New mask and new machine, now I'm tired again

I just got a new respironics apap machine with a setting of 8-12. Before this I had a respironics cpap with a pressure of 10.
I also went from a full face mask to a Wisp. I tape my mouth shut every night, so I don't need a full face mask anymore.

according to my data my leaks are minimal with the wisp and I never even reach a pressure of 10 (9.5 is the highest my pressure setting has ever went).

According to the wisp measuring guide I should use the small nasal mask but when I put it on it constricts my nasal airway to where I find it hard to breathe out my nose. The large constricts my airway as well but not as bad. I have been using the large mask and I'll wake up several times during the night to push it up because it has slipped down a bit and it restricting my airway badly.

My AHI is still under two, but I feel super sleepy again. I could go back to the full face mask but I hate how my face gets wind burned from the full face mask.

Two questions, if my AHI is great and and my leaks are minimal could size of the mask be causing my sleepiness?

Also, Should I try extra large nasal mask?

I'm going to try nasal pillows next month when I get new mask from insurance

araris wrote: I'll wake up several times during the night to push it up because it has slipped down a bit and it restricting my airway badly.

This alone could be the cause of unwanted daytime sleepiness....too many wake ups during the night will destroy the normal sleep cycles we need for good restorative sleep.

I couldn't use the Wisp because it caused nasal congestion...pressure on the bridge of my nose does this to me.
I removed the Wisp briefly and reseated it and the congestion would immediately clear up but only to return a short while later. Changing the size of the cushion wouldn't have changed the pressure and it was so annoying (those repeated wake ups) that after 90 minutes I bailed on using the Wisp any further.

Now the Swift FX Nano cushion is similar in construction to the Wisp cushion and I tried it...I really expected the same results as I got with the Wisp but was very pleasantly surprised to find I had great success with the Nano. In fact such good success that I used it for a week or so with various Swift FX nasal pillow gear to make sure the parts were interchangeable and even had success using the Nano with the Bella Loops and that surprised the heck out of me.

My main go to mask is still nasal pillow mask but I kept the Nano just in case I ever had occasion to need a mask that didn't go into my nostrils in any way (like a big zit or something). I don't keep a mask if I won't use it.

If you want to try the Nano...and want to try a nasal pillow mask...get the Nano package and I have some Swift FX nasal pillows you can have to try...they will fit on the Nano headgear just fine.
Or get the Swift FX nasal pillow package and buy the Nano cushion separately (EBay great source for just cushion). I do think that the Nano short hose is probably a tiny bit improved over the Swift FX nasal pillow short hose..I tried both. Not a deal breaker and only tiny bit better.

Thanks Pugsy,

I called my home medical provider a they told me to try the larger mask. I also have a resmed airfit coming, so I hope that fixes my issues.

araris wrote:I just got a new respironics apap machine with a setting of 8-12. Before this I had a respironics cpap with a pressure of 10.
I also went from a full face mask to a Wisp. I tape my mouth shut every night, so I don't need a full face mask anymore.

according to my data my leaks are minimal with the wisp and I never even reach a pressure of 10 (9.5 is the highest my pressure setting has ever went).

According to the wisp measuring guide I should use the small nasal mask but when I put it on it constricts my nasal airway to where I find it hard to breathe out my nose. The large constricts my airway as well but not as bad. I have been using the large mask and I'll wake up several times during the night to push it up because it has slipped down a bit and it restricting my airway badly.

My AHI is still under two, but I feel super sleepy again. I could go back to the full face mask but I hate how my face gets wind burned from the full face mask.

Two questions, if my AHI is great and and my leaks are minimal could size of the mask be causing my sleepiness?

Also, Should I try extra large nasal mask?

I'm going to try nasal pillows next month when I get new mask from insurance

Could be the pressure changes (or lower pressures) are leaving you felling "unrested" (or "tired again")

Are you monitoring your therapy with software?


Den

.

Yes, I check everyday with sleepyhead.

I find that the respironics machines often have a 95% percentile pressure to be less than the other brands. It makes me question whether the AHI reported is truly accurate. Maybe I'm alone in thinking this, but I am often surprised when it finds a pressure of 8 to be satisfactory yet the Resmed will find 10-11.

Is it possible that my nasal mask is inaccurately recording things?

I still feel excessively tired. I going back to my old mask tonight and maybe even my old machine....

My AHI has been consistently at 1 and I mean 1 not 1.2 or .9 or anything else but 1. I have felt like I haven't even started cpap therarpy. I am soo discouraged. everytime I think things are getting better I run into a crap.

I am waking up soo many times a night again.

araris wrote:Is it possible that my nasal mask is inaccurately recording things?

I still feel excessively tired. I going back to my old mask tonight and maybe even my old machine....

My AHI has been consistently at 1 and I mean 1 not 1.2 or .9 or anything else but 1. I have felt like I haven't even started cpap therarpy. I am soo discouraged. everytime I think things are getting better I run into a crap.

I am waking up soo many times a night again.

Switch it to straight pressure. It's probably the pressure changes in Auto mode that are wrecking your sleep. When you enter a deep or REM sleep stage, your breathing can change and that may trigger the machine to increase pressure. That increase can bump you out of your needed sleep stage and leaving you feeling the way you're feeling. And, if your minimum pressure is too low to begin with, it is going to chase events all night long.......and the same thing happens.


Den

.

I appreciate your response.

