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ALERT regarding possible re-breathing issues with Resmed Airfit P10
#1
I am a physician and have used probably over 20 different products from full face to nasal mask and pillows. I finally settled for the Resmed Airfit P10 pillows because it's split head strap resulted in much improved position stability over the usual pillow design which tended to pull upward and back. The P10 pulls more directly backward making it much less prone to being dislodged by any lateral pull on the tubing.

I have sent well over 60 of my patients to get sleep studies who were diagnosed with OSA and started using CPAPs. Many used P10s. But a few would say they had a hard time using it because they felt they didn't get enough air or felt claustrophobic. I always reassured they that they certainly got enough air since, if anything the positive pressure would aid in inhalation. But sometime the pressure head on exhalation makes people feel it's harder to breath; but it's breathing out that might feel a little more resisted. The newer machines like the Resmed AirSense 10 solve the expiration problem by the Expiratory Pressure Reduction Option which drops the substantially drops pressure on expiration.

However I do think there is a valid reason why some might feel short of breath (dyspnea) when using the P10. It has a trangular matrix of extremely small exhaust ports that sit on each side of the pillows. They are so small you can not see any light shine through them. It seems the air channels are designed in a way that baffles the air flow. The very positive result is that you can not hear the exiting air and you can barely detect air flow with the back of your hand held in from of the ports.

But I have found a concerning problem with this design. I'm using a AirSense 10 with the AirFit P10. In the colder period of the year I will typically get some water condensation (rein out) in the tubing even when I adjust the temperature and moisture to optimal levels. Usually its not much. I do have the main heated tube encased in an insulated jacket so it's only the terminal tube of the P10 that gets a bit hazed or has a few droplets. However, under these circumstances I believe that the slight moisture is sufficient to significantly block the exhalation ports. I will awaken feeling like something is not right and can detect no air exiting the ports. I have to detach the P10 tube and plug the end. Then while holding the pillows forcefully against my face I have to exhale as hard as I can into the pillows. Usually I will feel a fine spray of water hit my hands and then I can again feel that the air is exiting the ports. Since I believe the ports were substantially or perhaps completely plugged, it would mean that I was re-breathing my expired air. This would certainly cause my CO2 to increase and problably result in lowere O2 eventually since fresh air cannot freely enter the tube. The respiratory center of the brain is sensitive primarily to CO2 rather than O2. So when CO2 increases in your blood (hypercapnia) it leads to feeling a shortness of breath and increased respiratory drive. (This is the same reason why skin diving snorkles are limited in length otherwise you would rebreath your air and get short of breath.) This could be a clinically significant hazaard, especially in someone with marginal cardiovascular or pulmonary function.

This essentially leads to the very condition that our user manuals caution us to avoid doing--taping over the exhaust ports in an attempt to reduce the noise or don't blow on ourselves or our spouse.

Anyway, I am interested to know if anyone else has experienced this problem.

I have tried to write/email Resmed about this but I can find no channel for doing this. They do have a phone contact but it's always a lot easier to have a concern lost in the shuffle when there is no paper trail of the complaint.

Doug
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#2
Yes, this has been reported before. It seems to only affect some people so it may be related to the batch of material the mesh was made from. Some have resorted to puncturing it with pins or making small cuts in it. If you search around there is at least one long thread on this topic.
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#3
There have been some extensive discussions on this forum regarding "blocked vents" on the P10. Some members have gone as far as to modify the vents by cutting or piercing larger holes in the exhaust baffle. I think you have hit on the source of the problem being moisture build up that can restrict the vents.

I have never run into this problem, and was one of the early adopters of the P10. I move my fleece tube cover over the small hose so it nearly reaches the mask connection. That leaves the part near the machine exposed, but I have never seen condensation there. Another source of moisture is cleaning. I try to do any cleaning early in the day, with the awareness moisture may restrict the mask.

I don't know if there is actually a re-breathing risk. The vent rate is reported by the machine, and I am yet to see anyone show there is a quantitative difference in the vent rate between a new dry mask, and one that has been in service and reported to have this problem. Respironics machines report total vent and excess vent in mL/minute, so even with those, I don't see the total vent rate at less than 25-29 mL with the P10. This mask has been around nearly 3 years and while I have heard some complaints of discomfort, I'm not aware of any actual injury, and we are still waiting for someone to prove this is a real problem. My perception of the mask is that the vent rate has been increased over the past year, but I have not seen a quantitative difference in the vent rate reported by Sleepyhead. I'd like to see some repeatable experiments to demonstrate this problem. If it was real, I would think it might trigger a mask recall or re-design.
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#4
Thank you for the heads up! I've been on treatment for apnea since June of this year and have only ever used a P10. I definitely know what you mean by feeling claustrophobic, a feeling of not being able to breath and having to take the mask off. I thought it had to do with adjustment to the air pressure, even though it only happened certain nights while others were just fine. However for the last three months I haven't had anymore episodes like this. Come to think of it, I started using heated tubing around the same time. Not sure this means anything.
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#5
Do you know which words I can search with to find these threads? I tried searching before posting and couldn't find any hits on my search terms.

Any Help would be greatly appreciated.

Doug
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#6
Here is one of the larger threads on subject....started in 2014 into this year!

http://www.apneaboard.com/forums/Thread-...fit+P10%22
OpalRose
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#7
This should get you started.

http://www.apneaboard.com/forums/Thread-...nt-blocked
http://www.apneaboard.com/forums/Thread-...a-P10-mask
http://www.apneaboard.com/forums/Thread-...n-t-exhale
http://www.apneaboard.com/forums/Thread-...P10-issues
http://www.apneaboard.com/forums/Thread-...our-tubing
http://www.apneaboard.com/forums/Thread-...ge-in-tube
http://www.apneaboard.com/forums/Thread-P10-Vent-Rate
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#8
Thanks for all the threads. I look forward to reading through them and it's nice to know I'm not alone in experiencing this problem.

Doug
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#9
The intended vent can vary from one mask to another. My first mask (Resmed brand) showed me with a constant leak from 2 to 6 every night. I thought I had a mouth leak problem. When I got my first replacement, my leak rate went to 0 every night. Except when I truly had some leaks which are never over the 24 limit. I am not convinced my new mask is not the Resmed brand.
Dont-know  I am an accountant so any advice given here is not medical. If I give any financial advice, you can take it to the bank. However, you will have a hard time cashing it in. Okay
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