Changed to FFM / AHI is Up--Need Suggestions

[plr66]

Well I've just passed my first anniversary on this forum! For 9 months I had AHI nearly always between 0.5 and 1.5 with no leaking. (That was until ResMed's Swift LT pillows went bad with faulty manufacturing quality control, and all new pillows no longer held up to produce effective therapy). Sadly, I've had to move on to other alternatives.

For the past few months, I have been experimenting with a couple of other masks--mainly, the UltraMirage FFM. I do have to fiddle with the cushion a good deal, and seem to have to snug down the mask to where the side rims of the hard frame are against my cheeks, in order to eliminate farting leaks. Chin and bridge areas of the mask have more of a floating feeling with a bit of air in the cushion, and only at times do I feel a tiny bit of leak near my eyes...unless it's just the vent air I'm feeling.

My leak number stays at 42-45 with my pressure set at 10.5; and no matter what I do to fiddle with the mask, I absolutely cannot get my AHI below 2. In fact, it stays between 2.5 to 3.8 !!! Aarrgghh!!! Yes, I do feel the difference during the days.

I am using a Small Shallow mask which is very comfortable and I believe fits perfectly from top to bottom. Have no big spikes at all in my leak line. Tried pressure set at 11 for a week, but could not manage the leaking without having to tighten the mask too hard against my face. Surprisingly, my AHI also went up at that pressure, so I backed off.

I am just stumped here and need some help again.

[DoriC]

I'm sure the experts will jump in, but have you thought about increasing your pressure a bit?

[ozij]

What does your AHI consist of?
Is there any chance you may be waking up more because of the mask, and having more apnea /ca or hypopnea without flow limitations, both of which may indicate arousals, or tossing, and not obstructions?

The 420E only let us add 0.5 cm/h2o increment, and you've already tried 11. How about trying 10? Maybe with less leak to bother you you'll sleep better?

Mack's silicon earplugs (rolled into snakes on your mask's seal (or parts of it), not plugged into your ears ( ) may help with the leaks too.

O.

[DoriC]

Oops, that'll teach me to read the entire post right to the end! But I was right about the expert jumping in).

[ozij]

Not an expert -- just experienced, curious, and have read many many posts since I was a beginner 4.5 years ago.

O.

[plr66]

What does your AHI consist of?
Is there any chance you may be waking up more because of the mask, and having more apnea /ca or hypopnea without flow limitations, both of which may indicate arousals, or tossing, and not obstructions?

The 420E only let us add 0.5 cm/h2o increment, and you've already tried 11. How about trying 10? Maybe with less leak to bother you you'll sleep better?

Mack's silicon earplugs (rolled into snakes on your mask's seal (or parts of it), not plugged into your ears ( ) may help with the leaks too.

O.

Iappreciate both of your responses, Dori & ozij. Tomorrow morning I will look at the AHI content...though I'm not sure how to report that. I am thinking I do wake up more because of the mask adjustments...have never been a heavy sleeper, and have always had wake-ups whenever I change sides with mask & hose. I'll try your suggestion of going back to pressure of 10 for a few nights, but I had changed that to 10.5 with the FFM because I just felt like I wasn't getting enough air in the mask. I haven't messed with the earplugs yet, and sure hope I don't have to......but it's a good suggestion, ozij.

[plr66]

What does your AHI consist of?
O.

Hard to even look at the numbers, but here they are for the past 6 nights:

..............................................M.....T....W....Th....F.....S
Apneas......................................6...10.....5.....6.....5....2
Apneas w/Cardiac Oscillations........2.....1....2.....1.....9.....5
Hypopnea..................................10...11...12.....6....11...10
Hypopnea w/Flow Limitations..........0....1....2.....0.....2.....1

Not sure what details you meant by your question.
I forgot to drop my pressure back last night, but have just done so, and will try this for a few nights.
I do show a bunch of "events" during the last hour or less before getting up on a few of these nights, and believe I was not fully asleep, and fiddling with a bit of leaking at those times when turning over.

