sb2p - Therapy Thread

[sb2p]

Hi everyone, 

First time here----seems like a great community!

Info & short history: 35/M, 175lbs (down from 205lbs over the past few months), complex sleep apnea, just changed to using ASV, previously using CPAP since 2019. Results of the most recent sleep study indicating complex sleep apnea attached, as well as OSCAR charts from last night.   

My doctor recommended a full-face or minimal-contact mask for use with the ASV, but I've struggled to find one that provides a good seal while I'm asleep because I open my mouth / relax my jaw while sleeping, changing the shape of my face and leading to "face farts" and high pitched whining that disrupt my sleep. The AirFit F40 worked during the sleep study, but not in the home setting. (I've tried 12 different masks----list below. I can get a decent-feeling seal, and not overly tight, with some of them, but none have been good while I'm asleep.) The doctor recently bumped down EPAP from 12 to 10 to try to help, but it didn't. 

I've reverted to the nasal mask I've used since 2019 (Philips Dreamwear nasal/under-the-nose), and tape my mouth with a small strip down the middle so that I don't become a "babbling brook" with the air coming out of my mouth. I've also tried a few chin straps, which have been too elastic to really keep my mouth closed, and I've also tried the silicone "mouth shield," which blew out of my mouth(!) when the ASV was at high pressure. The nasal mask + mouth taping seems to work OK, but having my mouth taped is not the most comfortable sensation, and I don't know whether there are any long-term risks in mouth-taping. The set-up also isn't completely solving my sleep apnea; with it, AHI has been generally between 1 and 3.

Based on all this, do you have any recommendations on improving my set-up, either with the ASV settings or the mask/taping/accouterments? 

Let me know if any zoom-ins on the OSCAR data, or other info, would be helpful.

Thanks, 
SB

Masks I've tried (I still have all of them):
------------------------------------------------------------
Amara Full Face CPAP Mask with Headgear
Fisher & Paykel Simplus Full Face CPAP Mask
Quattro Air Full Face Mask
AirFit F10 Full Face Mask
Amara View Full Face CPAP Mask with Headgear
AirTouch F20 Full Face CPAP Mask
Mirage Quattro Full Face CPAP Mask
AirFit F20 Full Face Mask
AirFit F40 Full Face Mask
Evora Full Face Mask with Headgear
Fisher & Paykel Vitera Full Face Mask

 

[ejbpesca]

"The AirFit F40 worked during the sleep study, but not in the home setting. (I've tried 12 different masks----list below. I can get a decent-feeling seal, and not overly tight, with some of them, but none have been good while I'm asleep."

Can you estimate why sleeping during the study made the F40 effective but not at home?  I use the F40 and appreciate it after many years with F10 and F20.  I have a beard so I have to strap it tighter than maybe most would accept but it has been the best sealing mask out of the six I've tried.

Much has been said in PAP communities about using tape to seal off the mouth during sleep.  I've heard respiratory therapists say do not do it due to it being dangerous but they did not explain why it is dangerous.  You may want to search for that info.  I tried it but even the strongest tape would not keep my mouth closed.  Collars and chip straps failed also so a full face mask is what I use.

Your OSCAR report does not show excessive leaks.  My Leak Rate runs from 3/L to 29/L depending on the age of the mask cushion.  By the end of the month, my F40 is leaking badly and AHI goes up. Some use a cushion for more than a month with success.

If you can replicate the scenario of your success with F40 during the sleep study, you may have a winner out of the 12 tried.

[Sleeprider]

We have a lot of members that do well on ASV with a nasal pillows mask like the Resmed Airfit P10. There is really no justification for a full-face mask, and it's a common misperception that a full-face is better with ASV when exactly the opposite is true. The pressure changes in ASV will cause a full-face or nasal mask to "puff" and change shape, while nasal pillows simply transfer the pressure changes to the airway with minimal disruption.

Your doctor is using a fixed EPAP setting with ASV and ramp. I disagree with both. My suggestion is as follows:

Mode ASVauto
EPAP min 6.0
EPAP max 10.0
PS min 3.0
PS max 10.0
Ramp OFF

Give it a try and report back with a new graph.