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My AHI 5 times higher with a Facial mask than with the Nasal One
#1
I've been using a Resmed S9 for 2 weeks, with immediate benefit (my AHI droped from 30 in the sleep study, to 2 or 3 in the first days !). But as I had difficulties with my Mirage Fx nasal mask after a few days (my nose was more and more obstructed and I almost suffocated), I changed to a facial mask (Quattro). I had no apparent difficulties to deal with it, and my nose was no more obstructed, but...

But my AHI changed back from 2.1 to 10.8 the first night with the facial mask, then 13.1 next night. I changed from Nasal to Facial several times to be sure : always this kind of result, only the nights with the nasal mask get correct AHI. And as I installed ReScan yesterday, I could see that during some parts of the nights with the Facial mask, I had many Obstructive Apneas (more than forty 35 to 45 seconds apneas in one specific hour !) During these moments, the pressure from the S9 was at the maximum value of 13 - as my doctor ordered.

How is that possible ?

I noticed today, during a nap with the Nasal mask, that I woke up 2 or 3 times with a high flow noise in the mask - and my mouth was opened with air going out. Could it be possible that the good results with nasal mask is a kind of artefact, the air during the apneas entering through the nasal mask and going straight out of my mouth, the result being that the apneas could be hidden to the S9 ? Or is it that the 13 high value is not enough to get rid of the apneas, at least with the facial mask ?
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#2
did you check to see what your leaks were like? Also, do you have a Resmed S9 Elite or a Resmed S9 Auto Set?

Stand by for more answers to your question.
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#3
Could be a leak problem as stated before. It is definitely necessary to eliminate pressure escaping through mouth with a nasal interface in order to get accurate readings and effective therapy.

Also, make sure you are changing the "mask type" setting on the machine to the proper setting when changing mask types.

Sleep-well
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#4
Thanks for your answers... as well as your questions. My S9 is a "Autoset" (there was a mistake in my profile !)... And I thought about changing the mask type everytime...

According to the graphs in ReScan, the leaks during the apneas hours of nights with the facial mask were higher than in other moments, but always under the "acceptable" limit (seems to be the red line at 24 l/min in ReScan). Average leaks in these moments (as I can juge visualy on the graph) were about 16 L/min.

And during the nights with the Nasal mask, the leaks were a bit higher, often close to the 24 l/min limit, and with a few moments (may be 15 minutes in the whole night) above the limit (around 30 L/min). But no apneas then (at least on the graphs!).

Does it mean I should have a night with the facial mask with my mouth closed (with a kind of adhesive tape) to see if no apneas appear then ?
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#5
(11-02-2013, 12:50 PM)Rouletabille Wrote: Does it mean I should have a night with the facial mask with my mouth closed (with a kind of adhesive tape) to see if no apneas appear then ?

Probably not a good idea if you almost suffocated using the nasal mask.

This is an odd problem. I'm sorry I don't have any ideas about why you're seeing such a difference.
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#6
(11-02-2013, 12:56 PM)mdh235 Wrote: Probably not a good idea if you almost suffocated using the nasal mask.
Too-funny Well, 3 days of nasal mask gave me a kind of rhinitis, but it's almost over now ans I could give this idea a try. Isn't it what jgjones suggested when he wrote "It is definitely necessary to eliminate pressure escaping through mouth with a nasal interface in order to get accurate readings" ?
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#7
Hi Rouletabille,
WELCOME! to the forum.!
Best of luck to you with your CPAP therapy.
trish6hundred
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#8
(11-02-2013, 01:29 PM)trish6hundred Wrote: Hi Rouletabille,
WELCOME! to the forum.!
Best of luck to you with your CPAP therapy.
Thanks, trish6hundred ! I WANT it to work !

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#9
(11-02-2013, 01:11 PM)Rouletabille Wrote:
(11-02-2013, 12:56 PM)mdh235 Wrote: Probably not a good idea if you almost suffocated using the nasal mask.
Too-funny Well, 3 days of nasal mask gave me a kind of rhinitis, but it's almost over now ans I could give this idea a try. Isn't it what jgjones suggested when he wrote "It is definitely necessary to eliminate pressure escaping through mouth with a nasal interface in order to get accurate readings" ?

I actually tried taping my mouth shut because I really, really, really wanted to be able to use nasal pillows instead of a ffm.

Total failure. All that did was make my cheeks balloon out like a puffer fish, and the air still got out anyway.

Good luck. It's a long, often confusing road you're heading down.
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#10
(11-02-2013, 01:11 PM)Rouletabille Wrote:
(11-02-2013, 12:56 PM)mdh235 Wrote: Probably not a good idea if you almost suffocated using the nasal mask.
Too-funny Well, 3 days of nasal mask gave me a kind of rhinitis, but it's almost over now ans I could give this idea a try. Isn't it what jgjones suggested when he wrote "It is definitely necessary to eliminate pressure escaping through mouth with a nasal interface in order to get accurate readings" ?

I probably wasn't as clear as I should have been. What I meant was that you have to eliminate mouth leaks when using nasal pillows or a nasal mask. You don't have to worry about mouth leaks or mouth breathing with a full face mask because your mouth is within the pressurized system; this is the biggest reason many of us use a full face mask - because we are unable to keep pressure from escaping through our mouths when we use a nasal-only interface.

A chin strap or tongue positioning techniques are the only methods I would recommend for eliminating mouth leaks with nasal-only interface. Some people do use tape, but I wouldn't recommend it...I don't think it is safe. If a chin strap and/or tongue positioning don't work for you, you are better off just using a full face mask imho.

Sleep-well
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