Advice moving to a Full Face Mask

[prodigyplace]

I have been using P10 pillows for a couple on months, but seasonal allergies are forcing me to mouth breathe at times. Last night was my first full night with the Quattro Air mask. My pressures are at 5 & 10 as set by the DME. I think i may need to raise the minimum pressure. I had a few large leaks die, I think to moving my jaw. I need to work on remedying that, but previous experience tells me my AHI will still be hogher than desired when using the FFM. Here is last night's data. (I think)

[LSAT]

You should raise your minimum to 7, maybe gradually. I would also raise your maximum to 12 . I hope you understand that regardless how high the max is set, the machine will not raise the pressure unless it needs to stop an apnea event. Leaks are also a problem...possible from mouth breathing. FF mask should help. Most of your events are CAs. The pressure change may not help that.
They may just be junk.

[prodigyplace]

Thanks
I think the leak problem was probably lower jaw movement. I figured the FFM is better than no CPAP when I cannot use the P10.
For a week or so a while ago I used this model mask without the leak issue, but my AHI was not as low as I liked. The P10 does much better that way.

I may try 6 & 11 while I deal with the leaks & see how that works out.

[Pugsy]

The bulk of the AHI is Clear Airway/Central which might be more related to SWJ than real centrals because the leaks may have caused arousals from sleep and thus increasing the chances of SWJ breathing confusing the machine.
More pressure isn't going to fix the Centrals...remember the airway is already open even if these are real centrals (which I suspect the bulk of them are SWJ centrals).

Due to the number of graphs and the scale it's hard to see just where the pressure went to but we know it hit 10 max but I couldn't tell how long it was at 10.
You can omit the snore graph (it's not needed) and make your other graphs a little larger.
Also here's a little trick you can do so the scale on the pressure graph reflects the max the machine went to and not the 25 that you never go near.
Take your mouse cursor and point it over on the vertical line on the scale on the left side of the graph...just above the 4.0 cm mark...double click on that vertical line and the scale will change to a floating scale that reflects the max and you can see the pressure movement more easily and not so much wasted space.

You can probably omit the Flow Limitation graph also...it's not hugely active and if someone needs it later you can always include it. When you have so many graphs in one image it makes for some tiny graphs.
No need to redo this image though. I think we can see it well enough...just mentioning it for future graph evaluatioins.

There does seem to be a couple of little OA clusters with the one about 21:30 being the worst. Might have been REM or maybe on your back and obviously a little more pressure was needed. It happens sometimes with FFM usage...sometimes people need just a little more pressure than they needed with a nasal mask. I think it may be related to the position of the jaw that the lower strap on FFM have to anchor the bottom of the mask. I think it pulls the jaw back ever so slightly and alters the airway just a bit...maybe making it a bit more narrow and thus increases the chance of it getting even more narrow if the tissues collapse.

So maybe a little more minimum is indicated for the obstructive stuff in clusters (otherwise your pressure is doing well)...just remember that you can't fix centrals with more pressure. I know the knee jerk reaction when we see a higher AHI is "more pressure please" but we have to step back and look to see what that AHI is made up of and then decide if more pressure is needed. Gotta make sure that what we are wanting to fix with "more pressure" is fixable with more pressure and centrals aren't...at least with your machine.

Full face masks can be challenging getting that seal to stay...after all there is simply more mask to skin contact area to deal with but with time and experience you will get a handle on it.
I think the change to 6 cm minimum is a good compromise...you really only need to break up those 2 little clusters and 1 cm more might just do the trick.

[prodigyplace]

Thanks, Pugsy

What is SWJ?

I may be later than usual to bed. I got called into work for a hardware failure, it appears

[Pugsy]

SWJ Sleep/Wake/Junk
When the machine flags awake/semi awake breathing irregularities as some sort of apnea event but it really isn't a real apnea event.
Awake/semi awake breathing is much more irregular than asleep breathing so the machine is sometimes fooled.
Remember the machine doesn't know if you are asleep or awake and it can only measure air flow. Sometimes the air flow is irregular and we get apnea flags that aren't real apneas. If they are awake breathing getting flagged by mistake they don't count in the AHI evaluation and have to be mentally removed from things.
Problem being is that it isn't always so easy to know if the machine flagged awake breathing by mistake or not.
Sometimes you can tell if you zoom in real close on the flow rate and get a pretty good idea but sometimes it's not all that easy.

