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Where to from here (7 days in with new FFM)
#1
Where to from here (7 days in with new FFM)
So I'm a week in since switching from the F&P Eson nose mask to the Resmed Airfit F20 full face mask.

The new mask seems to have overcome the air leakage from the mouth I'd developed over the last few months (four years on the nose mask with good numbers, but slowly sliding in the last 12 months).

There doesn't seem to be significant leakage from the FFM, but my AHI seems to not have responded beneficially in any way to the new mask.

Where do I go from here in an effort to get my AHI heading back towards lower numbers. Thinking-about


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- They are not spelling/grammar errors.. I live in Australia, we do it differently Down Under  Big Grin -
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#2
RE: Where to from here (7 days in with new FFM)
To treat your hypopnoea I would say a tad more pressure there is nothing much you can do about the Clear Airway numbers other than reduce flex which may or may not have a positive effect. Your overall AHI is 2 which is a good number and normally we would only be looking at minor tweaks based on how you feel. It’s not all about numbers
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#3
RE: Where to from here (7 days in with new FFM)
Unfortunately numbers are a priority.. if I reach an AHI of 4 as a 30 day average I lose my professional driver endorsements, and my business in the hire car industry.

Strangely Oscar and my machine also show a different number for average AHI over the last 30 days.. Oscar says 2.* while the Dreamstation is showing an even 3.0 ?

My numbers have crept from the low 1.* of the previous 3 years slowly up over the last 12 months to the now 3.0 showing today as the average over the last 30 days.

I will bump the minimum pressure to 8.5 and try it for a week and see if that helps.
Prior to changing the mask I had a play around with increased pressures, and also tried switching to APAP mode as well.
- They are not spelling/grammar errors.. I live in Australia, we do it differently Down Under  Big Grin -
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#4
RE: Where to from here (7 days in with new FFM)
It is extremely common to need a bit more pressure with a full face mask than with nasal therapy. It may be one or two cm. I realize you have an overseer that takes your decision-making away and restricts the changes you make to settings. So if I tell you to try either auto mode or trial pressures in 0.5 increments between 8.0 and 10.0, I might as well save my breath, but that is what you need to do.

Previously, I suggested that you request your case to be transferred to an individual that is not quite as controlling with regard to therapy parameters. Any progress on that front?
Sleeprider
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INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#5
RE: Where to from here (7 days in with new FFM)
Sleeprider.. 

I'm going to get through my next compliance sign off, now not due until July 2021 for some reason.  Thinking-about  (should have been January 2021 for my next one)

Tonight I have switched over to Auto again, with 8.5 > 20, and have switched on Flex (which is currently set at 3, but I have no idea what I should be setting it at Dont-know  ).
I will reset my machine a month before my appointment back to what my sleep specialist thinks I've been on, if my numbers aren't within the RMS specified requirements a couple of days prior to my appointment I will simply cancel the appointment and surrender my professional driver endorsements.
I'd be happy to retire, but my wife would have to support me.. even though I'm about to turn 66 they won't give me an old age pension.☹️

I will just have to go gold detecting and find that big retirement nugget.  Big Grin  

Anyway, I will see how the next few nights go on auto, and will bump the pressure up 0.5 in a few nights if no significant change to my AHI, and will repeat at 0.5 steps as the days go on if necessary.

Thank you for the advice, I understand your frustrations with the way our system here works compared to over there.. if I had years of professional driving ahead of me I would definitely follow your suggestion of finding a different respiratory specialist.
Cheers,
Steve
- They are not spelling/grammar errors.. I live in Australia, we do it differently Down Under  Big Grin -
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#6
RE: Where to from here (7 days in with new FFM)
My experience with Flex was that a setting of 2 was better. It's mostly personal preference, so feel free to experiment with it and see what works best for your comfort and if it has an influence on your event rate. Let us know what you find using auto pressure.
Sleeprider
Apnea Board Moderator
www.ApneaBoard.com

____________________________________________
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INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#7
RE: Where to from here (7 days in with new FFM)
(06-10-2020, 08:27 AM)Sleeprider Wrote: My experience with Flex was that a setting of 2 was better. It's mostly personal preference, so feel free to experiment with it and see what works best for your comfort and if it has an influence on your event rate.  Let us know what you find using auto pressure.


