One year -- whazzup with these numbers?

[M'ohms]

I think leaks (both large and small) are a problem. I started with a Quattro FX FFM last October and had difficulty with small leaks that would wake me up. A padacheek maskliner helped some. Recently tried switching to a Mirage Quattro FFM. And this week have been trying AirFit P10 for her nasal pillows. Thought the nasal pillows might be worth a shot because my face is cheekbone-y and the FFMs leak under the cheekbones.

I know I'm a little late in this discussion with the focus being on your pressures, but your mask problems have not been visited by anyone yet.

When I was first fitted with the QFX, my face measured out as a Medium. Since I don't like anything pushing against my teeth, I went against my DME's advise and got a size Large instead. I learned how to wear it leak-free with the help of a cushion liner. Out of curiousity, I wanted to try the size Medium and Pugsy had one for me to try. I have made a number of attempts at trying to keep it from leaking, but it just isn't going to happen. I tell you this because you might have better luck with a mask, that you otherwise like, in a different size. It really does make a difference. BTW, I have a cheekbony face too.

I also disliked the headgear that came with the mask for different reasons. I'm on ASV with pressures going up to 25 every night and had to crank down my mask in order to keep it from flying off my face!
The part of the headgear that goes around the back of my head would stretch out to my ears. Unfortunately, all my headgears are designed the same way. Out of desparation, I tried the Respironics headgear that fits like a cap. It has been a game-changer for me. It holds my mask securely in place throughout my pressure swings. And it doesn't mess up my hair either!
Here it is: https://www.cpap.com/productpage/softca ... aQod6rII_Q

Hope this helps!

[Pugsy]

I just realized that you say you are now using nasal pillow mask instead of the full face mask in your profile.
You know if you used a full face mask at the titration sleep study that might explain the 13 cm suggestion.
It's not uncommon at all to be able to get by with less pressure when using a nasal pillow mask than when using a full face mask.
I know it shouldn't be that way....that pressure is pressure no matter which mask but maybe the full face mask alters the jaw or something a little causing more collapse or something...but I have seen it too many times to discount it.
I have seen the reports....where maybe someone needs a pressure of 16 cm with a full face mask to get a desired AHI and gets the same AHI at 13 cm with a nasal pillow mask.

[RubySnooze]

As it turned out, I only used the nasal pillows two nights. I think they were June 17th and 19th. I dropped the minimum pressure just a bit those nights (from 7 to 6.5) 'cuz I wasn't sure what to expect.

Last night I went back to the FFM. Didn't want to overlay nasal pillow adjustment with pressure changes. Planned on staying with the FFM while doing pressure games (?).

Sleep study was done with the Quattro FX FFM.

M'ohms, thanks for the interesting info on mask fit. Us cheekbone-y types don't seem to have a lot of options. Very interesting headgear. How do you keep it from messing up your hair?

The sleep center didn't have me try different masks, or sizes; just ordered me the medium Quattro. On top of everything else, I ended up being wildly allergic to the headgear. I think it's the neoprene ("2009 Contact Allergen of the Year" -- ). Within two days I had a rash and sores every place the headgear touched me. Within ten days it had spread down to my waist. No, no help from the sleep specialist. She'd never seen that before.

The only thing I could figure to do was sleep in a hoodie. So I now have a summer hoodie and a winter hoodie. I sleep with the hood between me and every friggin' millimeter of that damn headgear. Believe it or not, the rash has still not entirely cleared, although it's much better. I am a little nervous that one of the neighbors might see me wandering around the house in the middle of the night, wearing a hoodie and a mask, and call the police. Or shoot me!

[Pugsy]

Check with Karen at Padacheek.com about maybe fixing up some sort of covering for the headgear if you want to continue using the full face mask. Her headgear would be a lot less annoying than wearing a hoodie in the summer.
She will do specialty items like that. I bet she can figure out something. I once saw something like that for the Swift FX headgear...everything was covered by her soft fleece. Quite comfy.

[M'ohms]

Concerning the blue mesh headgear: there is no neoprene on it--just a cool polyester type fabric with holes in it to keep it cool and elastic straps. It doesn't mess my hair up because it fits well on my head and it doesn't slide around. Put it on like a baseball cap and take it off the same way in the morning. Your hair stays the same under the cap all night.

With the cheekbone issue, I tighten up the lower straps snugly to anchor the mask in place. Since I have a large mask, it rides on the lowest part of my chin (boney part) and is not restrictive at all, and no pressure on my teeth or lips either. If I want to open my mouth, the mask just stays in the same spot on my chin and there is enough room at the nose to keep it from breaking the seal. I keep the upper straps a little looser so that the cushion can fully inflate around my cheekbones and nose bridge. If I wake up during the night, I have to feel if the mask is still on or not because it is comfortable enough for me not to notice it. At one time I had a problem with my jaw falling backwards while I was sleeping, so I used a cervical collar for a while. This taught me how to keep my jaw in place so I have no mask issues at all any more.

[OSAHell]

Hi RubySnooze,

While doing the "pressure game" like you said, I'll suggest you stick with one mask (unless there's a good reason) and use the mask you're most likely to use in the futur. But If you start with the FFM and feel good with it no problem, by the time you fixe your problem, you will have learn a lot with Pugsy and others and probably be able to make the small change required for the nasal pillow yourselft if you want it.

...
So far I haven't seen any real reason to warrant 13 cm fixed cpap titration suggestion.
...

