Different mask - different AHI

[tuzacat]

I got the Amara View mask recently and I really like it except my AHI has skyrocketed. I don't really understand it. It is comfortable, no leaks but my AHI has gone from 0-.5 using the F10 to 3-5.5 using the Amara View! Very strange and a little frustrating. Not only that with the AV my patient triggered breaths have also tanked to 20% as opposed to 85-95%. I have had the mask for over a month and have fiddled around trying to have better results but 2 nights ago I went back to the F10 and last night my AHI was 0. I know when you change masks sometimes there is a learning curve and it takes time to get used to it but I have had it for about a month. Do you think I should pack it in on this mask? Can you think of any reason why this would occur? Thanks! Tuza

[Wulfman...]

I got the Amara View mask recently and I really like it except my AHI has skyrocketed. I don't really understand it. It is comfortable, no leaks but my AHI has gone from 0-.5 using the F10 to 3-5.5 using the Amara View! Very strange and a little frustrating. Not only that with the AV my patient triggered breaths have also tanked to 20% as opposed to 85-95%. I have had the mask for over a month and have fiddled around trying to have better results but 2 nights ago I went back to the F10 and last night my AHI was 0. I know when you change masks sometimes there is a learning curve and it takes time to get used to it but I have had it for about a month. Do you think I should pack it in on this mask? Can you think of any reason why this would occur? Thanks! Tuza

It's been reported periodically that switching masks has affected their numbers. You're definitely not the first.
Usually, it's the users who switch from nasal masks to full face masks have reported higher AHI numbers.
If you like the mask, maybe you need to tweak your pressures a bit.

Den

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[tuzacat]

Den, I love not having something on top of my nose because that pressure makes my nose kind of close up. I moved my EPAP pressure up from 11-15 to 12-16 because I was starting to get the grunts again. It stopped the grunts but didn't seem to affect the high AHI. Do you think I should move it up higher? Thanks! Tuza

[Wulfman...]

Den, I love not having something on top of my nose because that pressure makes my nose kind of close up. I moved my EPAP pressure up from 11-15 to 12-16 because I was starting to get the grunts again. It stopped the grunts but didn't seem to affect the high AHI. Do you think I should move it up higher? Thanks! Tuza

I think you need to analyze your AHI as to its makeup. The "rules" about setting Bi-PAP pressures are to set the EPAP to eliminate the Apneas (as much as possible) and to set the IPAP to eliminate the Hypopneas (as much as possible).
In other words, you need to know what you're adjusting for........is it Apneas or Hypopneas? (or both?)


Den

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[Wulfman...]

By the way, are you using software.......like Sleepyhead?


Den

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[tuzacat]

Yes, I'm using Encore Basic. It looks like a little of each - some OA's, some CA's and some hypopnea's. The reason I'm on ASV is because of the Central's. Den, I thought if I raised the Epap it raised the Ipap by whatever the respiratory therapist set as pressure support. When I look at the chart it rarely hits the the top of the Ipap range of 25. Tuza

[Wulfman...]

Yes, I'm using Encore Basic. It looks like a little of each - some OA's, some CA's and some hypopnea's. The reason I'm on ASV is because of the Central's. Den, I thought if I raised the Epap it raised the Ipap by whatever the respiratory therapist set as pressure support. When I look at the chart it rarely hits the the top of the Ipap range of 25. Tuza

The ASV category is getting beyond whatever knowledge I have of Bi-Level therapy.
I'm sorry, but I can't answer your specific questions. Maybe some of the folks with ASV knowledge can give it a shot.

But, yeah, that's my understanding of how pressure support is supposed to work with the EPAP and IPAP, too.


Den

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[tuzacat]

OK, thanks, Den, I appreciate your responses. I didn't know the info you shared about the hypopneas. I am not hitting the top # on the Ipap very often. Sadly, this just may not be the mask for me. I can't complain about the therapy I'm getting with the F10; I just want to be a little more comfortable. Tuza

[Wulfman...]

OK, thanks, Den, I appreciate your responses. I didn't know the info you shared about the hypopneas. I am not hitting the top # on the Ipap very often. Sadly, this just may not be the mask for me. I can't complain about the therapy I'm getting with the F10; I just want to be a little more comfortable. Tuza

I happened to think of one other question that may (or may not) affect your settings or help somebody with answers.......
Did you notice whether any particular category of events (Hypopneas, Apneas or Centrals) happened to increase with the different mask?


Den

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[tuzacat]

I will have to go back and look again but I'm thinking hypopneas.

[Pugsy]

With the 960 I wouldn't be surprised if it was mainly hyponeas.
Getting more IPAP can be accomplished 2 ways...increasing that minimum EPAP a little and letting the PS push the IPAP up. Or increasing just the PS a little.
If there are any OAs at all...I would just do the minimum EPAP thing to cover all bases...and because using more PS might not be as comfortable.