My recent attempt with auto didn't make any real difference to my AHI, and I had it set for no flex with a pressure of 8.5 as the minimum, 20 for the maximum, which is why I went back to the fixed mode again.

Last night I set it back on auto with the minimum at 8.5 again, but with flex on 3... (didn't see your reply re setting on 2 before going to bed last night)

This morning I've woken to find an AHI of 3.3, so it has actually gone up again.  Huh

It is showing the 90% pressure as having been 9.5 - so I have just kicked it straight to a minimum of 10.0 with no flex ready for another go tonight, and then will try flex at 2 once I see how the pressure jump goes.
At least the new Airfit F20 FFM seems to hold the extra pressure of 9.5 last night with ease, 100% mask fit again with it.. and I don't show any periodic breathing on the machine readout.

Nothing so far has given me good sleep where I don't wake up feeling some level of tiredness in the four years since I started on CPAP.. on the nights where I don't use the machine I usually get 7>8 hours of unbroken sleep, and wake feeling quite good.
My wife says I don't stop breathing during my sleep, and rarely snore (she is up and down two or three times a night, and often has trouble going back to sleep once awake)

I now have 12 months before having to see my specialist to get signed off again for licence compliance, so I have some time to play around with various settings to see if I can get my AHI back down, or at least stop it from rising.

Thanks again for the feedback and ongoing support mate, it is appreciated.  Thanks
- They are not spelling/grammar errors.. I live in Australia, we do it differently Down Under  Big Grin -
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#8
RE: Where to from here (7 days in with new FFM)
Good luck. You're on the right approach, and you will find the sweet spot.
Sleeprider
Apnea Board Moderator
www.ApneaBoard.com

____________________________________________
Download OSCAR Software
Soft Cervical Collar
Optimizing Therapy
Organize your OSCAR Charts
Attaching Files
Mask Primer
How To Deal With Equipment Supplier


INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#9
RE: Where to from here (7 days in with new FFM)
(06-10-2020, 09:30 PM)Sleeprider Wrote: Good luck. You're on the right approach, and you will find the sweet spot.

Thanks..

I just had a quick look at how the C-Flex / A-Flex operates on the Dreamstation.

It seems fairly straight forward in that it drops the exhale pressure resistance to 1 - 2 or 3 below the set fixed or minimum pressure the machine is set to in either CPAP or APAP mode. 

So in simple terms it reduces the force needed from the lungs to exhale against the incoming air, and also can help reduce mask leaks.

Easy peasy..   Coffee

We are going away in the campervan tomorrow for four days, and though I normally take my CPAP (have it all sorted to run off the house battery in the van) this time I'm thinking I won't bother.. I haven't worked since mid March thanks to the Covid-19 lockdown here in Australia, and I'm not planning to start my hire car business up until the end of July at this stage, so don't have to worry about driving fatigued at the moment.
- They are not spelling/grammar errors.. I live in Australia, we do it differently Down Under  Big Grin -
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#10
RE: Where to from here (7 days in with new FFM)
Well the new FFM and increasing pressure settings, as well as trying both auto and fixed, has not reduced or stabilised my AHI numbers.

So I've gone back to the settings I originally started with on day one of my CPAP treatment.
(when you can't find the answer, go back to ground zero and start again.. as any good investigator will tell you  Idea )

Given that I was started on auto 5.0/20 and it seemed to be giving good results - I have no clue why the clinic bumped my pressure to 6.0/20 and then to 7.0/20, and ultimately to 7.0 fixed (or perhaps my RT ordered the changes)

With 7.0 fixed I rarely saw an AHI below 1 and average around 2 - 2.5, and progressively over time my average went up.
Since then I've been battling the climbing average with various changes, all to no avail.

Last night I reset to auto with a 5.0/10 pressure setting (decided not to go the full 20 maximum to see if my sleep was less disrupted during the night by the machine)

I had a mostly undisturbed sleep at that setting, but my AHI was 4.4 - unfortunately that is not low enough though, I need my average to be under 4.0 consistently to remain compliant to the medical conditions on my driving licence to maintain my professional driver endorsements. 

Anyway I will see how it goes for a couple of nights again before considering my next step.


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- They are not spelling/grammar errors.. I live in Australia, we do it differently Down Under  Big Grin -
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