AHI lower with nasal pillows?

Good morning. Last week after my appointment with my sleep doc I picked up a ResMed P10 pillow mask from my DME as a mask replacement in order to give it a try. I've been using a FFM with no issues, but I wanted to try a different style to see how it works.

Interestingly enough, my AHI has gone way down with the pillows. I was running in the 2.5-3.5 range with the FFM, and it has been under 1, right at 0.9, each night I've tried it. Is this common for a change in mask style to affect AHI like this? It was not something I expected to see. I have been aroused a few times when using it as air starts to blow through my mouth, but I've been able to go right back to sleep after adjusting my tongue position. My machine hasn't registered any large leaks, in fact I don't even see any spikes in the leak graph so I'm assuming it is waking me right away and I'm fixing it before it has time to even register. Is that why my AHI may be better, due to being forced to hold my tongue in place to maintain my own seal rather than the FFM "allowing" my tongue to be in whatever position seems to fit? And finally, for those that have had this issue, is this something that has improved over time without needing to resort to tape or a chin strap? If not I may be better off just sticking with the FFM to keep a better night's sleep even though I "like" the feel of the pillows better.

Thanks everyone!

While in theory X amount of pressure should give you the same therapy no matter which mask is used (FFM vs Nasal of some sort) I have seen too many instances where pressure needs or therapy results have changed between the masks to say it can't happen. I have seen proof with the software reports and not just a one night difference either.
So yes...AHI can reduce and if the AHI was already really low with a full face mask at X pressure then maybe a little less pressure could be used and still get the same nice low AHI with a nasal mask.

About the mouth opening and air rushing out because the tongue dropped down and opened the door....there's a good chance with time and experience that the tongue will learn to stay in place and these episodes will decrease in number to the point they rare or never happen. When I first started therapy I was having them pretty often and that's why I elected to tape my mouth (chin straps for me were more annoying than helping) and after a couple of months I started forgetting to tape until lights were out and machine was on so I said to heck with it and slept without the tape. Come to find out those mouth opening episodes pretty much quit. Now sometimes I might still wake up with my mouth open but they don't happen often and I no longer get that big rush of air that is exiting the lips that is so disturbing. So mainly I sleep through the mouth openings and from the leak graphs they are very rarely horrible leaks.

It's up to you to determine just how much those mouth opening gushes of air are disturbing your sleep.
Along what you want to do about it. I can't guarantee that they will cease on their own but it's possible.

Thank you Pugsy.

My pressure is already set to 6-10 after my appointment. With the pillows I've not seen it go above 6.5 other than the probing pressure spikes the Respironics machines perform. With the FFM it will go all over in the range.

Last night I did switch from the nasal to the FFM in the middle of the night. I woke up with a stomach ache and was a bit gassy (sorry for the detail but it is relevant) so I changed back to FFM. I think it was a general sour stomach rather than aerophagia, but since I had to work today I didn't want to risk having a bad night of sleep if not. I'm planning on going back to the nasal tonight. Is it common for aerophagia to be worse with one style of mask than another? I'd suspect it to be worse with FFM than nasal if so, but it doesn't hurt to ask.

I appreciate all of the help you're providing!

I would also expect aerophagia to be worse with a full face mask but that's just based on my very limited (1 night ) experience with a full face mask which let me experience a full range of really nasty aerophagia symptoms. In reality I think it has to do more with the patency of the LES (Lower Esophageal Sphincter) and logic tells us that more pressure (like you see with a full face mask) increases the chances of the LES giving way and letting the air enter the stomach. Why it's worse with nasal masks and lower pressure doesn't compute logically.

So I don't know why. I could go way out on a limb and come up with some WAGs (wild ass guesses) but that's all they would be and the end result is we still need to limit aerophagia if it's ugly and causes distress.
One WAG might be with the air rushing out through the mouth and it wakes us up we have a big arousal and reflex action of where we maybe take in a big gulp of air and swallow it. Arousals do beget reflex actions and have been known to increase the chances of swallowing more air and with a full face mask that gush of air going outward may not happen as often and thus less arousals and as a byproduct of less arousals we have less chance of taking a big gulp of air and swallowing it. It's just a WAG though based on a what I have read about arousals. I think RobySue and Morbius had this discussion a while back. I don't remember all the particulars but maybe she will stop by and refresh my memory. She has a lot of experience with aerophagia and I do not. I can count on one hand the number of times I have had it really bad. The rest of the time it's been very minor or non existent.

Well so far as the day goes on I'm more and more convinced it wasn't aerophagia. It was just a WAG in the middle of the night when I switched the mask to be on the safe side.

your pressure needs change on a nasal pillow mask due to 2 things:

1) There is less pressure loss in nasal pillows vs FFM due to reduced dead space and also less turbulent flow (most FFM have air path making a 90 degree from elbow connector to nose.
2) mouth breathing needs more pressure which is eliminated if you use pillows with mouth shut.

