This isn’t a solution but a possible line of inquiry. At that hour, you are likely to be experiencing REM Sleep during which you may need much higher pressures.
Check your sleep study. If done in a lab, that number may be broken out separately. (My overall AHI was 19, but during REM it was 83.)
If you are experiencing apneas during REM due to the higher pressure needs, what would happen to the nasal pillows? Could the vacuum effect of an apnea make them collapse? I use a nasal mask, personally, and not the pillows, because they always felt too claustrophobic, but people who use them may have some other ideas….
I use the same machine and mask, and have not really had those issues. About the only basic thing I see different in your setup is that I put my humidity control on Auto. That should be the default setting. I find it works well and I have never had rainout other than once when I moved the machine perhaps a bit roughly when it was full of water. That certainly caused some gurgling and water carryover. I had to get up and dump the water out of the hose!
I have had something similar to what you describe was when I was first using this P10 mask and used a nose cushion that was too small and went too far into my nostrils. I find you get the most comfort and best function when using the biggest nose pillow size that still seals. Also, excessive tension in the headgear may be causing the nose cones to go too far in, causing them to collapse.
What is your EPR set at? The lowest exhale pressure will be when it is set at 3 cm.
Another thing you can do is download OSCAR. With OSCAR you can see what is happening during the night in breath by breath detail. It requires a PC or Mac and a SD card reader. If you need help using it or interpreting the results just post, ideally with a screenshot of the Daily Report of a night. You can zoom in on the areas of concern to see the real detail.
Hope that helps some,
Thanks for your thoughtful replies. I am waiting for delivery of a SD card reader and will see if OSCAR can help me figure this out. At first, I tried the extrasmall P10 pillow “for her”, which eroded my nasal septum. I have been using a small P10 pillow, since I tried the medium 2 months ago and lasted only 8 minutes with a medium with REMZzzs before my nose hurt and had to switch back to a small. I had previously used the automatic climate setting, but had turned the humidity down a notch in the hope that there might be less condensate in the cones — literally only 2 droplets. Never true rainout. But maybe enough surface tension to stick. Weirdly, when an exhalation blockage woke me up several mornings, I was able to break through with first a short inhalation followed by a forced exhalation. But it recurred intermittently while I was awake— so I don’t think this is a REM apneic-inducedvacuum effect. The RT had me switch to a Nuance— and it was even worse— an inhale- exhale could not blow through it. So I went back to the P10 …It’s only occurred 15 out of 63 nights used.all things considered , it’s been much less of a problem than the 6 other masks(2sizes of DreamWear, Airfit 30, Airtouch F30, F20, Brevida,Nuance) I’ve tried. But it’s got everyone baffled. I’ll post if I come up with something. & appreciate any other thoughts anyone might have.
That is unusual. You have tried your share of masks. I have tried a bunch too and came back to the P10. I am male and must have a large nose as I use the size large cushion. I recall the mask came with a fit kit which included the S, M, and L size. Tried them all, and settled on the L. I rejected a Brevida and my wife now uses it and likes it. I recall she was having similar blockage issues with the Brevida with the smaller cushion and had to go back to the larger one. I think she still has issues with it now than then, but is basically happy with it. The Brevida irritated my nose and I couldn't get used to it.
You are probably aware of it, but one trick I use with the P10 if it is not feeling right is to lift it off my nose until it starts to leak badly, and then gently let is settle back down again. I think that inflates the nose cones to help them seal and to some degree unkink.
Thought about your issue a bit longer last night. Since you say it does not allow you to exhale, that does suggest the nose cones are collapsing or folding over. I have a recollection of someone having that issue and they solved it by trimming the length of the double wall nose cones. If you have an old cushion insert to experiment with I think it could be done by pulling the insert out of the mask and squashing down each cone and trimming the length of it back some with some sharp scissors. Another option would be to flatten it on a cutting board and use an Exacto knife to trim the flattened cone length.
I also noted in your original post you are use RemZZZs with the P10. That seems unusual as they are most often used with a full face mask, and shouldn't be needed for the nasal cushion type.