Bear in mind that if you do then you run the risk of aerophagia rearing its ugly head again.
Anything you increase is going to potentially affect the aerophagia issues.

An AHI of 3.0 with mainly hyponeas on a 960 machine isn't all that alarming though and there is no urgent need to make it lower other than you want it lower like you had with a different mask unless you are noticing subjective sleep quality issues along with that 3.0 to 5 AHI.
I know we all like the verification of nice low "numbers" but sometimes attaining those numbers opens up a whole different can of worms.
If I remember correctly there were some potential issues with aerophagia at higher pressures for you...if so, then you may need to compromise a bit and if you are sleeping decently and feeling good then I wouldn't worry so much about the "worse" numbers because they are far from being horrible.
If you like the mask otherwise better than the prior mask...the difference in AHI isn't that bad.

As to why the difference between the 2 full face masks...beats me unless it has to do with strap positioning maybe affecting airway position a bit which in turns affects the pressures needed to maintain an open airway.

Up to you if you want to be a little more aggressive in trying to reduce the hyponeas.
You can try both ways...more EPAP to push the IPAP up or more PS to just push IPAP up. See if one works better than the other or if one has less impact on any aerphagia issues than the other.

[tuzacat]

Thanks, Pugsy! It's really hard to tell sometimes the difference between a 0 night and a 3 night. I have rheumatoid arthritis and fatigue is apparently one of the symptoms that can manifest itself with it. I suppose I'm fooling myself but I keep thinking if I had consistantly lower AHI's I'd feel better and have less pain. That's my motivation for optimizing everything. I appreciate the explanation! Maybe I shouldn't sweat it.

[Pugsy]

I also can't really tell the difference between low AHI and high AHI nights...sometimes I have felt really good and think that the AHI must have been really low and to my surprise it might be 8 and the very best I have ever felt was following a night with AHI of 10. Go figure that one.
There are just some things wrong with us that the best AHI in the world isn't going to fix. You have the rheumatoid and I have the osteo arthritis. Both can seriously impact our overall sleep quality and thus how we feel the next day.

I have resigned myself to the fact that some nights are just crappy like my recent issues with my shoulder or knee and the machine can't fix those things.

I do whatever I can to make the best of the sleep I do get and if that means using a mask that maybe was a little more to my liking or comfortable then so be it regardless of the minor differences in the AHI.
That's why I don't worry about a little leak (no matter what the cause) as long as I am sleeping through the leaks and I am feeling decent and the leak isn't massively long way up in large leak territory. I could fix up something where I never had any excess leak but if I did that then I can pretty much guarantee that my overall sleep would suffer more than the measures to get the 0.0 leak would improve anything.
I found that out back when I was first starting cpap therapy...yeah I could tape or use a chin strap but they were a disruptive factor to my already fragile sleep so the cure was causing more problems than the leak was.

[tuzacat]

Yes, Pugsy, I am probably a little naive in terms of what good therapy is going to do for me. It is so rarely that I wake up in the morning and actually feel rested no matter how long I sleep or what my AHI is. It's been that way for as long as I can remember. I just keep hoping. Lately, I have tried CBD Oil for pain management and to help with insomnia. I have found it very useful for the insomnia - not so much for the pain. (I have both osteo and rheumatoid). What has been helping for the pain is an herbal prep called Dr. Christopher's Complete Tissue and Bone. Just passing those on in case you use other things besides meds. Best, Tuza

[Pugsy]

Waking up well rested and feeling like a million bucks....man would I love to experience that feeling too. I am waking up feeling better than without cpap though. Gone are the killer AM headaches from lack of oxygen and gone are the wake ups to pee what seemed like every hour on the hour. So I at least don't have those making things worse. I rarely have nights where I don't wake up at least a handful of times with some sort of pain issue. Most of the time not horrible pain but just enough to wake me up and have to change position. It is what it is and like I often say...I may not wake up feeling like going out and running a marathon I sure don't wake up feeling like I just ran one and got run over by a bus at the end of it.

I would still have the arthritis issues even if I didn't have sleep apnea and as much as I wish the machine could fix the arthritis issues I know that the best it can do is with effective sleep apnea treatment then maybe the pain issues are better dealt with. I know that when I am extra tired from a bad night of sleep that it's harder to manage the pain. Chronic pain in itself is fatiguing. I do the best I can given what I have to work with and that's about all anyone can expect...yeah, we can wish for better but sometimes life just craps on us. When I get to feeling too sorry for myself and tired from the aches and pains I usually take a step back and try to look at the big picture....at least I am walking even with a limp and at least I am feeling something in my extremities instead of nothing with paralysis...so I am not as bad off as others.

Negatives are always easy to find...positives are out there but we sometimes have to look harder for them. but that just makes them all the more precious when we do find them.