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Significant AHI results with different masks.
#1
Significant AHI results with different masks.
I have used a Swift Nano FX nasal pillow for many years with satisfactory results - AHI usually under 6. In that mouth breathing became an issue a full face mask was recommended. 

The Resmed Airfit Touch worked well (AHI under 6) but because of irritation on the nasal bridge, I tried the new Resmed F-30 hybrid mask.

Leakage ( under 24) was not a problem with any of the masks and all pressures etc . were the same for all masks. 

The F-30 did not control my apneas in any form. I could not get my AHI's under 16 after 7-8 tries. Between uses of the F-30 the other masks consistently kept my AHI below 4. 

Is there a possible explanation as to why the F-30 has failed me? 

I use a Respironics ASV System One unit and again the F-30 was comfortable, did not leak and seemed to fit well.
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#2
RE: Significant AHI results with different masks.
ttsleeper, the answer may be in the details of your therapy. If you will download SleepyHead you can see what kind of event made your AHI unexpectedly high and whether they correlate with leaks, backup breaths or pressure changes from your ASV. There are so many possibilities when dealing with ASV that speculation is futile. One thing to keep in mind is that nasal pillow masks apply pressure very directly and without the delays that happen with a higher volume full face mask or hybrid. While I'd like to help you overcome the mouth breathing problem so you can get back to nasal pillows, the most likely cure for the F-30 is a slightly higher EPAP minimum pressure.

Now for the fun stuff...are you using the Resmed Aircurve 10 ASV or the Philips Respironics System One SV Auto advanced? You sort of mixed the two in the name of the machine. If you are on the Philips you need the newest version of Sleepyhead here; http://www.apneaboard.com/forums/Thread-...stallation In fact, that is probably best for either model.
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#3
RE: Significant AHI results with different masks.
sleeprider, thanks for your response. I see the confusion in the name of my machine and have corrected it in my profile. 

Increasing the min EPAP for the T-30 makes sense. However, the current settings work fine for my Resmed Touch which is a full face mask. Perhaps the problem is unique to a hybrid type mask. I will change the pressure and continue trying to see the results.

I now have the latest Sleepyhead software update and will try to make sense of the events versus pressure and breathing changes.
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#4
RE: Significant AHI results with different masks.
I'm sure that seeing the charts will help us make better decisions.
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#5
RE: Significant AHI results with different masks.
These are the most recent screenshots of the discrepancy between a Nano mask and my newest Resmed F-30. I have also included a shot of my F-20 Touch full face mask to show that another full face mask does not respond similarly as the F-30. All other parameters should be equal. To the best of my knowledge, significant leaks have not been a problem with any of the masks. 

I would like the F-30 to work for me as I do have nasal bridge irritation issues and some mouth breathing. 

In that, this is my first post with screenshots I am unsure if this data will be helpful.

Thank you,


Attached Files Thumbnail(s)
           
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#6
RE: Significant AHI results with different masks.
ttsleeper, your charts show remarkably different results from night to night. On 1/2/ and 2/3 you had a pretty decent therapy nights and with mostly hypopnea and a few central coming through. On 2/6 we see a full display of complex apnea with very high AHI, and apparent failure of your machine to create breaths where they were needed. The flow rate chart shows a lot of time where expiration seems cut-off.

My first question is whether your provider will let you try a Resmed Aircurve 10 ASV. These machines usually react faster and more comfortably to bring AHI to near-zero. Next, let's verify your settings. Version 1.1.0 of Sleepyhead is all we have to view the therapy of individuals on the Philips Respironics SV machines, but it is still far from perfect in telling us the settings. The charts are showing EPAP min 6.5, IPAP max 25 and PS 0.0 to 15.0. My immediate suggestion is to increase PS min to 2.0 to intercept some of the hypopnea.
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#7
RE: Significant AHI results with different masks.
I will leave the mask comments to those with more overall knowledge/experience than I.. 

But you may benefit from training yourself out of being a mouth breather as well as looking at the other aspects. 

