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Have you tried a chin strap? They worked for me. And they avoid the hazard of suffocating due to taping, because you can still quickly open your mouth to breathe, if need be.
A leaky mask used with a variable pressure machine, such as an APAP, etc. can result in soaring pressures. I found myself trying to exhale against what felt like a hurricane. My normal average pressure was about 11, but it went to 18 with a bad leak. That will wake you up for sure, and probably many times a night.
So, the first order of business is to get the best fitting mask you can find, and eliminate mask leaks. People often have to try five or six to get one that works optimally. You also have to eliminate mouth leaks, so use a chin strap, if necessary.
However, there IS something else that can be done: optimize your pressure settings. Your sleep lab can adjust the pressure settings to a narrow band around your average pressure. That way, even if you experience a bad leak, the upper range of the variable pressures will stay within reason, and you will avoid the feeling of trying to exhale against a hurricane.
Finally, assuming your machine has the expiratory assist setting feature, make sure it is turned on. In general, you should study your user’s manual and familiarize yourself with your machine operations and settings.
Also, when I went from the gen 8 to gen 10 RESMED machines, my residual AHI went from 3.0 to 0.3, and I could feel a huge improvement in my general alertness and physical well being. Net/net, I am quite unconvinced that an AHI of 5.0 is remotely “normal” or acceptable. Even one apnea, if it lasts long enough, can kill you… 5.0 and above is just the level that the insurance companies and the medical system are willing to pay to treat…..
Sometimes you are better off using a nasal mask with a chin strap than trying to eliminate leakage on a full face mask. Many people have to experiment with a large number of masks.
There are issues with the AHI measurement criteria, however.
The criteria are designed around men. Women and children will often have apneas or hypopneas that won’t be counted as such, because they will either not desaturate by 4% or the cessations in breathing will be shorter than ten seconds.
Accordingly, there are currently research projects looking into developing alternative measurement criteria based upon the impact on the heart during events.
Could that have happened because the machine kept running? Mine used to turn off automatically a minute or so after I removed the mask, but now it doesn’t.
I would mention it to your cardiologist. A greater number of CSRs can be associated with increasing severity of CHF in people with OSA. (You can Google the studies on the subject.) Perhaps your cardiologist will want to adjust your cardiac meds.
PS. I’m not a doc, just a OSA patient who has had the condition for a long time and read a lot…..
Could this reflect centrals?
Three hours into the night is the point at which the first major cycle of REM sleep occurs. Typically, people have many more apneas during REM. My overall AHI was only 19, but my AHI during REM (when I could sustain REM) was 83, and Imwoild desaturate to life threatening levels.
The reason is that during REM, to avoid you acting out your dreams, which can be dangerous, your muscles disconnect from your brain. Sleep walking, sleep eating etc., are what happens when that disconnection is incomplete or unsuccessful. I suspect your flow limitation are occurring during periods of REM sleep. How badly are yoj desaturating? If you don’t know, check your sleep reports or use overnight recording oximetry.
Biguglygremlin: I concur in your view that the way your mask interfaces with the machine is the problem. Have you tried a variety of other style nasal masks?