tbhausen - Therapy Thread

[tbhausen]

Howdy! Last night was my first night at home on BiPAP. I was diagnosed with severe OSA almost four months ago after home and lab sleep studies. I tested at 48.3 AHI. The whole process of getting me on a machine (AirCurve 10 VAuto) finally ended yesterday. I chose an AirFit F30i mask (standard frame, medium cushion) during my fitting (note: Indiana University Health has been good, including dispensing DME, though my insurance [CareSource] is only covering 50%). Mask check looked pretty good in the office.

I awoke this morning feeling pretty wired--like I'd gotten an unusually good night's sleep   

I was surprised to see high mask leakage in the morning, though. I had Leak Alert turned on but didn't hear any alarms. I've attached my OSCAR charts showing everything that was on by default (two screens). I think an AHI of under 3 is a pretty good starting point, but I have to get the mask working better. Beyond that, as I'm quite new here, your thoughts and insights are appreciated.

I will also post screenshots from a period of typical rest, and another of the time leading up to one of the few OA events I had.

[tbhausen]

Here's a period of normalcy (with high mask leakage) at about 2:30 AM:

[tbhausen]

Here's one of the few OA:

[gainerfull]

Welcome to the board - I'm not a huge fan of the hybrid masks precisely for the leaks you're experiencing.

I'm hesitant to recommend any changes until you get your leaks under control. To save yourself some time - have you considered a simpler full face mask? I use a Resmed F20 and can consistently get 95% leak rate to 0.00 and highly recommend it if you can tolerate it.

[tbhausen]

Thanks... I'm a side sleeper. Would the F20 work OK for that?

[LazyBones]

Howdy! Last night was my first night at home on BiPAP. I was diagnosed with severe OSA almost four months ago after home and lab sleep studies. I tested at 48.3 AHI. The whole process of getting me on a machine (AirCurve 10 VAuto) finally ended yesterday. I chose an AirFit F30i mask (standard frame, medium cushion) during my fitting (note: Indiana University Health has been good, including dispensing DME, though my insurance [CareSource] is only covering 50%). Mask check looked pretty good in the office.

I awoke this morning feeling pretty wired--like I'd gotten an unusually good night's sleep   

I was surprised to see high mask leakage in the morning, though. I had Leak Alert turned on but didn't hear any alarms. I've attached my OSCAR charts showing everything that was on by default (two screens). I think an AHI of under 3 is a pretty good starting point, but I have to get the mask working better. Beyond that, as I'm quite new here, your thoughts and insights are appreciated.

I will also post screenshots from a period of typical rest, and another of the time leading up to one of the few OA events I had.

   Welcome aboard, you are new to this world of assisted respiratory sleep. It takes time to get everything adjusted. I have been through several different mask & pillow styles, everyone of which were leak tested and fitted in the clinic. But after I got home I found that in real world sleeping they leaked. I had to readjust head gear to get a reliable nights sleep, "Leak Free".

  I currently use a medium wide DreamWear full face cushion with a medium headgear, very similar to the AirFit F30i mask, which I have used in the past. That style is very good for side sleepers who roll around through out the night. Because the mask does not protrude out from the face like the  ResMed AirFit F20, which I enjoyed for awhile, then moved on to a different "over the nose style", Then I tried several nasal pillows, Then to the hybrid style FFM.  The low profile hybrid FFM is less likely to leak for me. (at this time)

   Over the last ten years of CPAP I have learned that you have to  get rid of the mask/pillow leaks. Head gear adjusted to the Goldilocks standard.
   Not too loose you'll leak, making noise all night, bother the people you sleep with, but the dogs still love you, your Oscar AHI scores may be in the OK range, but they can get better!
    Not too tight, you will get sores on your nose and face, and regret cinching up that last little bit of adjustment you made last night, because it will take forever to heal!. You look funny too, everyone is staring at you, but the dogs still love you.
     Then finally you find that sweet spot . No  leaks, no noise, People love you, dogs still love you. But most of all it felt like you spent your night sleeping on an Angle Food Cake, Oscar shows you had no leaks!  Yeah  Now mark the adjustment tabs with ink so you can find that sweet spot again. Because
over the next month that elastic head gear is going to relax and stretch so you will have to readjust your headgear straps, it is a good thing you marked them so now you know where to start adjusting from. Once you find that new sweet spot, mark it again. 
   Now as your body adjusts to therapy the good people here will help you fine tune your therapy to resolve any developing issues. 
  I found as I adjusted to therapy, felt refreshed and re-energised, became more active, did more, got out more and lost weight, Damn mask, no longer fit my face! I really liked that mask, but had  to move on and try something different.
   Over the years I have accumulated a tote of spare mask that I on occasion I retry, but for the last two years I come back to my Dreamwear hybrid FFM. 

    That AirFit F30i is a good mask, give it a break in period, both you and the mask. If you jump to different style of mask too often you will not have  given the equipment sufficient time to get adjusted properly.

   Sleep Well, my friend.
   

 

[tbhausen]

Thanks, LB!

Masks are such a pain! I was given the medium F&P Evora I used during my titration study, so I decided to try that last night. Had to cinch it on really tight to control leaks, but night #2 was AHI of 0.55 with under 6% mask leakage over redline. I went back to my DME and we tried a bunch of masks, including a large Evora, F20 with both silicone and memory foam in medium and large, and a wide cushion F30i (mine was a medium). Everything I tried leaked into my eyes along the sides of my nose except the wide cushion F30i, so I traded in my medium cushion F30i for that. I know my medium F&P Evora can work, but it has to be uncomfortably tight to do so. We'll see how a better-fitting hybrid does next.

[tbhausen]

Well, last night was a disaster. One step forward and three steps back. The mask that didn’t leak during fitting did while I was trying to sleep. I got the bright idea to put a Breathe Right Strip on my nose to flare it out and try to help with the leakage. That seemed to be working, but I woke up in the middle of the night to terrible stats (high AHI) and nose pain. Changed back to the Vitera (I was previously referring to Evora, but it’s been Vitera all along) and the stats recovered slightly, but I still didn’t sleep well. Might just run the Evora over the weekend and see if I have as good night as I did the second night. The thing has to be killer tight on me but at least it seemed like it worked.

[Sleeprider]

tbhausen, if you'd like to be a bit adventurous, we can find settings that are more comfortable and effective for you, and that may help you with leaks by cutting back on peak pressure. What I'd like to do is to utilize the Vauto titration feature on your device to see where we really need to be to prevent OA and perhaps even reduce the few CA events. Mostly, this "experiment" is to identify a comfortable pressure range that is effective. If you want to play along, these are the settings:
Mode: Vauto
EPAP min: 9.0
Max IPAP: 18.0
PS: 4.0
Trigger sensitivity: High
Cycle sensitiviy: Medium
TiMin: 0.3
TiMax: 2.5

[tbhausen]

I appreciate that. I’ll run the Vitera over the weekend to see if I get back to results similar to the second night, then give that a try.