Horrible AHI with full face masks

Ritap1965 · Post by **Ritap1965** » Thu Apr 27, 2006 7:55 am

I don't understand why my AHI is so much worse when I am using a full face mask. I got a new mask yesterday, the Fisher & Paykel Flexifit HC431. I did not sleep well. Woke up several times. It was leaking around my eyes and not comfortable at all. But I thought it was just because of me not being used to it yet. Then I just looked at the numbers, and I have an AHI of 5.5 for last night. 10 Apneas and 30 Hypopneas. When I use the ComfortCurve I usually have an AHI less than 1. Maybe 1 or 2 apneas, and 5-6 hypopneas.

I thought the reason my AHI was so bad on a full face mask was that I was using the Ultra Mirage FF, and it was pushing my jaw back. I thought that is what the problem was. So I went with the HC431 to get one that went under my jaw and helped keep my mouth shut, but I still had the horrible result of AHI 5.5. I don't understand why I can do so well with the notorius ComfortCurve and do so poorly with the full face masks.

The reason why I try with the full face masks is because I mouth breathe. I also have very poor skin, Roseacea, so I can't tape my mouth shut. Now I'm thinking I'm better off with the ComfortCurve and AHI of 1 or less and a little mouth breathing. I certainly sleep better that way.

FYI-My Resmstar Auto is set to 12cm-15cm. It usually never goes over 14cm. My lowest AHI is always between 12 and 13.

WindFlyer · Post by **WindFlyer** » Thu Apr 27, 2006 9:20 am

In my experience the bigger mask like the UMFF tends to be a bit more cumbersome in general. It has been more prone to getting nudged out of place just so during normal tossing/turning at night to where I've had to make minor adjustments. The wife says it makes leaky noises every now and then, too. Probably because of the same thing. When I use the nose mask I never have this problem.

My guess as to why your AHI rate creeps up is because of a similar issue- like I said in my experience the big mask gets pushed slightly off to the point of leakiness more often. Unless I sleep on my back all night but that's rare for me. If I could sleep on my back then a nose and mouth mask would work great.

But then I'm not an APAP user and I'm not sure how those react to little leaks like that. Anyone else know what might be going on?

NightHawkeye · Post by **NightHawkeye** » Thu Apr 27, 2006 9:52 am

Basic physics . . . The Fisher Paykel mask covers more area of the lower jaw, so the total force (from the air pressure) pushing the lower jaw back is greater.

Regards,
Bill

Ritap1965 · Post by **Ritap1965** » Thu Apr 27, 2006 12:16 pm

I thought the under the chin full face masks would push up on the jaw and help keep my mouth shut. Kind of like a chin strap. I guess I'm wrong. I'l just give up on the full face masks for now, and live with the mouth breathing.

Goofproof · Post by **Goofproof** » Thu Apr 27, 2006 8:23 pm

Part of the secret if in the adjustment, I use the 431 too, and have noticed my AHI is a little higher with it than the ComfortFull. I think it is because the leak rate is a little higher. The 431 doesn't have to be as tight and I can move from side to side with it. I can even spend some time on my stomach, if I brace my head just right with my arm.

Your AHI 5.5 is still good, it shouldn't make you feel bad, did you try the other size inserts, you have lots of option, even Mole skins.

Ritap1965 · Post by **Ritap1965** » Thu Apr 27, 2006 8:53 pm

Goofproof,

I tried both small and medium inserts. With the medium it leaked way to much. I did buy moleskin, and I'm thinking if I put that on the mask where it leaks around the eyes it will improve. But my biggest concern is the awful AHI's.

Do I get better treatment with some mouthbreathing on my ComfortCurve and AHI from .5 to 1.0, or is the treatment better with no mouthbreathing in a full face mask and an AHI of 5 or greater.

Sleepless on LI · Post by **Sleepless on LI** » Thu Apr 27, 2006 8:59 pm

I have avoided full face masks like the plague all this time because I thought it would overly cumbersome and provide too much area to keep leak-free, but I finally gave in and tried an Ultra Mirage last night for the first time since starting therapy. I loved it. It didn't leak at all and my AHI was just as low as it is with my Aura. I was surprised that nothing about the mask, other than it felt like cold air being blown against my lips at first, bothered me. I don't use my heated humidifier, but I can see why someone would want to with this UMFF. But that feeling went away after awhile. But other than that, first night review was an amazing thumbs up. I really liked it a lot. I think I will develop an irritation on the bridge of my nose with it since it was red from one night's use, but right now I'm thinking I could get used to this. And this coming from someone who only uses nasal pillows...surprised the heck out of me.

NightHawkeye · Post by **NightHawkeye** » Thu Apr 27, 2006 9:03 pm

Ritap1965 wrote:Do I get better treatment with some mouthbreathing on my ComfortCurve and AHI from .5 to 1.0, or is the treatment better with no mouthbreathing in a full face mask and an AHI of 5 or greater.

Hmm . . ., sounds like the right question to ask. So what is the answer Ritap1965, how do you feel after sleeping with the CC vs the F&P?

Of course, if you want an objective assessment, then an oximeter is probably the instrument of choice . . .

