YES! YesyesyesyesyesYES!!!!!

[DreamOn]

The "short" answer is, I wasn't getting the full benefit of the therapy with my nasal mask because of mouth leaks. BUT...it's because of those leaks, that my doc could see the "type" of apneas I was having on the graph. (something to do with REM sleep) On nights where I wore a FFM, my AHI was a LOT higher, but the apneas were "different" than they were with the nasal mask.
My original sleep study used a nasal mask, and my therapy was based on those numbers, which didn't give an ACCURATE picture of what was going on with me. The next series of tests he's sending me for will be done with a FFM.

Hi Komodo,

I also tried switching to a full face mask because I was tired of having to wear a chin strap with nasal/pillows masks to prevent mouth leaks.

You didn't specify how your apneas were "different" when using the FFM vs. other mask types, but this thread that I started several weeks ago regarding my experience with the Quattro FFM and clusters of apneas may be of interest to you: viewtopic.php?f=1&t=48909. There are lots of charts there for comparison.

My AHI and apnea numbers were much higher with the Quattro than with the nasal and nasal pillows masks (27 apneas per night with the Quattro vs. 0 - 2 per night with the nasal/pillows masks). And with the Quattro, these apneas were appearing in large clusters. I discovered that the very large apnea clusters were because I was on my back! I sleep on my side most of the night, but I started noting the times I'd wake up on my back and I compared that to the software results. Because I had to wear the bottom straps so tight to prevent leaks with the Quattro (unlike my other masks), it was pulling my jaw back and obstructing my airway when I was in the supine position.

If you are using a FFM at home, try restricting yourself to side-only sleeping and see if that makes any difference. I used a homemade tennis ball setup to do that:



Looks funny, but it works! I cut a hole in the bottom of a tube sock, guided an old belt through the sock, put in two tennis balls, and secured the tennis balls in place with three rubber bands. I wore it wrapped around my upper body, just under my armpits, with the tennis balls on my upper back.

If I restrict myself to side-only sleeping with the Quattro, my results are great. When on my back, results with that mask are terrible. It wasn't just bad "numbers" either, I felt awful during the day too. I don't have these large apnea clusters with the other masks, even on my back. Maybe because I don't have to tighten down the straps with those?

We do tend to have more mouth leaks during REM sleep because all our muscles (including the mouth and tongue) relax completely during that sleep stage. Our mouth can drop open, letting therapy air escape. At first I didn't have a problem with mouth-leaking. I started having mouth leaks when I was finally sleeping more deeply.

Anyway, if it's apnea clusters you were referring to, the cause could be REM sleep or it may be sleep position. It may be worthwhile to experiment at home before the sleep test to see if you can narrow down the cause. If you do ever find yourself on your back, restrict yourself to side-only sleeping and see if there's a difference in results. It could be your neck position too. Because I had to wear the straps so tight on the Quattro, it felt like it was pulling my chin down towards my neck more too. I did try all sizes of the Quattro, and none seemed to work for me. For now anyway, I've gone back to nasal/pillows mask + PAPCap chin strap.

I hope you'll let us know what happens!

~ DreamOn

[Komodo]

DreamOn,

The "difference" in the apneas was that with the nasal mask, they were mostly, and highest, while in REM sleep. With the FFM, none were in REM.

My numbers were also a LOT higher with the Quattro compared to the nasal. I thought the FFM itself was obstructing my breathing, but that may not be the case now. The higher numbers may be because there are ~ZERO~ leaks, and I'm getting an accurate reading. After I got the software, I could see that the nasal mask's leaks went OFF the chart.......a lot!

Sleep position.....not much I can do in that area, I toss & turn all night long. So much so, that for the longest time I thought THAT'S why I woke up tired every morning! It's due to a back injury, and I can't stay in any one position for very long. Your tennis ball setup is good for most people, me, I'd need to use bowling balls!

[DreamOn]

I'd need to use bowling balls!

The "difference" in the apneas was that with the nasal mask, they were mostly, and highest, while in REM sleep. With the FFM, none were in REM.

I wonder how you/the doctor could determine from the software reports alone when you were in REM sleep and when you were not, and therefore that your apneas with the FFM were not during REM. Maybe they weren't in clusters with the FFM, but rather were spread more evenly throughout the night?

