AHI increased using FF mask and never getting restfull sleep

[One tired puppy in Indiana]

I just switched to a full face mask from nose pillows and my AHI increased from 1.0 to 8.1. Plus had horriffic "rain out" one night with my humidifier set at 6...machine is lower than my mattress and tubing loops over the headboard. Switched back to nose pillows after the 8.1 AHI reading and it is now back to 1.2. I have never experianced the "burst of energy" except the first time using a cpap machine at the sleep study. Been using this blasted machine for over 6 months...anyone have any suggestions?

[BlackSpinner]

Fill in your equipment in your profile so people can help you.

There is software available if you have the right kind off machine that will show you what is happening.

[Pugsy]

Why did you change from the nasal pillow mask to a full face mask in the first place?

When someone reports that they aren't feeling as good as they want to after being on cpap therapy for a while then we have a standard speech of sorts.

Please register here at the forum and add your equipment so we can see at a glance what you are using.
You have AHI mentioned....where are you getting this number from? The machine or software?

When we don't feel the good numbers we need to first look at the software reports and make sure everything is optimal at least on paper.
Then we look at hours of sleep...fragmented sleep....anything that might be disrupting the normal sleep cycles like pain, mask issues (comfort or leaks), bed comfort, pillow comfort, general health issues, meds, insomnia, aerophagia and the list goes on. Often there is more to feeling well rested than just putting the mask on. So time to do some detective work to see what needs to be worked on.

First let's see if you have some software and evaluate your therapy at least on paper.

[Bazinga]

I am a newbie (2nd week of CPAP), and I have experienced the same thing. I started with a trial of Swift effects nasal pillows (which I like the best) but found uncontrolled mouth leaks and cheek billowing (I call it the Dizzie Gillespie effect) kept waking me. I tried the massive black chin strap, also many homemade chin straps, but found that even with my mouth kept closed, air escaped and woke me. So I have trialed the Quattro nose/mouth FF mask. Seal is good, but AHI numbers have been 9 to 11...I don't understand. With the nasal pillows, my AHIs were under 1.0.

I have been reading various forums and have read about the homemade boil & bite mouth guards, but have not yet tried that. I have tried mouth taping with paper tape, but the cheek billowing still wakes me, even though no air comes out of my mouth.

I wonder with the Quattro FF mask if there is a CO2 issue, because I find myself not having the urge to breathe as often, and the air pressure starts to vibrate (I wonder if this is the auto start/stop feature about to kick in after so many seconds.) This vibration also wakes me. Or possibly there is an element of central apnea here...will need to ask my doc about it.

I am feeling rather depressed, since I thought this would be a rather straightforward thing...after I got past the idea of feeling like a dog with a cone on in bed. It seems the whole CPAP xperience is causing me more sleeplessness than the apnea. Any ideas?

[Pugsy]

Anyone using a nasal interface mask who is having massive leaks from mouth breathing can't rely on the machine to report accurately. If leaks are really bad then the machine may lose the ability to sense the apnea events and thus miss recording them....giving a possibly falsely low AHI.

To evaluate any AHI the leaks or mouth breathing needs to be eliminated first.

[One tired puppy in Indiana]

Sorry for not listing the machine / mask details...new to this forum.

The AHI readings are from the machine. Seams like the insurance company, doctor, and company that I got the machine from does not want me to program or learn how to read the machine reports. I do find myself sleeping with my mouth open that is why I needed to go to a full face mask. Can not wear a chin strap since I have a very sensitive TMJ and any pressure put on that joint by way of chin pressure causes prolonged pain. I started out this quest to correct my apnea with a oral repositioning splint...messed up my TMJ severely and had to be on a soft diet for 6 months. As stated earlier, when I was in the last sleep study getting fitted to a cpap machine and pressure I did experience restful sleep and energy. So I know how I should feel after using the machine.

It sounds like, from the replies to this post, the machine is now able to read the true number of episodes with the full face mask and the pressure needs adjusted.

Thank you for your input!

Machine: ResMed S9 Elite
Nose Pillows: F & P Opus
Full Face Mask: ResMed Mirage Quattro

[Pugsy]

Machine: ResMed S9 Elite

You can use ResScan or SleepyHead to evaluate your data more closely than the machine offers.
See my signature line for information on SleepyHead.

For ResScan...http://www.resmed.com/int/assets/html/s ... ister.html

For a tutorial on how to manage ResScan http://montfordhouse.com/cpap/resscan_tutorial/

[Lizistired]

I know what you mean, I have a ff on trial and my 0.3 AHI jumped to 2.8. You still have to compare how you think you slept and how you feel. Then look at the data, the FLOW line. I experienced some wierd breathing patterns, but that may have been adjusting to the new mask.
I like being able to open my mouth to breathe but the chapped lips are probably going to be a deal breaker, and the mask tends to leak around the sides of my mouth.

[robysue]

I have been reading various forums and have read about the homemade boil & bite mouth guards, but have not yet tried that. I have tried mouth taping with paper tape, but the cheek billowing still wakes me, even though no air comes out of my mouth.

