Question on Changing Masks

[RWhipkey]

I am about 3 1/2 months into CPAP therapy.  Recently I became aware that Medicare would pay for a new mask at the 3 month point.  I decided to get a F&P Simplus based on all of the good reviews I have read.  I have been using a Dreamware nasal pillow with my Dreamstation, but have found great results only by adding a chin strap and taping my mouth.  Over the past month, my AHI has averaged .54 and my RDI .89.  The Simplus felt good at the DME supplier and it is very comfortable at night.  I have used it 3 nights.  The AHI and RDI results have been disappointing.  AHI hovers around 2.7 and RDI around 3.2; quite a change from where I was with the Dreamwear, chinstrap and taping.  The big difference is that OA’s make up the bulk of the AHI ( and they appear in clusters) and RERA’s are up a bit as well.  CA’s remain a non-factor.
My question is this; does the FFM Simplus require another pressure range adjustment?  I have been at 8.00 to 12.00 with the Dreamware mask. I did make a slight pressure adjustment with the Simplus using 8.5 to 12 and 9 to 12, but perhaps I should have stayed at 8.0.  The reason I did so is, that with the full face Simplus, I felt my breathing more difficult at 8.0.  By the way, the leaks with the Simplus are non-existent as they have been with the Dreamware.  Also, I have little or no aerophasia and I do not have to use a chinstrap or tape, so I have not done so.  I can always go back to the Dreamware setup, but it would be nice to have both options.
Attached is a Sleepyhead result for 4/19.


[url=http://imgur.com/tqa3g54.png][/url]

[big_dave]

All of your obstructive events occur in a short period of time between 1:45 and 3:00. It is probably a one-off unrelated to switching masks. It's hard to tell if the higher AHI is significant with only one night's worth of data. I would suggest waiting until you have at least a week's worth of data.

[chill]

If find that full-face masks need about 1 - 1.5 higher pressure for the same effect.

[justMongo]

You went from a nasal pillow to a full-face. Respironics has a mask resistance setting.
That may need to be changed.

Since the OAs are mostly during a period when the machine has raised pressure, I do not believe a pressure increase is called for.

[Hydrangea]

I don't have the wisdom to answer your question well. But I'll share my experience.

When I use the DreamWear mask, my auto-adjusting pressure never goes higher than 11. When I use a FFM (Amara View), my auto-adjusting pressure goes up toward 16.

So now, when I use a FFM, I put my max pressure higher, so it has the room to go higher if need be.

[AshSF]

I started with an f10 and my 95% pressure used to go up to 14cm.

With my p10 (and yes, this will be the mask you finally gravitate to because 'resistance is futile'), my pressure never budged from 8cm. That's when I switched and never went back to the FFM. During the days when I have a severe nose block, I just change pressure to 8.5 or 9 for that night. It works well for me.

[RWhipkey]

Since the last post on this thread, I have returned to the Dreamwear Nasal Pillow to see if my AHI and RDI would return to the low levels I had before trying the Simplus and, of course they did.  My breakthrough with APAP came on March 16 when, based on a thread suggestion, I changed the FLEX setting on my Dreamstation to C-Flex from A-Flex.  I set C-Flex to 2 and, immediately, my AHI fell that night to .14 and my RDI to .55.  My 38-day average since then has been AHI at .54 and RDI at .94.  The first two weeks AHI average was .24 and RDI .54; since then, AHI average has increased to .76 and RDI to 1.24.  I’m not sure why it went up, but the numbers are still very good.  I can’t say that the quality of my sleep is better, but I do have more energy at the gym (which is great at age 68).  I finally met with a sleep doctor who reviewed my history and commended me for finding this site.  We talked about mouth breathing and it was he who suggested a FFM to avoid taping and a chinstrap.  He also said that I might not actually feel “better” for some time even though the APAP numbers are great.  This is consistent with what I have read on this site.

I’m willing to try the Simplus again.  In addition, when I was doing some research on mask fitting, an Amazon ad for the Resmed P10 for $49 popped up on my screen.  And, since “resistance is futile”, I bought it.  So, I’m ready to try it as well.

