First 2 weeks and my thoughts on P10, Brevida and Dreamwear masks

[OpalRose]

Your results are fairy good, but you could do with a narrower pressure range.

Try a minimum pressure closer to your med. pressure, and bring the max pressure down to 18cm.  So a range like 10-18 for now.  That is still a wide range, but it's best not to make drastic changes.  Go slowly and watch results for a few days.  I think you may end up with a slightly higher minimum pressure, but wait and see.  You may not need to go any higher, and there is no point in using a higher pressure if not needed.

Also, change the ramp starting time to be closer to the minimum pressure.  So if your minimum pressure is 10cm, start your ramp at 8.

The time period around 1:00, I see a cluster of Obstructives.  You could have rolled onto your back at that time.  Try to stay off your back (I know, it's not always possible)  

You can also try a "soft" cervical collar.  This helps with chin tucking and also helps to keep the jaw/mouth from dropping open.  A lot of us here have found the collar very effective.

Next time when arranging your graphs, include the following:  Events, Flow Rate, Pressure,
Snore and Leak rate.

[Gideon]

Leak Rate may show mouth leaks, and Flow Limit and Snores are indicators of Obstructive type events  You can squeeze the graphs vertically to gain some space.
I can see you going to 9 min

[JeffT]

I think I worked out the Dreamwear. My frame is a medium, and with my big head, it is sitting to far forward, and the angle of the mask is wrong. I tried to use it last night but simply couldn't get it right. I'll see if I can get a bigger frame and try again. I note there is also a medium-wide mask option, so I might try that also. For the time being I'll stick with the Brevida.

I've adjusted my pressures just a little - to 9-18 from 6-20. I know it could, and no doubt will, go tighter, but I figure a little at a time is best seeing as generally things are working well and I am still new to all this. I'll see what happens and post some graphs in a day or two. Thanks again to everyone.

[JeffT]

Changed my pressure from 6-20 to 9-18. Results are good I think. The AHI is higher than it really is because of all the events in the morning which happened when I woke early and couldn't get back to sleep - they weren't actually while I was sleeping and was more a result of me controlling my breath too much. 

[OpalRose]

Yes, I would ignore the early morning events. Probably SWJ (Sleep Wake Junk). Could also be positional. Are you using a soft cervical collar? That may help. Also, notice the snore graph and how that drives the pressure up.

You could stay with this a few days, and watch the med and 95% pressure readings. It would be beneficial if your minimum pressure is closer to the med. pressure reading.

[JeffT]

Thanks. I will let it run a few days and then raise the minimum. No, not using any collars/straps at the moment, and yes, the events I believe are clearly happening when I am on my back, so I am probably mouth breathing a bit - as a long time very heavy snorer I'm actually super happy with how little is going on now comparatively. Trying an arrangement of pillows to help me side sleep more - a step at a time but heading in the right direction. Thanks for looking and providing your thoughts. Much appreciated.

[ajack]

I think you are getting a pressure rise from the mouth breathing at 3:15-45. The machine wrongly sees it as a problem to fix by pressure, which may only increase the mouth breathing.

[JeffT]

My last two nights. First at 9-18.



The leak near the start was because one of the nostril vents inverted when I put the mask on and I realised and popped it back out again (Brevida mask).

I raised the minimum last night to 10-18.



Both nights I managed to stay on my side all night I think - arrangement of pillows now prevents me getting comfortable on my back.

And here is my overview since I started on the machine.


The two larger leak nights were when I tried the Dreamwear mask that is too small for me, and the first week which shows large leak events was when I was using the P10 mask. The bad night (August 1) with higher AHI I had a cold, which definitely was impacting my breathing.

 Overall pretty happy with all of that I think, but interested in any insights if anyone has some.

[JeffT]

Dialling things in - have been slowly adjusting my pressures. Last night I went to 11-17.4 after being on 10-18 for 3 nights. The higher minimum has dropped the median, 95% and max pressures, and lowest AHI yet.





Still loving the Brevida mask.

[JeffT]

Last week of my one month trial - the DME loaned my a Resprionics Nuance Gel Pillow mask to try since they didn't have a large dreamwear frame for me, and the Nuance insert looks like it is very similar to the similar insert available on the Dreamwear.

On the plus side, I seemed to be able to adjust the headgear to get it to fit me, but only just, and the leaks are essentially non-existent - the gel seals really do their job and seal everything very well. But, while it didn't feel like it was inside my nose like the P10, it was still applying pressure to my nostrils and became quite irritating to the skin. After the softness of the Brevida, I really didn't like the sensation at all. The other negative was the exhaust port - like the Brevida, it is an articulated hose joint with an exhaust port on the swivel, but this one has no diffuser (Brevida and P10 do) and the air literally streams out. Not has fast as through the little slot on the Dreamwear pillow, but still enough that on several occasions it woke my when I moved my air into the airflow. 

So, four masks in four weeks, and the Brevida is the clear winner for me.

- P10 was fine, but after a few nights my skin between the nostrils was becoming quite sore and sensitive, and I didn't like the feeling of the prongs pushing into my nose. It also dislodged reasonably frequently, not fully, but enough that I would need to reposition it. This was because the mask sticks out from my face and really has only two points of contact, so as I squirmed around at night it moved out of alignment. Also more difficult to find a good position on my side where my head pillows didn't interfere with my mask. It also may be that the headgear was applying too much pressure because of my head size, but it isn't adjustable, so it is what it is.

- Nuance was more comfortable then the P10 and sealed better, but similar issues of soreness were arising, and I didn't like the exhaust stream waking me up. It also sticks out a bit, but not as much as the P10 because of the way the hose connection worked, and the headgear has rear and top straps and overall it seemed to me less easy to dislodge throughout the night than the P10. More forgiving of moving around than the P10 - those gel rings really do seal well.

- Dreamwear simply didn't work for me, but that is probably a sizing issue - unfair of me to judge it too harshly until I can try a better size. Liked the hose position, and that the mask doesn't stick out and is very much harder to knock out of place (no hose as well to interfere with things). But I just couldn't get the angle right to make it work effectively. When it was in the right place it felt much like the Brevida on the nose, but the headgear was more noticeable against my face than the other masks.

- Brevida is much lower profile on the face than the P10 and Nuance and basically doesn't move around at all. Good seal (though not as near perfect as the Nuance, but better than the P10). Adjustable headgear that actually fits me. Exhaust diffuser that eliminates a cold wind waking me up and keeps it nice and quiet, and much softer on the nose - no irritations or issues at all. Negative is that it does cover the whole end of the nose and as such can feel like it is a little sweaty under there. Also need to be careful to ensure that the nasal vents don't get inverted when you put it on. But those are minor gripes.