help with FFM data

[wolf911]

i have been on cpap for around 3 months now. Before starting cpap i always slept on my back then while waiting for the sleep study i started sleeping in the falcon position (or as some call it half swastika position). I did the titration study using nasal pillows on my back and they never said anything about mouth leaks using the nasal pillows but over the last three months i noticed that when on my back using nasal pillows the air just blows thru my mouth most of the time so ive spent the last months in the falcon position using my nasal pillows. the second image shows a typical night which is usually below 1 AHI. Ive tried taping so i could lay on my back with the nasal pillows and my AHI still stays around 1 but the taping usually starts leaking and causes problems and irritates my skin so i stopped. ive also tried 3 different chin straps.

Finally i ordered a FFM (Resmed) and decided to just get use to that but i tried it twice and as you can see from the first image my AHI goes way up and it now shows cheyene strokes. My normal pressure range using the nasal pillows is 8 to 11 and i even tried raising the pressure to 12 with the FFM the second time using it and it didnt help so ive given up for now.

My question is why wont the FFM work at the same pressure as the nasal pillows and why does it show the cheyene strokes stuff now when it never showed that before with the nasal pillows. How can i get this sorted out as i dont want to spent all my time in the falcon position as it bothers my back and neck but i need my therapy to work properly so i can function. Any insight welcome.

[Julie]

Can you not sleep on your side? Have you looked into a Pap Pillow (see Cpap.com) that has cutouts for masks when side sleeping? I agree that back sleeping is not a good idea. You do have to try various FFMs when lying down because your face changes then, but if you're really losing weight fairly quickly, that can make a difference. Overtightening won't help as it mashes down the thin silicone 'cushion' that touches your face and it won't inflate properly, so you may have to find a mask that fits better. I can't comment on the Cheyne-Stokes, however, someone else will do that.

[Pugsy]

Some people simply need more pressure using a FFM than they need with a nasal pillow mask. You can see where your pressure pegged out at the maximum on the FFM report. It wanted to go higher but couldn't.
Part of it may have been supine vs other position and part of it may just be FFM vs nasal pillow.
It's common for OSA to be worse (sometimes much worse) when we are supine and it's common to need more pressure when supine (sometimes a lot more).

If you need to sleep on your back due to pain issues then you will need to use more pressure if you are using a full face mask.

I don't know what to say about the CSR and why at this point unless those OAs are more central in nature.
Might help to see the CSR time zoomed way in.
If it is really CSR then that's some unstable breathing going on and maybe the truckload of apnea events caused it.

The logical step might be to let the machine go higher since it wants to anyway and see if the CSR remains a factor once the apnea events are reduced.

[wolf911]

Ive thought about just letting the machine pressure go higher in auto mode but was afraid of just making it worse. Ive also thought about a hybrid mask as I thought they blow air straight up the nose like nasal pillows. It just seems strange to me that nasal pillows with mouth taped still gives me the same low AHI on my back as when I sleep in the falcon position but then FFM on my back causes such high AHI numbers.

[JDS74]

Are you continuing to use the chin strap with the FFM?
A chin strap in this configuration has a tendency to increase obstructive events.
Using a soft cervical collar to support your jaw when the facial muscles relax with sleep will help with any leaks.

[wolf911]

Are you continuing to use the chin strap with the FFM?
A chin strap in this configuration has a tendency to increase obstructive events.
Using a soft cervical collar to support your jaw when the facial muscles relax with sleep will help with any leaks.

No, I only used the chin straps to try and stop the mouth leaks using the nasal pillows while on my back but they did nothing as the air still came out my mouth. Ive never tried a cervical collar, is it possible to sleep on your back with one of those on?
The best I've felt was when sleeping on my back using the nasal pillows and taping. I had low ahi numbers and my neck and back felt good each day but the taping sucked every night and alot of nights id still wake with air leaking out a corner somewhere. I'm sure I could get use to a FFM if I could keep my ahi numbers down.

[Pugsy]

Can you give us a zoomed in snapshot of a short period of time during the flagged CSR?
Just go to the events tab and then to the Obstructive apnea section and click on it so that you see all the OAs shown and the time they happened and then click on one of them that happened during the CSR time...then the graphs on the right will zoom in on that event and the wave form/flow rate so we can see a few of the events and the breathing. Try to pick an event that has a couple of other events very close to it in time so that we see more than 1.

[Pugsy]

Also...are you using EPR and if you are at what setting?

[SewTired]

If you WANT to get back to sleeping on your back instead of other positions, I would suggest a wedge or something to raise your upper torso. That in turn likely will lower your need for much higher pressures. You don't even have to do it a lot.

My sister uses something like this http://www.amazon.com/Removable-Microfi ... XVYW7XG8GV. I'm not recommending a specific one, but just letting you know what is available. Some of the supports are pretty high and they don't need to be.

[wolf911]

no EPR
i look at closeups of the OA events and most of them that are clustered have a few straight lines (no flow) just like the snapshot i posted


ill look into the wedges. the problem is not sleeping on my back as i can do that with nasal pillows(just have leaks thru mouth),its sleeping on my back with a FFM im trying to figure out

[Pugsy]

All I know is that your machine wants to go higher to try to prevents those OAs.
You might just let it try it and see what happens in terms of OA reduction and see if the CSRish stuff goes away with the OA reduction.

Needing more pressure with a full face mask is common. Seeing CSRish looking stuff with a FFM and OAs like this is not common.

[Sheffey]

Ive never tried a cervical collar, is it possible to sleep on your back with one of those on?

Yes, I mostly sleep on my back with some time on my sides. I have used one of these collars for years. It allows my machine to run a lower pressure and still prevent breathing events.

Be wary of the wedge pillows. Most of them are short and cause you to bend at the stomach which can worsen or cause reflux. There is a long wedge pillow, but you certainly could not carry it on an airplane and it would take up a lot of space in your vehicle. On the other hand, my spinal collar is easily stuffed into my CPAP bag.

A cervical collar holds your neck in the best position to keep the airway open, and also, some people claim it helps keep the jaw from dropping.

Here is an example of the soft spinal collar: http://www.amazon.com/Carex-Health-Bran ... cal+collar

[Guest]

All I know is that your machine wants to go higher to try to prevents those OAs.
You might just let it try it and see what happens in terms of OA reduction and see if the CSRish stuff goes away with the OA reduction.

Needing more pressure with a full face mask is common. Seeing CSRish looking stuff with a FFM and OAs like this is not common.

How much higher would u suggest for the max number

[Pugsy]

How much higher would u suggest for the max number

I don't have any way to know.
It would just be a guess. If it were me I would just open the range up and set max at 20 and see what happens.
The minimum might also need adjusting but I think I would just open max up first if it were me.
The machine won't go up unless it thinks it has a reason to go up.
It won't respond to centrals...just obstructive stuff.

It might only want to go to 12 or it might want to go to 18...we don't know and have no way to know.
If the CSR stuff gets worse then may have to re evaluate the whole thing.