Edit to try to get the columns right...

[plr66]

I'm resurrecting my thread as I am still stumped, and for the past 5 nights (as suggested by ozij above) have backed down my pressure to 10 from 10.5, to see if there would be any improvements.


Here are the numbers since decreasing pressure:
(Edited again to try to line up the numbers)

..............................................M.....T....W....Th......F
Apneas.....................................13....7....10....10.....3
Apneas w/Cardiac Oscillations.........9....2.....5......1.....4
Hypopnea..................................13....7....16.....11...17
Hypopnea w/Flow Limitations..........1....1.....5......1.....1

AHI's were: 2.5, 4.8, 4.3, 3.0, 2.7
ARGGHH! This is awful in comparison with where I've been for most of the last year, at well below 2.0!!

Upon further thought, I don't believe I have awakened much more with the FFM than with the Swift LT. My leak rate seems to be under control and at about the right place using the chart which came with the mask.

I really need some help here, to figure this out!

[Muse-Inc]

Try a mask change. RespCare Hybrid covers nose and has nose pillows -- does NOT touch or cover anything else. Remarkable comfortable. Comes with 3 sizes of oral cushions and 3 sizes of pillows that can be set at 2 heights from the oral cushion making it pretty easy to get a good fit. ResMed makes the Liberty -- the other hybrid-style FFM -- but only comes in sizes and is much more complex (more the wash).

[plr66]

Try a mask change. RespCare Hybrid...

Thanks for the suggestion, M-I. I've actually had a Hybrid for many months as a potential backup mask, and just got it fitted this morning for a second trial-run starting within the next week.

But I want to understand what the problem is with the UMFFM before just moving on. Was hoping for more help with this than has been forthcoming.....Is there detail that I have ommitted which would help y'all to help me figure this out?

[Watts]

What is meant by flow limitations? I'm still rather new and still fiddling try to get the right mask - pressure setting. I've noticed that I have 0 flow limitations in my numbers but have no idea what that means.

[ozij]

I don't have an explanation, PLR -- I am just stating a fact: apparently you can't get therapy that good with your FFM as you did with nasal pillows.

Two things I know for sure:

• The type of mask changes the machine's response characteristics.
  On their newer, Sandman Auto machine covidien added a mask calibration circuit.

Since you feel the difference during the day, I would suggest trying another kind of nasal pillows mask (Opus? Headrest?). Or else, concentrating on getting rid of leaks at 11, so that you know for sure you're sleeping without leak arousals.

Arousals often register as apneas for me: When I have toss an turn nights for non-breathing reasons, I'll have a higher AHI.

O.

[Wulfman]

What is meant by flow limitations? I'm still rather new and still fiddling try to get the right mask - pressure setting. I've noticed that I have 0 flow limitations in my numbers but have no idea what that means.

Well, if you use Google and look it up, you will find a lot of information. But, basically it's a partial hypopnea and is only detected in Auto-type machines as they trigger a pressure increase on them.....anticipating a more significant event.

http://sleepapnea.respironics.com/techn ... ation.aspx

Since you have a data-capable single-pressure CPAP machine (and not an Auto), you won't see them in your reports. I run all my machines in straight CPAP mode, too, so I don't seem them, either.


Den

[mindy]

Since you're using the "shallow" UFMM mask, is it possible that you're not getting appropriate CO2 clearance? I can't tolerate a shallow mask because I feel I'm not getting enough air.

Mindy

[DYNE540]

Sounds like the way your mask fits your face is similar to mine.

I got very lucky and found the Fisher Paykel FORMA FF mask to the perfect fit for me.
I tried the other ones and their seemed to be leaks around my eyes and nose bridge.
I even tried the comfort gel FF masks and those had similar leaks.

https://www.cpap.com/productpage/fisher ... -mask.html

have a better night resting,
vve