AHI/Leak Data and Nasal Pillows vs FFM

[palerider]

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?

sorry, I'll go back and edit my post... I try not to be confusing, but I see I was too brief.

I'm talking about the extra ventilation, as in deeper breaths, that aflex can cause, by having a higher inhale and lower exhale pressure, it can increase the tidal volume, ie, how deeply you're breathing, and that can cause you to blow off more co2...

it doesn't have anything to do with the type of mask.

also, the way many FFMs are designed, there's little, if any co2 retained, especially the ones with the vent up high... there's always air flowing through the mask, and if it's venting up above your nose, and coming in by your mouth, that's a pretty good flush going on all the time

I apologize for the confusion.

[mlg123]

Well, after one night I can say that the pressure change caused me to rip my mask off after slightly less than four hours and it increased RERA dramatically, from under 1 to over 4. My hypopneas went down but my obstructives increased. I ended with a slightly lower AHI than the night before but the increased RERA is really bothersome. So I'm going to give it a few more nights at 8 cm and then I might consider going back to 7 cm or trying auto again with a 4 to 9 or 7 to 9 range. It's a process. I'm committed to making this work! (partly because my gastroenterologist told me I could not drink caffeine anymore ) I will update in a week or so with more info just to let you all know how it's going. Thanks.

[palerider]

So I'm going to give it a few more nights at 8 cm and then I might consider going back to 7 cm or trying auto again with a 4 to 9 or 7 to 9 range. It's a process.

yes, when fine tuning you should never rely on one nights experience, we all have occasional bad nights, and it could just be coincidence, or it could be your body needs a bit of time to adjust to the change.

[mlg123]

I promised an update, and I am super grateful for the help, so I'd like to keep the promise. I have to say I did have one night with truly incredible numbers, AHI under 1, and I've even had some other decent nights this week, AHIs under 5. Some nights the mouth breathing seems to be very little, but other nights it's really a problem. The biggest problem is though that, regardless of the decent or even really great numbers, I still don't feel rested, in fact I feel REALLY lousy. This past week at work sometimes I would look up at the monitor and see something like "eeeeeeeeeeeeeeeeeeeeeeeeeeeee" because I my head was bobbing while I was typing. Im sure I'm not the only one. I also am not dreaming, at least not that I can remember. I do remember dreaming on the full face mask so I feel like there's definitely a difference. So I have a Flexfit 431, purchased from our sponsor (with insurance), being delivered tomorrow. I'm hoping it will help the major mask leakage that happens for me with the Airfit F10 because of my recessed jaw. Once I fall asleep my jaw falls back and there's apparently a decent windstorm going on. I otherwise love the Airfit F10, so light and comfortable. I hope the under the chin design of the 431 will help. I noted a lot of people on this board have found it to be helpful for this reason. So I seem destined to be a full face mask wearer despite my efforts to avoid it. Maybe one more update here on the 431 if it works out. Hopefully something to the effect of a Woohoo!

[Krelvin]

I use the Flexfit 432 which is basically the same mask you are getting with an extra insert in it. It is more comfortable to wear, but the mask itself has a higher flow rate (without leaks, just out the vents). I also use the Quattro Air. It is smaller, not as comfortable but has a much more acceptable leak rate.

When I did my last study, they would not let me use the 432 because it was leaking too much. Not around the mask, just out the vent. The tech thought it was weird since she felt around the mask and didn't notice any leaking. So for the titration part of the test they used a Mirage Quattro instead. I picked the Quattro Air when I got my new machine since it felt lighter and seemed to fit better. I already had several 432's with parts, so I have both.

I switch from time to time for comfort to the 432. But it sometimes causes issues with my eyebrow, so I switch back. I've had my best numbers with the Quattro Air, but not really by much and not significantly to make a real difference.

I have a full beard, and successfully sleep 7-8 hours most nights without too many issues. I consider myself being treated as I am not tired most of the time, alert etc... all of the things I don't have when I don't get enough sleep or have lots of interruptions at night.

I have never bothered with a Pillows mask as I have issues with my nose on a regular basis, sleep on my stomach and am a mouth breather at least some of the night.

There are a couple differences between the 431 and the 432. The 431 comes with 3 sizes of inserts, the 432 is ordered in a specific size. the 432 has an extra blue/grey foam insert which helps keep contact of the mask to the face. Outside of that, not a lot of difference. The headgear is the same if I recall.

[mlg123]

Krelvin, thanks for that additional info. I did not know some masks had higher than average, maybe even troublesome, vent rates. It also caused me to look up the masks on the F&P website and the specs show that the 431 has the highest vent rate, the 432 is lower and the forma is still a bit lower than the 432. I feel right now that I need something that goes under my chin, and the hans rudolph just looks like too much mask to consider. I chose the 431 because it comes with all three cushion sizes and the return insurance on it was cheaper than the 432. Also, I did note in the reviews that some people did not like the extra foam cushion on the 432. We'll see. For tonight I will sleep with my F10.

[mlg123]

Ok, the FlexFit 431 is comfortable, light, and seems to mostly stay in place and mostly not leak but my AHI is not good, 19 and 11 the last two nights. I'm bummed. Going to make some adjustments to the F10 to see if I can make it work. Thanks.

[mlg123]

So I'm stumped, and I feel like I am asking the same question again that I started with, but let me make it more general, all other things being equal (leak rate, pressure settings, etc.) has anyone else seen significantly different AHI scores with different masks? If so, any theories as to why? This really puzzles me so much. I realize I'm repeating myself, but the FlexFit 431 is super comfortable, light, doesn't leak excessively, but my AHI on it stinks! Thanks as always for your wisdom...

[Pugsy]

What is the event category breakdown of the AHI with the FlexFit 431?

Meaning if the AHI was 12....what is that comprised of? How much is CA/central index? How much is the OA index? and how much is the hyponea index?
If the AHI is composed of mainly obstructive in nature events (OAs & hyponeas) then you probably just need a little more pressure to get those reduced.
If it is mainly central in nature then we can't fix those with more pressure and depending on how many centrals we talk about a different diagnosis and maybe different form of therapy.

[mlg123]

Sorry Pugsy, I'm a slow learner.

Saturday night AHI 19.53
CA 5.08, OA 14.06, HA 0.39
I should add this was only 2 1/2 hours with the mask on

Sunday night AHI 8.88
CA 1.73, OA 6.28, HA 0.87
This was 4 1/2 hours with the mask on

So then my question is why would my pressure needs change with a different mask?

Thanks.

[Pugsy]

Some people just seem to need more pressure with a full face mask when compared to what they can get by with when using a nasal interface mask.
In theory it shouldn't make any difference because x amount of pressure should work no matter which mask but I have seen where it doesn't work out that way in real life.
It might be because the full face masks and those lower straps tend to pull the lower jaw back and thus maybe making the airway smaller and thus it tends to get obstructed easier and needs more pressure to hold it open.
All I know is that I have seen the reports from people who have dramatic differences in pressure needs to get the same level of AHI control (and leaks aren't a factor)....sometimes 1 to 3 cm difference in pressure.

The night with the 2 1/2 hours of mask on...did you spend a lot of time awake with the mask on?
If so then it's very possible that those CAs/centrals are awake/semi awake breathing irregularities getting flagged by mistake and we have to sort of ignore them.
Now if you are regularly seeing CA index around 5 and you know for sure that you were asleep then you need to be talking to you doctor about what you are seeing. Awake/semi awake centrals we ignore....asleep centrals we ignore if they are random but if consistently seeing 4 to 5 per hour average when we are asleep then that's a potential problem.