You may need to reduce your pressure range. Also, one thing you may find is that the variation in pressure of APAP may bother you and make you feel less rested even though AHI is lower. This is due to microarousals - read about it on pubmed.
If they do bother you then a straight pressure may be the answer.

Pugsy wrote: . . .some WAGs (wild ass guesses). . .

Sometimes known as SWAG (scientific . . .)

That does make sense Guest1. Though my pressure is already at 6, I don't imagine going any lower would be beneficial. It may be worth running by my doc after I get used to the new mask a bit first.

My AHI is lower with a nasal mask than with pillows. I also noticed that i feel better the day after using a nasal mask than with pillows. Guess i have to go back to my Eson and all that head stuff.

I remember a while back reading someone's "rant" (for lack of better term) about how we're all sent home with this machine, based on a SWAG, as to what mask we want to use. The DMEs seem to downplay the options we have with regard to getting extra masks in order to find the one that fits well for us. We're all so new we don't know what "issues" may be caused by the mask, even though we don't "notice" anything wrong, because we have no baseline to go from. We're all afraid of not meeting our insurance compliance because paying for it all out-of-pocket is not usually an option. We understand the necessity of treatment, therefore if we're getting our 4 hours per night of use, we don't want to rock the boat and try something new that may make it worse temporarily. After being on xPAP for 6 weeks I'm finally comfortable enough with having a baseline to compare against, hence asking about trying a different style of mask.

Insurance companies should pretty much ignore the first 6 weeks of "minimum 4 hours" as long as there is obvious attempts to make it work. DMEs should send everyone home with all 3 of the main mask styles (FFM, nasal mask, and nasal pillows) and encourage people to try one for a week, then try another for a week, then try the next for a week. After the 3rd week, use the mask that you liked the best for a couple of weeks, and stick with it if there are no issues. Insurance should start their compliance monitoring after the first follow-up with the sleep doctor as that is usually when some tweaks are made to iron out the last issues.

I would think the mask manufacturers would encourage this too as it would mean a bit more expense up front, but should result in better compliance for everyone in the long run. This means more mask replacement sales due to less machines sitting in the closet because they're "too annoying" or "don't work." DMEs should like it as they should have less paperwork and hassle for extra fitting sessions, and would also enjoy the additional orders over time. Insurance companies should like it as they'd see less appeals for new compliance periods if they better allowed for the initial adjustment periods. Doctors and patients alike would love it as there would be far less anxiety over treatment without the hassle of begging for a new mask or concern that if some minor issue will cause non-compliance and a big bill as a result. I'm sure I'm not the only one that has sat and watched TV for an hour on a Saturday morning after discovering I took my mask off overnight and only had 3 hours of use.

Sorry, I'll get off of my soapbox now. I know I'm preaching to the choir here anyway.

Guest1 wrote:your pressure needs change on a nasal pillow mask due to 2 things:

1) There is less pressure loss in nasal pillows vs FFM due to reduced dead space and also less turbulent flow (most FFM have air path making a 90 degree from elbow connector to nose.
2) mouth breathing needs more pressure which is eliminated if you use pillows with mouth shut.

I'm afraid I have to disagree with both of those, or at least, ask for citations.

there's not less pressure 'loss' in pillows vs a ffm, where is that pressure supposedly lost?

mouth breathing has never been shown, to my knowledge to require more pressure, again, citations please.

what has been documented is that full face masks tend to put pressure on your lower jaw, forcing it backwards to it's limits, thus reducing your airway... nasal and pillow masks don't do this, allowing your jaw to be neutral or even forward due to the pressure in your throat, thus opening up your airway a bit.

try moving your jaw forwards and backwards, there's normally a bit of play there.

Guest1 wrote:2) mouth breathing needs more pressure which is eliminated if you use pillows with mouth shut.

Bwexler, You might be surprised to learn that many of us use FFM with mouth closed most of the night.

Elle wrote:My AHI is lower with a nasal mask than with pillows.

It's amazing, jjhall, that your results are better with pillows (vs. a nasal mask). The only reason I use a pillows mask is that my alternative Wisp nasal mask leaves red marks on the bridge of my nose. I like the WISP for comfort and, at least for me, a far lower leak rate than my Swift FX pillows. I keep the WISP because it serves me well on rare occasions when my nares are sore. Anyway, whatever works for you is what you should have and use; and the other kept as an as-needed backup. All the best, jjhall.

ChicagoGranny wrote:

Guest1 wrote:2) mouth breathing needs more pressure which is eliminated if you use pillows with mouth shut.

Bwexler, You might be surprised to learn that many of us use FFM with mouth closed most of the night.

Be surprised - look at the results of my poll here: viewtopic.php?f=1&t=104522

yaconsult wrote:

ChicagoGranny wrote:
Bwexler, You might be surprised to learn that many of us use FFM with mouth closed most of the night.

Be surprised - look at the results of my poll here: viewtopic.php?f=1&t=104522

That poll has nothing to do with the statement I made. Logic fail and nothing deserves a laughie.