New results with Dreamwear gel pillow mask

[booksfan]

I tried the Dreamwear with pillows last night. I did have fragmented sleep, a problem both before and since starting CPAP. I did drop back to sleep quickly, however, which IS an improvement! The strap kept slipping up the back of my head and I felt like I had to keep adjusting the mask. Which, actually, seems to be borne out the data--a very leaky night (for me). However, a great AHI! Are the leaks from last night high enough and/or long enough that I need to worry about them? I've only been using CPAP since mid-Jan so I'm still fairly new to all this.

I have a small head, so am using the small headgear. I *may* have tightened it a little too much, because my nose (which is sensitive to pressure) was a bit sore this morning. I will try loosening the straps a little tonight. It's just that the mask felt so loose on my face last night.

I am open to any suggestions, for leaks, keeping strap down, etc. The strap riding up is a recurring problem, no matter what mask I use. Part of the issue is that my hair is silky fine and slippery, but when I look at mask fit pictures, I am beginning to think my ears are too high on the sides of my head! The straps rub/ride on the tops of my ears and seem to want to sit a little lower down <sigh>.

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[Pugsy]

The leaks aren't anywhere near high enough to negatively impact the therapy itself.

The worst it got to was a little under 17 L/min ad you weren't up there for very long anyway. 24 L/min is ResMed's line in the sand but even that is a real conservative number. From personal experience I found the machine was fairly accurate in both response and reporting up to around 35 L/min. Over that and things got a bit iffy but again only iffy during the time deep into large leak territory.

First night with a new mask has always been rather challenging for me. Getting the tension just right and wearing something new that my body isn't accustomed to. I always wake often the first night with a new mask just fiddling with things so unless I really don't hold much chance for it working out well I will usually give a new mask at least a week trial before I form much of an opinion about the mask.
The one exception was the Respironics Wisp mask...lasted 90 minutes one night with it and I said I would never let it touch my face again and I haven't. Hated it.

[Hopeful50]

If your hair is long enough, put it in a ponytail and run the strap below the ponytail. If your hair is too short for that, you could try a barrette or sort of hair clip hold the strap in place. Some have found that putting a bit of velcro on the inside of the strap helps keep it from sliding.

[booksfan]

So I've still been having really fragmented sleep and problems with the backstrap. I decided to try a ponytail again (short hair!) the 4th time I woke up Tuesday night as I am almost due for a haircut. Lo and behold, although it slipped up a bit and the bottom half of my hair fell out, the strap needed no adjusting! Hallelujah! Worked a like a charm last night, only had to redo the ponytail once (when I had a major wake up), no other backstrap adjustments (yay!) and I had my best night in a long time. I am attaching both charts.

I do have a question. I know the AHI last night at .74 is great and even the night before a 2.66 is OK, but I am still not clear on what, if anything, I need to do about my flow limitation. They seem to be all over the place.

Thanks!

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[Mikebear]

Flow Limitations are considered more or less the start of apneas. So, you typically need a bit MORE pressure to fight them.

I'd turn off Ramp, and maybe try setting EPR = 2 (or even Off) and see what happens. If you don't want to turn off Ramp, set the start pressure to at least 9.

[Pugsy]

I am still not clear on what, if anything, I need to do about my flow limitation. They seem to be all over the place.

How is your nose? Are you having much/if any nasal congestion going on.
If you are having some nasal congestion then part of the FLs could be the nasal congestion and not much the machine and pressure can do about it.

But if your nose is clear then it's possible that the airway is trying to collapse and trying to collapse to a point where the air flow gets reduced but it doesn't make it collapse badly enough to earn an apnea or hyponea flag. The fix is more pressure but if you are sleeping good and feeling good then I don't know that I would necessarily go increasing that pressure. There's no urgent need to kill all FLs if they aren't growing up to earn the apnea/hyponea flag.
Now if your sleep is disturbed and you don't feel so great then maybe trying to kill those FLs would be worth investigating to see if it helps your sleep quality and how you feel.

In your case that would likely mean changing the minimum from 11.6 to something higher and based on where the machine is wanting to go when you see those FL spikes....maybe around 13 minimum or even more.
It doesn't seem to be hitting the max of 16 so increasing the max won't likely help. More minimum to better hold the airway open in the first place is the preferred way to go.

Some of it might be related to REM...some might be related to being on your back...or maybe a combination of both.
Assuming it's not nasal congestion FLs.
If it's nasal congestion you need to work on the nasal congestion side of things...more pressure doesn't usually help with nasal congestion FLs.

[booksfan]

I am still not clear on what, if anything, I need to do about my flow limitation. They seem to be all over the place.

How is your nose? Are you having much/if any nasal congestion going on.
If you are having some nasal congestion then part of the FLs could be the nasal congestion and not much the machine and pressure can do about it.

