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+--- Thread: Newly diagnosed severe CSA & OSA (AHI=108) seek advice (/Thread-Newly-diagnosed-severe-CSA-OSA-AHI-108-seek-advice)
RE: Newly diagnosed severe CSA & OSA (AHI=108) seek advice - Dormeo - 02-13-2020
Liteheart1, congratulations on getting the machine you need!
You mentioned that you tend to be warm at night and that you haven't tried a pillow mask yet. You might want to consider the ResMed P 10, which is about as minimalist as they come. (The Bleep has no headgear at all but I wouldn't myself recommend it, though it has its major fans.) But honestly, everyone's faces and sensitivities are different, so you do just need to try options.
Your question about the trial period is a good one, but the rules on that can vary from one DME and insurance program to another. I would just ask the DME.
RE: Newly diagnosed severe CSA & OSA (AHI=108) seek advice - Liteheart1 - 02-13-2020
Thanks all for excellent tips and advice; not sure all are in current mask wiki (especially 2-step approach of hand fit first then if a "pass" strap up). My take aways so far:
Criteria for a good mask for me ...
1) Must deliver air withOUT leaks
2) see (1) as all else is frosting on cake
3) Learns from others; read reviews ... if someone has similar face characteristics (size, shape, sensitivity ...); sleeping position (especially side versus back versus all); and other criteria (small mask foot/face print; quiet; unobtrusive; doesn't over heat face; cost; etc.) then can help narrow the list to audition.
4) Pressure needs change for various reasons AND faces change due to allergies or seasonally with room temperature AND as a mask ages what might work well when brand new might degrade in fit for any of the prior things noted.
5) As one gets used to and more experienced with ASV, CPAP, etc. the type of mask (full, nasal, pillow) that you are willing to try might change. For many the mask game is serial monogamy.
Auditioning a mask ...
at DME:
A) under pressure and both sitting/standing and lying down (preferably with your own pillow perhaps especially important for side sleeper).
B) Use 2-step hand fit 1st and then uses straps
C) For a promising mask model also try different sizes of it or its variations (cloth versus silicone)
Proof is in pudding at home and results of at least several nights of sleep experience:
D) take notes on exp.; check overnight results; make minor tweaks and adjustments and continue use if still seems promising
RE: Newly diagnosed severe CSA & OSA (AHI=108) seek advice - Dreaming1 - 02-14-2020
The other guy might not recommend the bleep, but I would and have been using it since about May last year. If you apply it right it won’t leak. And you’ll have no straps to contend with and be free to sleep in any position you want, including stomach and not the mask slip out of place or tear up the inside of your nose like the p10 nasal pillows did me.
RE: Newly diagnosed severe CSA & OSA (AHI=108) seek advice - Gideon - 02-14-2020
Note that a properly fitted P10 should rest on, NOT in the nose.
RE: Newly diagnosed severe CSA & OSA (AHI=108) seek advice - Liteheart1 - 02-14-2020
Again thanks all. Pretty well set for the moment. I picked up ResMed 10 ASV on Feb. 13th only 7 biz days after sleep study. Unfortunately they didn't give me chin strap yesterday so will return to get that today unless the mail order one arrives today. Soon will be off and running/sleeping.
RE: Newly diagnosed severe CSA & OSA (AHI=108) seek advice - Dormeo - 02-14-2020
Keep us posted!
RE: Newly diagnosed severe CSA & OSA (AHI=108) seek advice - SarcasticDave94 - 02-14-2020
Congrats on getting your ASV. Please keep us updated on how the therapy is going. Post OSCAR data when available. As needed, we can assist in pressure setting optimization that almost always will be required. Best wishes for success.
RE: Newly diagnosed severe CSA & OSA (AHI=108) seek advice - Liteheart1 - 02-15-2020
First 2 nights ... off to pretty good start; also some ?s:
2nd night MyAir shows 0.6 events/hour which is huge change from 1st sleep study showing 108 AHI; and 2nd titration study showing 30.8 AHI but reduced to 2.6 during ASV titration. MyAir also shows Mask Seal as a 20 out of 20.
