Renamed: DurtGurl's adventures in therapy

[DurtGurl]

I was diagnosed last summer with sleep apnea. During this time of COVID, all visits to the respiratory therapists have been by phone only. I have been through three versions of ResMed mask and all end up leaking horribly around my cheeks. The most recent, the Airtouch F20, felt good when I went to sleep but woke me up with cheek flap many times and had slid up to cover the corners of my eyes. I adjusted and readjusted the straps but the result was always the same. I'm starting to think that maybe ResMed masks are designed for wider faces and since the therapist has not seen me in person the mask fit has never been optimized. Has anyone else fought with this problem and found a solution? I am a 58-year-old woman, a fit 150 lbs, with an angular thin face. I had the min mask pressure at 6 and the max at 13. I'm also a mouth breather who is willing to tape up my mouth if that is what it takes.

Different mask brand? Different size? Change the pressure settings? The new Airtouch F30, used for the first time last night, actually showed very little leaking but when it leaked it was an instant wake-up.

[ChicagoGranny]

Different mask brand? Different size? Change the pressure settings? The new Airtouch F30, used for the first time last night, actually showed very little leaking but when it leaked it was an instant wake-up.

Was it the ResMed AirFit F30?

Find the exact mask on youtube and watch three or four videos on fitting and adjusting. Some of the videos are quite good.

[LSAT]

If you have a mask you like..ie F20...go to padacheek.com. They have custom mask cushions. If you don't find what you want, ask for Karen, the owner. She is a member of this board. I think if you increase your minimum pressure to 7, you might bring your AHI down a bit.

[Miss Emerita]

I know you're asking about leaks, but I agree with LSAT that your AHI also needs some attention. At 7.7, it is too high. It looks as though your pressure maxes out for much of the night at your max pressure setting.

Could you posted a chart that is revised to show just these graphs:

Events
Flow rate
Pressure (not mask pressure)
Leaks
Flow limitations
Snores.

Don't include MV or TV or any of the other graphs. That will make it easier to see the key ones I've listed above.

[zonker]

is it possible for you to stay in one thread, please? kind of hard to keep up with your past.

thank you.

as to the current post, i agree with what has been stated. youtube for mask fitting videos.

increase minimum for better ahi. however, that won't mean much if your leaks keep waking you as you say they do. so would be great to get them under control first.

also, have you tried a nasal pillow mask like the P10?

[DurtGurl]

I know you're asking about leaks, but I agree with LSAT that your AHI also needs some attention. At 7.7, it is too high. It looks as though your pressure maxes out for much of the night at your max pressure setting.

Could you posted a chart that is revised to show just these graphs:

Events
Flow rate
Pressure (not mask pressure)
Leaks
Flow limitations
Snores.

Don't include MV or TV or any of the other graphs. That will make it easier to see the key ones I've listed above.

Sure thing! Let me note that the night started in CPAP mode at a pressure 9 while I was reading (not an easy task with the new FF mask!). I then set it to AUTO mode with min:max of 6:15 before I drifted off to sleep. After a bunch of leaks that don't seem to show up on OSCAR, I then set it to 6:13 where things were okay for a while until more cheek flapping caused me to remove the mask.

What does the Flow Limit graph demonstrate??

[Miss Emerita]

Flow limitations are like baby hypopneas. The muscles lining your airway relax and limit the flow of air to some extent. You then have to work harder to complete your efforts to inhale. For some people, FLs are not really any kind of bother; for others they are.

Your FLs are pretty significant for a fair part of the night, and they are driving your pressures up. The introduction of EPR (expiratory pressure relief) may help with the FLs and possibly also the hypopneas and RERAs (respiratory effort related arousals).

If you want to try an experiment, set your EPR at 3. This will produce a difference of 3 between your inhale pressure and your exhale pressure. To make sure your exhale pressure stays where it is, you'll need to increase your minimum pressure by 3. So the other part of the experiment would be to reset the minimum to 9.

If you try this experiment, I would recommend making no other changes so you can see more clearly what effect this change has. And pick a maximum and stick with it. Maybe 13, since that went better for you.

As you work on the leaks, try putting the mask on during the day. Take the SD card out of the machine. Lie down and hook yourself up to the machine, setting the pressure to, say, 13. Imitate what you probably do at night by way of sleep position and turning over. When you notice a leak, make a little mask adjustment to see if it works. (Be sure to put your SD card back in when you're done.)

