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Transition from NP to FFM
#1
Now 100 days into xPAP. Split sleep study showed AHI of 21; 55 in REM. On CPAP, OAs not controlled until very brief time at 13 cm H2O. Sleep doc recommended 8-15 APAP with 3 EPR. Great DME set me up on Resmed A10 and F10 FFM. By mistake, set up at constant 15cm H2O initially and had no improvement initially, but AHI dropped over 1 1/2 week to about 12 before I added a chinstrap due to dry mouth, and then to 7. When I switched to P-10 pillows3 days later, DME discovered the error in pressure settings and corrected to 8-15. I was in heaven! Despite having few symptoms of sleep apnea before, I found I slept much more soundly, and felt better during the day. AHI dropped to 4 and gradually down to 0-2 range. 95% pressures started at 13 and dropped to 11.

The problem with the pillows was that despite all sorts of machinations with the chin strap and trying to hold my tongue just right, I couldn’t keep the mouth leaks low enough to prevent dry mouth. To the point I developed canker sores in upper gum areas. Sleep doc said long term I needed to get the leaks in control for teeth and gum health. Said the new View mask might help. While waiting for the mask, I went back to the F10 FFM with 8-15 APAP setting unchanged. AHI shot up to 10; 95% pressures 15. Back to NP for 2 days – pressures and AHI lower as before.

Since, I have struggled with the FFM – AHI running 10-14 and not sleeping as well. Hanging in there after 2 ½ weeks but quite discouraged. The Amara View mask seals well and is comfortable, though I have to clamp it down at higher pressures. Spent a couple of days reading RobySue’s great writeup on interpreting Sleepyhead. Looked at SH data with new eyes and surmised that the A10 was being overly aggressive in preemptively raising pressures due to flow limits and OAs combined and that the higher pressures put me into OA clusters (might be faulty reasoning – I gather that CAs usually the result of rapid pressure increases). Reset pressures to 9-15; then 9-14; then 9-13.6 with 3 instead of 2 EPR. No joy.

Now thinking I need to try higher pressures and maybe higher pressure bracket, or possibly fixed pressure, but would really like some feedback. After such wonderful experience on the P10 NP (except for mouth leakage) this is very frustrating and discouraging. I think this is first post, so I gather I can’t post images.
Dick
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#2
I'm only 5 weeks into this new adventure, but for what it's worth here are a few thoughts:

1. My sleep doc, who I believe is very good, told me that CAs (a concern of mine) are often a normal consequence of transitioning from awake to sleep or from sleep to awake. In his opinion, a moderate amount of CAs are usually not a serious concern if they occur primarily when falling asleep at the beginning of the night, when awakening in the morning, or when awakening or falling back to sleep due to a middle-of-the-night bathroom break.

2. I've tried nasal pillows, nasal masks and full face masks. The pillows and nasal masks gave good AHI numbers, but I had significant major leaks due to lip bubbling and a droopy mouth. I tried a "boil-and-bite" mouthguard, a chinstrap and even taped my mouth closed for a week (that worked, but it's not a viable long-term solution for me). I tried to train my tongue to stay against the roof of my mouth, but so far haven't had success with that even though others here say it's a good solution.

I've used the Amara View full face mask for the last 4 nights. My results are similar to yours -- higher AHIs at identical pressures with the Amara (and the F&P Simplus before that) than either the pillows or nasal masks. My APAP pressure is 8-13, with no ramp and no EPR. My plan is to stick with the Amara View for a couple of weeks, in hopes that my body and brain will become acclimated to the different feeling of using a FFM and will eventually produce consistent AHI results under 5 (vs my sleep study result of 41 AHI). The Amara View experiment is a work in progress -- my average AHI is 7.2 for the last 4 nights, with last night being the best at 3.87.

My suggestion is to give yourself more time to get used to the Amara View. You've proved you can persevere -- 100 days of APAP therapy takes determination, in my opinion -- so what's a couple of weeks to see if things will settle down? I would prefer to use a pillows mask or even a nasal mask, but that may not be in the cards for me. At this point I'm going to work on adapting to the FFM; perhaps later I will go back and try the pillows or nasal mask again.

Good luck!!

Andy
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#3
Thanks,Andy. Good advice. Have been back at the FFM (F10 until I got the View and View since) about 2 weeks. Hoping to tweak it a bit and get back on track. Right now I'd love to have your numbers :-)
Dick
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#4
I'm using an F&P Simplus, which I have nicknamed the "Facedigger." My DME wants me to try the Amara View, so I'm thinking of doing so. I've been on ASV therapy for about going on 5 months now.

I should also add that I get dry mouth even on a full face mask, with my humidifier and climate line hose set to auto.
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#5
JVinNE, I found the chinstrap pretty much stopped dry mouth with FFM, even tho it is a lot of gear to wear. I hear you on " Facedigger". I'll be there too if I have to raise my pressure more.
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