During 1st sleep study I was started on nasal mask but due to mouth breathing was switched to FFM which in that setting I found quite claustrophobic and also warm on the face. 2nd titration study used Wisp and under chin strap. My initial home approach will be nasal mask with chin strap (under the jaw lift such as Knightsbridge Cap) HOWEVER I only used ASV on 1st home night for 17 minutes as it felt weird and DME did not give me chin strap so I figured therapy wold be a bit useless that night. I practiced some the next day so was quite fine on home night 2 however with the over the head/under the chin strap I had bought (not Knightsbridge) I found it to be too much material and so for above results I did NOT have on a chin strap at all. While I have begun the tongue suck exercise and others to train consistent nostril breathing I expect that I do at least some mouth breathing.
1) How do you know that mouth breathing has occurred during sleep? Does MyAir really detect that and it shows up in their 4-part score? I will install OSCAR today and know that it is more detailed and preferred here so expect that OSCAR truly can determine that there has been mouth breathing.
2) I am wondering whether a FFM would be better approach for me. So far the Wisp nasal mask has fit well, seems comfortable, etc. but if I need chin strap which so far has felt like too much stuff on my face and cheeks, then perhaps a FFM would be one piece of gear and solve any issue about mouth breathing. I think my response to FFM during 1st sleep study was the unexpected shock (since I am primarily asymptomatic) of likely apnea diagnosis, the strange environment, and being wired up. I believe I might be able to be comfortable with FFM and at least have not ruled that out; also would not rule out Nasal pillows either. For now I think I will stick with nasal mask and try some chin strap as I expect that it is usually preferable to change treatment approach (equipment, settings, etc.) in small increments and one at a time in order to assess what is contributing to different results.
Given that I did not use chin strap is the MyAir result of 0.6 events per hour on 2nd night really to be trusted?
3) ASV CPAP pressure is only 5 per Dr Rx and titration study so is not intrusive. Climate is on automatic per DME with humidity having been set while in Manual by DME to 4, and hose set to 78 degrees. I sleep in a room temperature of 64 degrees. I woke up at night with slightly dry mouth and behind my lips next to my teeth (I suspect an indication of mouth breathing) and very slight dryness in throat. I read another thread indicating that over time one might simply get used to such slight dryness. I did this morning set the humidity to 5 and then put back in auto climate mode. I did not see any condensation in hose. Should I leave climate on auto for now?
I also have a soft cervical collar on order so that will be tool that I can add to the mix if warranted. Since as is a habit for me, I fell asleep last night in reclining chair and only moved to bed and ASV later and was on device for only 4.5 hours. I woke up this morning probably feeling somewhat less rested than typical even though apneas were seemingly much reduced. So subjectively the good news is that I adjusting rapidly to mask; but not feeling more rested and have yet to have both mask and chin strap together as successful experience. So I feel encouraged and tonight will only be night 3.
RE: Newly diagnosed severe CSA & OSA (AHI=108) seek advice - slowriter - 02-15-2020
On mouth leaks: on OSCAR, if you look at your leak chart, mouth leaks will show up as short periods of leaks. I would post a screenshot, but I've run into a bug that won't let me.
RE: Newly diagnosed severe CSA & OSA (AHI=108) seek advice - SarcasticDave94 - 02-15-2020
On OSCAR and mouth breathing, it's something that's seen by data interpretation. So don't expect some kind of event flag or such like.
Climate Auto: that's your choice for maximizing comfort. You can easily switch it to manual and see if you prefer that. Comfort settings focus on the obvious maximizing comfort, so it shouldn't hinder apnea therapy.
When you get data to us, I'll suggest running ASV in Auto Mode. I have a clue in your left panel info that you're set on ASV mode. With ASV Auto you gain an EPAP range not a set EPAP.