AHI/Leak Data and Nasal Pillows vs FFM

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mlg123
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AHI/Leak Data and Nasal Pillows vs FFM

Post by mlg123 » Tue Apr 28, 2015 9:35 pm

When I use nasal pillows I average an AHI above 5. When I used a FFM I average an AHI of around 2. All others things being equal I cannot determine why this is. My sleepyhead data rarely (if ever) shows a large leak when I wear the nasal pillows, so while I suspect I am a mouth breather from time to time, I assume I am not opening my mouth too much or it would register a leak, would it not? The full face mask is very leaky due to my recessed jaw and jaw drop after I fall asleep and it is also much drier than the nasal pillows which leads to discomfort, but the nasal pillows, according to the data, are not producing a good result. I'm stumped. I've searched for similar stuff on the forum and could not find any. I would appreciate your collective wisdom, if any on this subject. If there are no leaks, why do the nasal pillows produce such a different result from the FFM? Is there any chance that if I persist in using the nasal pillows the numbers will eventually improve? Has anybody had that experience over a considerable period of time? If so, how long did it take?

Masks I have been trying:

Resmed Airfit F10
F&P Opus 360

I don't want to seem ungrateful for your collective wisdom, so I might add that tomorrow is an insanely busy day for me. I will be back to you all on Thursday!

Thanks so very much!

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mlg123
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Re: AHI/Leak Data and Nasal Pillows vs FFM

Post by mlg123 » Tue Apr 28, 2015 9:41 pm

Haha, I just remembered that I know this could be a case of complex sleep apnea as I have read on here that complex sleep apnea does better with a FFM, however the FFM is just so uncomfortable that I really don't want that to be the answer. Just being honest...

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tazman
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Re: AHI/Leak Data and Nasal Pillows vs FFM

Post by tazman » Tue Apr 28, 2015 9:48 pm

Have you tried the nasal pillows for a week straight? From my little experience and what I have read here it can take time to get used to changes in therapy.

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Gasper62
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Re: AHI/Leak Data and Nasal Pillows vs FFM

Post by Gasper62 » Tue Apr 28, 2015 10:57 pm

Could it be that the air pressures actually delivered are different with each type of mask and also the vent flow rate might be different between the two you're trying ? Thus, presenting your airway with a less therapeutic pressure with the pillow setup. Maybe bump up the pressure setting a little w/pillows and see. Just a thought.....

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Pugsy
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Re: AHI/Leak Data and Nasal Pillows vs FFM

Post by Pugsy » Wed Apr 29, 2015 7:43 am

What is the event category breakdown for each type of event with the
AHI of 5 with nasal pillows
AHI of 2 with FFM

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mlg123
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Re: AHI/Leak Data and Nasal Pillows vs FFM

Post by mlg123 » Thu Apr 30, 2015 6:32 pm

My recent night on nasal pillows shows:
Image

Last night on a full face mask was a lot of leaking:
Image

I had a couple of really good nights on a full face mask in March:
Image
Image

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mrog
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Re: AHI/Leak Data and Nasal Pillows vs FFM

Post by mrog » Thu Apr 30, 2015 11:23 pm

mlg123 wrote:When I use nasal pillows I average an AHI above 5. When I used a FFM I average an AHI of around 2. All others things being equal I cannot determine why this is. My sleepyhead data rarely (if ever) shows a large leak when I wear the nasal pillows, so while I suspect I am a mouth breather from time to time, I assume I am not opening my mouth too much or it would register a leak, would it not? The full face mask is very leaky due to my recessed jaw and jaw drop after I fall asleep and it is also much drier than the nasal pillows which leads to discomfort, but the nasal pillows, according to the data, are not producing a good result.
It could be that you have the same AHI with both masks, but the FFM leaks make it harder for the machine to detect the apneas.

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mlg123
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Re: AHI/Leak Data and Nasal Pillows vs FFM

Post by mlg123 » Fri May 01, 2015 5:26 am

I was wondering if that was a possibility but I cannot deny how much better I felt after those good nights on a FFM. Still I would like to hear if others think this is a possible reason for the difference in AHI.

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mlg123
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Re: AHI/Leak Data and Nasal Pillows vs FFM

Post by mlg123 » Fri May 01, 2015 8:16 pm

I'm still looking for some experience and feedback here.

Can my AHI improve over a longer period of time? Say months instead of days or weeks? In other words do I need to give nasal pillows a longer time to see if they work? Can it take a while for the mouth breathing to resolve, if there is any occurring?

Does anyone think that the data might be less accurate with a FFM vs nasal pillows? I'm thinking that's just something I tell myself because I don't want to use a FFM. I have given a decent try, but I'm really struggling with leaks because of my recessed jaw (the cause of my apnea in the first place!).

I did OK on nasal pillows last night, but there were some decent leaks, just not as bad as with the FFM. I had some decent dreams which was nice, although sometimes disturbing when you are not used to them.
Image

Again, with thanks.

