Sierra

Welcome to the forum,

Some thoughts on your issues. First, an AHI of 7.5 is not real high. On the surface one could question how much benefit one could get from reducing the AHI from 7.5 to 2.5. Some, but not a lot. Then there is the issue of the discomfort in getting used to the machine and especially the mask. There is definitely an irritation factor that does not improve sleep, until you get used to it, and maximize the comfort of the machine. You seem to have had some fairly serious oxygen desaturation events, so it is possible that your AHI is underestimating your apnea. AHI is based on the number of events, but not the length of them. Perhaps you are not having many events, but the events you are having are longer in duration. SleepyHead should help you with that. Just beside the Details tap is the Events tab. You can then click on the type of event, and it will show you how long each one is. Mine seem to range from 10 seconds (the minimum to be called an event) to 14 seconds. I was a reluctant user of the machine (I have the AirSense 10 AutoSet too), but over 6 months I have gotten quite used to it, and I am at the point where I can say it really does improve my sleep. It takes time, and a lot of fine tuning with both the machine, and the mask type.

On your question about the type of machine it is, the colour is the give away. Your SleepyHead may identify it as well. The standard machines are black except for the humidifier reservoir. The For Her machine is a cream color with a floral or leaves graphic on it. The For Her version in my opinion is the better machine. The For Her mode is selectable and you can run the machine in either standard mode or For Her mode. It is part of the setup. The For Her mode can be more suitable for someone using lower pressures and having more flow limitation issues than apnea events. It is not so good if you have obstructive events that require more than 12 cm pressure. The good news is you can try both modes and see which one works the best for you. Here is a link to a manual that shows you how to switch the mode. It is worthwhile to download the PDF so you have it for reference. It also has a good explanation on how the machine works.

AirSense Technical Manual

This machine has some good features that improve comfort especially when going to sleep. Here is how I set my machine up for comfort in the order they appear in the manual:

• Ramp Time: Auto
• Start Pressure: I have mine at 9 but since you are using a lower minimum I would suggest 6 cm
• EPR: On
• EPR Type: Ramp Only
• EPR Level: 3 cm

What this will do, if it is not already set up this way is start you out with a fixed 6 cm pressure on inhale and then the EPR will reduce it to 4 cm (machine minimum) on exhale to make breathing easier. When you fall asleep the EPR pressure reduction on exhale will stop, and the pressure will be put in automatic control mode to adjust to your events. I also use the ClimateLine heated hose and put it in auto too. For me this results in a pretty comfortable setup to go to sleep. Having EPR off when in the treatment mode generally lets the machine use less pressure to control events. Less pressure makes it easier for the mask to seal, and should also be more comfortable.

If you want to do a screen capture of the your daily report and post it here, I would be happy to comment on what I see. I am not a medical professional but do support myself with my machine as I have not sleep doctor to count on. I'm on my 30th version of machine setup, and I think I am pretty much there in what works for me. To capture the screen in SleepyHead just press F12 (on a PC). Then in file explorer just left click on the image file captured and drag it into the body of your post. You can tell a lot from where the pressure goes during the night and when the events occur.

What type of mask are you using? Generally most of the discomfort comes from the mask more than the machine settings. Are you having any issues with the mask?

Hope that helps some,

The main health risk with apnea is the oxygen desaturation periods when you stop breathing. Lack of oxygen to the brain is not good over the long term. Stopping snoring is just a cosmetic side benefit.

For what it is worth CPAP.com lists their masks in order of sales volume. It gives you an idea which ones are the most popular. Also with each mask there is typically many reviews by users. I have a friend that uses a DreamWear gel nasal pillow mask, and he likes it. Some complain about the noise in the two tubes that go up to the top of your head though.

CPAP.com Nasal PIllow Masks

I am not familiar with the Pilairo mask. I think it is one of the older ones, but don't know any more. I initially tried the Brevida, but I found it irritated my nose. It seemed to put too much pressure on the area between my nostrils. I suspect if I toughed it out, it would have worked for me eventually. I pawned it off on my wife and she likes it. The big issue in my opinion with the P10 is the somewhat mickey mouse headgear. I have cut mine and overlapped it about 1" and made it tighter. I also use a chin strap over top to hold it in place. If the Brevida did not bug my nose, I would prefer it over the P10. The headgear is quite a bit better. There is another mask that ResMed makes called the Swift FX. It has better headgear than the P10, but it is a bit bigger and makes a bit more noise.

