ASV setting and mask leaks

[Weagle]

I received my formal diagnosis for Complex Sleep Apnea (central and obstructive) recently and finally got prescribed a CPAP/ASV machine which I picked up about 3 weeks ago. I've been fumbling through this whole process and am on my 2nd mask but still having some issues and wanted a little insight. I know this is a bit long, but any advice is appreciated.

First, my list of problems:

1) Apparently I'm a mouth breather. While I don't normally breath through my mouth it does happen occasionally as night which totally throws off my therapy with the machine. The sleep tech who did my 2nd sleep study recommended the nasal pillow because it worked well for me for the 2-3 hours I used it that night. Well what works for a couple hours didn't work all night. After about 4-5 hours, almost every night, I open my mouth and either i wake up with a dry mouth of my wife elbows me because the air escaping woke her up. I picked up a chin strap to see if that would help, and it did for a night or two, but then my lips would open and I'd be back where I started. So I went back to my DME for a full face mask.

2) Not only am I a mouth breather, my jaw relaxes and breaks the seal on my full face mask. After my wife's lack of sleep, I managed to get an appointment with my DME to get a new mask. I explain ed the issues and they recommended the DreamWear Full Face mask. I had done some research on my own and thought that sounded reasonable. We did a test fit there in the office. it had to be snugged down a bit to handle the higher pressures but the seal worked fine and it was comfortable. I even tested it in a laying down position to ensure it would work. That night everything went great. The following night however, I woke up with a slightly dry taste in my mouth and I discovered that I was still opening my mouth, but my jaw was also relaxing and moving backwards away from the mask, breaking the seal. I tightened the straps a little further and finished out the night. The same think continued to happen. Next I tried the chin strap with the full face mask. This seems to work, but it brings up other concerns.

3) Chin Strap and Full Face mask issues #1. If I put my chin strap on first, the frame is a bit snug around my head (not intolerable, but noticeable). In order to get a good seal on the mask I have to put the chin section of the strap over the lower portion of the mask. This is good for a couple reasons. It keeps the mask seal in place when my jaw relaxes backwards. Overall this is a pretty good solution for mask fit. <except for the issue about bloating mentioned below>

4) Chin Strap and Full Face mask issues #2. If I put the mask on first, then the chin strap on over top of the mask, I'm concerned about pressures. In order to keep enough pressure to keep my jaw closed, I have to snug down the chin strap quite a bit. My concern here is that it pinches off the side tubes of the DreamWear Full Face mask. I'm concerned that I may not be getting adequate pressure to get the treatment I should have. I know it's not pinching off the entire air supply since my machine isn't complaining about a blockage, but I'm still concerned. Is this solution really working, or is it just hindering my machine from sensing what I'm actually doing through the night?

5) Chin Strap and Full Face mask issue #3. When I use both the chin strap and the full face mask the chin strap tends to push the mask up against the bottom of my nose. great ofr keeping the seal, but the nasal opening rubs up against the bottom of my nose making a small sore appear. I've since taken things into my own hands and cut the nasal opening so it's larger and doesn't rub. I'm not sure what the Dr will say, but it's still sealing and no longer rubbing and creating sores. Was I wrong to modify the mask? Maybe I can post photos later (once I figure out a method to do so).

6) Aerophagia. Every night I either wake up bloated. This usually happens after 4-5 hours on the machine. I tend to get to bed between 9 and 10 and usually wake up between 2 and 3 due to bloating. I've checked SleepyHead and these events tend to happen after I've had some apnea's and the machine pushes my pressures to the max of 25. The only exception is when I wear the chin strap over the mask (pinching off the air supply). During those nights either the machine isn't detecting my apnea's or the lower pressures are helping me sleep better.

7) Trying to find who can change my CPAP/ASV prescription. My last issue is trying to find someone to talk to in order to work through my issues. I called my DME who pretty much told me they can't do anything without the prescribing Dr's orders. I call my prescribing Dr (my ENT) and he isn't comfortable making changes, it's not his specialty. His prescription pretty much just said to do what the Analyzing Dr recommended from my sleep study tests. I called that Dr and he won't make any changes unless I'm under his care. In order to get under his car (which I'm working on doing), is to go through their new patient procedure and the next available appointment was 2 weeks out. This is quite the hassle to manage the therapy I'm already receiving.

[ChicagoGranny]

Hmmm. Where to start?

Try this. Click on the Edit Post button. Change the subject to ASV Change Settings and Mask Leaks.

[Weagle]

Done

Hmmm. Where to start?

Try this. Click on the Edit Post button. Change the subject to ASV Change Settings and Mask Leaks.

[ChicagoGranny]

the machine pushes my pressures to the max of 25

Quite a few of us wear firm foam cervical collars. These help to keep the neck in the best position for airway patency. Since starting to wear a collar five or six years ago, my pressure now maxes out at 12 or so. Without the collar, it was hitting 18 or 20 almost every night.

The collar also helps prevent jaw drop.

