Sierra

In Canada I found it at a place called Sleep Yedi for $25 plus shipping:

Sleep Yedi - Halo Chin Strap

I see that it is available in the US at CPAP.COM for $24:

CPAP.com - Halo Chin Strap

If you have a ResMed CPAP there are some interesting comments in the Clinician Manual.

"Note: Under conditions of high leak with EPR enabled, AHI detection may not be optimal." "Apnea-Hypopnea Index—average AHI during the selected period. AHI and AI are calculated for times of low leak only." "Happy Face for Leaks: Good—if the 70th percentile leak is less than 24 L/min."

So it seems that ResMed does not trust the machine to correctly identify apnea events when there is a high leakage rate, which it looks like they set at 24 L/min or higher. And, for that reason it appears they ignore the high leak rate periods of time during the night. It is my observation using SleepyHead that there seems to be very little indication of apnea events based on the flow signal trace during these high leak periods. If that is the case, then it seems like the process of ignoring high leakage periods, would tend to increase the reported AHI, because periods of time where there are very few apnea events are being ignored.

If you ask for a copy of the sleep report it should have the times or ratio of times that you sleep on your side, back, and stomach on it. Sleeping on your back is the easiest for using a CPAP, and side sleeping can be tolerated. Sleeping on your stomach with a mask on can be difficult.

With an AHI of 12 you are in the mild apnea category. A CPAP may still be the best option, but a dental appliance may also work for you. It should be easier to tolerate in all sleeping positions. I see there is a dentist contributing here, so perhaps they will comment. If you go the dental route you should discuss it with your doctor and dentist.

If you go the CPAP route, you are in the category where a fixed pressure CPAP might be prescribed. I would resist that, and insist on an automatic CPAP or APAP. There is little difference in the cost, and the APAP is more flexible. The ResMed AirSense A10 AutoSet is a very good choice. But, the mask could be your biggest issue - finding one that stays on and doesn't leak. Be sure to try different masks to see what works.

The most comfortable mask I have tried is the ResMed AirFit P10 nasal pillow type. However, I find the headgear that keeps the mask on your head very poor, and I have had the same issue as you have. The mask falls off in the night. One solution that I have found is to wear a chin strap like the Breathewear Halo. It not only keeps the mask in place, but it helps to keep your mouth closed. You put the mask on first, and then the chinstrap over it. The other solution I have tried is wearing a nylon and lycra head cap. They sell them for swimming, and other purposes. Just be sure to get one that is not waterproof, and is just fabric, or it would be way too hot. Speedo and others makes them. Again, put the mask on first, and the cap on second. The only downside of the cap is that depending on how tightly it fits, it can leave a mark on your forehead.

Hope that helps some.

The ideal water has no minerals in it. Minerals will build up in your humidifier reservoir over time, because each night you are evaporating the water, and leaving what doesn't evaporate (minerals) to build up in the reservoir. For that reason, distilled, demineralized, or reverse osmosis (RO) water is the best to use. I have heard that it is hard to find in the UK however. Just plain bottled water is usually just tap water in a bottle. Mineral water is probably about the same. If you look on the ingredients list, distilled, or demineralized, or RO water will have zero or close to zero calcium (Ca), or Magnesium (Mg). If you can't find water without minerals, just use ordinary tap water, and rinse out the reservoir daily before you refill it. If you see any build up of minerals use vinegar to remove it, and then rinse thoroughly. When we go on holidays and don't have easy access to demineralized water, we just use tap water. Using vinegar to clean the reservoir every few weeks even when you use demineralized water is a good practice.

It sounds like you have a lot going on. I have had none of the issues you describe, but here are some of the things I have tried with the pillow issue. Prior to using CPAP I have used an orthopedic shaped memory foam pillow. It seems to minimize getting kinks in the neck, as it provides higher neck support than head support, kind of like your wedge pillow. However with a CPAP mask on, I find it is too resistant to pressure and dislodges the mask easily causing mask leaks. For that reason I have switched to a down alternative pillow, which form fits to your head neck, but does not have the same push back resistance on the mask. Costco has them for about $18 a pair.

Some people suffer from positional apnea, or restrictions caused by your head position when sleeping. I do not, but those who do report that wearing a cervical collar during sleep helps by keeping the neck more aligned.

