New To Apnea Board [confirmation of my data analysis]

[Walla Walla]

If your going to try a nasal pillow mask I'd recommend the ResMed Airfit P10. If another Full face mask than the ResMed AirTouch F-20.

[Apnea Infant]

Hello Jbuch002

I started with a full face mask bu the leaks situation was HORRIFIC. The sleepyhead charts were like mountainous peaks of leaks. Also my diagnosed pressure was far too high as the collapse of my airways was extremely severe, it seems. But back then I was back sleeping without a collar with a full face mask and was a mouth breather.

Using the nasal pillows with a soft collar helped with lots of positional induced clusters and also serious leaks. I learnt to sleep with my mouth closed with the chin tuck technique and am successful in the main. At times I still swallow some but never as much as in the early days.

The P10 pillows is much hearalded. Try it to see if it works for you.

[Sleeprider]

Resistance is futile, and if you try the Airfit P10 you will like it. A couple notes on it's use:
1. You probably need a larger pillow size than you intuitively think.
2. Your pressure requirement may drop by 1 cm or so due to more direct application of positive pressure.

[jbuch002]

Resistance is futile, and if you try the Airfit P10 you will like it.  .......

Thanks for the input from all on this mask. Did a little research, talked with Supplier #1 and the order for a the P10 ships out tomorrow. I also got a chin strap (a Ruby Red?). 

I'm probably relating what most here know but for those that don't and are side sleepers struggling with a full face mask,  the P10 is a good choice for "active sleepers." Even though I sleep without thrashing most of the night, I still roll over and my primary posture while sleeping is on my side. It seems that for some, not all, the full face mask just doesn't work well for side sleepers. Too much leaking. I am told the P10 is designed for that kind of thing with minimal impact on pressures by movement. I will be my own test case on this thinking.

So, I'm excited about getting on with this and a new P10. I'll post when I have something to add. Again, thanks for everyone's hand-holding and advice. Much appreciated.

[Sleeprider]

One additional pointer is that the P10 is much better if you use a hose 'cozy' (fleece cover), and pull it up along the P10 connecting hose to within a couple inches of the mask frame. When sleeping on my side I often end up sleeping over the hose, and the cover makes it soft and unnoticeable. Don't worry if the cover does not cover all the way down to the machine, it's mostly for your comfort, and quiets any noise in the tube.

[jbuch002]

Located a SnuggleHose fleece cover. I think this is what you mean. Cozy makes a hanger contraption you stick on the wall to elevate the hose above your head. Don't think I need that at present. I've just been running the hose back from my face and running it down between the mattress and head board. Seems to stay out of the way. I did notice that I had a 90 degree bend in the hose (did not appear obstructed) as the heated hose made it's way back to the device. Despite no apparent obstruction, I would not doubt that 90 reduced flow and/or produced some unintended back pressure the device sensed. I fixed that but I do like your idea.

[Sleeprider]

May bad using the 'cozy' term. I also use the Snugglehose, and got one first thing for my wife when she started last year. I use a lanyard to suspend the hose from the headboard. It comes up from the machine, and is hung from the headboard, and there is enough room to turn and move around freely. Whatever works is the right solution, and no problem with the hose bending as long as it isn't kinked.

[jbuch002]

Just received and used last night the Airfit P10 Nasal Pillow mask. Started with the medium size and it seems to fit well. After only one night of use I can say:

(1) It is less intrusive than the full mask. When you first try it on it feels good compared to the full-face.

(2) Like all full-face masks and from what I've read of all the rest (make and model), the much heralded P10 has it's own set of issues for me and these may not apply to everyone and some of these will probably resolve over a 2w trial period; some won't:

   (a) This mask has a much lower noticed leak rate than my full-face. See comments below on why I don't have SleepyHead data/charts.

   (b) The humidity and temperature settings (I use manual on my ResMed Airsense 10) had to be turned down a bit in the middle of the night as condensation was a problem. This was never a problem with the full-face set at 84 degrees and a 7 (full) on the humidity level. I really enjoyed those settings with the full face; enjoyed the same moist warm air on the nasal after I turned it down to 81 and 5.
 