Seems like your apneas, especially with the FFM, could be positional, like mine are with that mask. Since you switch sleep positions frequently during the night, it may be difficult to determine that at home, though. Most of the time I side-sleep. If I roll onto my back I tend to stay there for a while. You could see from my graphs in the thread I mentioned just how strongly my apnea clusters were tied to supine sleeping with the FFM. In contrast, I only have a few apneas when on my back with the nasal/nasal pillows masks, with about the same low leak rate regardless of mask type.

The good thing is, they will be able to get a clear picture of all that during your new sleep study.

It makes sense to me that you would be having more mouth leaking during REM sleep with the nasal mask, since that's when all our muscles relax and our mouth tends to open, letting the therapy air escape. So, because you're not getting the full benefit of therapy air during those times you would be more likely to have apneas. Were the apneas occurring at the same time as the leaks when using the nasal mask?

So, if you can't solve the mouth leaks with the nasal mask by mouth-taping and/or chin strap, it does sound like you'll need to use a full face mask. I'd be very interested to know if they find that you need a higher pressure during your titration sleep study while using the full-face mask. I'd also be interested to know what they discover regarding your apneas and their relationship to sleep position and REM sleep.

It is wonderful that you were able to narrow things down with the software!

~ DreamOn

[Komodo]

I wonder how you/the doctor could determine from the software reports alone when you were in REM sleep and when you were not, and therefore that your apneas with the FFM were not during REM. Maybe they weren't in clusters with the FFM, but rather were spread more evenly throughout the night?

It makes sense to me that you would be having more mouth leaking during REM sleep with the nasal mask, since that's when all our muscles relax and our mouth tends to open, letting the therapy air escape. So, because you're not getting the full benefit of therapy air during those times you would be more likely to have apneas. Were the apneas occurring at the same time as the leaks when using the nasal mask?

So, if you can't solve the mouth leaks with the nasal mask by mouth-taping and/or chin strap, it does sound like you'll need to use a full face mask. I'd be very interested to know if they find that you need a higher pressure during your titration sleep study while using the full-face mask. I'd also be interested to know what they discover regarding your apneas and their relationship to sleep position and REM sleep.

The nasal mask apneas showed up as a flat line, where the FFM showed as a jagged line. He said the flat line meant I was in REM sleep. Don't know if that's true or not, but that's what he said.

My "events" do corespond to the higher leaks, BUT, they occur prior to, or after, the "events". I think, it has to do with my COPD. I think, the highest leaks are when I have a coughing fit. When I go for the new study, I'm going to ask them to pay SPECIAL attention to when I cough, and make a note of the time so I can compare it to the report.


Because of my COPD, mouth taping is out of the question, as is a chin strap.

I'll let you know how I make out after the study.

[deerslayer]

Glad your headed on the right track & doc listened instead of calling the cpap police ...No, you're not crazy, hi five * C O P D here also...learning to keep my tongue on roof of mouth has helped me keep the yap shut while using the headrest...has made all the difference in getting a solid nights sleep,low leak line, good #'s w/ no mask issues-- period

[cpapper]

When I first read the title of your post

Re: YES! YesyesyesyesyesYES!!!!!

I thought it was a quote from the "Harry Met Sally" movie (the famous restaurant scene)
Seriously, I'm glad you are getting the right treatment due to your own persistence. This forum is an invaluable source of information. I wish you continued success.

[JohnBFisher]

... My "events" do corespond to the higher leaks, BUT, they occur prior to, or after, the "events". I think, it has to do with my COPD. ...
_________________
Machine: S8 Elite II CPAP Machine
Mask: Mirage Quattro Full Face CPAP Mask with Headgear

Ah, if you have COPD, then depending on the severity, you may want to ask about a different xPAP unit, such as the Respironics BiPAP AVAPS unit. You will almost certainly need to "fail" with a CPAP and perhaps BiPAP unit before your insurance company would foot that type of bill. But it is specifically designed to deal with someone who struggles with COPD. Per the Respironics literature:

Any of your patients who develop chronic hypoventilation may find the BiPAP AVAPS a more comfortable and effective NIV therapy. For example, neuromuscular, COPD, and obesity hypoventilation patients are strong candidates for BiPAP AVAPS.

Of course, I don't know if you have hypoventilation. But if you do and if your sleep apnea continues to be poorly managed by your CPAP unit, then it might be time to ask leading questions. Only your doctor will know from the sleep study data if you might need this.

Some links include:

http://bipapavaps.respironics.com/
http://bipapavaps.respironics.com/PDF/B ... ochure.pdf

Hope that helps.