Another issue that CPAP users of nasal masks have issues with is the mouth coming open during sleep. It is often called mouth breathing, but with CPAP pressure on your nose, it is nearly impossible to breathe through your mouth. However, if you do open your mouth and your tongue does not block the airway, you can get a major flow of air out of your mouth which is being supplied from the CPAP. That can cause a dry mouth and irritation. In your case without a CPAP you may be actually breathing through your mouth and causing issues with your tongue. Just guessing. I deal with the air leakage through my mouth by using paper medical tape on my mouth to force all air flow through the nose, and not the mouth.

Yes, in theory I have a GP overseeing my care. I have diabetes (my wife as well), so we are seeing him every 3-6 months. My wife asked to have a sleep study done as she was having sleeping issues, and he prescribed one. It was a home study, and came back as severe apnea at about 67 AHI. I was a much more reluctant candidate as I could see what she was going through using a CPAP, and I really didn't want any part of it. I was getting good sleep, and really did not have sleep issues other than I was snoring, and that obviously was bugging my wife. I finally got coerced into completing a questionnaire, and I failed that, so I got the home sleep study prescribed as well. My AHI came back as lower but still severe at 33. The study lab which was the same one for both of us, send the results to the GP recommending a CPAP, and the GP just rubber stamps it.

The way the government health care system works in our area is that the sleep study, and a two week trial of a CPAP, is fully covered at no cost. However the CPAP is not. In both of our cases the sleep study clinic offered to sell us the machines at a cost of $2400 each. After some research I found I could buy them on line for about $900 using the prescription from the sleep clinic, signed by our doctor. So we each bought one, with mine this year, and my wife about 3 years ago. At that price you get limited follow up and monitoring. That is where the do it yourself part comes in. Our GP is of very limited help. I suspect he knows very little about apena other than what it basically is.

That said, I am not complaining. I know people who have insurance and take the deluxe $2400 deal, all paid for by insurance, and I think they get short changed. Their monitoring and followup is minimal to none. They just get an auto machine set with wide min max limits and the machine does its thing. And unless the results are really bad, nothing changes.

When we bought the machine for my wife, the lady we dealt with was good enough to tell us about SleepyHead, and we have used it ever since. I frankly don't know how anyone could effectively monitor and adjust their treatment without it. One the other hand I can also make you a bit obsessive. My one criticism of SleepyHead is that it seems overly harsh on the way it rates leaks. My machine always gives me a happy face, but SleepyHead almost always is very critical. I just ignore it!

Bob,

Unless you have software like SleepyHead it is pretty hard to determine the cause of the leaks. Assuming your data is being transmitted so your provider has access to it, you may want to ask the provider to look at the detailed data for their opinion. The possible causes are:

1. Mask not adjusted properly and just generally leaks too much. Or the mask is getting old and losing flexibility.
2. You are changing position in the night and in particular when side sleeping you are moving the mask causing it to leak.
3. You are opening your mouth and air is leaking out your mouth. The chin strap should help with that.

This said, I'm not sure that 15 L/min is all that high. It perhaps can be improved, but at the same time is not that big of a problem. My 3 month average leak rate is 23 L/min.

The best mask I have found so far has been the ResMed P10. I really like it except for one thing. The headgear is really flimsy and of a poor design. It has no adjustment feature, and seems to stretch quickly. Yes, they include some goofy little clips that you are supposed to use to tighten the straps, but the biggest issue I have with this mask is that it will not stay on my head. I find that when I use the clips they catch on the pillow and make it even easier for the headgear to move and let the mask come loose.

Has anyone found any solutions to this? I would be really nice if someone developed a generic headgear that would fit on the funny attachment system that the P10 uses. I also have a Brevida nasal pillow mask which has a much better and adjustable headgear. However I can't see any easy way of adapting it to the P10. Unfortunately the nasal pillow part of the Brevida does not seem to agree with my nose. That part works much better on the P10.

Thought I would throw it out there in case someone is aware of a good solution. The best one I have come up with so far is to use a Breathewear Halo chin strap. It helps somewhat in keeping your mouth shut, and in keeping the P10 headstraps in place.

That is the same mask as my wife uses. Opening your mouth can be a problem. It may account for your higher use of humidifier water. I use a Breathwear Halo chin strap to reduce the open mouth time.

If you look on the end of the hose it will say Climate Air Line on the grey fitting if it is a heated hose. Unless you have a heated hose, you will not be able to select the auto climate control feature.

A pressure setting of 4-12 is quite a wide range. I find that 4 cm is quite a low pressure and it can feel like you are starving for air. Assuming you need 12 cm maximum, a more normal range would be 9 cm minimum to 12 cm. The start pressure for the Autoramp should be about 7 cm.

If you want some help with how to make these setting changes, it is probably best to start a new thread.