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Problems with therapy and mask, could use some advice

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MaskedDreamer +0 points · over 3 years ago Original Poster

Hello! I'm new here. Here is my background:

-I'm in my late 50s, have lived at high altitude (~7,000 ft) for over 30 years.

-I've had two lab sleep studies in 2018, diagnosed with severe complex apnea.

-My AHI during the study while untreated was 43; on APAP and various BiPAPS was in the 60s and 70s. Dr. said I have treatment-induced central apnea.

-I sleep on my back due to chronic pain issues.

-I have been on a DreamStation APAP for two months.

-Started with Amara View mask (mouth breather) and got AHI down to an avg of 20 with pressure range 12-15. Mask sometimes leaked but not enough for the machine to record it as a leak. Silicon a bit uncomfortable.

-Pressure max was increased to 17, avg AHI went down to 18.

-Bought a wedge pillow, 7" tall, 16 degree angle, AHI avg went down to 12.

-Pressure issues caused the tech to decrease max pressure to 16, now not having as much air swallowing.

-Switched to Airtouch F20 mask with memory foam three days ago, small sample size at this point but had two great AHIs (5.5 and 6.6) and one high one (17.5) so far.

The most pressing issue now is that while the new mask had no leaks and is really quite tolerable, I now have an ugly red pressure sore on the bridge of my nose. I will likely need to use the Amara View a few days to let the sore spot settle down.

I loosened the top straps a tiny bit last night and had less strap marks, no increased noise signifying leaks, but I'm wondering if that caused the higher AHI.

Does anyone have a suggestion for something to help take the pressure off the bridge of my nose?

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Sierra +0 points · over 3 years ago Sleep Patron

I tried the AirFit F20 (silicone material) and had similar issues to yours. I gave up on it, but since that time I have read that putting pads of just cotton t-shirt fabric under the seal portion can help. There are also commercial versions of the mask pads you can buy.

I also have issues with mixed apnea, and initially had trouble getting AHI under 5 with pressures as high as 15 cm. With various changes such as turning off EPR (like Flex on a DreamStation) I have managed to get AHI down more and pressure down. More recently I have switched to a fixed CPAP pressure of 11 cm and over 6 weeks averaged about 1.7 for AHI. My theory is that in auto mode these machines can get confused by mixed apnea and end up chasing the pressure and AHI up. So you might want to talk to your tech about trying a fixed pressure. You may have to move it around a bit to find out what pressure gives the best results.

You may want to consider downloading SleepyHead which is a free data viewing software program that can be very helpful in evaluating your results. Of your current AHI do you know what % is central and what % is obstructive? SleepHead is good at showing that, as well as at what pressure they are happening.

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Sierra +0 points · over 3 years ago Sleep Patron

If you cannot get AHI under 5 and central apnea (clear airway) remain an issue, there is another option to explore. That is an ASV machine like the ResMed AirCurve 10 ASV machine. It is expensive, and not for everyone. You need to undergo a special heart function test before they will prescribe it. But for those that suffer from central apnea that cannot be reduced any other way, it can work. Some glossy manufacturer info on the machine. It is something you would want to discuss in full detail with a qualified sleep doctor and cardiologist before going down that road.

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Sherry +0 points · over 3 years ago Sleep Commentator

Check out "Pad a Cheek" or "Snugz Mask Liners" to help keep the mask from rubbing.

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MaskedDreamer +0 points · over 3 years ago Original Poster

Thank you for the replies! I don't have SleepyHead but I am going to look into getting it. In the meantime using data from the DreamMapper app, for the last seven days cumulatively I had 19% Clear Airway Apneas, 49% Obstructive Apneas, and 32% Hypopneas.

I am seeing the doctor late next week and will discuss whether an ASV machine might be helpful.

I just ordered some mask liners that are supposed to fit on the Airtouch F20 mask and they should be delivered tomorrow. Tonight I need to sleep with the Amara View mask again since I want to give my nose bridge another day to heal. I think I may have been given a mask liner for the Amara View and if so I will try it tonight. Last night it kept leaking (though the machine showed 100% mask fit).

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Sierra +0 points · over 3 years ago Sleep Patron

I am less familiar with the DreamStation machines, but on the ResMed machines you cannot trust the green happy face that says mask fit is fine. Leaks have to be absolutely terrible to bring up the red unhappy face. SleepyHead is a far more reliable guide to evaluate your mask leakage. It graphs the actual leakage throughout the night, so you can see when and at what pressure the leaks occur at.

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MaskedDreamer +0 points · over 3 years ago Original Poster

I also meant to ask, when you asked what percentage of my AHI was Central and what was Obstructive, I put 19% Clear Airway Apneas, 49% Obstructive Apneas, and 32% Hypopneas. Should I have added the hypopneas with the OSAs?

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Sierra +1 point · over 3 years ago Sleep Patron

Sorry, I forgot to comment on the apnea breakdown you gave. That is not a real high % of centrals compared to what I see in my results. It suggests your main issue is obstructive apnea, and that usually can be solved with more pressure, but the pressure may increase the central frequency, so you have to watch that. If you are using Flex, turning that off may reduce your obstructive events some without increasing pressure.

Hypopneas are more complicated. Typically they are not broken down into central and obstructive because it is very difficult to do. It is my view that they can be due to flow restrictions and are obstructive in nature, and they can also be due to reduced effort to breathe which is a central type of issue. My personal view is that one could allocate them roughly based on your ratio of obstructive to central events. That is pretty simplistic, but is the best I have come up with.

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bonjour +0 points · over 3 years ago Sleep Commentator

Here Are the basic Medicare requirements for getting an ASV machine.

  • Titrate to minimize OSA, that is the obstructive AHI to less than 5 per hour. This typically is raising EPAP or pressure until obstructive AHI is less than 5 per hour, we expect this to make the Central and Complex Apnea worse thus failing the current treatment
  • Record the central apnea-central hypopnea index (CAHI) (looking for greater than or equal to 5 per hour and greater than 50% of total AHI)
  • Document the presence of at least one of the following symptoms: These symptoms are specifically noted by Medicare. These are key symptoms that we look for by asking "How do you feel?". Do not limit your answers to the following and do not fabricate the answers.

Sleepiness, "How do you feel?"

Awakening short of breath, "How do you feel?"

Difficulty initiating or maintaining sleep, "How do you feel?"

Frequent awakenings, or "How do you feel?"

Nonrestorative sleep, "How do you feel?" Nonrestorative sleep is defined as the subjective feeling that sleep has been insufficiently refreshing

Snoring, Can be documented on Sleepyhead

Witnessed apneas Most of us have this one with our significant others or during a Sleep Study

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