[DreamOn]

I'll let you know how I make out after the study.

Thanks so much for sharing your experience, Komodo. I will be interested to find out what they learn from your sleep study and what is decided regarding machines.

[Komodo]

Ah, if you have COPD, then depending on the severity, you may want to ask about a different xPAP unit, such as the Respironics BiPAP AVAPS unit. You will almost certainly need to "fail" with a CPAP and perhaps BiPAP unit before your insurance company would foot that type of bill. But it is specifically designed to deal with someone who struggles with COPD. Per the Respironics literature:

Any of your patients who develop chronic hypoventilation may find the BiPAP AVAPS a more comfortable and effective NIV therapy. For example, neuromuscular, COPD, and obesity hypoventilation patients are strong candidates for BiPAP AVAPS.

Of course, I don't know if you have hypoventilation. But if you do and if your sleep apnea continues to be poorly managed by your CPAP unit, then it might be time to ask leading questions. Only your doctor will know from the sleep study data if you might need this.

Some links include:

http://bipapavaps.respironics.com/
http://bipapavaps.respironics.com/PDF/B ... ochure.pdf

Hope that helps.

Hi JohnB
Thank's
I have a question for you. Why the link for Respironics, when YOU use a Resmed? If you were going to buy a new machine right now, which company would you go with?

[JohnBFisher]

... Why the link for Respironics, when YOU use a Resmed? ...

Yup. I pointed out that unit, because ResMed does not have a comparable unit (of which I am aware). Of course, I also used Respironics for almost 20 years. So, I am not really partial to one or the other.

... If you were going to buy a new machine right now, which company would you go with? ...

Depends on my need. And I tend to include cost, features and reliability.

Both ResMed and Respironics make good, reliable machines.

I *really* like the feel of the ResMed unit in comparison to the Respironics unit. That is their Easy Breathe technology. I also find that the ResMed unit is a bit quieter.

The Respironics units are a bit more transportable. (Though the ASV units for both manufacturers are fairly large. They are built on older frames and technologies.) Respironics tends to have better connection to 12V DC power.

I think I prefer the EncoreViewer software over the ResMed ResScan software. But both are pretty good. However, the Respironics ASV units include a Smart Card and the ResMed ASV units do not.

The Respironics unit feels more as if it is playing "follow the leader" and helps maintain a normal breathing pattern. As I fall asleep I tend to find I have a certain breathing pattern ... shallow breath (sb), sb, sb, sb, deep breath (db), db, sb, sb, sb, sb, db, db ... and so on. Unfortunately, due to my central apneas, I would fail to breathe. Often I would fail to breathe on a deep breath. But the Respironics unit note my lack of deep breath and would suddenly increase the pressure on that breath. Sudden, IN YOUR FACE (literally), pressure change. I found it hard to adjust to there.

However, the ResMed unit keeps track of the "minute ventilation". If it senses that you will not meet the average over the past 3 minutes, it increases the pressure to 90% of that average. What often happens with me is that my breathing shallows out before I stop. In that case the ResMed unit would gradually, but INSISTENTLY increase the pressure. I find that less distrubing to me as I fall asleep. DSM notes the ResMed can be a SERIOUS task master for breathing. But that's not a problem for me.

In my case, the less expensive unit was the ResMed. My DME had a policy of trying the ResMed ASV unit before the Respironics ASV unit. If the ResMed did not work out, they would have switched over to the Respironics unit. The advantage of that approach is a lower cost to me and my insurance company. And I'm all in favor of lower costs.

So, as long as the unit meets my needs (or the needs of another), I'm happy to recommend either a Respironics or ResMed. I can honestly say I staked my life on either choice.

Hope that helps.

[Komodo]

Hope that helps.

NO IT DOESN'T HELP!

All the points you brought up (excellent BTW!) on the positive/negative of both brands are the same things I've been thinking of.

There are two things that make me lean towards Resmed. 1, it is slightly less noisy. 2, I already have the software/reader

There are two things that make me lean towards the Resp. 1, their pressure goes up to 30 h2o. 2, I like their software better.

Cost, shouldn't be an issue. My insurance will pay 100% for whatever machine I need to get. (at least that's what they say NOW! ) If Resmed came out with an S9 Vpap Auto S/T I'd jump on that in a heart beat! (I like the new look of the S9 Cpap)

Once again John, I want to thank you for your help. It really DID help me!