In the end everyone has different preferences and will tolerate a different mask...

Bill, good to hear you are still working on the issues . Yes, I would try to make the treatment as comfortable as possible so you can get more uninterrupted sleep. I use a generic Otrivin nasal spray (Walmart), which I believe is similar to Afrin. However, I try to minimize the use as much as possible. If one uses it too often you can get a rebound effect which increases nasal congestion. I try not to use it day after day, but as occasionally as possible and only in one nostril at bedtime.

You may also want to consider a trial at a fixed pressure of about 10 cm based on the last readings you posted. If obstructive events are more frequent than clear airway, then you could bump that up to do a trial at 11 cm. If clear airway events are higher than obstructive, then you may want to bump it down 0.5 to 1.0 cm. For more comfort you may want to try using the ramp function with a start pressure of about 7 cm ramping up to your fixed pressure over 20-30 minutes. The idea with the ramp time is to try to guess when you are most likely to be asleep. Often getting to sleep can be the hardest part and a little less pressure over that going to sleep time can be helpful.

I think I have posted it before, but I have found some help with insomnia issues at the SleepWell website. In particular I found these sections helpful:

The hygiene of Sleep

CBTi

And if you want to go smart phone tech with it all, they have a link to a free Veterans Affairs app that apparently one can use to help with the use of the CBTi techniques. I have not used it though.

CBT-i Coach

Hope that helps some,

It may be your machine, or machine set up. What type of machine do you have? Are you using EPR or Flex?

All I can think of in response is that I am a big Star Trek fan, especially the original TV shows. Shatner is a Canadian.

Resistance is Futile!

A nasal mask is like a small full face mask that covers your whole nose, but not your mouth. A nasal pillow mask fits on the nostrils of your nose. My wife originally used a Mirage nasal mask for a number of years. It had to be fairly tight or it leaked, and it left marks on her face that took a few hours to go away after she got up in the AM. I convinced her to try the F&P Brevida nasal pillow mask, and she now likes it much better. I have tried 5 different masks including the Brevida and have settled on the basic ResMed AirFit P10. I think the secret with a nasal pillow mask is to get the right fit on your nostrils. The mask insert size should be as big as possible while still sealing to your nose. I think an insert that is too small goes too far into the nose and can cause irritation, and at times can also restrict flow. My wife initially rejected the Brevida because she said it was impossible to breathe out. The size was the problem, and she now uses the larger of the two sizes it comes with. I also use the large size of the P10. I do find if it is not inserted correctly or the straps are too tight, it can crush the nasal cone part and restrict flow as well.

I think for sleeping on your side the smaller the mask the better it is. The Mirage FX is still a fair sized mask and it can dislodge on contact with the pillow. The Brevida is smaller and easier to sleep on your side with. And the P10 is smaller still and I think the better of the two, but I have not convinced my wife of that yet! The headgear on the Brevida is definitely better than on the P10.

Those are the only two nasal and nasal pillow masks I have experience with. The Mirage Quatro and AirFit F20 full face masks were a definite no go for me. One issue with nasal masks is air leaks through your mouth. I now tape my mouth to prevent it. My wife was highly resistant to that practice as well, but I have finally convinced her of the benefit. It has made an amazing reduction in her obstructive apnea frequency, as well as stopping the dry mouth issue.

Hope that helps some,

I used the warm up mode on my AirSense 10 last night. My going to bed routine is fairly short, so it only had about 10 minutes to actually warm up. But, it does seem to work. There is a very small amount of air flow while it is warming up.

I have never used it because I have only had dry mouth issues when I was opening my mouth with a nasal pillow mask. I also had it when I woke up after using a full face mask. I was obviously breathing through my mouth. Now that I tape my mouth closed and use a nasal pillow it is no longer a problem.

Edit: I forgot to mention that the warm up mode is turned on with the User Menu on the ResMed AirSense. It is just above the Airplane Mode.

I have not used it, but at least the ResMed AirSense machines apparently have a warm up mode you can initiate. It takes 20 minutes to bring the humidifier water up to full temperature and then holds it for 10 minutes. So, it may help to initiate it when you are getting ready for bed, if your machine has this feature. I'll try it tonight and I may know more tomorrow! A heated hose can allow a higher humidity, but it probably does not make that much difference in the first 5 minutes...