Thanks, Sierra. I do have an old one and will try that. (It happened one time last night at 1:30 am and again one time at 2:05 am. ) The reason I use the nasal pillow REMZzzzs is that I developed pustules in my nose from the silicone( despite having washed the area with soap and water immediately before using the pillows and again each morning. ) I tried a full face mask for the next night to spare the area and ended up with a macerated nose and massive leakage to show for it. I had to skip CPAP for three days while I treated it and it healed enough to resume with the liner. I figured it was a sensitivity to the silicone. Yeah, I’ve had a tough time of it but am gutsy and stuck with it, with creative troubleshooting, as you can tell from my first post—using religiously for 7-8 hours every night from day 1 (even when miserable and sleepless to the amazement of my sleep doc) except for that hiatus of healing time until I finally found something that worked. I was an obligate mouth breather all my life , so went for full face first. Epic fail ( leakage unless straps tight enough to cause headaches, TMJ pain and pressure on carotids from straps) . Then tried nasal with chin strap, but woke up with swollen tonsils ( no joke). Went through 3 cervical collars before found solution with Releaf collar. Motivated because apnea diagnosis was prompted by 2 episodes of a fib, which has not recurred since started CPAP— and blood pressure normalized as well. What a journey.
My experience with the nasal pillows is that the smaller the size the further they go into the nose and the more discomfort they cause. In the other direction when you go too large, they start to leak all the time. When I get a different mask or even a new insert I do tend to have some discomfort which I treat with a 1% hydrocortisone cream. I use it on the external part of the nose only. After a week or so the irritation of a new cushion seems to go away and I stop using the cream.
My experience with the smaller pillows was the same as yours. The medium didn’t leak, though, just hurt the nostrils laterally. When I had the pustules, I scrubbed with soap and water, used Mupirocin ointment ( to cover nasal flora) and 1% hydrocortisone. Since using the REMZzzzs , I have minimal imprinting and if I do feel a little chafing (rarely), I use Lansinoh in the morning and wash it off in the evening before using the pillows.
I wonder if the mask might not be the real problem because if you experiment with the muscles in the back of the mouth and throat when breathing at just the right airflow against the machine you can get a door slamming effect that is not caused by the mask.
I used the Nuance for years and really liked it but ended up having to make adaptations to it and eventually abandoning it altogether.
Sierra,I tried trimming the p10 cones on an old pillow I had saved, and unfortunately, the pillow wasn’t useable because the peak of the cone was what anchored the REMZzzzs liner in place. So I went back to my newer untrimmed one. Oh, well, it was worth a try. As luck would have it , no obstructions last night. It’s totally unpredictable. I have kept a detailed “lab book” and found no correlation of any kind. But recently, I’ve noticed it does seem related to whether I lie flatter rather than more inclined ( I sleep in a recliner). We’ll have to see if OSCAR sheds any light on this. Any idea how sneezes impact apnea-flagging? Had an isolated run of 5 sneezes and am curious how that may have impacted results. Have also noticed that there is poor linear correlation between the events per hour on the air sense 10 display and the total AHI trend. Also weird ( and no credible explanation from the MD, RT or RESMED) why there is*absolutely* no correlation between the air leak recorded on the air sense 10 and the MyAir app…, even accounting for average leak and 95%ile leak. Even as analyzed by a mathematician in the family. Machine always reads either 14 or 16 liters/ min and app records anywhere from 0-25.2 L /min. [I suspect the machine is in error, but it has been otherwise OK and I don’t want to rock the boat …2 weeks into CPAP, my first machine was clearly defective — controls did not work properly— and after the exchange , the data was lost from the first machine. But the DME twice contacted me twice, in August and yesterday that “I hadn’t used any CPAP “ because they didn’t seem to realize I was on the new machine….and had to reload the data. ] so I basically ignore the leakage data unless I feel a leak…Always something…
It is unfortunate that the trimming did not work. My recollection is that the small size insert has quite small holes at the end of the cones.
OSCAR should show you very clearly what the impact of sneezes are on the event flagging. You just keep left clicking in the area of interest and the graph will zoom in to an amazing level of detail showing each breath and exhale. Air leaks will also become very obvious. OSCAR will graph them as well in detail and you can see how much air is leaking at any given moment. I recall that it reports peak leak, 95% level and average, in addition to the graph. If you need any help with OSCAR just post.
Used P10 small pillows last night with one small vertical slit cut into the end of each double cone, not changing the overall contour— a “relaxing incision”, if you will. At 5:30 am, I woke up with two very momentary blockages which instantly blew through with exhalation. As we say in the medical literature, “this is a small sample and further study is warranted”….but I am hopeful that I found a solution.
I considered that option, but did not want to recommend it as I thought it would weaken the cone portion and make it easier to collapse. There is one of the newer masks out, and I am not sure if it is a ResMed or DreamWear, but instead of having nasal prongs, it has a single oval shape opening that goes under the nose, but not into the nostrils. I wonder if that may be a better option for you.