I prefer the DMI Firm Foam Cervical Collar in 4-inch width. You might want to start out with 3.5-inch collar in firm foam. https://www.walmart.com/search/?query=d ... lar%20firm

[ChicagoGranny]

You can change the machine settings yourself. I'll let one of the ASV users help you with that.

Let's get the settings and mask problems corrected and then see how the aerophagia is proceeding.

[dubito]

I use an ASV machine with the DreamWear mask and nasal cushion. To prevent mouth leaks, I tape my moth shut using 3M Micropore tape and wear Dr. Dakota's soft cervical collar. I initially tried using a chinstrap, but it actually applied a backward pressure to my jaw, which caused problems. And after a few months, I'm now able to consistently keep my tongue pressed against the roof of my mouth while I sleep, which helps to prevent mouth leaks.

I also suffer from aerophagia, if I happen to sleep a lot on my side. I haven't found a solution, but I'm willing to trade bloating for quality sleep.

[ChicagoGranny]

And after a few months, I'm now able to consistently keep my tongue pressed against the roof of my mouth while I sleep, which helps to prevent mouth leaks.

Weagle, don't overlook this. It may not solve your problem, but it is still a good practice to adopt.

[Weagle]

I'm hoping that once I'm more comfortable with everything and get into a stable pattern that I will eventually be able to go back to the nasal pillow mask instead of a full face. I believe I breathe out of my nose 90%+ of the time, I just need to resolve some of the other issues before I get to that point. I'm a little reluctant to do the mouth taping...not sure if that would help with my jaw dropping anyways. Maybe a cervical collar of some sort would help.

[zonker]

I'm hoping that once I'm more comfortable with everything and get into a stable pattern that I will eventually be able to go back to the nasal pillow mask instead of a full face. I believe I breathe out of my nose 90%+ of the time, I just need to resolve some of the other issues before I get to that point. I'm a little reluctant to do the mouth taping...not sure if that would help with my jaw dropping anyways. Maybe a cervical collar of some sort would help.

i, too, use a cervical collar. as CG said, it helps with the airway and it also helps keep my jaw from dropping. you mentioned upstream here that your lips still part and that allows air in. instead of mouth taping to solve that, may i offer an alternative?

viewtopic/p1089718/viewtopic.php?f=1&t= ... s#p1086296

i am very grateful to jay for posting this. i'm a big believer in this method. it has helped me out tremendously. i use a nasal pillow mask and this works in conjunction with that. i have NO idea if it would work with a full face mask.

good luck!

[Weagle]

I believe my lips and mouth pop open due to the aerophagia. I swallow air and occasionally burp. I believe it's during these events that my mouth/lips pop open to let the gas out and then the floodgates open from the CPAP/ASV pressures. I'm hoping that when I meet with the Dr in a couple of weeks that they can lower my pressures a little and solve a majority of my issues.

Without the extra pressure, maybe I won't get so bloated, which in turn will stop me from opening my mouth which means I can use my nasal pillows again. <I'm praying it's all that simple.>

[zonker]

I believe my lips and mouth pop open due to the aerophagia. I swallow air and occasionally burp. I believe it's during these events that my mouth/lips pop open to let the gas out and then the floodgates open from the CPAP/ASV pressures. I'm hoping that when I meet with the Dr in a couple of weeks that they can lower my pressures a little and solve a majority of my issues.

Without the extra pressure, maybe I won't get so bloated, which in turn will stop me from opening my mouth which means I can use my nasal pillows again. <I'm praying it's all that simple.>

well, let's hope it's just that then.

good luck!

[Weagle]

I finally got in touch with a local Dr willing to work with me on the settings on my ASV machine. After my appointment yesterday they dropped my EPAP pressures from 10 to 5. Last night I didn't wake up bloated like so many nights before. Unfortunately my AHI went from an average of below 1.0 to about 1.5 last night. I've had previous intermittent nights above 1.0 before so I'm not concerned yet. I'm supposed to give it a week and then follow up with the Dr. If that doesn't stop my aerophagia, then there was talk about taking me off ASV mode and moving to some other mode (auto something...maybe ASV Auto?) that would require even closer monitoring.

My previous settings were:
EPAP 10.00
Max IPAP 25.00
PS Min 3.00
PS Max 15.00

I didn't screenshot the updated settings, all I know is that they told me they dropped the EPAP from 10 to 5.

Either way, I'm happy to finally find someone locally to help manage this machine. I think it's a joke to prescribe this kind of therapy and not give you someone to work with from Day 1. It took me over a month to find someone local to work with in person. Don't get me wrong, I love the advice I get here. There's a wealth of knowledge on these boards.

[Okie bipap]

The main criteria is how you feel. If you are sleeping well and feel rested in the morning, don't worry about the actual AHI value. I really can't say I feel any different if my AHI is 0 or 3. For me, it is just a matter of being slightly OCD and I felt a need to try to get as low as I can, not because I feel better physically, but just to prove I could do it.