Sierra

Yes, I did have issues with it when I first tried it when not using the chin strap. Since that time I have discovered that the tape works much better if your wash your face right before putting the tape on to get rid of any oils on your skin. The tape never comes off when combined with the chin strap. Have not tried the tape only without the chin strap since I have been doing the face wash trick. Also, I know I will have problems keeping the P10 mask on without the chin strap. The 3M tape is cheap to try. Should be at your local Walmart.

I do not use that specific product but I mouth tape every night using 1" 3M Nexcare paper medical tape (Micropore). It costs $2 or so at Walmart and a roll lasts a long time. I just fold over about 1/4" of the end so that part does not stick to my face, and makes it easy to remove in the morning, or if you get up at night. I tape from left to right horizontally. I also use a Breathewear Halo chin strap, and have tried the tape only, but it doesn't seem to be enough to keep my mouth closed. Also I use the AirFit P10 mask with the flimsy headgear system, so the chin strap helps a lot in keeping the headgear in place overnight. Here is a video and article on mouth taping that has been put together by a dentist. I have found the 3M tape works perfectly for me, and have found no need to buy a specialty product. I see no need for a hole in the tape when the purpose is to make you breathe through your nose.

How to Mouth Tape for a Better Sleep - Video

How to Mouth Tape for a Better Sleep - Article

Here is an example of the control system issue from one of my SleepyHead reports. You can see the waxing and waning of breathing effort following a disturbance in breathing.

And in the extreme, this can progress to the point where it becomes unstable and the cycles are not damped out for a long period of time. ResMed flags that as Cheyne-Stokes Respiration. I experience that perhaps once a month or so.

What you are looking for in zooming in on those central apnea events is an indication of waxing and waning breathing depth. In one sense sleep wake junk can be dismissed at noise, but the underlying problem may be that your body respiration control system is not stable. To make a auto cruise control analogy, if your car encounters a hill and the car slows down, the cruise gives more power, and then you go to fast, and then slow down again. I see some evidence of that in your close up. If you scan through your events on multiple nights you will get an idea of how often you see that waxing an waning pattern. I find they sometimes produce a CA event, or sometimes an OA event, or sometimes a hypopnea event. However, the underlying problem is the breathing effort control system is not stable. The next question is why? Well then it starts to get complicated. Here is an article that is worth reading. It is from a blog area of this website.

Complex Sleep Apnea

One thing that can happen is that the CPAP significantly improves your breathing, your oxygen levels go up and CO2 levels down, but your body is not used to those levels and it brings out the control system instability. Increasing CPAP pressure can make things worse, and that is why the first step is to minimize the pressure used. EPR also improves breathing effort. It is kind of a double edged sword though. It changes O2 and CO2 levels, and may hurt, but at the same time it assists with breathing effort to counteract the body's waxing and waning effort. But the first step is usually to turn EPR off, and then try it as a last resort. That would be my suggestion to you.

In summary, I think I would turn EPR off, and continue to reduce maximum pressure in 0.4 steps. One would expect OA to rise and hopefully CA to reduce. The optimum may be when they are about equal. When you are getting close to an optimum maximum pressure and are starting to see OA events become significant you may be able to reduce the OA by increasing your minimum pressure. At the end of the day you may be best off with a fixed CPAP pressure.

On the EPR I have found that the AirSense 10 has a very useful feature. When you set your ramp function to Auto you get to set a Ramp Start pressure. And you can also set your EPR to be in effect during the ramp only. For example you could set your Ramp Start Pressure at 7 cm, EPR at 3, and EPR type to Ramp Only. Then it will cycle pressure during the ramp to 7 cm on inhale, 4 cm on exhale, and when you fall asleep the EPR will shut off. This will stop reducing your exhale pressure and probably reduce OA events.

Hope that makes some sense. Any questions just ask...

First the easy question. Virtually all of the masks use a standard size fitting and are interchangeable. The travel size AirMini machine uses special masks, but outside of that you can use a ResMed, Respironics (DreamStation), or F&P mask, and others.

The very difficult question is which mask. I think probably one of the most popular masks on the market is the ResMed AirFit P10 nasal pillow. That is the one I started out with, and had some issues with it not staying on my head at night, and also that I was opening my mouth in the night. I do suffer from some nasal congestion and that turned out to not be an issue. The machine blowing air directly into your nose seems to keep everything clear over the night.

Next I tried a Full Face Mirage Quattro. I could not make it seal, and it is very bulky and seemed to get knocked out of place when side sleeping. After that the ResMed AirFit F20 full face and while it was better, I still had leaks, had some bridge of nose irritation, and could not get comfortable with it. I tried my wife's Mirage FX Nasal mask, and it was better than the full face masks, but it had leak problems and comfort issues. Then I tried a F&P Brevida nasal pillow mask which seems to get good reviews. I had some nose irritation from it and it seemed more sensitive to being dislodged when changing sleeping positions. I then went back to my AirFit P10, and now use a chin strap to keep my mouth closed and in addition I tape my mouth closed with 1" paper medical tape (3M Nexcare). The chin strap goes on second and holds the mask in place quite well. Sounds awful but it is the most comfortable arrangement I have come up with. My wife is now using the Brevida mask instead of the Mirage FX and she likes it better. It leaks much less than the FX.