I would appreciate some advice and insight.  Here are my questions regarding my present arrangement (Pressure range 8.00 to 12.00, C-2 FLEX, Dreamwear   mask, chinstrap, taping):
1. Should I even be concerned that my numbers have been increasing slightly above the initial period lows since March 16?  Should I increase pressure range        slightly?  My mask is now 3 1/2 months old; I have replaced the cushion but, not the frame.
2. RERA has been increasing, so should I increase C-Flex to 3?
3. I did try a cervical soft collar and found it as effective as the chin strap.  Is there an advantage of one over the other?
4. My average pressure has been 8.21 (min = 8.00, med =8.00).  Does this suggest I might have less awakenings with a “fixed pressure”?  I don’t think, by             eyeballing my Sleepyhead charts, that my awakenings occur with pressure changes, but I’m far from an expert in interpreting Sleepyhead data.
 
Regarding the P10:
1. Should I give it a go?
2. Sleeprider mentioned in a post on 4/8/17 that most people changing from a Dreamwear pillow to a P10 find they need 2 – 3 cm less pressure with the P10.          Where do I start?  Do I reduce my current range and increase as necessary (work up)?  Or, do I start at my current range and reduce pressure as necessary        (work down)?
3. Am I likely to still need the chinstrap or cervical collar?  Do I start with or without it?
4. Will leaks be harder to control with the P10?
5. What mask resistance setting on my Dreamstation do I use?  Dreamwear is -1.
6. What prong size do I start with?  I wear a medium Dreamware pillow.
 
Regarding the Simplus:
1. Should I give it another go?
2. Chill mentioned in this thread that, typically a FFM will require a 1-1.5 higher pressure. Where do I start?  Do I increase my current range and change from     there as necessary (Increase and work from there)?  Or, do I start at my current range again and increase pressure as necessary (work up)?
3. What mask setting should I use?
4. I didn’t need a chinstrap in my short trial.  May I need one with increased pressures?
 
And finally, am I being foolish in even considering these alternatives?  I don’t want to be a number chaser, but I’m really interested in getting the most from this therapy.  So, I’m willing to experiment.  I most definitely would welcome your thoughts.

[Sleeprider]

My ears were burning

I think you may need slightly less pressure with a P10 than Dreamwear, but I would put it at about 1-cm. I think a lot of your success in using hte Dreamwear is the minimal pressure change that it requires to be effective, so don't drop down too far; in fact 7.5 minimum might be a good start, and if you find the pressure never increases then try 7.0.

The Simplus is just the opposite. The higher volume is going to take 1-2 cm higher pressure. Same principle applies. Your median pressure was 9.0 in the graph at the top of the page, and I could see where 9.5 might be the magic minimum for that setup. As you know, there are no set rules, but rather trial and error. If you introduce more variables like masks and Flex settings, it just takes some patience and more time to find the sweet spot. Regardless, you have better numbers than I do, so don't focus too much on the AHI stuff unless it is affecting how you feel and that positive gain you've experienced in activity level and sense of well-being.

Tom

[Hydrangea]

I have a thread going, discussing my venture into P10 from Dreamwear. Search for that, and see how it compares to your experience.

I seem to have similar pressure needs with P10 vs Dreamwear. But when I've experimented with the Amara View FFM, my pressure has needed to be significantly higher, *and* my AHI is twice as high.

I do like the P10, especially since it is so quiet. But I find the Dreamwear to be more comfortable, and with less need to fiddle to avoid leaks. So I'm kind of torn.

[AshSF]

As SR said, your numbers look good so tweaking much from here will not get you much bang for your buck.

Your pressure barely budges from 8cm. It's a pretty low pressure as far as tolerance goes. So exploring if the P10 can let you reduce it further by 0.1-1.5cm is not relevant. I have experimented with changing pressures with p10. My AHI at 7.5cm constant and 8.5cm constant is pretty much the same. But I feel like I am starved for air at 7.5. So I keep it at 8.

A higher pressure than optimal for AHI will not cause any trouble for you, especially at levels below 10cm. Higher range may bring up CA events.

Also, AHI is the only metric we have in the machine that we can track so we get obsessed with reducing it to dust. But there are a lot other metrics at play when you look at sleep quality. But we don't have sensors for that in our Cpap setup. That is why once AHI < 5, you should start asking 'how do I feel when I wake up and during the day'. That is our best proxy for the other metrics that Cpap doesn't provide. And the caveat here is that 'how do you feel' takes some time to settle down. So doing changes every 10 days or so is advised.