ok, my first night...

[wrangler]

My story starts with my Dentist giving me a take home sleep apnea recorder (watermark). There was no way that I was ever going to go some clinic and be observed like a rat while sleep. I know I have had it for a while based on waking up in panic gasping for and the house shaking and rubling from my Harley Davidson like snoring. The results, as they were described to me were overwhelming. The only things I remember ahI of 29 and oxygen saturation that would drop below 90. So I was going to go to his Doctor when I found out my obama/california care with its $6000 deductible and 20 % compensation for a machine wasn't going to cut it. So, feeling dismayed about it all I decided to see what my options were. I figured I would buy one on my own and figure it out. I do this alot in most areas in my life.
When I satarted calling around about machines I got dismayed again. Although my good ol Doc gave me a prescription everyone told me I had to know the settings. Everyone told me the only way to get your setting was to spend $3000 and go be a rat tonight. Now I was starting to feel that this whole sleep Apnea thing was a scam and quickly becoming a cottage Industry. So I did some research on the internet and finally ended up buying a resmed autoset with humidifier and a quattro fx mask for under $1000 shipped. After watching some you tube videos on set up etc I got comfortable as what to. Mind you the frustration with researching an area I knew nothing I kept my fortitude directed. So I used it last night and did pretty well. After three hours the thing was blowing so hard I was sure it was coming out my butt. Iturned it off, wen to the bathroom, restarted it again and went another three hours when the wind storm started again. So I got up, went to the bathroom, started it up and slept for another 2 1/2 hours until I woke up with a farting noise coming from the side of my nose (leak) So here are the results:

Ahi 2.7
Pressure 7.6
Leak 67
Time 8+ hours.

Any feedback? Remember, I know nothing about all this stuff

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Oh yea, I have a full long beard so I sure that makes some sense out of the leakage.

[me50]

Could you look by the start button and tell us specifically what Resmed machine you have? Is your mask new? Have you downloaded Sleepyhead and/or Resmed software to take a look at what happened during your sleep? Hopefully you have an SD card that came with your machine but if not, they are not all that expensive. Your leak rate is definitely too high and that could be why you kept waking up. Your AHI isn't bad.

[wrangler]

Rs9 autoset. I woke up twice after 3 hours with hurricane winds blowing. I have a full long beard, I am sure that plays into it, but I am not sure. Brand new quattro fx full face. Not set up for data yet. My card reader does not work at this point on my computer.

[me50]

Have you considered nasal mask or nasal pillows? They might serve you better since you have a beard. Or you can buy or make mask liners. I never had much success with the full face mask and eventually I got an RT manager that really helped me out and I chose a wisp nasal mask and it has been a huge improvement and I have used that mask for almost a year now.

[herbm]

First, CONGRATULATIONS on WEARING the mask - that is half the battle.

The rest is finding the proper information and equipment, and then learning to make it work. Since you have a good machine (Resmed Autoset S9) and you are here asking questions you are well on your way to figuring this out.

You have a very LARGE LEAKS -- 67 is more than the system can support and still give reliably effective therapy.

This is also the reason for the wind storms you are experiencing (wind is about air moving from one place to another of lower pressure -- in an uncontrolled manner.)

The first order of business is to cut the leaks down to (well) below 24 -- the Resmed threshold for getting effective therapy from the machine. 95% of 10-15 (or less) would be a lot better even.

To do this you need to properly adjust your mask.

Start by watching some more youtube videos and (re-) read the instruction manual to learn how to adjust YOUR mask.

Two common mistakes (frequently related) are over-tightening and uneven tightening.

You may need a different mask if the quattro fx just happens to be a poor fit for you, but likely a mask liner (cut from old t-shirt or store bought) or proper, even tightening will make your current mask workable.

Hang in there -- plenty of people here will help you.

[becker44a]

. . .
So I did some research on the internet and finally ended up buying a resmed autoset with humidifier and a quattro fx mask for under $1000 shipped. After watching some you tube videos on set up etc I got comfortable as what to. Mind you the frustration with researching an area I knew nothing I kept my fortitude directed. So I used it last night and did pretty well. After three hours the thing was blowing so hard I was sure it was coming out my butt. Iturned it off, wen to the bathroom, restarted it again and went another three hours when the wind storm started again. So I got up, went to the bathroom, started it up and slept for another 2 1/2 hours until I woke up with a farting noise coming from the side of my nose (leak) So here are the results:

Ahi 2.7
Pressure 7.6
Leak 67
Time 8+ hours.

Any feedback? Remember, I know nothing about all this stuff

---

Oh yea, I have a full long beard so I sure that makes some sense out of the leakage.

Hi Wrangler,
First, welcome to the forum. You have found a VERY good place to learn about this condition and treatment.

Second, you have a GREAT machine, one that delivers excellent therapy, and has full data capability, so that you can monitor your therapy, and adjust as needed. This is critical for you, as you don't have a Sleep study, or a Sleep Dr to help get started.

