Recently switched to full face mask - question

General Discussion on any topic relating to CPAP and/or Sleep Apnea.
Ray-zer
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Recently switched to full face mask - question

Post by Ray-zer » Sat Feb 03, 2018 9:21 am

Hi everyone. I'm a new user. Wow, lots of information in this forum!

I am recently diagnosed with sleep apnea and have had a Dreammaker CPAP machine for about 3 weeks.

The first week I had a nasal mask and slept great. Around 3.5 - 4 hours and only woke up once at night to use the bathroom and then once during that week I woke up twice. That was great!

But during the past 2 weeks I have been sleeping for about 90 minutes, waking up, then getting up to use the bathroom. Sometimes I would wake up even more frequently. Many times I would wake up and not realize why, but sometimes I could tell that my mouth had opened and the air was rushing out and I believe that is what woke me up. The last 2 nights that is definitely what woke me up, at least part of the time.

Since I was within the first 30 days I was able to return the nasal mask and trade it in for a full face mask. So now I have the ResMed Airfit F20. Well, last night was my first night with it and I still woke up about the same number of times (far more than the first week). And when I downloaded the data from my Dreamstation into the Dreamstation app on my phone, my AHI was at 14.7! Previously almost every night for all three weeks it had been down to 2.0 to 3.0. So that is quite a difference. And coincidentally I now have a sore throat and my mouth was dry when I woke up. My Dreamstation does have a heated humidifier, by the way.

So my question is.....could the mask not being tight enough cause this? I am pretty disappointed because I really thought this would solve my issue of waking up, which it didn't do and now my numbers are so much higher. I didn't really feel any leakage last night although I did hear airflow but that was coming out of the exhaust/outflow valve at the base of the connector to my mask. The mask was definitely louder than my nasal mask because of that, but I assume that's normal?

I would appreciate any advice. I'm kind of regretting switching masks just purely based on that number. And of course now I have to keep that mask until the 3 month point at which time I can swap back. But the nasal mask really wasn't doing me justice either, since I was waking up because my mouth wouldn't stay closed all night.

Thanks for any help.

Ray

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Allessio77
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Re: Recently switched to full face mask - question

Post by Allessio77 » Sat Feb 03, 2018 9:41 am

Ray,
I am a new user also (66 days) and had the same problem--the air just would bubble out of my lips with a nasal mask.
I tired chin straps, cervical collars and tape to solve the problem to no avail.
I moved to a Full mask after about a month, and my AHI dropped by 60% and has continued to improve since.
I have had no leaks above threshold since my switch.
I thought I would have a hard time with the FFM, but I have been pleasantly surprised. I Use a Quattro Air, and I have a Simplus on order...I want to compare.
With Medicare, I think you can get a new mask every 90 days, but I could not wait and just bought the Simplus ($85.00)
Tightness of the mask is tricky. Everyone says to keep it loose, but I have to tighten mine up to stop the leaks. It is not uncomfortable, but I feel it is tighter than recommended. But it works.
I don't perceive the 'waking up' problem in my case. I wake up less under Therapy than before Therapy. So I am happy. But I usually still wake up once or twice a night.

Hope these reflection help.

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Pugsy
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Re: Recently switched to full face mask - question

Post by Pugsy » Sat Feb 03, 2018 9:57 am

Sometimes people need more pressure when using a full face mask than they needed with a nasal interface mask.
So the higher AHI might be the pressure is now sub optimal. Sure goes along with the increase in nocturia. More apnea events more stress hormone (ANP) getting dumped into the blood from the heart and going to the kidneys and making them work harder. When kidneys work harder they make more urine.

What setting are you using on the humidifier and are you using a heated hose?
Unfortunately sometimes people just get the dry mouth from mouth breathing even at maximum humidity setting when using a full face mask.
The humidifier wasn't designed to re-hydrate the oral cavity..it was designed to help with the nasal cavity moisture and the nasal cavity is a lot small and easier to add moisture to.

I suspect you need more pressure since the AHI has increased but unfortunately the DreamStation CPAP machine model DSX200xxx doesn't tell us the event category breakdown. We assume obstructive but it could be Clear Airway/Central Apneas that are just Sleep/Wake/Junk (not real) because of the wake ups.
Now you might be able to go to the DreamMapper website and get a total events happening with categories but you can't get it with software.
Then we could backwards calculate the AHI based on total events and time asleep.

You get AHI but you don't get what makes up that AHI. The model DSX200xxx is what I call a half assed brick...very limited data.
To get full efficacy data you need at least model DSX400xxx or what is called the DreamStation Pro.

So you probably need more pressure with a full face mask but I can't be 100% certain. How much more I don't know but might be 2 or 3 or more cm more. We think that the change in pressure needs comes because using a full face mask sometimes causes a change in the airway position from the lower strap pulling the mask/jaw back just a little and restricting the airway size a bit.

