Sierra

I am in the camp that says CPAP cleaners are an unnecessary gimmick. I would worry about the impacts of ozone on the life of the equipment. Neither ResMed or Respironics recommend them, that I am aware of. I just disinfect with vinegar, followed by Dawn dish soap and water, and then a final rinse with water to hang to dry.

I think the ResMed N30i is ResMed's answer to the Respironics DreamWear masks. The DreamWear headgear looks very similar. With the DreamWear system you can use the nose and mouth (full face) but minimal contact inserts, the nasal with the oval opening, and the nasal pillow type. So you can change your mind on the type of mask without changing the headgear. Not sure if ResMed does that as well. I have a friend that uses the nasal version of the DreamWear and he likes it. The only possible downside is the tubes going up the side of your face and any potential noise from them.

Or the little math quirk that investment advisers never tell you about. If your investments go down 50% in one year and go back up 50% the next year, you are still 25% in the hole. It takes a 100% gain to recover from a 50% drop.

I have tried the nasal pillow type (ResMed P10, F&P Brevida), the nasal (ResMed Mirage FX), and full face (ResMed Mirage Quattro, AirFit F20). I could not get the full face masks to seal against my face without the leaks making rude noises, or worse still blowing into my eyes. The nasal type had the same issues but to a lesser degree. The two nasal pillow masks did initially irritate my nose to some degree. I did get used to the P10 by getting the right size that was big enough that it did not go too far into my nostrils. I also used some hydrocortisone 1% cream on the exterior of my nose for the first week or two. The Brevida seemed to irritate my nose more, and if I had toughed it out longer I probably could have gotten used to it. It is larger and seemed to deflect off my face easier than the P10, so I gave up on it.

This said masks and what each individual likes and tolerates differ a lot. Many people use full face masks quite successfully. Same with nasal masks. My wife used the nasal Mirage FX for more than three years, and said she liked it except for the marks it left on her face in the morning. I finally convinced her to try the Brevida (that I rejected!), and she now achieves a much lower leak rate. She couldn't exhale with the small size, but the larger insert works fine.

The other thing to keep in mind is the big "mouth breathing" issue. You really can't mouth breathe with a CPAP. If you open your mouth, air blows out, but you can't breathe in. It just results in a large leak that drys out your mouth and throat. The issue is that sleep clinics can designate you as a mouth breather, and not suitable for a nasal or nasal pillow mask. You must use a full face mask! The problem is that with a full face mask you will still breathe through your mouth and get a dry mouth and irritated throat. Believe it or not, the better solution is to use a nasal or nasal pillow mask and tape your mouth shut. This forces you to breathe through your nose, which is the way we were intended to breathe.

When I decide to try it, my wife thought I was nuts. She claimed it was not necessary and if one sucked it up, you could learn to keep your mouth shut. But, for me it worked. Despite being male, I couldn't keep my mouth shut without tape, and I couldn't stand the full face option. Then she began having issues, and I told her she was making a lot of loud "air leak noises" during the night. I also showed them to her on SleepyHead. She put that together with waking up with a dry mouth, and started to accept she had not actually "learned to keep her mouth shut". The final straw was a YouTube video I found on the internet. She watched it, and reluctantly agreed to try mouth taping. She is now sold on the idea. The amazing part is that not only did her leak rate go down but her obstructive apnea frequency went way down too.

Sorry for the long story, but the point is that I think there are alternatives to using a full face mask, and they are probably a better solution, because it is much better to breathe through your nose, than your mouth. Don't reject a nasal pillow because of potential nose irritation or "mouth breathing". There are solutions.

Here is the video. It was done by a dentist - Mouth Taping for a Better Sleep

On the sleep mask thing, a nasal pillow type mask would probably be the best type to allow the use of the eye mask. They tend to fit under your nose and make minimal contact with your face.

The American Academy of Sleep Medicine is on the record as being against the use of medical marijuana or derivatives to treat sleep apnea.

In general medications that relax the muscles tend to make obstructive sleep apnea worse. Sedatives and in particular opioids are a significant cause of central sleep apnea.

Also, marijuana is legal in Canada now, so there is no need for a prescription. You can just buy it and try it. If you are trying to get a doctor to say it will help with apnea, that may be more difficult.

Thanks for the explanation. My cursory review of the technology (which may be in my future for treatment) is that the AirCurve BiLevel machines monitor breathing on a more macro basis. They see breathing depth and rate going down so they boost pressure support somewhat blindly to try and prevent it. Depending on the model they may have some adjustments to control the switch from EPAP to IPAP to improve the breathing support effect. And also depending on the model they may have a fixed backup rate at which they will provide pressure support somewhat blindly trying to maintain breathing at a fixed rate when the user is not trying to breath. The ASV model on the other hand looks at Minute Ventilation and breath by breath flow. When it sees Minute Ventilation falling it responds on a breath by breath basis by boosting pressure support but in sync with any breathing effort the user may still have. In theory Minute Ventilation will be maintained as constant as possible. That was my conclusion. I like to simplify technology to an understandable level. My conclusion was that the basic BiPAPs were doing in a crude manner what the ASV does in a much more sophisticated manner on a breath by breath basis. Yes, it may be a bit of an oversimplification.

I think the sad part in this, and my current opinion for my own future, is that a BiLevel machine is not all that useful. It is more likely to create more problems than it solves. My thinking now is that I will use a basic CPAP for as long as I can and then go straight to an ASV if I can't control central apnea any other way.

I am not a doctor, sleep specialist or neurologist, but if you want to post a SleepyHead Daily Detail screenshot here I will give you my sleep apnea sufferer opinion. I don't take driver's licences away and I have seen some pretty bad SleepyHead reports. See below.

Carroll,

I would make some points on what you are thinking about.

• One of the advantages of a fixed pressure CPAP mode is that when your ramp finishes you go straight to your treatment pressure. There is no waiting around for snoring, or hypopnea, or apnea events to trigger a pressure rise. With a fixed pressure you eliminate that potentially less than ideal treatment pressure gap.
• I thought after I found what looked like a good fixed pressure of 12 cm I could improve that by going to a minimum pressure of 12 and then give the machine in Auto some room to increase it above that for unexpected pressure needs. In other words eliminate the initial treatment pressure gap and leave some reserve in the tank for the unexpected. Well, it didn't work, and that may be something that could be particular to those with central apnea. My suspicion is that hypopnea events which were central in nature were bumping my pressure up to the higher pressure, and that was actually causing more central events. But for those with obstructive apnea only that may not be an issue. For me preventing the machine from going too high reduces my apnea frequency.
• If you are using EPR or Flex full time you may be able to get a significant maximum pressure reduction by just turning it off. The pressure reduction would not happen automatically unless you are in Auto mode. But in fixed CPAP mode you are likely to get the same results with less pressure if EPR is turned off.

Will be interested to see the SleepyHead charts. It sounds good.

I think the first step for comfort is to get the pressure down while getting the AHI down. But, when you post your SleepyHead I will give you my thoughts.