There are threads on the topic.. but the aim is basically to get your tongue to seal against the roof of your mouth and/or your throat muscles to close your gastric tract so that air only comes in and out through your nose when sleeping. (sorry for the non biologically specific description)

One technique to practice is holding water or other liquid in your mouth and breathing through your nose while doing so. 

Also consciously practice placing your tongue against the roof of your mouth and keeping your mouth closed while breathing in and out at times during the day.

When I first started CPAP a couple of years ago I found I would sometimes wake in the middle of the night with a dry sore throat.
It was a random thing, so it took me a couple of months to figure out that my mouth was dropping open at times when the muscles fully relaxed in deep sleep, it wasn't until I came fully awake one night with air rushing out my mouth that I realised I was even opening it in my sleep. 
( I wonder how many bugs and spiders have walked in there over the decades  Thinking-about  Huh  Laugh-a-lot )

I have not had a problem with it for ages now, I use a Fisher & Paykel Eson nose mask as my sensitive nasal lining can't tolerate nose pillows.
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#8
RE: Significant AHI results with different masks.
I had the same problems with my full face mask after using it successfully for 9 years, it created pain on the bridge of my nose and rashes where the mask pillow met my face.  There
were mask leaks and high AHI frequently.  I'm a side sleeper and I'm sure this didn't help, but I thought it was strange that this was happening after using this equipment very
successfully for 9 years.  I decided to try a Dreamwear full face mask and found that it doesn't work as well for side sleepers and then I tried the Dreamwear Nasal Cushion (not the pillow with the nasal inserts) mask, because I'm a mouth breather, my results were negatively affected by my mouth.  I looked for a solution and found Snorless Strips which I started using and immediately experienced fantastic results.  No more pain or rashes and my AHI is consistently low with no mask leaks, the strips take some getting used to and they do leave an annoying residue
over your lip in the morning that I have to remove, but they work very well apart from that.  Snorless Strips are part of teaching a breathing method that I believe is designed to help you move away from being a mouth breather.  I did forget to put a strip on one night and the next morning I found that my AHI was a little higher, but not much which I think means that the air seal from a closed mouth was working.  I haven't tried it again, but maybe it's moving me in the right direction.   If you do a search you'll find the Snorless Strips on Amazon.
Hope this is helpful.
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#9
RE: Significant AHI results with different masks.
Recapping my inquiry. All things being equal I get satisfactory results with my nasal mask (Swift FX Nano) and consistently poor results using my hybrid mask (ResMed F-30).

Sleeprider suggested an increase min PS from 0 to 2. I thought we were on to something as I got better results.
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#10
RE: Significant AHI results with different masks.
(02-07-2019, 04:33 PM)Ockrocket Wrote: I will leave the mask comments to those with more overall knowledge/experience than I.. 

But you may benefit from training yourself out of being a mouth breather as well as looking at the other aspects. 

There are threads on the topic.. but the aim is basically to get your tongue to seal against the roof of your mouth and/or your throat muscles to close your gastric tract so that air only comes in and out through your nose when sleeping. (sorry for the non biologically specific description)

One technique to practice is holding water or other liquid in your mouth and breathing through your nose while doing so. 

Also consciously practice placing your tongue against the roof of your mouth and keeping your mouth closed while breathing in and out at times during the day.

When I first started CPAP a couple of years ago I found I would sometimes wake in the middle of the night with a dry sore throat.
It was a random thing, so it took me a couple of months to figure out that my mouth was dropping open at times when the muscles fully relaxed in deep sleep, it wasn't until I came fully awake one night with air rushing out my mouth that I realised I was even opening it in my sleep. 
( I wonder how many bugs and spiders have walked in there over the decades  Thinking-about  Huh  Laugh-a-lot )

I have not had a problem with it for ages now, I use a Fisher & Paykel Eson nose mask as my sensitive nasal lining can't tolerate nose pillows.

Thanks for your post; I sometimes mouth breath. It's time for me to learn this skill again.
DaveL--25+ years compliant.
DaveL
Compliant for 25+ years
iMac computer/SleepyHead
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