But if your nose is clear then it's possible that the airway is trying to collapse and trying to collapse to a point where the air flow gets reduced but it doesn't make it collapse badly enough to earn an apnea or hyponea flag. The fix is more pressure but if you are sleeping good and feeling good then I don't know that I would necessarily go increasing that pressure. There's no urgent need to kill all FLs if they aren't growing up to earn the apnea/hyponea flag.
Now if your sleep is disturbed and you don't feel so great then maybe trying to kill those FLs would be worth investigating to see if it helps your sleep quality and how you feel.

In your case that would likely mean changing the minimum from 11.6 to something higher and based on where the machine is wanting to go when you see those FL spikes....maybe around 13 minimum or even more.
It doesn't seem to be hitting the max of 16 so increasing the max won't likely help. More minimum to better hold the airway open in the first place is the preferred way to go.

Some of it might be related to REM...some might be related to being on your back...or maybe a combination of both.
Assuming it's not nasal congestion FLs.
If it's nasal congestion you need to work on the nasal congestion side of things...more pressure doesn't usually help with nasal congestion FLs.

Interesting...I noticed when I got up around 4 (not 3, I didn't change my time setting ) that I DID have some congestion on the right side. It cleared up quickly, within a few minutes and I was breathing freely on BOTH sides when I put my mask back on.

I sleep is generally disturbed. Last night is one of the few nights I have slept more than a couple of hours stretch with minimal arousals. Usually I wake up and lie awake for extended periods of time. In fact, I decided, within the last week or so to mark those periods by stopping the machine so my doctor could see exactly how disturbed my sleep still is. I go see him next week.

I will raise the pressure again. I've been inching my way up toward 12. When I initially started raising it, I had some trouble with air puffing up my cheeks and blowing out my mouth, so I am being cautious with the increases, moving slowly, with a few days in between.

Thank you for the advice!

[booksfan]

I was just looking at my Sleepyhead statistics and was shocked to see that my first 18 days on xPAP my AHI averaged 0.79! It rarely if ever gets that low! I did a lot of trying different masks and reading in bed with the mask on to get used to it when I was starting out and I have fragmented sleep. But I would love to get my numbers that low again!

Since then, changes I've made are adding EPR, increasing minimum pressure to help with flow limitation, and decreasing maximum pressure. Could those changes account for the higher AHI numbers? I can't see how decreasing the maximum pressure could have a negative impact since I don't get up that high. Should I try reducing or turning off EPR? My initial, knee-jerk thought was to put things back as they were and see if I got the same results! But that doesn't really seem like the best route to take. Thoughts?

I am attaching a screenshot of the statistics page.

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[Pugsy]

Where or how is your sleep quality and how you feel evaluated in all this?

Why did you start changing things in the first place?

What are your goals?

Adding EPR does effectively reduce the pressure averages being used but you increased the minimum to offset that change.
And you are correct...reducing the maximum doesn't do much if you never ever got near the max anyway.

[booksfan]

Where or how is your sleep quality and how you feel evaluated in all this?

Why did you start changing things in the first place?

What are your goals?

Adding EPR does effectively reduce the pressure averages being used but you increased the minimum to offset that change.
And you are correct...reducing the maximum doesn't do much if you never ever got near the max anyway.

My sleep is fragmented. I still wake up several times each night, but at least I only have to get out of bed once (to go to the bathroom). It used to be 4-6 times per night! Some nights I am able to adjust the mask/headgear and go back to sleep, but some nights I lay awake for hours. There doesn't seem to be any rhyme or reason. I wake up exhausted. I can't remember the last time I slept through the night, could be 10 or 15 years ago!

My goal is to have a consistent AHI <1, to sleep through the night, and to wake feeling rested.

I increased pressure to try to control flow limitations. I was told my pressure setting of 8 was too low. At the time my median pressure was around 11 or 12, 95% pressure around 13. So I've been inching up. My initial increase from 8 to 10 caused my cheeks to puff out and air to puff out of my mouth, so I wanted to take it slowly. I added EPR (another suggestion) to see if that would increase my comfort level, and it did.

I did turn EPR off last night, leaving everything else the same. I was only able to actually sleep until about 3:30, waking briefly a couple times. I was unable to go back to sleep, not because of CPAP, but because of an upsetting evening. But my AHI for that part of the night was amazing...0.24! Zero OSAs, 2 Hypopneas. I am hoping tonight will be a calmer night and give as good a result.

[Pugsy]

Okay.
Be careful.
An AHI below 1.0 doesn't guarantee we will sleep through the night or wake up feeling like we want to feel.
Believe me I have lots of first hand experience in that area. As much as we want cpap to fix all our problems it doesn't always work out that way if our problems aren't caused by sleep apnea.

I don't blame you for trying though....been there and done that myself and how I learned.

[Holden4th]

Last night is an example of what Pugsy is talking about. I woke up after 3 hours sleep and knew I wasn't going back to sleep in a hurry. However, I do have a trick that helps this process - a peanut butter sandwich. Getting back to sleep took time (about 30 minutes) and while drifting off thought I'd feel a bit bad in the morning. When I woke, while I'd have liked a bit more sleep, I was OK

I put the SD card in and looked for the SWJ during the get back to sleep time and it wasn't there.

Other nights can appear better but I don't feel as good. It's all part of the PAP process.