Discussed in the past...and there's some links within this thread with more examples.
viewtopic.php?f=1&t=114600&p=1110933#p1110933

[prodigyplace]

Sorry about the graphs. I set up by the Sleepyhead page.
What do you want to see & I will adjust before posting again, but likely not tonight.

[Pugsy]

Just make the graphs a little larger so they are more easily evaluated.
No need to redo this one though. Just mentioned this for further evaluation. We can get a bunch of graphs on one image but they are so tiny it's hard to evaluate what we are seeing. I prefer just the basics and then if I need anything else I just ask.

On a ResMed machine...this is what I like to see and about this size graphs. This is one of mine.... Bad leak night...mask movement...was trying a new mask...even taped my lips to make sure it wasn't mouth breathing and it wasn't. Decided the mask was simply moving too much for me especially because it was waking me up with the leaks. Nice mask (the Brevida) but the back strap was simply allowing the mask to move around too much and nothing I did with the side adjustments could fix it.
I loaned it out..when I get it back I may take a couple of stitches in that back strap to shorten it and revisit that mask again.
I liked the Brevida fairly well other than the back strap...I have a small head and it's just a little bit too long to give me good tension.

[prodigyplace]

As expected, last night was a short night. I also took off the mask a little early. Apparently, I had some leaks. My main purpose is to validate the graph layout.
Apparently, I forgot ti fill the humidifier. Although Sleepyhead says pressures were 5 & 10, they were actually changed to 6 & 10.
I have found a site gives BBCode that works well here without setting up an account. Go to imgbb.com. Aftter you upload, choose "BBCode Full Linked". You may need to remove a SPAM link at the end of the code.
I may go back to the P10 tonight to get a little more rest.

[prodigyplace]

Last night I went back to the P10 to try & get a better nights sleep. I continued to use pressures 6 - 10.

Any ideas on how to reduce CAs? My home sleep study did not detect any. I am getting close to the end of my first 90 day rental approval.
Would a different machine help?

uploaded photos

[LSAT]

Last night I went back to the P10 to try & get a better nights sleep. I continued to use pressures 6 - 10.

Any ideas on how to reduce CAs? My home sleep study did not detect any. I am getting close to the end of my first 90 day rental approval.
Would a different machine help?

uploaded photos

On this night, CAs are most likely from restless sleeping. CAs come when your airway is open, but you stop breathing for 10 seconds or more. Pressure increase will not help. Don't worry about them. Pugsy calls them Sleep/Awake Junk. Be concerned about A and H. Yours look great. Some people get CAs all the time...me included...but as long as my AHI is reasonable and most events are CAs, I ignore them.

[prodigyplace]

On this night, CAs are most likely from restless sleeping. CAs come when your airway is open, but you stop breathing for 10 seconds or more. Pressure increase will not help. Don't worry about them. Pugsy calls them Sleep/Awake Junk. Be concerned about A and H. Yours look great. Some people get CAs all the time...me included...but as long as my AHI is reasonable and most events are CAs, I ignore them.

Thank you for your comments.
What is your evaluation of the previous night with the FFM? It appears to be there was some leakage that did not totally wake me up.
I was very late getting to bed and, apparently forgot to fill the humidifier.

I notice an OA cluster. Perhaps raising the minimum from 6 to 6.6 or 7?

[Pugsy]

Looks like at least 2 breaks in therapy where the machine was turn off briefly and then back on.
Just before 21:30 and 1:00. Any idea why the 2 breaks in therapy? What caused the wake ups?
So we know you were awake then and there are a few centrals flagged around those 2 known wake ups. Looks like 3 right after the first break in therapy.....were you awake?
And a handful around the second break in therapy....how long were you awake?
And the last little cluster right before you turned the machine off this morning...were you awake or semi awake?

SWJ....Sleep/Wake/Junk..you can get a decent enough idea if it's SWJ by just zooming in on those centrals.
viewtopic.php?f=1&t=114600&p=1110933#p1110933

Now are all your centrals SWJ? Probably not, there's probably few that are real...sleep onset or sleep stage transition. They are normal and to be expected and we just have to accept it.