I have a pressure setting of 8-12. I never go higher than 9.5. My issue with a straight pressure and the reason I changed to an apap is that If my pressure goes higher than 8, I bloat up like a wombat, and then I'm waking up with extreme gas pain. I have a love hate relationship with sleep. I so desperately want to sleep and love it, but crap almost always goes wrong. I can handle having a few nights of bad sleep, but It seems like I'm only getting a few nights of good sleep a month. And good is relative.
a
I know that I feel the best with a pressure of 10, but the extreme stabbing pain that feels like I'm going to pop like a balloon.

araris wrote:I appreciate your response.

I have a pressure setting of 8-12. I never go higher than 9.5. My issue with a straight pressure and the reason I changed to an apap is that If my pressure goes higher than 8, I bloat up like a wombat, and then I'm waking up with extreme gas pain. I have a love hate relationship with sleep. I so desperately want to sleep and love it, but crap almost always goes wrong. I can handle having a few nights of bad sleep, but It seems like I'm only getting a few nights of good sleep a month. And good is relative.
a
I know that I feel the best with a pressure of 10, but the extreme stabbing pain that feels like I'm going to pop like a balloon.

So, set the machine at a straight 8 and see what things look like.
You say you're having issues with pressures above 8, so just limit it to that.


Den

.

APAP range from 8 to 9.5 (if that is as high as it ever goes) isn't a huge range but it still will vary a little and those variances could still be a potential sleep disruptor.
What would happen if you used 8 minimum and 8 maximum so that the machine works like a cpap machine?
Would too many apnea events slip past the defenses at using 8 or 8.5 all night? How much time do you spend at 9.5? If it's a minimal amount of time maybe a compromise might be in order.
Having the max at 12 doesn't really do anything if the machine never ever goes beyond 9.5...wonder what would happen if you had a tiny range like 8 to 9 or 8.5 to 9?

Maybe at least try to find out if the pressure changes are a factor or not? For some even the tiniest change can impact sleep quality and others can sleep through a hurricane but if you are one of those that the tiniest change does impact your sleep quality....might be worth at least seeing if it helps to use no range or a teeny tiny range.
I like to suggest we use the Respironics machines in apap mode with minimum to equal maximum because then we still have flow limitation flags (it's turned off in cpap mode) so that it works like cpap but we don't lose some potential data.

I'm tired all day with anything lower than 10. I've tried a constant pressure at 8,9, and 10 ten is where I feel the best but I have to deal with excruciating gas

Wulfman... wrote:

araris wrote:I appreciate your response.

I have a pressure setting of 8-12. I never go higher than 9.5. My issue with a straight pressure and the reason I changed to an apap is that If my pressure goes higher than 8, I bloat up like a wombat, and then I'm waking up with extreme gas pain. I have a love hate relationship with sleep. I so desperately want to sleep and love it, but crap almost always goes wrong. I can handle having a few nights of bad sleep, but It seems like I'm only getting a few nights of good sleep a month. And good is relative.
a
I know that I feel the best with a pressure of 10, but the extreme stabbing pain that feels like I'm going to pop like a balloon.

So, set the machine at a straight 8 and see what things look like.
You say you're having issues with pressures above 8, so just limit it to that.


Den

.

I'll look into how long I'm at 9.5... I use sleepy head. I know this sounds weird but if I use 8 or 9 as a pressure range my AHI always goes above 3 and possibly close to 5. I feel tired all day.

But as soon as I reach anything over 8 I get bad gas. Even at 8 I get gas but not excruciating gas


hi quote="Pugsy"]APAP range from 8 to 9.5 (if that is as high as it ever goes) isn't a huge range but it still will vary a little and those variances could still be a potential sleep disruptor.
What would happen if you used 8 minimum and 8 maximum so that the machine works like a cpap machine?
Would too many apnea events slip past the defenses at using 8 or 8.5 all night? How much time do you spend at 9.5? If it's a minimal amount of time maybe a compromise might be in order.
Having the max at 12 doesn't really do anything if the machine never ever goes beyond 9.5...wonder what would happen if you had a tiny range like 8 to 9 or 8.5 to 9?

Maybe at least try to find out if the pressure changes are a factor or not? For some even the tiniest change can impact sleep quality and others can sleep through a hurricane but if you are one of those that the tiniest change does impact your sleep quality....might be worth at least seeing if it helps to use no range or a teeny tiny range.
I like to suggest we use the Respironics machines in apap mode with minimum to equal maximum because then we still have flow limitation flags (it's turned off in cpap mode) so that it works like cpap but we don't lose some potential data.[/quote]

Are you using AFlex exhale relief and if so at what setting?
If not you might try AFlex at 3...that offers the greatest exhale relief and thus a drop in pressure during exhale (up to 2 cm is the max) and that might enable you to be able to use that higher pressure without the aerophagia problems.

Or if that doesn't work then maybe talk with doc and DME about trying a bilevel pressure machine in an effort to be able to use the pressure that let's you feel better and not make the aerophagia issues worse.
If you were using a ResMed machine we could try EPR at 3 which is a 3 cm reduction and it's more dramatic than Respironics AFlex. So the S9 with EPR at 3 is pretty much working like a bilevel machine but it's limited to 3 cm difference. The bilevel machines offer greater than 3 cm difference between inhale and exhale so they can give 4 or 5 or more cm difference which helps a lot when people have aerophagia issues.

No, I have turned those the cflex and aflex options. I guess I could play with them again.