Some Recommendations:

1) Download and install the free Sleepyhead software and start checking your data regularly. This is critical for you since you have no one else to monitor your thereapy and suggest what changes might work better. I download daily for now. Be aware that the S9 Autoset only keeps 7 days worth of the hi-res graph data on your SD card, and starts overwriting on the 8th day. This means you must download and examine your data at least weekly, or you will lose some data. Sleepyhead runs on Windows, Mac, and Linux. As an alternative, the ResScan software from ResMed is also available thru this forum, but only runs on Windows.

2) Request the Clinician's Manual for your machine. There is a procedure on this forum to make this request.

3) Buy some spare SD cards. This will insure that you will continue to be able to get the data from your S9 even if the SD cards become unavailable. I bought several 2GB standard SD cards so I have some extras, and I alternate between the ResMed original and one spare.

4) You have listed your pressure range as 4 to 20 cmH2O. Many people have found such a wide range to be uncomfortable. Some have suggested that is better to narrow the range somewhat to begin with, then adjust from there as needed. Often people have reported that they find a starting pressure of 4 leaves them feeling as though they can't get enough air, and a lower limit of 6 or 8 is more comfortable for them.

5) In the beginning, pay attention primarily to the leaks. Your S9 Autoset reports what is called "Unintentional Leak", that is leak above the designed vent rate for your mask. The S9 can compensate for unintentional leak rates up to 24 liters/minute. Leak rates above that will affect the machine's ability to deliver proper therapy, and to distinguish types of apneas.

6) For many CPAP patients, the severity of the condition is worse when sleeping on their backs (supine). Until you are monitoring your data, it may be prudent to attempt to avoid back-sleeping. There are numerous threads on this forum that address avoiding supine position, from wedging pillows behind your back, to wearing a backpack stuffed with lumpy, uncomfortable objects. Avoiding back-sleeping often limits the pressure the machine must use to counter obstructive apneas, which helps the leak issue. If I allow myself to sleep supine, my pressure cranks up into the 19 - 20 range, and the leaks can be severe. Avoiding supine position, my max pressure is rarely over 14, and the leaks are usually minimal.

7) Don't be surprised if it takes several tries to find the right mask. It is not uncommon to try half a dozen masks or more to find the right one. This is often simpler if you have a copy of your PAP prescription. Many of the online suppliers (see the link at the top of every page) have a mask trial program, where you can order a mask and return it for a full refund within (usually) 30 days. Most of these will need a fax or email of your prescription.

8) Keep reading this forum. Even threads that initially don't seem to apply to any issue you have, often contain some nugget of information that proves useful.

For your 1st night, all the results you reported are great, except for the leaks. My guess is that once you conquer the leak issue you will adapt well to CPAP therapy.

Hope these thoughts are helpful. Good luck on your journey.

[wrangler]

Great feedback, Thank you Herb and Becker! Thank you

[wrangler]

Sometimes I don't know if it better to start a new thread for a derrivitive question or not. Any way I am thinking about giving nose or pillows a try. I didnt know if I breathed thrught my nose or mouth. One day I took a nap and tried to pay attention. It seemed I was breathing my moth but wasnt sure. Because I have some issues with sinus stuff I read full face is best. I did notice last night at one point I was breathin through my nose and my mouth was shut. So I am thinking of trying one or the other. So, nasal or pillow and which one. Remember, full beard with mustache like a gnome!

[me50]

I have trouble with allergies and stuffy nose, etc. and I do really well with a nasal mask. If you are a mouth breather then you can use a chin strap. I started out with a chin strap and then I quit using it because at some point, I learned to keep my mouth shut, at least when I slept. As far as your beard, I don't think the nasal pillows or the nasal mask will be a problem. The nasal mask doesn't go in the area that normally sports a beard. You don't say if you have a mustache or not. Every one is different so it is hard to say which one will work for you. I wasn't fond of the feel of the nasal pillows but a lot of people have a lot of success with them. You will get varying opinions on pillows vs. nasal masks. You could look at the supplier list on this forum after you decide which one you want to try because I have read here that some of the suppliers have a return policy. Keep asking questions. Keep using your machine every time you are sleeping or considering sleeping. Keep coming here and reading the info here. We are here to help you as much as we can and there is always someone that will be able to help you with apnea related things.

[herbm]

To use a nasal pillow mask, you need to be able to breath through your nose even if it takes preparation (saline wash, nasal spray, decongestant, allergy pills, corticoid sprays, etc.) AND you need to be able to keep your mouth close even if that takes a chin strap or tape.

I was TOTALLY CONVINCED that I was a mouth breather and would never be able to use a nasal pillow mask or really even an oral-nasal mask (called a full face mask), but ordered an AirFit P10 which actually arrived FIRST when starting my CPAP therapy.

The P10 arrived first through good luck, and it's really been the only mask I have EVER NEEDED. (I tested two other masks a 2-3 nights each just to prove they COULD work if the P10 ever failed or my nose was too blocked to use it.)

However, when the puppy ate my mask and straps, I never even considered going to those other masks as backups -- I just made do by gluing the pillows onto the damaged P10 and covering the leaks with silicone cement. It wasn't pretty and it wasn't perfect but it was much better than using anything else even with my leaks near the acceptable threshold.

For about $100 you can try a P10 (or other pillow mask).