Your leak line is like mine...not real pretty but time in large leak was brief and you barely went past the 24 L/min line in the sand.
While I can sleep through worse leaks than this..maybe the leaks are causing some arousals which either wake you up enough to get SWJ central or maybe the arousal is enough that when you go back to sleep you have a sleep onset central.
The leaks are big enough and frequent enough that they could have contributed to maybe some arousals...and thus the increased chance of SWJ or sleep onset centrals.

Here's the deal though...even if every single one of your centrals were "real" you aren't having enough of them that anyone would worry about it.
There's nothing you can do to reduce the number of centrals unless they are SWJ centrals (for the most part) and once you sleep more soundly with less wake ups there's just less chance of having SWJ centrals and once there are less arousals that might cause a sleep onset central those would reduce.

You are new to therapy and while I know you wanted to have the full face mask mastered for allergy season congestion....I would concentrate on simply getting used to sleeping in general with all this "stuff" we have to do and save the full face mask experiment for a bit later once you are sleeping more soundly in general.

Right now...how to reduce the centrals? Get better quality sleep and fix whatever it is that might be impacting that sleep quality.

And yes...when using the FFM you likely will need a little more minimum pressure. It's common. While X amount of pressure should give the same results if everything else is equal...when you put a full face mask on everything else is not equal. That lower strap pulls the jaw back ever so slightly and it could potentially alter the airway a bit making it a bit more narrow and more likely to close off and just need a little more pressure to hold it open.

[prodigyplace]

Thanks, Pugsy.

I boosted the pressure once and it helped some. One reason I am concentrating now on the FFM is that this is one of my peak congestion times for mouth breathing.

I turn off the machine if I need to get up at night. How often varies a bit based on diet, stress, etc. I figured turning it off made more sense than letting it run & leak with me not wearing the mask. That would really skew the leak metrics too.

I really appreciate being able to make use of the collective wisdom here. My general philosophy is to take a little extra effort to help wherever I can so other may have a smoother experience. Here I feel I am more on the receiving end of things.

I may well have decided to quit CPAP in frustration without the helpful information & people here. The attitude in this area, is that almost all people prescribed CPAP give up on it as being unhelpful. Lack of knowledge & help from local professionals plays a large part of that issue, I am sure.

I hope you have a great weekend.

[Pugsy]

I also turn the machine off if I get up in the night. It's a good marker for when we wake up and sometimes I tell people to do turn if off and back on again even if they don't get up out of bed. It's a way to tell how many wake ups we are having and not have to try to remember anything like time or whatever.

I understand the need for the rush to master the full face mask due to seasonal allergies but you might find that humidified air from the nasal pillows can help with the seasonal congestion issues. Many people find that the usual allergy symptoms are less annoying once they are getting the filtered air with some moisture. Maybe you will be one of those lucky people.

Early in my therapy I spent a week trying to get used to a full face mask (because everyone told me that I just HAD to have one for when I got a cold or upper respiratory infection)...it was a miserable week and I never really got a good handle on. I have a bad neck and that lower strap caused neck pain and headaches...and anything on my nose makes congestion worse so I finally said "to hell with it" and decided I would cross the full face mask bridge only when/if I caught a cold.
Next month will be 8 years on cpap and I have yet to have a cold that I couldn't get the nose opened up well enough to use a nasal pillow mask.
The extra humidity actually helps and most often I wake up breathing easier in the morning than when I went to bed.

Last year I did finally find a full face mask I could actually sleep with....the Respironics Amara View and I have it in my stash of supplies available just in case I ever can't get my nose opened up but in 8 years...it has yet to happen.
Maybe...just maybe the humidity and the direct air using nasal pillows will help reduce some of your allergy congestion. It does happen for some lucky people. Crossing my fingers that you are one of those people.

Have a good weekend yourself. I am in spring planting mode right now. Flower beds and my straw bale garden (tomatoes and potatoes).
I bought over 240 annuals last weekend...half are in the ground now and the perennials are in the ground....and now I have to do all my various potted plants...so off I go today to get more plants....Lowes is having a big sale today. Lots of work and I fell yesterday (twisted my ankle) so I am in super slow mode due to the ugly ankle but once it's done things look so pretty it's all worth it.