Slits solved blockage problem -as long as I don’t lean too far back in recliner— guess is gravitational effect sleeping on my back. My guess is that side sleeping in bed would also not be a problem. Sierra, I just downloaded OSCAR and find the huge panoply of settings daunting. Do I just leave the default settings, or are there some I should change ?
I was thinking further about your blockage problem. You may want to consider cutting slim pie shaped pieces out of the nostril prong part of the mask. That would seem to allow the prong to still located the mask properly with the RemZZZ's, but reduce the chance that the split parts of the prong would collapse and overlap to block the airway.
There is not much setup to do with OSCAR. I like to do a few things like clean up the format of the Daily Report layout. Here are some suggestions:
My basic routine of looking at the data is to first look at the Daily Report to see when the apnea events occurred. If there are say a series of events or a cluster, I will left click repeatedly to see more detail. It is amazing the granularity of the data right down to each breath. You can also use the up down arrow keys and left right arrow keys to look at different areas of the night. If there is nothing further of interest to look at, then I click the Statistics tab to see how I am doing with my current settings to see if everything is stable or possibly improving. This screen is useful in displaying what setting have worked the best (highlighted in green), and the worst (highlighted in shaded red). Last I click the Overview tab to see if I can see any trends especially in the type of apnea events I am having. It also displays what your total time in apnea is each night, which may be of interest to see if there is a trend.
There is more you can do to investigate issues, but this is my basic routine. If you have any questions just ask...
If you want to post a Daily report here for comments that is a bit of a trick. You first need to display the Daily Report full screen and press F12 (on a PC) to save the screen shot. A message will display temporarily in the bottom right of the screen to show where it got saved. Take note of that so you can find it with File Explorer (PC). In File Explorer when you find that screenshot file, left click on it and then drag it into an open message here that you are composing. Best to only post one screenshot, as multiple images can make the post get hung up in the spam filter. For the best detail start your comment with the orange "Write a Reply" button so you get a full width image that is easy for people to read without resorting to other tricks. I will now break that rule and post my screenshot for last night in a reduced width window! But best to avoid that if you are looking for comments from others here.
Thanks,Sierra. I hadn’t even accessed the SD card yet when I was confronted with several tabs worth of settings. Will sit down and keep notes for questions.
Once you have installed OSCAR you should only have to put the SD card into your computer and follow the instructions. There may be a bit of a registration process, but I just put the minimal amount of info in there. If you want to post your reports on line, you don't really want any personal information to show. It can handle multiple users, so you do need one name to distinguish between the users.
OK. So I’ve imported all my data in ( an embarrassment of riches ). One problem I haven’t been able to figure out is that I configured OSCAR For Pacific time, my computer is set for Pacific time, but the data set seems to be coming out in Eastern time. Clearly, I can compensate by subtracting 3 hours, but when I’m trying to correlate times of cone collapse with events, it’s kind of annoying. Any ideas what I need to do to fix this?
Would it be inconsiderate and tactless to laugh?
If so then my sincere apologies. :(
Resetting CPAP time and Daylight Saving Discussion
I've never bothered to set the time on my CPAPs which would be confusing if I ever looked at the data. What is disappointing is that the suppliers do not bother to set the correct time in the first place.
I had a phone for some years that I was using for work and it had a massive list of past messages. At some stage it glitched back to the year of manufacture but still showed the correct time so for quite a while I was getting no messages until I discovered that they were being chronologically sent back, prior to those hundreds of 'more recent' messages!
Sierra, If it the air sense 10 that is set to eastern time, should I just change the OSCAR setting to eastern time to compensate. Or will that mess up the data.
That is a little puzzling. I checked my settings on the File, Edit Profile, first page screen. I don't have the country entered, nor the time zone, and the DST Zone box is not checked. My time is correct. I think I would try that first. Just don't put anything in there and then OSCAR should get the time from your AirSense data.
But, just to confuse things a little. I then checked my wife's Profile, and she has the country entered, the time zone, and the DST box checked. And her time is ok too. If worst comes to worst, you could fudge the time zone in the setup to get the time correct. I do not think that will impact any existing data.
We are using SleepyHead, so there is a possibility that OSCAR is a little different.
Really odd: looking back, on the daily wave traces page, on some days the x axis lists military times ( not pacific) and on other days, today included, the x axis is labeled as actual time on the machine ( from t= 0 :00 to 9:01 hours). I had recorded on paper the actual time I started (PST) and when I turned off the machine to see how I could correlate events. What’s so weird is that I didn’t change anything in the settings and in fact I can’t see where one enters preferences for how the the X axis for time is labeled. Anyone know?