You might consider trying a cervical collar with the full face mask as it can keep the jaw up and won't let it fall back and tend to close off the airway so much.
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Bons
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Re: Recently switched to full face mask - question

Post by Bons » Sat Feb 03, 2018 10:09 am

I find that my pressures and my AHI are higher when using a full face mask. Like Pugsy says I think it is the nature of the mask not something I’m doing. My ASV is able to raise the pressures so it’s not as big a problem as it would be if I weren’t on an auto set machine.

I use a nasal mask most of the year but during winter sinusitis means a full face. That also helps up the pressure and AHI of course. But I’ve played with both masks in all seasons just to get a comparison.

Hounds3
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Re: Recently switched to full face mask - question

Post by Hounds3 » Sat Feb 03, 2018 1:44 pm

On my airsense 10 i had similar issue. I had bad numbers at my usual pressure of 9cm. When i went to my FFM i got so so seal and ahi of around 37. When i upped my pressue to 10.6 i got better seal and ahi of 4.6. Next time i use it i will go to 11cm and i think that will be it.

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MrsRinPDX
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Re: Recently switched to full face mask - question

Post by MrsRinPDX » Sun Feb 04, 2018 1:57 am

Pugsy wrote:...
Unfortunately sometimes people just get the dry mouth from mouth breathing even at maximum humidity setting when using a full face mask.
The humidifier wasn't designed to re-hydrate the oral cavity..it was designed to help with the nasal cavity moisture and the nasal cavity is a lot small and easier to add moisture to.
...
Pugsy is right on about the dry mouth. If I don't use my chin strap with my full face mask, even at full humidity, I wake up with a very dry mouth. (I'm a mouth breather during REM. BTW, my AHI are consistently below 2; my pressures are quite high and I was titrated and use the AirFit F20 mask. So your pressures may indeed be the problem.)

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Ray-zer
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Re: Recently switched to full face mask - question

Post by Ray-zer » Tue Feb 06, 2018 5:30 pm

Thanks very much for the responses. I greatly appreciate it. I talked to my equipment provider and he said to give it a few days and then he'll change the pressure from 8.0 to maybe 10.0 to see how I do. I know I can change it myself (I found the way to access it online), but I'm not sure if they/he would then lock it down further :-)

Unfortunately after a few nights with the full face mask I now have a red rash (dry skin, I think) on my face in a triangular shape inside of the shape of the mask (the whole inside). So I increased the humidity last night and hope that solves it.

Does anybody have any explanation as to why my first week was so awesome and then the subsequent weeks weren't? What I mean by that is that for many, many, many years I've woken up at night at least 4-6 times but sometimes even more. Immediately that first week on the nasal mask I slept for 4 hours at a time and only woke up once all night, and then once or twice I woke up twice. So that was FAR better than I've ever done. But then starting the second week, still with the nasal mask and now with the full face mask, I wake up every 90-100 minutes or so. Coincidentally that is what is supposedly a sleep cycle, but I'm not sure if that's a coincidence.

I haven't changed a thing (other than of course the mask 3-4 days ago), so I have no idea why that first week would've been so much better.

Thanks again. I appreciate learning from all of you and your knowledge and experience.

Ray

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Red423
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Re: Recently switched to full face mask - question

Post by Red423 » Tue Feb 06, 2018 5:49 pm

yes but here's where some points are missed, I went FFM, and during the first week, I had the driest mouth on the planet when I woke up. Then to top it off swallowing air all night I sounded like a freightliner coming off a mountain if you get my meaning. I have a myriad of masks I have tried, due to bad ok severe stomach issues I have to sleep on one side or the other, the valve to my stomach won't close ( GERD) so they give me a dreamscape jack it to 20, FFM and here I go starting other issues. I had to go to the MD beg for flonase to keep my nasal passages clear, buuuuut since the dreamscape even on 1 will emit too much humidity, my sinuses will swell causing my auto human settings to use oral tube (mouth)for breathing. While this may sound funny, it isn't to me. I wish I had an answer, my next move will be a proven anti snore chin strap to see if it blocks my mouth popping open, let you know, anyone try nose pillows and not the dreamscape version either it doesn't allow for sleeping on the side. yours red423

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LSAT
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Re: Recently switched to full face mask - question

Post by LSAT » Tue Feb 06, 2018 6:09 pm

Ray-zer wrote:Thanks very much for the responses. I greatly appreciate it. I talked to my equipment provider and he said to give it a few days and then he'll change the pressure from 8.0 to maybe 10.0 to see how I do. I know I can change it myself (I found the way to access it online), but I'm not sure if they/he would then lock it down further :-)

Unfortunately after a few nights with the full face mask I now have a red rash (dry skin, I think) on my face in a triangular shape inside of the shape of the mask (the whole inside). So I increased the humidity last night and hope that solves it.

