Need Help Optimizing Therapy

I am new to the forum, seems like a great group of people very willing to help, so here's my brief story and questions.

Over the last 5 years, I have gone from being told by bed partners that I just snore, to full blown OSA diagnosis. AHI much worse supine versus side sleeping. I'm 44, very healthy and fit. CPAP sucked at first, always tearing it off at night, hating the idea of being tied to a machine forever, etc. So I went down the MAD route and once I got it fully advanced to the target it worked OK. As long as I stayed on my side and used it regularly, I felt alright...maybe a 6 on a scale of 1-10. Then the last few months it just stopped working. I was down to feeling 2/10 and dug the CPAP machine back out of the basement, thinking, I'll just use this to get back on my feet and then figure out what else I can do. (Even went to an ENT lately to see if he had any surgery ideas, but he said there is nothing for him to do in there from an anatomy perspective.)

So now its been 3 weeks on the machine and started reading this forum, trying different masks, a few different pressures, and nothing is getting better. I have been getting ~7 hours on the machine recently but the AHI is still in the 6-8 range and giving me this feeling of being "foggy",hard to concentrate, etc. Like I said 2/10. I just downloaded the SW from sourceforge and ran the data.

What I found is that the first week, I was using a nasal mask and chin strap (b/c my mouth always pops open) and was getting AHI in the 1-3 range. Sounds pretty good but still felt awful. Remember I didn't know this was the AHI at the time b/c didn't have the SW. Then the second week I switched to FFM that I found very comfortable and was able to sleep for 7-8 hours with it on. No chin strap, didn't seem to lead, etc. But again still felt awful. Went to the sleep doc and they upped the pressure from 7 to 10. A few days of this and it still didn't seem to be any better.

Looking at the data, I am getting AHI consistently of 1-3 with the nasal mask but am annoyed by it and can't sleep as long with it. The FFM is much more comfortable and easy to use, but the AHI data is much worse (as high as 25 some hours), even with the higher pressure. In either case I don't feel rested in the morning.

Set aside for now the fact that the sleep doc didn't say anything about the poor AHI with the new mask and just turned up the pressure using the clearly poorer solution. Wouldn't you think they should have talked me through the 2 paths a little better?

Is there a chance the machine is misreporting the difference in the 2 masks? Does it have to be calibrated in some way to know which one it is using? I am surprised the data is SO different between the 2 masks given how much better the FFM "feels" to me in terms of comfort and sleep disruption.

The machine is a System One Remstar Auto with A/Flex.

Anyhow, hoping you all have some ideas. Appreciate any advice on how to get this dialed in better.

Welcome to the forum.

It will be very helpful if you to fill out your profile with all your equipment and pressure settings. This information is required to aid in any advice you may receive. Also, please look into downloading Sleepyhead version 0.9.8.1-testing. This will allow for a better analysis of your sleep patterns and problem areas.

Once again, welcome to the forum.

Welcome,
This site will show you how to put your equipment in your profile. If your equipment is in the 60 series you have to scroll down to the ones that say 60 series. You find out which machine you have by removing the water and looking for the REF# on the bottom of the blower. Then we can help you with the specific choice.
wiki/index.php/Registering_Equipment_in_User_Profile

I updated the info as best I could. To be honest none of the drop downs fit EXACTLY to what the machine and equipment say.

System One (60 Series)
RemStar Auto with A-Flex (560P)
I got it in July 2013..?

I do have the SleepyHead 0.9.8-1 testing version running and the descriptions there match what is above.

Thx

Looks good! Now if you want to post images from your data, here is a tutorial that explains how to do it. https://sleep.tnet.com/reference/tips/imgur

You have the correct machine chosen but not humidifier.
The correct choice for the humidifier is the PR System One 60 Series heated tube humidifier with heated tube (even if you don't have the optional heated tube)...see my equipment profile. It has to be that one because the other Respironics humidifiers won't work with the 60 series machine and that's what the 560 is.