   © I remembered after my first REA (about 2h in) that I needed to reset my Airsense for the nasal mask from full face to nasal. This makes a difference. It feels like the pressure is delivered for a nasal mask a bit more softly than the full-face. It felt like it was a 1cm decrease even though technically there isn't. I had a higher AHI (3.29) on this first night's run than my best run with a full-face after 3w on it (0.95); not really comparing apples to apples but, subjectively, I felt like I had less mask leaking than the full-face but still had more AHIs. Pretty sure I need to bump up the pressure setting (To simulate CPAP and retain all the SleepyHead data, I used 9.0 - 9.0 to start, bumped it 9.4-9.4 and should probably be at least at 10-10.  That's what I'll try tonight
   
   (d) I am an active sleeper and primarily side sleep. The P10 is a little better for the side sleeping but your facial muscles and bone structures still can compromise mask integirty. Just does not seem to be quite as bad as the full-face.
   
   (e) I'm a mouth breather. I purchased a chin strap (Ruby Red) to go along with the P10. It worked but it adds to the stuff on your head and face which you're trying to eliminate by using a nasal mask. I was also aware of it's presence even though it did it's job. I think the sensation of it being there will abate over time.

   (f) I had a lot more awakenings that I thought I would have (3-4). This is about the same as with the full-face. So, a bit disappointing to my expectations but I think this will improve in the next couple of nights. It's worth noting that when I took 2 nights off after getting frustrated with the full-face and while waiting to receive my P10, I returned to snoring loudly, soar throat in the morning and feeling like a 3 on my 1-10 feel good in the morning scale. I put the full-face back on for a night, still had 3 awakenings but achieved deeper sleep I think (I dreamed), a 0.95 AHI and had a 7 on my feel good in the morning scale. Maybe that darn full face works fine!

   (g) I've been alternating back and forth between a TempurPedic hard neck pillow and a universal soft pillow trying to reduce mask leaks when on my side. With my full-face, I had evolved to a pretty good situation when I let my entire mask hang over the edge of the hard pillow so the mask wasn't distorting and leaking. While there is much less of that with nasal, I feel it is still problematic, especially on a soft pillow. You still have to do the same thing ..... let the smaller profile of the nasal hang over the side of your pillow for best results.... regardless of the style of pillow. An xPAP pillow might be worth a try but I think I can compensate without buying one of those.

(3) I'd post my SleepyHead charts but, darn, I forgot to insert the SD card last night. Whoops. In the Clinical Setting mode, you can see AHIs, use and mask integrity (without any detail). The SD card is already back in the device and tomorrow, I'll have the data and already know what kind of adjustments I need to make so, hope it's a good night.

More tomorrow with SleephyHead data.

[jbuch002]

2nd night on P10 w/chin strap. Sense of a restful night with one perceived awakening (many RERAs). AHI 3.91 with more OAs and CAs than I would like to see. 

Leak control pretty good and as I had hoped for with the P10. 

RERAs possibly associated with movement (only once consciously awake and only for a short period).

Suspect I snored when on my back. I don't go there much. Snoring, usually briefly and unconsciously awakens me and I roll over.

Feel good index upon awakening around 8/10. A good night with a few runs of restful sleep by the data and subjectively even though too many CAs present (???). 

I wonder if these are actually CAs? - coned down on the period 04:32 to 04:37 - Screen shot #2 and #3 show respiratory changes that I'm not confident I know what these mean. Help here please? 

Current settings with AirSense 10 set at min. 10cm , Max 10cm to simulate CPAP. Options to tweek the device to reduce OAs and snoring include (1) Increase Min./Max. pressures to 10.5 or 11 or (2) try Autosense with Min at 8 and Max at 11. I have some concerns about the CAs and no significant underlying diseases are present. I have rate controlled Paroxymal A-Fib. Thoughts?

[Walla Walla]

Overall your numbers look good. Except for one cluster of hypopneas you didn't really have a problem with obstructive events. As far as the Clear airway events there's not much you can do but wait for your body to adjust. It can take a couple of months. To tell if those CA's you highlighted are real or not you need to zoom in more.