Doesn't it feel good to have these choices?

Regards,
Bill

Ritap1965 · Post by **Ritap1965** » Thu Apr 27, 2006 9:14 pm

Nighthawkeye, you just helped me make up my mind.

I sleep better with a nasal interface. And I did have the oximeter test last month while using my ComfortCurve. I did 2 nights, one with 12cm and one with 15cm, and according to my sleepdoctor I was not below 80% on either one of the settings. He said I could use whichever setting was comfortable for me. So I set my auto to 12cm-15cm. Thank you for reminding me of the oximeter test. Since I was good with that using a nasal mask and having some mouth breathing, I'm going to stick with my nasal masks.

Now, if you could help me find a support group for people who are addicted to purchasing cpap masks.... Hi, my name is Rita and I have 5, 6, 7 masks...

Wulfman · Post by **Wulfman** » Thu Apr 27, 2006 9:15 pm

Sleepless on LI wrote:I have avoided full face masks like the plague all this time because I thought it would overly cumbersome and provide too much area to keep leak-free, but I finally gave in and tried an Ultra Mirage last night for the first time since starting therapy. I loved it. It didn't leak at all and my AHI was just as low as it is with my Aura. I was surprised that nothing about the mask, other than it felt like cold air being blown against my lips at first, bothered me. I don't use my heated humidifier, but I can see why someone would want to with this UMFF. But that feeling went away after awhile. But other than that, first night review was an amazing thumbs up. I really liked it a lot. I think I will develop an irritation on the bridge of my nose with it since it was red from one night's use, but right now I'm thinking I could get used to this. And this coming from someone who only uses nasal pillows...surprised the heck out of me.

Lori,

It's tempting to say something "clever" after reading that, but I'll restrain myself.....

I'm so glad to hear you had a good experience with MY choice of masks.

As far as the nose irritation.....it may have been a little too tight or worn a little too low.....try moving it up just a little, adjusting the forehead piece or loosening the top straps).

Best wishes,

Den

Goofproof · Post by **Goofproof** » Thu Apr 27, 2006 9:15 pm

[quote="Ritap1965"]Goofproof,

I tried both small and medium inserts. With the medium it leaked way to much. I did buy moleskin, and I'm thinking if I put that on the mask where it leaks around the eyes it will improve. But my biggest concern is the awful AHI's.

Do I get better treatment with some mouthbreathing on my ComfortCurve and AHI from .5 to 1.0, or is the treatment better with no mouthbreathing in a full face mask and an AHI of 5 or greater.

Ritap1965 · Post by **Ritap1965** » Thu Apr 27, 2006 9:25 pm

Lori! I think you have the better of the full face masks. I find the Ultra Mirage FF very comfortable. The problem I have with it is it pushes my jaw down, making me snore, and giving me higher AHI. But if it is comfortable for you, you definitely have a winner there.

Goofproof! I admire you for having made friends with that mask. I will probably give it a couple of weeks and then try the 431 again. I gave the CC a rest several times before I figured out how to make it seal, and that is now my favorite. I also like the C2 a lot too. I really wanted the Under the Chin thing with the 431 to work so it would keep my mouth shut, and it did. I just didn't like the numbers and it felt very cumbersome to sleep in. Hopefully I will get over that.

Guest · Post by **Guest** » Thu Apr 27, 2006 9:26 pm

it all depends on WHY your using a FF mask to begin with; chronic nasal congestion or for mouth breathing...

it is easier for the cpap air pressure to push your tongue up and out of the airway if the delivery route of said air pressure is coming from the nasal passage or from the top. The tongue is attached to the backside of the chin bone.

if the tongue is the cause of your obstruction, it could be the way your tongue is occluding the airway. If the air delivery is from the mouth, it may not be high enough to move or stent the tongue up out of the way.

With a FF mask, the air pressure should be able to go into either the mouth or the nasal passage. If the nasal passage is completely blocked then it can only go in via the mouth and I imagine in some cases push the tongue further into the airway vs pushing it out of the way.

So if you have chronic nasal congestion, you should address that FIRST in any way you can. Using OTC sprays is NOT the way to address it unless it is a pure saline solution. See an ENT and have them rule out any deviated septum or other obstruction like as a polyp.

While the numbers you post are still fairly low, there is a clear advantage in your own study case using a nasal mask over a FF.

your only alternative is to use a good nasal mask and try taping your mouth. You also need to practice keeping your tongue into the hard palate of the mouth if you can, but you cannot control the tongue once you reach REM.

Sleepless on LI · Post by **Sleepless on LI** » Thu Apr 27, 2006 9:53 pm

Den,

Okay, I'll bite. Can't make a comment like that and not say what you were thinking. I think I have a way of bringing out comments like what you're probably thinking in people...my own worst enemy perhaps.

Rita,

I hope you find a solution to your dilemma. All I can say is, I am a true mask junkie, have tried just about everything that has caught my eye. To me, it's like the spice you add to the boring recipe. I am now awaiting delivery of a Fisher & Paykel FlexiFit 407 that I won on an auction last night. Just keep trying and eventually you do find the right mask, or two, that you don't really mind wearing. Best of luck to you. Feel well.

Mask