When you have time please post a couple of SleepyHead's detailed nightly reports....a good one and a bad one and let's see the difference.
This thread explains how along with examples of what we like to see to start with.
viewtopic/t103468/Need-help-with-screen-shots.html

You did good on finding your cpap. Need to check for the 60 series humidifier. It can be confusing, I know because I didn't get it right at first. On your question reguarding mask settings on the machine. The PR machines have what is called System One Resistance. It was something they came up with for their masks and made it corrolate to numbers on their masks. Now when a lot of people use other masks, it wasn't helpful and I don't think many bother with it. I understand it makes minimal difference and wouldn't think it would be the complete answer to your differences.

OK lets see if this works.





The "bad" night has higher AHI, but I am more comfortable wrt mask, etc. FFM

The "good" night has lower AHI, but I struggle to tolerate the mask/straps, etc. Note I took it off for a while around 430am.

In neither case am I feeling rested.

You'll need to gradually bump up your pressure and the results should improve.


Den

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So its better to increase the pressure on the FFM, than try to make the nasal mask work?

Why such a disparity on pressure? I can get low single digit AHI on the nasal at 7cm, and am hitting 25 AHI sometimes on the FFM with pressure all the way up to 10cm?

I don't get it.

donewithbeingtired wrote:So its better to increase the pressure on the FFM, than try to make the nasal mask work?

Why such a disparity on pressure? I can get low single digit AHI on the nasal at 7cm, and am hitting 25 AHI sometimes on the FFM with pressure all the way up to 10cm?

I don't get it.

When you change masks, you are changing the setting in the machine, right? I believe your machine has a pressure offset value. What are your settings for each mask? Some of your events could be disguising a leak.

donewithbeingtired wrote:So its better to increase the pressure on the FFM, than try to make the nasal mask work?

Why such a disparity on pressure? I can get low single digit AHI on the nasal at 7cm, and am hitting 25 AHI sometimes on the FFM with pressure all the way up to 10cm?

I don't get it.

I don't know. Some of these discrepancies have been noted before. Theoretically, it shouldn't happen, but for some it does.

Use the one you're more comfortable with or that gives you the best therapy.......and if they're the same one, so much the better.


Den

.

SGearhart wrote:

donewithbeingtired wrote:So its better to increase the pressure on the FFM, than try to make the nasal mask work?

Why such a disparity on pressure? I can get low single digit AHI on the nasal at 7cm, and am hitting 25 AHI sometimes on the FFM with pressure all the way up to 10cm?

I don't get it.

When you change masks, you are changing the setting in the machine, right? I believe your machine has a pressure offset value. What are your settings for each mask? Some of your events could be disguising a leak.

He's got a Philips Respironics machine and they don't have the mask settings like the ResMed machines do.


Den

.

So from doing a little more reading on the various mask threads, sounds like folks like the mask that requires the least amount of contact and therefore is less likely to lead? FFM worst, nasal second, pillows best?

For me the 3 things that are the hardest to tolerate are (1) the sound of the machine and mask (2) the feeling of the straps/tightness around the mask (3) mouth popping open.

The FFM is comfortable to me in that its quiet, it seems to stay in place when I sleep on my side, and doesn't matter if my mouth comes open. The nasal Wisp seems noisier, is less comfortable and requires that I use a chin strap. But if the AHI is so much higher on the FFM, does that mean that its leaking more and I just don't know it?

Can someone help interpret the leak data? I have no idea how to tell if any of that is meaningful.

I would love it if Den's suggestion to just increase pressure gets me there, but want to understand a little more about why that's the recommendation.

Thanks,

SGearhart wrote:

donewithbeingtired wrote:So its better to increase the pressure on the FFM, than try to make the nasal mask work?

Why such a disparity on pressure? I can get low single digit AHI on the nasal at 7cm, and am hitting 25 AHI sometimes on the FFM with pressure all the way up to 10cm?

I don't get it.

When you change masks, you are changing the setting in the machine, right? I believe your machine has a pressure offset value. What are your settings for each mask? Some of your events could be disguising a leak.

Gearhart, the PR machines don't have the easy mask settings that the Resmeds do. See my reply above. I do remember Palerider comparing the two and got this from another thread.

Palerider wrote: also, what the new respironics machines DO have is a 'resistance setting', and numbers marked on masks so you know what to set the resistance setting to.
all their full face, and nasal masks are x1, then pillow masks vary based on size... large, x1, medium x2, small x4..

So if you wanted you can try out the Resistance settings. Remember these numbers were on the Respironics masks and not the Resmed but should be similar.