That said a mask is a very personal fit issue. If it is at all possible I would try and get one from a place that does returns or exchanges. You can find many reviews of masks at the CPAP.com website. But if it comes down to just trying one, I think I would go with the AirFit P10. You buy it as a fit pack and it comes with three sizes of inserts. You can try each to see which fits best.

It is always good to get a few days of data without any changes. It gives you a benchmark that you can always come back to if further changes don't work out.

While your AHI is technically within the treatment goal of 5 for apnea, there are a couple of things that are a bit concerning. First is that you were diagnosed with an AHI of only 5. That is right on the dividing line of no apnea (0-5 AHI) to mild apnea (5-15 AHI). Do you have the breakdown of the type of events you were having at diagnosis. Were the CA events significant at that time or have they developed with CPAP treatment?

The second issue is that you have such a high proportion of CA events to OA events. You mentioned that you thought it was SWJ which I take to mean sleep wake junk due to waking up and going back to sleep frequently. Can you show a close up of the events when there are a number or mix of events. 2:50 looks like a good time, but there may be others. Just keep left clicking on that area until it is possible to see the individual breaths. Also do you have any thoughts on what may be waking you up frequently?

I mentioned that I like to move minimum pressure up first, but in your case if this is a typical night, there are really no OA events to prevent. So, I think I would instead start by bringing maximum pressure down. I see it is at the default maximum of 20 cm now. I think I would try 13 cm first to see what that does, and then follow that with steps down of 0.4 and see if there is a point where CA events start to decrease or OA events start to appear. It helps to try 2-3 nights at each pressure to get a representative picture of what each max pressure does.

On SleepyHead layout it may be helpful to squeeze in the snore chart unless nothing ever shows up as snore. It can drive pressure up. I also like to see mask pressure just to verify what the machine is doing. My interpretation is that Pressure is the machine setpoint, while Mask Pressure is the result.

So I hope that helps. Post your results as you progress and I will give further comments. There may be one other thing or two to try if reducing max pressure does not help.

I think the first thing I would check is that the mask does not have any leaks by feeling around it when using it and the machine is up to pressure. All masks have a vent arrangement where the air goes out when you exhale, and essentially all the time the machine is running. They sometimes put filter material over the vent, and this may be optional or removable. The main purpose is to reduce the noise the exhaust air makes. If this material is not in place it may not only exhaust more air, but also be noisier.

Next I would check to make sure the machine mask type is set properly. With that mask I believe it should be on Nasal, not Nasal Pillows.

Yes your supplier should have software that can display your detailed data which will show leak rate continuously during the night. That information is also stored on your SD card and if you have a PC or Mac and an SD card reader, you can view it yourself with a free software program called SleepyHead. You can also see what your pressure is doing during the night compared to when you have apnea events. That will tell a lot as to whether or not the pressures are set right.

My wife used a nasal mask not unlike yours and was experiencing significant leaks. I convinced her to try a F&P Nasal Pillow mask called the Brevida. Her leaks have gone down a lot since switching masks, so masks can make a difference. Her mask has that filter piece that looks similar to the one on the Eson, and she has had it come loose, so check that part.

I use a ResMed AirFit P10 nasal pillow mask and have issues with large leaks when I open my mouth when sleeping. A chin strap helped a lot but did not stop them. Here is an example below of what I was getting for leak with just the chin strap, and then again after I started taping my mouth shut for the night. It sounds horrible, but it is really not that bad. Here is a link to a video by a dentist on the benefits of stopping mouth breathing with tape.

How to Mouth Tape for a Better Sleep

And here is what mouth taping did for me using SleepyHead to display the results. The first is with a chin strap only, and the second is with a chin strap and mouth taping. I use 1" 3M NexCare paper medical tap from Walmart. See the Leak Rate graph at the bottom of each report.

Hope that helps some. If you want help with SleepyHead just ask.

This information comes from a free software program called SleepyHead. You need a PC or Mac and SD card reader to transfer the results from your machine to the computer. See the links below:

SleepyHead Download

SleepyHead Basic Instructions

Unfortunately ResMed seems to understate the mask leakage issue. I do not use MyAir, but do look at the happy faces each morning on the display. In six months I only got leaks bad enough to get the red unhappy face once. And those leaks were really really bad. To see what is really happening one needs to look at the results in SleepyHead. Here are two SleepyHead reports. One is without using mouth tape, and the second one is with mouth tape. Both were with the same nasal pillow P10 mask. In these reports the gray areas are times when the leak rate is over the leak redline.