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mlg123
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Re: AHI/Leak Data and Nasal Pillows vs FFM

Post by mlg123 » Fri May 01, 2015 8:18 pm

Sorry wrong image:
Image

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palerider
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Re: AHI/Leak Data and Nasal Pillows vs FFM

Post by palerider » Fri May 01, 2015 8:57 pm

you need higher pressure to prevent the hypos...

why do you have your auto machine in manual mode?

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Re: AHI/Leak Data and Nasal Pillows vs FFM

Post by Pugsy » Fri May 01, 2015 9:15 pm

Yes, with time and experience mouth breathing can improve so that it doesn't happen often and if it does happen it doesn't last long.

The report from last night...those leak humps you are seeing are probably mouth breathing but it isn't a huge amount of mouth breathing and well within the machines ability to compensate for leaking.

My suggestion, use the mask that you prefer to use that lets you get the best sleep and is more comfortable and if the AHI with that mask is not quite you would like to see...adjust the pressure upwards just a little.
I don't know why your AHI is higher with the nasal pillow mask than with the FFM because if your leaks aren't any worse than these from last night then it can't be blamed on leaking. Usually it is the other way around and the AHI is higher with a FFM and lower with nasal pillows.

To me it wouldn't matter though...I would simply want to have good results with the mask that I preferred to use and slept the best with. I would attempt to deal with the higher AHI (no matter what the cause) and that usually means just a little more pressure....or use APAP mode and let the machine climb just a bit and I doubt it would take much to reduce the AHI.

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mlg123
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Re: AHI/Leak Data and Nasal Pillows vs FFM

Post by mlg123 » Fri May 01, 2015 9:57 pm

Palerider, Auto mode did not seem to work well for me, however, I was changing maybe a bit too may things all at once, I'm not sure, I was getting desperate for a good night's sleep. I shut off the Flex and the Auto at the same time. Flex seemed to be bad for me too. I think I'm in Den's camp in the sense that pressure changes seem to bother me, increases my CAs. I was averaging CAs around 2.5 and higher every night with Flex, some nights 3, even close to 4. I shut off flex and went to straight CPAP and rarely do I see CAs above 0.5.

To both PR and Pugsy, I'm going to try to increase the pressure a bit. See what happens. The nasal pillows are the most comfortable for me by far for lots of reasons. They maintain higher humidity than the full face mask, they leak less, they're lighter, I can breathe through my nose better... Maybe after a bit I will revisit auto mode with no flex and a tighter range to see how that works for me.

I can't say enough for how grateful I am for the people on this forum.

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palerider
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Re: AHI/Leak Data and Nasal Pillows vs FFM

Post by palerider » Fri May 01, 2015 10:16 pm

mlg123 wrote:Palerider, Auto mode did not seem to work well for me, however, I was changing maybe a bit too may things all at once, I'm not sure, I was getting desperate for a good night's sleep. I shut off the Flex and the Auto at the same time. Flex seemed to be bad for me too. I think I'm in Den's camp in the sense that pressure changes seem to bother me, increases my CAs. I was averaging CAs around 2.5 and higher every night with Flex, some nights 3, even close to 4. I shut off flex and went to straight CPAP and rarely do I see CAs above 0.5.
for some people, the extra ventilation that occurs because of the difference between inhale and exhale pressures that happen with aflex, (and EPR on resmed) ,and concomitant extra blowing off of co2 can increase centrals, since it's the buildup of co2 in the blood that makes you want to breath. basically, you're inhaling at a higher pressure than you're exhaling, and that causes you to move more air through your lungs than if there wasn't a pressure differential.

you may be one of those folks

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Last edited by palerider on Fri May 01, 2015 10:47 pm, edited 1 time in total.
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mlg123
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Re: AHI/Leak Data and Nasal Pillows vs FFM

Post by mlg123 » Fri May 01, 2015 10:32 pm

palerider wrote:
mlg123 wrote:Palerider, Auto mode did not seem to work well for me, however, I was changing maybe a bit too may things all at once, I'm not sure, I was getting desperate for a good night's sleep. I shut off the Flex and the Auto at the same time. Flex seemed to be bad for me too. I think I'm in Den's camp in the sense that pressure changes seem to bother me, increases my CAs. I was averaging CAs around 2.5 and higher every night with Flex, some nights 3, even close to 4. I shut off flex and went to straight CPAP and rarely do I see CAs above 0.5.
for some people, the extra ventilation,and concomitant extra blowing off of co2 can increase centrals, since it's the buildup of co2 in the blood that makes you want to breath.

you may be one of those folks
OK PR, I need some clarification please. Extra ventilation you are indicating is a bad thing, right? And that extra ventilation occurs in nasal pillows, correct? Because I've read elsewhere on the forum that people with complex sleep apnea do better with with a FFM due to the retention of the CO2 in the mask. That's what you are talking about, correct?

Thank you.

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