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FFM Too Tight and Present Results
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BiBob Offline

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Posts: 36
Joined: May 2014

Machine: ResMed s9 VAuto
Mask Type: Full face mask
Mask Make & Model: ResMed Quattro FX
Humidifier: H5i
CPAP Pressure: 18/12
CPAP Software: ResScan SleepyHead

Other Comments:

Sex: Male
Location: Port Townsend, WA US

Post: #1
FFM Too Tight and Present Results
Present Results
AHIApnea / Hypopnea Index 14.98
HypopneaHypopnea 2.79
ApneaUnspecified Apnea 0.00
ObstructiveObstructive Apnea 9.93
Clear AirwayClear Airway Apnea 2.26

Event Breakdown


Statistics
Channel Min Med 95% Max
EPAPExpiratory Pressure (cmH20)
W-Avg: 18.12 16.00 18.28 19.82 20.00
IPAPInspiratory Pressure (cmH20)
W-Avg: 20.30 19.00 20.32 21.84 22.00
Minute Vent.Minute Ventilation (L/min)
W-Avg: 8.65 0.00 8.00 14.12 24.62
Resp. RateRespiratory Rate (breaths/min)
W-Avg: 18.06 0.00 15.20 33.60 43.40
Resp EventsRespiratory Events
W-Avg: 0.00 0.00 0.00 0.00 0.00
Flow LimitFlow Limit Graph (0-1)
W-Avg: 0.03 0.00 0.00 0.17 0.49
LeaksLeak Rate (L/min)
W-Avg: 5.14 0.00 0.00 58.80 104.40
Machine Settings
Pr. ReliefPressure Relief Easy-Breathe x1

I set machine at IPap=22, EPap=16 and RS=2

My sleep test prescription was 18 and 12 which reduced my events from 65 to 3 although I was told that at that time I was laying on my side.
So, I'm having difficulty in getting from two digit AHi numbers to anything approaching 5. Any suggestions are appreciated.

AND,

I have to wear my ResMed FX very tight to keep leakage under control which I have done successfully but would like to not have to wear it so tight. I've read that some are using cotton "T" shirt material to form a layer between their face and the mask. I've looked and can't find a description of this. So, if someone has a picture or written description they would be willing to provide it would be helpful.

Thank you
06-18-2014 03:00 PM
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diamaunt Offline

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Posts: 436
Joined: May 2012

Machine: S9 VPAP Auto 36006
Mask Type: Full face mask
Mask Make & Model: mirage quattro/pilairo q
Humidifier: none
CPAP Pressure: 9-20ish
CPAP Software: SleepyHead

Other Comments:

Sex: Male
Location: texas

Post: #2
RE: FFM Too Tight and Present Results
do a search for 'mask liner' Smile I think they're great, there's a number of different styles around, and some of the places will send you a sample pack.
06-18-2014 04:29 PM
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PaytonA Offline
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Posts: 3,019
Joined: Dec 2013

Machine: ResMed S9 VPAP Auto
Mask Type: Full face mask
Mask Make & Model: Resmed Mirage Quattro
Humidifier: H5i(distilled-top up)
CPAP Pressure: VAuto MinE14.0 MaxI 20.6 PS4.0
CPAP Software: ResScan SleepyHead

Other Comments:

Sex: Male
Location: Orange County,California

Post: #3
RE: FFM Too Tight and Present Results
I have not done it but here is how it works. Lay a piece of old T shirt or similar out flat. Take the straps off your mask. Put the mask, pillows side down, on top of the material. Cut around the mask. I would leave 1/2 to 1 inch border of material around the mask. Cut a hole for your nose to go through. Voila! Mask insert.

I see that much of your IPAP pressure is in the neighborhood of 20 cm/H2O. My experience (my IPAP pressure is 20) is that you are going to need the mask fairly tight to avoid excessive leakage. The mask insert may make it feel a little more comfortable. Make sure that your upper straps are the same length and your lower straps are the same length. When you put the mask on and have it strapped up grab the lower straps nad move the mask and headgear back and forth a little to ensure that they are centered. You fasten the straps one side at a time which can lead to more tension on one side than the otherDo the same for the upper straps. It is important to have the mask and headgear centered to avoid unequal tension on the mask which can cause leaks. The same reasoning goes for the strap lengths.

I had quite a bit of problem with leakage due to uneven tension when I first started with full face mask.

I also had to go to a different full face mask to minimize my leaks. I am successfully using the Resmed Mirage Quattro now. Full face masks are hard to get adjusted to be leak free. Here is a link to Jeffy's Mask Fit instructions. It is well worth consideration- http://www.apneaboard.com/forums/Thread-...434#pid434.

