biogon's Therapy Thread

[biogon]

Hi. Looking for some help with interpreting my CPAP's output.

Background: idiopathic hypertension controlled by medication. Had a bout of afib and extreme night sweats after COVID that triggered the sleep study. 

My DME is currently the hated Apria. They sent me a Luna G3 and I couldn't get OSCAR data off it so I get an Rx for the Airsense 11 which I am currently using. Have tried a variety of masks: ResMed N20, ResMed N30i, ResMed P10, F&P Evora Nasal cushion, Philips Dreamwear Nasal cushion. None seems to work particularly well, all for a variety of reasons. I'd like to move to a DME provider that will let me try out masks and return them (I just learned this is possible). I have a CPAP mask pillow with the cutouts on the sides. The mask fitting issues may be due to an "Asian fit" face profile.

I am mostly a side and back sleeper, with (I am told) fairly frequently and vigorous alternating between positions. I usually manage 5.5-6.5 hours of sleep a night, but as you can see, I take off the mask in middle of the night unconsciously.

Mostly, my (observable) concerns so far are:

- I have ridiculously bad fatigue and lethargy the day after -- I can readily nap within an hour of waking and in the afternoon a good three hours if I don't set an alarm.

- I think I'm having some significant leaks. I suspect I have mouth leaks due to the very dry mouth in the morning and sometimes in middle of the night -- enough that I have to get up to take a drink. I've tried taping my mouth shut as well as a chin strap but the tape leaves too much irritation on the skin and the chin strap doesn't feel strong enough to prevent opening (i.e. I still have a dry mouth).

Attached are my initial sleep study and the past few days of OSCAR readings.

Any advice is much appreciated. Thank you!

---

More days.

Thank you.

[HalfAsleep]

Making settings recommendations is not my skill set. I’m sure someone will check in who can help with those.

In the meantime….your mask visual looks like Niagara Falls. No wonder you’re exhausted. It looks MISERABLE. And you are likely throwing off the mask because the whole scenario is not working out for you and you’re begging for air.

So, here are some suggestions:
—it may be that you require your mouth for breathing. For whatever reason. Strategizing to keep it shut would be a waste of time and potentially hazardous. Perhaps at some point, you could look into why you might need to breathe through your mouth, but now’s not the time.
—focus on “good enough” and then work towards perfect: this is not true of pressure settings (which are largely data driven), but it is true of masks, which is a highly individualized adjustment.
—it may be that you can’t wear a nasal mask while you get all this figured out. I would get an FFM, settle in the idea that you may need to use it for a while so you don’t have to get super-fastidious over mouth breathing, and give yourself a chance to develop some skills and get habituated to the therapy, all the while getting at least some shut-eye.
—I use an F40, which is a hybrid. It has mask pieces for different-shaped facial profiles, including wider noses and shorter distance between nose and lower lip. I was sent some by mistake, so I know this! It might be worth investigating. There are other hybrids, too.
—Then, put your mask and machine on. While you’re AWAKE. Watch TV or read. Steady and relaxed. Get used to breathing. Get used to locating a leak and adjusting the mask. You want your body to get used to the ebb and flow, and you’re acquiring transferable skills that will make adjustments in the night easier. Do this for an hour or so every day.
—During your AWAKE sessions, adjust your humidifier and temperature so it is calming and feels good.
—Think of the AWAKE sessions as learning and skill acquisition.


Note: if you post Oscars that reflect AWAKE sessions, be sure to indicate, so they don’t get evaluated as sleep.

Note also; your mouth might very well pop open and become annoying when wearing an FFM, and you’d probably want to finesse that later. But, unless mouth drop is causing a huge leak with an FFM, you’ll still be getting viable treatment and loads of info that you can apply later. There’s not the urgency to fix the mouth breathing.

[Deborah K.]

You have several issues that we can address that should help.

1.  Your starting pressure is too low.  Most adults would feel air-starved at 5.  I suggest that you raise it to 7 or 8.
2.  You need to turn EPR on full-time, set at 3.  This will lower your flow limits and make breathing more comfortable.
3.  You have too many leaks on some nights.  These interfere with therapy and can give false readings on various items.  You need to use either a full face (they leak the most, however) or a nasal pillows mask with good mouth tape.  I understand about painful tape removal.  It's something I fought with for a long time.  I finally learned that applying Milk of Magnesia, of all things, on your face where the mask will be, letting it dry, and then applying the tape solved the pain problem. Yay! I also found that, for me, I need to use 2-inch wide tape, cut to about 5-1/2 inches long for it to work effectively.

I think these changes will solve lots of issues and provide you with better and more comfortable therapy.