Sierra

Could you clarify exactly what make and model machine you have? I'm wondering if you have an APAP machine with two set pressures (minimum and maximum) rather than a true BiPAP? Either one should work for you, but it would be helpful to know exactly what machine you have and what it is set at.

What make and model of a machine do you have? Have you considered downloading SleepyHead to view your data in detail? That is about the only way of making some sense of AHI numbers that go up and down drastically.

I have the AirSense 10 and the standard power supply is suitable for 100-240 volts, and 50-60 Hz. It will work fine in the UK. You just need the adapter to make the connection to their UK sockets.

Just joined today. I have been involved in the CPAP stuff for about 3 years now, when my wife got diagnosed with OSA at an AHI of about 75. Had no insurance so we bought a ResMed S9 online to reduce the cost, and I became the setup and tech support guy. Now I have been also blessed with OSA too and have a AirSense 10 AutoSet. I like to use SleepyHead to track the treatment of both of us as we have no sleep doctor or sleep tech support. Short story - self taught, and I am slowly learning that there is nothing simple and obvious about apnea treatment. It is complex, and not an exact science. I think the secret is to keep an open mind, and remember that we are always learning.

I had a similar issue with the P10. I had a fit pack with the three different sizes of inserts. For me the medium size caused more of a problem than the large size which I settled on. For you it sounds like the reverse might be true. My sore spots were just inside my nose.

I used a 1% hydrocortisone cream on the tender spots. I did not put it on in the evening with the mask, but in the morning after I took it off. I switched to a Brevida mask a few days ago and the issue has reemerged. I assume the contact points have changed. So I am back to using the hydrocortisone again. Note that I am not a doctor or a pharmacist so I can't comment on the safety of the product. It says it for external use only, and the edge of the nose is close enough to that for me...

I am currently having the same problem so I hope you get some suggestions that are the silver bullet!

I have tried 4 different types of chin straps and while they help, none seem to solve the problem completely. The best one so far was the cheapest. You can find them on ebay for as little as $2 each. They are just an elastic strap with two holes for your ears, and a Velco fastener at the top.

I have tried the paper medical tape over the mouth, and it does work too if you can keep the tape on. I was a bit reluctant about taping my mouth shut, and you will read warnings about how it could be dangerous if you throw up during the night. But how often does that happen, and is tape any worse than having a full face mask if that occurs.

This is an ongoing project for me, and my attempt tonight is to combine a chin strap and the tape to see if that works.

As for the full face mask solution, I tried the Mirage Quattro and couldn't tolerate it for more than a few hours. It seems to leak and make rude noises that wake me up, and I just couldn't get any sleep. I've also tried the AirFit F20. It was better and I lasted 4 nights with it before I gave up on it. I wouldn't rule out a full face mask solution as many tolerate them. If you are paying for them, try to get one that is returnable if it doesn't work for you.

One minor change that you could try that may help a little is setting your EPR to Ramp Only. That way you get the benefit of the exhale pressure reduction when you are going to sleep, and then it discontinues when you are asleep. With no EPR your treatment pressure may reduce a little - perhaps by 1-2 cm. That could delay the onset of when you start to have a mouth leak, but probably will not eliminate it. To do this you need to set the Ramp Time to Auto. I would set the start pressure higher than where you are now (4 cm), and increase it to 7 or 8 cm. This can be more comfortable when you are trying to go to sleep. Then finally set the EPR to ramp only. This will require access to the Clinical Menu. It is easy to get into. Just hold the bottom Home button down and the round button down at the same time for 3-4 seconds, and you will be into the Clinical Menu. But, like I say, it probably will not be the silver bullet.

Edit: One more trick I intended to mention. Some find it possible to hold their tongue at the top of their mouth, and pushed up against the back of the top teeth. I find it does stop the blow by effect, and you can do it when you are awake. The trick seems to be doing it when you are sleeping, and I can't claim to have that part figured out...

First, I would say that those Sleepyhead charts do not indicate any kind of real serious problem with the CPAP setup. You are not having a large number of apnea events with any of the settings. There are some issues with mask leakage on some nights. You have flow limitations and indication of snoring at the lowest pressure setting, but you say that setting gave you the best sleep.

I think I would focus on trying to figure out what is waking you up, and post again on your observations. Ideally one should try for about 7.5 hours of sleep per night to be fully rested for the next day. Waking up once or twice is not all that bad, but no wake ups is obviously good too.

Some comments on your CPAP and setup. You say you have a Resmed S9, but the Sleepyhead reports indicate it is an AirSense 10 AutoSet. I also see that you appear on some nights to be using the Auto Ramp feature that is in the A10, but not in the S9. I'm not real sure your setup is a problem, but if you want to try a new setup and you have the A10 model, here is what I would do. I noted that you know how to get into the Clinical Menu to adjust.

1. Set the Mode to AutoSet instead of CPAP - That will let you set a minimum and maximum pressure, and the machine will adjust between those limits to give you the minimum needed for treatment.

2. Set the minimum pressure to 7 cm. Set the maximum pressure to your sleep study recommended 9 cm.

3. Set the Ramp Time to Auto, and set the Ramp Start Pressure at 7 cm.

4. Set the EPR Type to Ramp Only.

5. Set the EPR to 3 (which is where I believe you have it now)

What will this do? First it lets the machine determine how much pressure you need, and it may result in a lower more comfortable pressure (within the limits you set). Using the Auto Ramp Time feature holds at the Start Pressure at 7 cm until it decides you are asleep. I think you may have it at 5 cm now. I find that pressure a bit low to be comfortable and you can feel a bit starved for air while trying to go to sleep. With the EPR set to Ramp Only with a setting of 3, this provides you with maximum comfort while you are going to sleep. Then when you go to sleep it stops the EPR reduction of the exhale pressure. This may also reduce the actual pressure the machine uses to treat your apnea while you are sleeping. Lower pressure not only improves comfort, but it may also reduce mask leaks, which can be annoying too, and wake you up.

So, while I am not sure your machine setup is the real issue, this method of setup could help by improving comfort some. But, most important, try to figure out what is waking you up.

Hope that helps some,