Does the mask make a difference if leakage is low?

General Discussion on any topic relating to CPAP and/or Sleep Apnea.
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novatom
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Does the mask make a difference if leakage is low?

Post by novatom » Wed May 27, 2015 11:25 am

I've been fortunate to be able to use a nasal pillow since starting CPAP on Jan. 1. My leak rate is very low--on 99% of the nights since Jan. 1, my seal has been 100% according to Sleepmapper (Sleepyhead also shows very low leakage as well).

And yet, the best I ever felt was on the night of my titration, where I had to use a FFM (along with the help of a sleeping pill). The morning after, I felt better than I had felt in years, getting that "CPAP high" that results after getting restful sleep. I have not regained that feeling since.

Now here's my question: Would it make any difference if I switched to a FFM? Even though my leak rate is very low? I know that sounds weird... why would anyone want to switch from a nasal pillow to a FFM in that circumstance, but for me it would be worth it if I could feel better after using CPAP for a night. I know that CPAP high is not a one time thing- that people are able to feel that even after months of using CPAP. (And yes, I still use a sleeping pill periodically)

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jnk
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Re: Does the mask make a difference if leakage is low?

Post by jnk » Wed May 27, 2015 12:37 pm

novatom wrote: . . . the best I ever felt was on the night of my titration . . .
If a body/brain hasn't experienced a complete uninterrupted sleep cycle in years, the first time that happens may indeed make you wake up feeling like you are walking on sunshine the next day. That effect may not be reproducible in the days that follow--at least not in any, uh, legal, healthy way.

You can post your data here for ideas for improving your therapy results, but it is possible your PAP therapy is fine but other things are affecting your quality of life and well-being. Many things affect sleep. In fact, my position is that EVERYTHING affects sleep one way or the other. Many of us didn't know the concept of sleep hygiene from a hole in the ground when we were untreated. And that was OK because back then sleep hygiene wasn't the primary issue. But now that we can actually breathe, sleep hygiene rises to the top of concerns for healthy sleep, along with other medical and psychological issues.

So make sure CPAP is working well for you according to your data, maybe dial-wing the pressure up a notch a few weeks to see if that helps (if you and your doc are good with that idea), but read up on sleep hygiene (as in serious, sustained study of it) and start seeing what diet and activity levels and proper hydration and any needed lifestyle changes and all those kinds of things do too. Because our capabilities in all those areas change after some time on the hose. The reason I mention all those seemingly obvious things is that tweaking them can often have more immediate and sustained results than tweaking a therapy that is in the general ballpark--although obviously there are exceptions to that.

As for your direct question, any change that makes you more comfortable at night may make you sleep better. Including a mask change.

Most find nasal pillows particularly comfortable in comparison with FFM, if they are anatomically a good fit for pillows and if they can use them without mouth-opening and mouth-leak issues. But mask choice is a HIGHLY individual thing, and the only way to know in your case is to try.

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LSAT
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Re: Does the mask make a difference if leakage is low?

Post by LSAT » Wed May 27, 2015 1:00 pm

Mask doesn't matter if you are comfortable and your leak is low.

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robysue
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Re: Does the mask make a difference if leakage is low?

Post by robysue » Wed May 27, 2015 2:26 pm

novatom wrote:I've been fortunate to be able to use a nasal pillow since starting CPAP on Jan. 1. My leak rate is very low--on 99% of the nights since Jan. 1, my seal has been 100% according to Sleepmapper (Sleepyhead also shows very low leakage as well).

And yet, the best I ever felt was on the night of my titration, where I had to use a FFM (along with the help of a sleeping pill). The morning after, I felt better than I had felt in years, getting that "CPAP high" that results after getting restful sleep. I have not regained that feeling since.
and
(And yes, I still use a sleeping pill periodically)
If your data looks good and two masks are basically the same in terms of comfort, it shouldn't matter which mask you use. But anything that can create additional discomfort can lead to more problems with plain old sleep continuity problems.

Which brings up the sleeping pills: You may have felt so good after that titration night because of a combination of the CPAP taking care of the OSA and the sleeping pill. The CPAP meant that for the first time in years, your body was not going through multiple mini-suffocations all night long and so it was able to get some badly needed rest. And the sleeping pill insured that all of the novelty of the mask, the air pressure, the hose, etc. didn't trigger a bunch of spontaneous arousals just because every was "different." In other words, the CPAP kept the apneas from happening and the sleeping pill kept the CPAP from triggering a lot of unwanted discomfort-related arousals.

You say that you still use the sleeping pills periodically. How often does that mean? And have you considered keeping a log of whether you feel better after the nights when you take the sleeping pill as compared to the nights when you don't?

Also out of curiosity: Why were you titrated with a FFM? Are you going through any efforts (taping, chin strap, consciously worrying about where your tongue is located) in an effort to make the nasal pillows work? If so, then yeah, it might make sense to see if you're more comfortable wearing a FFM simply because you no longer spend anytime worrying about whether the mouth might open up in a gaping hole ...

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novatom
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Re: Does the mask make a difference if leakage is low?

Post by novatom » Thu May 28, 2015 6:40 am

robysue wrote:
(And yes, I still use a sleeping pill periodically)
You say that you still use the sleeping pills periodically. How often does that mean? And have you considered keeping a log of whether you feel better after the nights when you take the sleeping pill as compared to the nights when you don't?
Unfortunately I am having to use the sleeping pills more often right now because I'm having a particularly hard time falling and staying asleep. Normally it may be 1-2 a week. Now I'm up to almost every other day, sometimes consecutive days. I know I feel better after I've slept, whether with the sleeping pill or not but the difference has been negligible.
Also out of curiosity: Why were you titrated with a FFM? Are you going through any efforts (taping, chin strap, consciously worrying about where your tongue is located) in an effort to make the nasal pillows work? If so, then yeah, it might make sense to see if you're more comfortable wearing a FFM simply because you no longer spend anytime worrying about whether the mouth might open up in a gaping hole ...
I didn't really know what type of mask I was going to use at my titration, it was just handed to me. That said, two days afterwards, when they gave me my gear, they gave me a nasal pillow and said if that didn't work, to ask them for a different mask (at the time I was not aware of the three types available). I assume, unless they know of a special situation, that DMEs will start you off on the least obtrusive mask (i.e. nasal pillow) and work your way through the other masks if the pillow doesn't work.

But that was the crux of my question: I handle the nasal pillow great. Very little to no leakage with no irritation on my nostrils. It took me only a few days to get used to it, so I'm not having any problems with it. I was just wondering why there was such a difference between how I felt after using the FFM and how I am feeling now using the nasal mask, with the same leak rate. My takeaway from all these responses is that I got that "CPAP high" after my titration because it was indeed, the FIRST time in years that I had had restful sleep. I may be getting restful sleep now because of my success with the nasal pillows (my average AHI now is between 3-4 and steadily going down), but I'm not feeling like I did when I had my titration.

Thanks everyone, for your help on this. I plan on asking this question to my doctor when I go for my next followup next month.

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