Newbie questions re masks, M Series, and stats (w/poll)

So, I've been, um, hosed? for a little under two weeks. It hasn't been an easy adjustment, but looking at the forum here, it doesn't sound like it's been particularly unusual either. I had a few questions about masks and the data readout on the M Series w/A-flex.

I asked some of these questions in the chat room yesterday. While I had no luck getting the specific answers I was looking for, I did want to say that I appreciated how welcoming and helpful the community was. (Thanks again to everyone who tried to help.)

So here's the background for the questions:

I had a home sleep study with no titration (AHI=76). My current pressure range is 5-15.

My current AHI 7 day avg is 7.5. This is down from about 12 when I started.

The current 90% pressure 7 day avg is 9.7, down from about 13.

I have yet to actually get a full night's sleep using the machine. I wake up after 5-6 hours and can not get back to sleep with the mask on.

1) In a few forum posts, it has appeared that it is possible to get the M Series to provide AHI and such for just the previous night (as opposed to the 7 and 30 day avg). Did I understand this correctly? And if so how is it accessed? I didn't find any mention of it in the instructions. (I don't have the card reader/software.)

2) Given that the goal is to get the AHI to be <5, is it strange that the AHI is greater than 5 and yet the 90% pressure is not higher? Isn't the APAP programmed to try to get the AHI <5? Is it common to have the AHI go down gradually after starting therapy, or does it usually drop right to whatever level it's going to go to for a given regimen? Is what's going on related to some kind of inadequacy in the APAP programming?

In the chat room, someone suggested that 5-15 was a rather wide range. However, if the 90% pressure is at 9.7, it seems like the low end shouldn't be too much higher. However, does the AHI at 7.5 suggest that the high end of the range needs to be higher? In other words, that a wide range makes sense for me? Do I have a weird nose? Or do I just not understand how all these statistics fit together?

3) I sometimes feel like I'm arguing with the A-flex feature, that it doesn't match the rhythm of my breathing. Is this normal? Or is it an indication that I'm one of the people that feature "doesn't work" for?

4) Now my meanderings on masks:

I have three masks borrowed from the sleep center to try out before I actually buy one: OptiLife, Opus, and F&P 406.

I tried the F&P, which seemed ok at first, but after a couple of hours was painful enough (at the bridge of my nose) to wake me up. Messing with the straps didn't seem like it made things any better, and my conclusion was that the mask was wrong for my face. Given that the 406 is apparently a "petite" mask for small faces -- which I didn't know at the time I tried wearing it -- it would not be surprising if it didn't fit me. So I guess I can't really say I've tried out a nasal mask properly.

The Opus was ok in terms comfort, and was great at low pressure, but when the pressure was high, the exhalation holes were very noisy, sort of whistling like a teakettle. This would wake me up and drive me nuts. I'm apparently pretty sensitive to any noise other than my own snoring...

So far the OptiLife has been the best. It's easier to get a good seal than the Opus, and is not excessively noisy at high pressure. Strangely enough, what bothers me about it is the little wheezy noise it makes at low pressure.

I like the tube hanging down, but could probably arrange things so it could go over my head if I had to.

From my impressions of the Opus and OptiLife, I would guess my ideal mask would be something like: Sound like the Opus at low pressure and the OptiLife at high, fit against the nose but not the lip like the Optilife, and feel somehow lighter to wear like the Opus.

I suspect that nothing is perfect, but if anyone with experience with various masks has any suggestions related to masks based on what I've said I'd appreciate hearing them.

For example, does anyone how the Swift LT compares to the OptiLife for noise factor?

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CPAPopedia Keywords Contained In This Post (Click For Definition): swift, Titration, AHI, seal, APAP

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CPAPopedia Keywords Contained In This Post (Click For Definition): swift, Titration, AHI, seal, APAP

Hi Plover,

I don't have an 'M' machine, but I think if you're planning to self titrate, you would be wise to get the card reader and software.
If you start at a pressure of 5 and need a pressure of 9.7 to open the airway...you need a starting pressure that is higher. The machine doesn't jump to a 9.7 quickly. It moves up slowly to the needed pressure. If it was me, I'd move that bottom pressure up to an 8(you may need to increase the pressure more slowly for comfort). Most find that you can leave the upper pressure high. I find that the machine will chase my snores and just keep raising the pressure(increasing the leaks and snores) until it wakes me. I actually do better on one set pressure. I use my machine in cpap mode, the changing pressures woke me all night. For now I think you should worry more about the lower setting and get that to where it works best for you.
A-flex(even c-flex) is not for everyone. You can try turning it down, if it's on 3 move it to 2. Some do better without the a-flex. It's a comfort thing and you need to find what works best for you.
Give any changes you make some time ( a few nights to a week) so you have time to adjust to them. Make only one change at a time so you know which change is making a real difference.
AAAAHHHH, masks! The mask is the hardest part to get right. The only way to know for sure what mask is best for you, is to try them. What one thinks is quiet, someone else will think is loud. I find that the CL2 has the least facial contact, only contacting the nares, and is very quiet. Do be sure that if you use a nasal mask you don't mouth breathe or mouth leak. I have tried chinstraps, but they don't work for me. I tape my mouth shut every night to keep it shut. I use Roosters method;


viewtopic.php?t=9653

I hope some of this has helped,

Brenda

Thanks for the suggestions Brenda.

I'm not completely on my own in terms of figuring out the machine settings. I will be going over the data with the doctor fairly soon.

I had to stop at the sleep center today to return the masks I borrowed, and I asked them to print out the card data while I was there. (They also let me borrow the F&P407 which was what they had intended to give me the first time.)

If appears that on nights that I sleep "normally", that is, sleep through the whole night with machine on, the AHI is between 3 and 5. The higher averages seem to be mostly an artifact of the adjustment period.

I understand what you mean though -- that a low pressure that's closer to that required to stop the apneas when they happen might be a good idea.

Another artifact in the data is that on a couple of nights, the highest rate of events actually seems to occur in the period before I fall asleep, and thus might be a record of this feeling of arguing with the A-flex feature. At this point, I suppose I've got the hang of this well enough to start fooling with the settings on the machine.

The data also seems to confirm my impression that the OptiLife does not leak for me and the Opus does (though not as badly as I suspected). There is nothing in the data that looks like it might be mouth breathing, so I suspect that's not a problem for me.

Thanks again.

plover wrote:... The Opus was ok in terms comfort, and was great at low pressure, but when the pressure was high, the exhalation holes were very noisy, sort of whistling like a teakettle. This would wake me up and drive me nuts. I'm apparently pretty sensitive to any noise other than my own snoring...

Do you still have this problem. You may be interested in this post:
viewtopic.php?f=1&t=31951&start=45#p297849

feeling_better wrote:

plover wrote:... The Opus was ok in terms comfort, and was great at low pressure, but when the pressure was high, the exhalation holes were very noisy, sort of whistling like a teakettle. This would wake me up and drive me nuts. I'm apparently pretty sensitive to any noise other than my own snoring...

Do you still have this problem. You may be interested in this post:
viewtopic.php?f=1&t=31951&start=45#p297849

You know you bumped a 7 year old post from a user last active in the forum (2-posts) in 2008?