If you want to try the nasal pillow route, then yes, you can tape your lips closed. You may also want to use a soft cervical collar to keep your jaw up, if it tends to drop. Nasal pillows can leak too, but the leaks may be less likely to annoy you, since they are less likely to blow on your eyes or cheeks. A lot of people like the ResMed P10; it is a minimalist mask. You'd want to be able to try all three pillow sizes. The "for her" headgear is for smaller heads.

But with luck, you'll get your current mask to fit better, and you'll start sleeping more soundly, which might prevent leak-related arousals.

[Okie bipap]

You need more pressure. Your machine is maxing out at its upper limit and wants to go higher to control your events. I would start with a minimum of 10 and max of 20 and see where it needs to go in order to control your events.

[chunkyfrog]

One question: Are you a "mouth breather" in the daytime?
If you breathe through your nose naturally while awake, the mouth breathing could simply be a habit,
born out of your apnea.
Many people are pushed into a full face mask, even though they could easily use a nasal mask or nasal pillows.
Sometimes it's ignorance--sometimes greed.
Decide for yourself.

[DurtGurl]

You need more pressure. Your machine is maxing out at its upper limit and wants to go higher to control your events. I would start with a minimum of 10 and max of 20 and see where it needs to go in order to control your events.

But at higher pressure the leaks at my cheeks. It's a catch-22...

[chunkyfrog]

With a mask liner (like Padacheek), the excess air sneaks out quietly, letting you sleep.
Mask liners do not improve leaks--they shush them--but that might be enough.

[DurtGurl]

If you want to try an experiment, set your EPR at 3. This will produce a difference of 3 between your inhale pressure and your exhale pressure. To make sure your exhale pressure stays where it is, you'll need to increase your minimum pressure by 3. So the other part of the experiment would be to reset the minimum to 9.

If you try this experiment, I would recommend making no other changes so you can see more clearly what effect this change has. And pick a maximum and stick with it. Maybe 13, since that went better for you.

You need more pressure. Your machine is maxing out at its upper limit and wants to go higher to control your events. I would start with a minimum of 10 and max of 20 and see where it needs to go in order to control your events.

Thanks for all the comments yesterday! I followed Miss Emerita's advice and used EPR at 3 with min pressure at 9 and max 13. I also watched the few videos I could find on mask fit and went out and bought some face cleaning wipes (instead of just cleaning with soap and water) and non-alcohol sanitizing wipes for the memory foam mask. NO CHEEKS LEAKS!!!! It also looks like the flow limit went down. However, my apneas were super active and the pressure was maxed out during those periods at 13. And holy moly, that period between 2 and 3 in the morning looks like I was in apena more than I was breathing!!! I will try leaving all the same but raising the max pressure tonight to 15 or 16 (20 seems like too big a jump) following Okie bipap's advice.

[DurtGurl]

One question: Are you a "mouth breather" in the daytime?
If you breathe through your nose naturally while awake, the mouth breathing could simply be a habit,
born out of your apnea.
Many people are pushed into a full face mask, even though they could easily use a nasal mask or nasal pillows.
Sometimes it's ignorance--sometimes greed.
Decide for yourself.

I am not a mouth breather during the day. but boy is my mouth all dried out after a night with the FF mask. My next step in the experiments after raising the pressure will be to tape my mouth within the FF mask to see if apneas settle down.

[DurtGurl]

is it possible for you to stay in one thread, please? kind of hard to keep up with your past.

thank you.

as to the current post, i agree with what has been stated. youtube for mask fitting videos.

increase minimum for better ahi. however, that won't mean much if your leaks keep waking you as you say they do. so would be great to get them under control first.

also, have you tried a nasal pillow mask like the P10?

Sorry about opening a new post, zonker. I will stick to this one from now on as I sort out my troubles. The nasal pillow masks are the one type I have not tried yet. I see how they would help with a thin face as they only touch at the nasal holes. But, good face cleaning with the AirTouch F20 minimized the leaks last night so I will stick to that one as I increase pressure to control apneas.

[Miss Emerita]

Well done on the leaks! The cluster of obstructive apneas suggests to me that you may be tucking your chin down toward your chest part of the time, which narrows the airway and makes it easier for relaxed tissues to produce OAs. There's also a bit of clustering in an earlier chart.

You might want to try using a soft cervical collar at night to see if that makes a difference. Or if you use a high pillow, try using a flatter, firmer one. Keep us posted!