Many people will try to sell you on a nasal pillows mask but I think your pressure may be a little too high for them to be effective. If you can avoid mouth leakage a nasal mask would be easier to seal even if you needed a chin strap to avoid mouth leakage

Best of luck,

PaytonA
(This post was last modified: 06-18-2014 04:45 PM by PaytonA.)
06-18-2014 04:42 PM
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BiBob Offline

Preferred Members

Posts: 36
Joined: May 2014

Machine: ResMed s9 VAuto
Mask Type: Full face mask
Mask Make & Model: ResMed Quattro FX
Humidifier: H5i
CPAP Pressure: 18/12
CPAP Software: ResScan SleepyHead

Other Comments:

Sex: Male
Location: Port Townsend, WA US

Post: #4
RE: FFM Too Tight and Present Results
Thank you so much. This is quite a journey. I think I'm getting closer on the numbers and if I can now get the mask leakage under control I'll be in better shape. I so appreciate the forum and the help I've gotten here.
06-19-2014 07:08 AM
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vsheline Online

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Posts: 1,909
Joined: Jul 2012

Machine: S9 VPAP Adapt (USA Model# 36007, not better 36037 or 36067)
Mask Type: Full face mask
Mask Make & Model: F10 or SimPlus w/ 2Liners. MirageQuatro & Gecko gel pad
Humidifier: H5i
CPAP Pressure: 15 EPAP, PS 5-10
CPAP Software: ResScan

Other Comments: Marfan Syndrome, chronic bradycardia, occasional Cheyne-Stokes Respiration

Sex: Male
Location: California, USA

Post: #5
RE: FFM Too Tight and Present Results
Hi BiBob,

Regarding "My sleep test prescription was 18 and 12 which reduced my events from 65 to 3 although I was told that at that time I was laying on my side" and "I set machine at IPap=22, EPap=16 and RS=2"

Bi-level 18/12 usually means IPAP=18 and EPAP=12. This would be a Pressure Support (PS) of 6, not 2.

Looks like you are using 16 for minimum EPAP, 22 for maximum IPAP, and 2 for PS. Did you find that lowering PS reduced your central apneas? Actually, central apneas often reduce on their own during the first few weeks of treatment, as our body adapts to breathing under pressure. But everyone is different.

To try to avoid your obstructive events, your machine is raising EPAP to its max of 20. No doubt, if the maximum IPAP were to be raised to 25 the EPAP would go be going even higher than 20.

To lower your pressure needs, it may be important to sleep on your side, never on your back. Sleeping on our back usually increases our pressure needs a lot.

Take care,
--- Vaughn

Membership in the Advisory Member group should not be understood as in any way implying medical expertise or qualification for advising Sleep Apnea patients concerning their treatment. The Advisory Member group provides advice and suggestions to Apnea Board administrators and staff on matters concerning Apnea Board operation and administrative policies - not on matters concerning treatment for Sleep Apnea. I think it is now too late to change the name of the group but I think Voting Member group would perhaps have been a more descriptive name for the group.
(This post was last modified: 06-19-2014 01:06 PM by vsheline.)
06-19-2014 12:19 PM
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justMongo Offline

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Posts: 3,855
Joined: Sep 2013

Machine: ResMed VPAP Auto (S9)
Mask Type: Full face mask
Mask Make & Model: ResMed Mirage Quattro
Humidifier: ResMed H5i
CPAP Pressure: 18 IPAPmax - 11 EPAPmin, PS=5
CPAP Software: Other Software

Other Comments: μολὼν λαβέ

Sex: Male
Location: Калифорния

Post: #6
RE: FFM Too Tight and Present Results
Seems like you should take countermeasures to prevent sleeping on the back.

Then, why have you set your pressures so much higher than your Rx?
Why don't you start with your Rx pressures; which may help you control leaks.

INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
06-19-2014 12:33 PM
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BiBob Offline

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Posts: 36
Joined: May 2014

Machine: ResMed s9 VAuto
Mask Type: Full face mask
Mask Make & Model: ResMed Quattro FX
Humidifier: H5i
CPAP Pressure: 18/12
CPAP Software: ResScan SleepyHead

Other Comments:

Sex: Male
Location: Port Townsend, WA US

Post: #7
RE: FFM Too Tight and Present Results
This is so good. I've had my one month check with the doc and that was no help at all. It's taking me time to really understand what will work for me. So far the help I've gotten has been on the forum. Thanks once again. I haven't tried keeping off my back and I will increase PS and give that a try. Thanks you guys. Thanks just doesn't seem enough but thank you lots.
Bob
06-20-2014 07:54 AM
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retired_guy Offline

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Posts: 2,744
Joined: Jan 2014

Machine: ResMed S9 Autoset
Mask Type: Nasal pillows
Mask Make & Model: Resmed Airfit P10
Humidifier: ResMed
CPAP Pressure: 10.6/14, EPR 3
CPAP Software: ResScan SleepyHead

Other Comments: Is it bedtime yet?