Hi Pugsy, I also don't see any real reason to warrant a pressure of 13 with the graphs above. But I just find it odd that they would go with a titration and don't use the results or at least a pressure range around it to start the therapy... As for the reason, I simply refrained myself from saying what I was really thinking... But to be politically correct, I'll go with a broken magic 8 ball and they couldn't get an answer, so they just leave the settings at there default value! =D

[Pugsy]

I simply refrained myself from saying what I was really thinking...

Oh...you mean like what I was really thinking....."what a bunch of idiots".
Or actually I had a little rather colorful adjective in front of the idiots.
And for more reasons than just the sub optimal apap range and apparently ignoring the titration suggestion.
IMHO the follow up care leaves a lot to be desired. I can see having problems but what I can't see is not trying something...even if it is a wrong something....at least try.

[fdw]

Another possibility that may help (which affects my AHI, and sleep quality) is late evening eating (dinner), over indulging, and types of food and drink.

I've noticed that if I eat a very, very light dinner (less than say 500 calories) I sleep so much better and a lower AHI as a result.


BTW, My last official in lab titration was 13.0 (8 yrs ago) and now I'm at 13.8 (fixed), EPR 3.0, using a FFM.

[RubySnooze]

Here are stats for the three nights I've had minimum pressure at eight:

Last night:


Night before last:


Night before that:


I'm quite excited about the results for the first two nights. Even had more energy than usual yesterday. But last night was all about mask problems. I battled leaks the whole night. Started out with the Mirage Quattro with padacheek mask liner. Had used that the previous two nights with little problem. Last night just could not get a seal. Finally got up early in the morning and switched to the Quattro FX with padacheek mask liner. Still could not stop the leaks. A very bad night. And not a fair test of the new minimum pressure!

[RubySnooze]

M'ohms, thanks for the headgear and mask fitting info. Good to know the blue mesh headgear has no neoprene. It's surprisingly hard to find out what these babies are made of.

Pugsy: thanks for recommending a custom padacheek cover from Karen. I love my PAC mask liners. If she could do a total cover for one of my FFMs, that would be terrific.

Think I'll put headgear issues on hold until I feel more solid about what type of mask is gonna work for me. It looks like the headgear to the AirFit P10 is possibly not neoprene; maybe I can go commando with that (have been to chicken to try that so far...).

And fdw: thanks for the thoughts on dinner. Sadly, due to other health issues, I'm livin' a pretty clean life. 'Cept for morning coffee (and I really don't want to discuss that ). Have you seen a sleep doctor in the last eight years? Or have you been able to work it all out on your own?

And all of you who are dissing my sleep specialist: I haven't even told you the most annoying things! I feel so validated reading your comments.

Big thanks to all of you!

[OSAHell]

It look like promising results so far, thanks for the update and don't give up!

And all of you who are dissing my sleep specialist: I haven't even told you the most annoying things! I feel so validated reading your comments.

English is not my first langage but I think I have a pretty good idea of what you mean! We can talk and talk about the titration result and your pressure at the beginning (first strike for them here). But after 7 months, they should have found out or tried something... To use Pugsy's own words "IMHO the follow up care leaves a lot to be desired. I can see having problems but what I can't see is not trying something...even if it is a wrong something....at least try." => strike out! And if you're looking for some distraction reading, you can look at the thread "PSG Revelation" there is a post in the first page where you can have a little glimpse of my own experience with my first sleep clinic. To their defence they were trying, just didn't know what they were doing!

[RubySnooze]

Well I did what I swore I was not going to do. After the night where I couldn't achieve a seal with either FFM, I switched to the AirFit P10 nasal pillows. Here are stats on the last two nights, using the pillows:

June 24


June 23


The huge gap in the middle of June 23 is me waking up, then falling asleep with a book on my tummy and no mask on. Aargh.

I much prefer using the nasal pillows. Don't feel like I'm awake all night battling small leaks. And yet, I'm clearly having leaks. So frustrating.

Any suggestions will be gratefully accepted! If not, I think I'll continue on with the AirFit P10 and a minimum pressure of eight and see if I can coax out some better nights.

[JimP]

Ruby,

I wanted to mention this and please forgive me if it's already been discussed.

By any chance are you sleeping on your back? Most of us do better sleeping on our sides.

Even with sleeping on your side, I've found that your pillow should elevate your head just enough that your airway has a straight shot. Too high and you're creating a breathing reduction that once you airway relaxes closes up. By keeping it straight, it helps with airflow.

In any event its admirable that you're sticking with this and are trying to find solutions. Lesser people just quit.

[Pugsy]

Use the mask that is more comfortable and gives you better sleep. Right now sleep is what you need and sleep is more important and besides...the leaks aren't that bad. You didn't hit large leak territory until right at the end of the night on the 23rd and then it was for just a short period of time and it was barely into large leak territory at that. The machine can do a decent enough job until you hit 100 L/min total leak and the it gets iffy.
Short periods of large leak like you see at the end of that night aren't the end of the world.

[OSAHell]

Hi Robysnooze,

Pugsy is right for the mask. And, confort and leak problem are good reasons to switch mask.

As for a suggestion, I'm not a Respironics expert but from your past graph, some nights your machine seem to be chasing something that doesn't look so obvious (to me anyway)... I would suggest setting the pressure to 9-14 and see how it goes. My guess is that you might end up with a close APAP range (like 10-13) or a fixed pressure or maybe even with an other kind of machine but this is highly speculative at this time.

Have you ever been on fixed pressure of 13 (or lower) for at least a week or so in the past?

I also noticed your inspiration-expiration time are reverse compared to mine. And looking back at my old APAP data I was like you on APAP but not on ASV. I don't no much about I:E ratio but it might worth a look.