Does anybody have any explanation as to why my first week was so awesome and then the subsequent weeks weren't? What I mean by that is that for many, many, many years I've woken up at night at least 4-6 times but sometimes even more. Immediately that first week on the nasal mask I slept for 4 hours at a time and only woke up once all night, and then once or twice I woke up twice. So that was FAR better than I've ever done. But then starting the second week, still with the nasal mask and now with the full face mask, I wake up every 90-100 minutes or so. Coincidentally that is what is supposedly a sleep cycle, but I'm not sure if that's a coincidence.

I haven't changed a thing (other than of course the mask 3-4 days ago), so I have no idea why that first week would've been so much better.

Thanks again. I appreciate learning from all of you and your knowledge and experience.

Ray
You supplier has no way to lock down your machine

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Re: Recently switched to full face mask - question

Post by palerider » Tue Feb 06, 2018 6:52 pm

Ray-zer wrote:Thanks very much for the responses. I greatly appreciate it. I talked to my equipment provider and he said to give it a few days and then he'll change the pressure from 8.0 to maybe 10.0 to see how I do. I know I can change it myself (I found the way to access it online), but I'm not sure if they/he would then lock it down further :-)
Like LSAT says, there's no way to lock a cpap down *at all*...

However, they can change your settings remotely, until you tell them not to, or turn off the modem.

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Matt00926
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Re: Recently switched to full face mask - question

Post by Matt00926 » Wed Feb 07, 2018 8:26 am

When you lay down, do you have a good mask seal? Check to see if you can feel air leaking out of the side of the mask and near your eyes as well. I'm not familiar with your machine, but you should be able to view the leak rate as well. It sounds like if you're getting sore/redness/skin irritation, it may be worth practicing fitting your mask in front of the mirror until it feels comfortable/is more secure.
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Ray-zer
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Re: Recently switched to full face mask - question

Post by Ray-zer » Wed Feb 07, 2018 9:46 am

Hi Matt. Yes, I'm pretty sure I'm getting a good seal. I feel all around the outside of the mask and don't feel any leakage. Here is something that is strange though. First of all, my AHI numbers were between 2 and 3 (per hour) for about three weeks while on the nasal mask. Now, while on the full face mask, they have been 14, 26.5, 21.5, 15.3, but then last night it was at 4.3. After my first night at 14 I figured maybe I had a leak so I cinched the mask down pretty tight, but then my numbers skyrocketed. So the last two nights I just slightly loosened the mask a little bit each night using the 4 straps. I made sure not to loosen very much, so there still was not a leak.

So I'm not sure if it's a fluke, but my numbers seem to be higher when the mask is tighter. On the tightest night, my numbers were the highest. And on the loosest night (last night), my numbers were the lowest.

Any idea on how a tight mask could cause higher numbers? Assuming this is it.

And for the redness, I increased the humidity level during the last 2 nights and I think it helped a little bit.

Ray

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Ray-zer
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Re: Recently switched to full face mask - question

Post by Ray-zer » Sun Feb 11, 2018 8:38 am

Everyone,
Well, the short story is that I went ahead and put my machine on Auto instead of just the straight 8.0 pressure that they had it set to. I'm sure I'll get talked to by the doctor or respiratory therapist about not changing my own settings, but oh well.

Prior to changing it to auto, the full face mask was giving me AHIs around 15 and even one around 20 and another around 25. There were a few nights as low as 7 or 8 though.

Well, I've had it on Auto and my numbers the last two nights were 1.2 for both nights. So it definitely worked!

Of course now I have the problem again of my back killing me from laying in the same position for so long, which is not what I'm used to. But I'm hoping over time that will go away.

And I'm hoping by the time the doctor or respiratory therapist slap my hand over changing a "provider" setting, I'll have the data to show them that it works.

Ray

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Pugsy
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Re: Recently switched to full face mask - question

Post by Pugsy » Sun Feb 11, 2018 8:45 am

Ray-zer wrote:Of course now I have the problem again of my back killing me from laying in the same position for so long, which is not what I'm used to. But I'm hoping over time that will go away.
You can move around...you don't have to stay in one position all night.
And if you are trying to stay on your back all night...don't...not only can it make the back pain worse it can make your OSA worse and cause pressure needs to be increased.

You can move around from side to side to on your back to even on your stomach...even with a full face mask.
Sometimes we might have to make a few changes to the bed pillow or something but it can be done.
All masks can be worn in all sleeping positions...some it might take a bit more work to keep mask movement leaks under control but it can be done.
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Re: Recently switched to full face mask - question

Post by Julie » Sun Feb 11, 2018 9:00 am

Are you keeping a pillow/piillows under your knees at night? It can make a big diff. as to how you feel on your back.