious lump off it to make up a new Rear Pad.

At the moment its around 340mm wide and 110mm tall, and cut to provide a wide area either side of the central part of the strap at the rear, extending around the sides to support the two lower straps.

I added two extra bits at each side to extend the pad towards my jaw and face, in an effort to further ease any pressure from under my ears, i.e. over the crucial Vagus Nerve skull exit points where the nerve routes down either side of the neck.

To that I have used Hot Glue to affix guide lumps to keep the strap in place, plus I had an old F20 For Her strap (my wife's), so I cut three of the Velcro parts off that, and added them to the outer rear of the Pad, so that the main strap will bind to them, and hopefully further help to keep the main straps in place so they do not slide off and touch my neck.

I have tried that on whilst typing this, and it feels very comfortable. There is still some pressure, but it now feels altogether less, and is no longer exerting anything like the narrow width pressure that the straps were exerting before.

I can move my head around now without anything like the restrictions I felt before, and cannot now feel any obvious changes to my heart rate as I do so.

I may have cracked it or, I may have at least rendered it safe. I can work on the design, as I have plenty of Yoga Mat left, and a pile of Hot Glue Sticks!

I have kept my current Strap and Pad as well so, if it doesn't work out, or I have not anticipated something, I can quickly swap back.

Right, fingers crossed, I need to give this feller a test drive in bed and see how it goes.

I will update tomorrow.

MoreBeers

[Gideon]

The core current problem is the Mask Strap tightness needed to stop Mask leaks at 20cm H2O is very onerous, which seems to have caused pretty severe problems now with Vagal AFib.

this statement alone screams that you have the wrong mask

[MoreBeers]

Hello Gideon!

It does indeed.

But until this Vagal AFib went ape, I otherwise had the Sleep Apnoea apparently well controlled, so I just put up with the rear neck ache for that reason.

I just never considered that it could do what it seems to have done, and was otherwise wholly unaware of the potential danger.

Indeed, it has taken me a few Months to realise what has almost certainly happened, i.e. 12+ Months of building rear neck pain, that got worse, and ended up with a really sharp pain one morning closely followed by 3+ Months of Atrial Fibrillation from that day onwards.

I do hope this Thread helps others to realise the danger, and to either take steps to make a rear pad similar to the one above I have just created, or to change Masks and find one that does not pose this risk.

The crazy thing is, a couple of years ago when I first started with the F20, I did leave a feedback review on the ResMed web site, saying that I had concerns about the rear pressure that the F20 Strap can cause, and suggested they ought to re-think the strap design from a comfort point of view.

Needless to say, that Review was never published, and ResMed never followed up on it.

At the time I was mainly thinking about comfort to help with sleep, I really had no idea it could potentially cause Atrial Fibrillation.

Disappointed isn't the word, I have been proactive managing Sleep Apnoea precisely to avoid cardiac stress and to avoid things like Atrial Fibrillation and Atrial Flutter caused by night time suffocation, and now I find that the ancillary Mask equipment appears to have caused the very thing I was trying to avoid.

You just cannot win sometimes!

MoreBeers

[SarcasticDave94]

Just an example, I had ASV therapy for 2 years. I used the same ResMed F20 and it didn't stop leaking. I changed to the Fisher and Paykel Vitera, voila! The leaks are controlled up to IPAP 25+. And no torqued straps. I sincerely hope you'll find a way to change the F20 for something better suited to you, as the mask will always make or break therapy, depending on leak control and mask comfort.