Apnea worse with full face

[basegolf]

I used a nasal mask for 2 years and have had to change to a full size mask recently.

The doctor was perplexed as to why I went from almost 0 events/hour with my nasal mask and then 11/hour with the full face Amara View. He increased the pressure of my machine to 16-18 whereas before it was 13-15. That helped, but it still wasn't as good as when I was using the nasal pillow mask.

Because I have a neuromuscular disease, the doctor did another sleep study to change me over to a ResMed AirCurve v-auto BiPap so that the exhale pressure could be less. They set the new Bipap at a max of +16 and a min of +8 with a PS of +4. Last night I had 18.5 events per hour, the highest I have ever been. I have the ramp time set for 10 minutes.

Does anyone know what could be going on? Does the pressure just need to be increased?

I am back to feeling lousy, and my neuromuscular disease is escalating as well. I'll bring the machine to the respiratory therapist tomorrow so she can take a look at the values, but that's what the ResMed MyAir program is saying, and it sure matches how I feel.

[OkyDoky]

Get Sleepyhead,free software and you can read the data on your SD card. With an increasing AHI you need to know what type of events make up your AHI (obstructive, hypopnea, or central) before making pressure changes. You can learn how to get SleepyHead here. https://sleep.tnet.com/equipment
If you have questions about downloading or what you see on the reports just ask. By evaluating your data you can learn what is happening and if changes need to be made before you get to see your doctor. Or at least have some knowledge of what questions to ask when you do see the doctor.

[D.H.]

If the events are concentrated at towards the very beginning of the night, then you need to disable the ramp, or reduce the ramp-up time, or increase the ramp starting pressure.

[basegolf]

The episodes seem to occur throughout the night, but I'll ask the RT tomorrow. Thank you.

[bonjour]

basegolf

without question we can help you, but as OkyDoky said we need information. That information is the data stored on the SD card in your PAP machine.
The graphs that you can get will help us help you more than you could believe.
Please download Sleepyhead,
Organize your charts (very important to provide the needed data)
Take a screenshot of your graphs,
Open an acconut at IMGUR.COM
Place your screenprint in your folder on IMGUR
Click on Large Thumbprint and the the copy to Board
Past the code in your post here

Please see my signature for how to do this.

[jimsp1]

When I changed from an Amara View mask to a DreamWear nasal mask by AHI dropped from an average of about 3 to less than 1. My guess was that the Amara put a little pressure on my jaw moving slightly back. Since a dental device that holds the jaw slightly forward can lower AHI it seems that moving it slightly back could increase the AHI.

[raisedfist]

What are your leaks looking like with the full face mask? Why did you have to switch to a full face mask?

On the vauto, try setting the trigger sensitivity higher - maybe bc of your NM you aren't triggering the device 100% during REM sleep. Muscle weakness can do that.

[bambiying]

I just discontinued use of my Amara View because it caused me to have higher AHI's than my other masks. I have to use a FFM due to mouth breathing. Before using the Amara, I was using the Resmed F10, but I found the Amara to be more comfortable. I now went back to the F10 after 6 months of Amara. Using the F10, my AHI is always under 1.5, usually under 1, but the Amara takes it up to between 2 and 4 all the time. I can really feel the difference too.

[Basegolf]

Thank you everyone. I will try those suggestions.

[DavidCarolina]

Im not surprised.

The nasal, to me, delivers a more powerful consistent open airway.

[palerider]

Im not surprised.

The nasal, to me, delivers a more powerful consistent open airway.

only because it doesn't pull the jaw back, further occluding the airway.

[basegolf]

Thank you everyone. I hope what follows answers some of your questions.

I also think the recent drastic increase has something to do with switching to the Amara View from my pillow mask. My pillow mask worked great for 2 years, although I had to use a chin strap and tape my mouth shut. Over the last year, my AHI was less than 1 with a pressure of 13-15.

A few months ago; however, my tongue started to come away from the roof of my mouth no matter how tight I made the chin strap. The resulting cheek puffs throughout the night woke me up within seconds of falling asleep. I tried a cervical neck collar, different chin straps and a boil and bite mouth guard --- all with no success. I have TMJ so I was also concerned about using a mouth guard, but I did try it.

The doctor seemed concerned that I was taping my mouth shut and wanted to find an alternative so he switched me to a full-size mask. The Amara View was the only one that stayed sealed on my small face and was comfortable, but my AHI increased to 11. So the doctor increased the pressure range to 16-18. Because I have a neuromuscular disease that can affect my breathing, he said that a BiPap machine would be helpful in my case and ordered a Sleep Study so that the insurance company would cover it.

Last night was my 3rd night with my new BiPap which was set at 16 for the inhale and 10 for the exhale. I had reduced the ramp time to 5 minutes. My AHI was 22 (most of which were obstructive and occurred throughout the night) so I took my machine into the doctor's office today.

The respiratory therapist said that when they reviewed my recent sleep study to change me over to a BiPap they noticed that the tech on duty that night did not increase the pressure enough to stop the obstructive apneas so today they increased the pressure once again today to 18 on the inhale and 11 on the exhale. I'm hoping this will do the trick, but I sure miss my nasal mask.

Any suggestions would be appreciated.

[Pugsy]

It's more likely that your exhale pressure (EPAP) that needs to be higher.
I have my doubts as to how much success just increasing it from 10 to 11 will have even with adding in a little more IPAP.
See what happens with the new settings tonight. Hopefully I will be wrong.

[D.H.]

Your pressure went up when you switched masks, but there seem to be other things going on at the same time. You alluded to the underlying reason that you had to change masks. I wonder if that's the problem rather than the mask itself.

You might want to put everything back to the old way (old pressure, old mask) and see if you do better.

[baseten]

Hi D.H.,

Thank you for your suggestion. I do have my old machine and will try that but am not hopeful. I tried for a few months to get the Nasal Pillow Mask to work again without success.