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Chin dropping down causing high AHP and AI
#1
I use a Resmed VPAP adaptive servo ventilator "enhanced" machine due to being diagnosed with Central Sleep Apnea. I also use a Respironics Supreme chin strap as my bottom jaw drops down causing large leaks. Have been using Mirage FX nasalmask but high leaks caaused me to go to a Resmed Mirage Quatro full face mask and a Resmed ultra Mirage II nasal. With the Quatro I got zero leaks but the AHI and AI went extremely high. Got fair results out of the Resmed Ultra Mirage II nasal mask but again somewhat high. I have to keep the chin strap so tight that I cannot open my mouth when I go to sleep, but it loosens during the night allowing mouth breathing. I also have the Cheyne-Stokes respiration pattern. Any suggestions toward solving this problem would be appreciated. I think the pressure on my machine is set at about 8.
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#2
Yow.

Uhm...sounds like you need to stick with the full face mask. You might be having issues with that because of leaks though.
In spite of the full face mask leaks the nasal method sounds like it does not work at all...
So..
Do you have a beard or other facial hair?
If you do, it might need to be trimmed back clear of the F.F. mask seal.
Second, wash the mask well with the Dawn dish soap (non-concentrated!) before every use. It must be squeaky clean and dry.
Wash your face with the same stuff.

See if that doesn't help get your leak rates down and your AHI down.

anyway...Hang in there ArfitoJr, I'm sure someone here will want to have speaks with you.


In the mean time:

Welcome
"With ordinary talent and extraordinary perseverance, all things are attainable." - Thomas Foxwell Buxton

Cool
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#3
Shastzi,
Thanks for the suggestions. No facial hair. I wash the mask and cushion daily with unscented baby shampoo as well as the humidifier tank. I had read that the baby shampoo did not break down the silicone components in the mask and tank like dish detergent does. I will try the Dawn dish soap (non-concentrated). Usually wash in the mornings and let the components air dry all day. Tried the Mirage Quattro last night and the AHI was 6.3, AI was 0.2 and leak was 5.0 L/min. Looked at 3 months using the Mirage FX nasal mask AVG AHI was 4.6, AI 0.1 and AVG Leak was 20 L/min. For last 2 or 3 wks with all masks have seen AHI as high as 19.5, AI as high as 7.0 and leak as high as 35 L/min. I did run the learning circuit for full face mask before wearing last night and that helped tremendously. I think the full facial mask is going to to be the way to go. (Also wore the chin strap) Have used a CPAP for about 6 years and the Resmed Adaptive SV enhanced for about 6 years. Many thanks for the reply
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#4
humm. 6.3 AHI isn't too bad for one night. AHI of 19.5 not good though. Hmm... Below 5.0 (daily) is more acceptable though.
The leaks seem a bit high. But the machine should be able to compensate.
I use a Quattro FX and I get 0.0 leaks unless I take the mask off to make a late night pit stop or I messed up & didn't wash my stuff...
Once or twice I had to re-tighten the straps to handle the higher pressures and at such times I used the mask leak test function from the front panel menu. That will run up the pressure for you so you can check to see if the straps are stretching on your head gear.
Very handy trick!

If you have stepped through all that mess and still have a 5L/min leak then maybe your face contour doesn't quite do well with your current mask and change in mask design is in order. ( I burned through 5 different masks that way, till I hit the Quattro FX. )

See how it goes for the rest of the week!
If your AHI can get below 5.0 each day you're doing great!

The cheyne-stokes issue will be for the other experts here.

Good Luck & stay in touch!

Wink
"With ordinary talent and extraordinary perseverance, all things are attainable." - Thomas Foxwell Buxton

Cool
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#5
I have found that a single strip of tape about 1 3/4 inches long, vertically across my lips right below my nose has eliminated my mouth breathing issue. I use a Resmed Activa mask and the wide Respironics chin strap.. Rexall Nexcare tape 1 inch width is available at most drug/first aid sections of variety stores.

TheDuke
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#6
TheDuke,
Thanks for your reply.

ArfitoJr
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#7
Hi arfitoJr,
WELCOME! to the forum.!
Hang in there for more suggestions. I know there was a mention about using tape to keep your mouth shut but try everything before you reach that resort. There are some threads about this on this board that you can read for more information.
Best of luck to you on finding a solution.
trish6hundred
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#8
(04-09-2013, 02:44 PM)Shastzi Wrote: humm. 6.3 AHI isn't too bad for one night. AHI of 19.5 not good though. Hmm... Below 5.0 (daily) is more acceptable though.
The leaks seem a bit high. But the machine should be able to compensate.
I use a Quattro FX and I get 0.0 leaks unless I take the mask off to make a late night pit stop or I messed up & didn't wash my stuff...
Once or twice I had to re-tighten the straps to handle the higher pressures and at such times I used the mask leak test function from the front panel menu. That will run up the pressure for you so you can check to see if the straps are stretching on your head gear.
Very handy trick!

If you have stepped through all that mess and still have a 5L/min leak then maybe your face contour doesn't quite do well with your current mask and change in mask design is in order. ( I burned through 5 different masks that way, till I hit the Quattro FX. )

See how it goes for the rest of the week!
If your AHI can get below 5.0 each day you're doing great!

The cheyne-stokes issue will be for the other experts here.

Good Luck & stay in touch!

Wink


Thanks for your information.

ArfitoJr
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#9
Thanks
(04-09-2013, 09:22 PM)trish6hundred Wrote: Hi arfitoJr,
WELCOME! to the forum.!
Hang in there for more suggestions. I know there was a mention about using tape to keep your mouth shut but try everything before you reach that resort. There are some threads about this on this board that you can read for more information.
Best of luck to you on finding a solution.

[

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#10
I've got real jaw problems myself. I found that my jaw was lowering even with a full fask mask on and causing leaks. Now I have the Innomed Hybrid mask, which is a full face mask, but with nasal pillows. The key to it is that it has a plastic cup on the bottom that my chin rests in. It is keeping my jaw closed which is really hard to adjust to. My AHI's are high at the moment, and I still have to figure out why. The chin cup does help way more than a chin strap, which is torture. I thought I'd mention that to you. DJ
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