Sex: Male
Location: Beautiful, albeit very wet Oregon Coast

Post: #8
RE: FFM Too Tight and Present Results
It's great to hear you're doing well Bob.

Do your reports show your events are under control now? Are you butting up against the max pressure a lot? Just curious what is making you feel you should up your pressure. It's fine if you do, just do it in small increments and allow a few days settle in time before you decide to change anything else. Once you get to that magic spot, maybe you'll even be able to sleep on your back again. That's the best of all worlds.
06-20-2014 11:55 AM
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vsheline Online

Advisory Members

Posts: 1,909
Joined: Jul 2012

Machine: S9 VPAP Adapt (USA Model# 36007, not better 36037 or 36067)
Mask Type: Full face mask
Mask Make & Model: F10 or SimPlus w/ 2Liners. MirageQuatro & Gecko gel pad
Humidifier: H5i
CPAP Pressure: 15 EPAP, PS 5-10
CPAP Software: ResScan

Other Comments: Marfan Syndrome, chronic bradycardia, occasional Cheyne-Stokes Respiration

Sex: Male
Location: California, USA

Post: #9
RE: FFM Too Tight and Present Results
(06-20-2014 07:54 AM)BiBob Wrote:  I've had my one month check with the doc and that was no help at all. It's taking me time to really understand what will work for me. So far the help I've gotten has been on the forum. Thanks once again. I haven't tried keeping off my back and I will increase PS and give that a try.

Hi BiBob,

I suggest adjusting the Pressure Support (PS) or the other settings gradually (for example, by 1 cm H2O every few days or weeks), keeping an eye on the weekly average of central apneas per hour (CAI), obstructive apneas per hr (OAI) and hypopneas per hr (HI).

Increasing PS may improve or degrade sleep quality, just like adjusting the other settings.

Keep in mind that increasing the setting for Pressure Support (PS) will decrease the maximum amount of EPAP pressure your machine will be able to provide, since the the max limit for EPAP is the Max IPAP minus the PS.

For your recent nights, what was the breakdown of AHI (Apnea Hypopnea Index, average per hr of total of all apneas and hypopneas), OAI (average per hr of only the obstructive apneas), CAI (average per hr of only central apneas, also called "clear airway" apneas)?

Also, I suggest using software (ResScan or SleepyHead) to see what is the length (in seconds) of your longest events, and how your pressure is varying throughout the night.

If using Pressure Support (PS) as high as 5 or 6, I recommend investing in a "recording" Pulse Oximeter to verify your average blood oxygen levels while asleep are not staying for hrs up above 97. The wrist-mounted ones with separate finger sensor are more comfortable than the ones where the whole unit clips on a finger. You don't need a prescription to buy one, but if you get a prescription you may be able to get your insurance to pre-authorize coverage.

If SpO2 (Saturation percentage of O2, oxygen) tends to average below 90 then increasing the PS would tend to increase the average. If the average SpO2 is above 96 then decreasing the PS would tend to decease the average SpO2. An ideal target for SpO2 is 94-96, or perhaps slightly lower when sleeping.

Take care,
--- Vaughn

Membership in the Advisory Member group should not be understood as in any way implying medical expertise or qualification for advising Sleep Apnea patients concerning their treatment. The Advisory Member group provides advice and suggestions to Apnea Board administrators and staff on matters concerning Apnea Board operation and administrative policies - not on matters concerning treatment for Sleep Apnea. I think it is now too late to change the name of the group but I think Voting Member group would perhaps have been a more descriptive name for the group.
(This post was last modified: 06-20-2014 01:37 PM by vsheline.)
06-20-2014 01:32 PM
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BiBob Offline

Preferred Members

Posts: 36
Joined: May 2014

Machine: ResMed s9 VAuto
Mask Type: Full face mask
Mask Make & Model: ResMed Quattro FX
Humidifier: H5i
CPAP Pressure: 18/12
CPAP Software: ResScan SleepyHead

Other Comments:

Sex: Male
Location: Port Townsend, WA US

Post: #10
RE: FFM Too Tight and Present Results
You guys are right. I've been jumping all over the place trying to find a sweet spot. I do have SleepyHead and am looking at the results. Data seems to suggest that when the OA events begin, the pressure starts up but doesn't eliminate the events. I'm going to try IPap (max)=22, EPap(min)=16 and PS=2 for awhile. It was at 18 cmH20 that the sleep test indicated that the events had dropped to around 3 per hour as opposed to 65/hour. So with minimal leakage and sleeping on my side, I'll see what the results are over a few days. Thanks to all of you.
Bob
06-20-2014 06:57 PM
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