The problem when you are using the nasal pillows may be that your tongue is not resting on the roof of your mouth. When the tongue is in just right position, it effectively blocks off the oral cavity from the nasal cavity, and the CPAP air gets blown down the upper airway where it belongs. When the tongue rests on the bottom of the mouth and is not touching the roof of the mouth, the connection between the oral cavity and the upper airway (and its connection to the nasal cavity) opens up and that allows the CPAP air to rush into the mouth and puff the cheeks out.

I wonder with the Quattro FF mask if there is a CO2 issue, because I find myself not having the urge to breathe as often, and the air pressure starts to vibrate (I wonder if this is the auto start/stop feature about to kick in after so many seconds.) This vibration also wakes me. Or possibly there is an element of central apnea here...will need to ask my doc about it.

What machine are you using? If it is a Resmed S9 Elite or a Resmed S9 AutoSet, that vibrating air pressure could be the forced oscillation technique (FOT) algorithm kicking in to try to determine the patencey of your airway. The FOT algorithm uses many small oscillations in pressure to determine if your airway is open or obstructed. Most folks don't notice these small oscillations in pressure, but some folks do feel them. And they are sufficiently annoying to a small number of folks to cause them to wake up---particularly if they're only half asleep when they start.

Also, since you are finding yourself "not having the urge to breathe as often", it's worth figuring out if your machine gathers efficacy data and whether the machine distinguishes between clear airway apneas (CAs) and obstructive apneas. The usual assumption is that a CA is most likely a central apnea if it occurs when you are genuinely asleep. And if I recall correctly, about 5-10% of new CPAPers do develop problems with CAs after starting CPAP therapy. So if your machine does record OAI vs. CAI data, can you tell us what your CAI is?

I am a newbie (2nd week of CPAP), ....

I am feeling rather depressed, since I thought this would be a rather straightforward thing...after I got past the idea of feeling like a dog with a cone on in bed. It seems the whole CPAP xperience is causing me more sleeplessness than the apnea. Any ideas?

I'd say that I found absolutely NOTHING about CPAP straightforward when I first started therapy. Then again, I also had a prolonged and difficult adjustment period that lasted almost a year. Things were complicated by aerophagia, air getting into my eyes via my tear ducts, and massive insomnia that started to set in by Night 3. And along the way I also had to deal with chronic migraines and TMJ issues that were not directly related to the OSA, but they (and their treatments) definitely affected my sleep, and not always in positive ways.

As for ideas:

1) Start with reasonable expectations. Most newbies take several weeks to a couple of months to start noticing a positive difference in how they feel. And most of us do NOT have a Eureka! morning where we wake up feeling more alive and more refreshed than we have in years. Indeed, the first positive differences may be quite subtle. In my case the first sign that PAP was going to be worth it started about 6 months into therapy: I started to wake up without pain in my hands and feet several times a week. If I hadn't been keeping a sleep log (for the insomnia), I probably would NOT have noticed this difference. I now wake up pain free every day. And I usually wake up feeling rested and often I can even say I feel refreshed. But these positive things developed very, very slowly over the course of several months in my case.

2) For suggestions about what to do about the sleeplessness with the CPAP, please read my Taming the CPAP-Induced Insomnia Monster link in signature. Much of what I write about may not directly apply to you, but some of it will. It might give you a starting place for tackling the sleeplessness issues.

Best of luck

[One tired puppy in Indiana]

Thank you Robysue...Loved your blog on "Taming of the Quattro". I am going to try your suggestions on how to adjust it tonight. May be that will work. Just came from my DME...no help at all...suggested I use the nose pillows even though I sleep with my mouth open at times.

[Bazinga]

Thank you RobySue for your detailed reply! I have done much better since implementing your suggestion re: parking my tongue at the top of my mouth. I still need a chinstrap, but have had NO air leaks from the mouth. I actually went back to the Swift FX Bella, which is so much more comfortable than the FF mask. My AHIs have been less than 1.0, so I am happy with that. I obtained the Rescan software but have not yet downloaded my card. I viewed the tutorial which was very helpful (http://montfordhouse.com/cpap/resscan_tutorial/).

Does anyone know if the data can be saved on the card after viewing...this may sound silly, but I don't want my doc or machine provider to necessarily be aware I am viewing the data on my own.

I have found that my dollar store chin straps are much more comfortable than the $40.00 one I trialed from my provider (that one made me feel like Hannibal Lector...huge black thing that made me claustrophobic). I like my polar fleece ear warmer with velcro closure as a chinstrap. I also use a terrycloth with velcro makeup headband, or a simple elasticized headband which seems to have the right tension for me. I have the tongue parking thing down, so it is working. I do sometimes find that I am having dreams about removing the nasal pillows and chinstrap while sleeping, but |I imagine that gets better with time.

Also thank you so much for cluing me in to the oscillation thing. I knew I wasn't imagining it, but my provider told me they knew nothing of no such a thing.

It was also interesting to hear about the eye dryness...I have been experiencing that, and wondered why, since I have no leaks pointing at my eyes. How does it get up through the tear ducts?

I too have noticed the aerophagia, and burping..seems positional for me, more when side-sleeping.

I am less frustrated than before, and am starting to feel better. Again thank you all for your good advice...you all make this seems so much less lonely and difficult!

[Pugsy]

Does anyone know if the data can be saved on the card after viewing.

The data files on the SD card are unchanged after downloading to software unless you do something on purpose to the SD card itself. There is no way for the DME to know that you have accessed the data from the SD card.