Different sizes of Mask resulting different AIH / LPM ??

[standke]

Hi,

I couldn´t find a topic like this and create a new today.

I use CPAP for about 1 month. A have a Respironics Pro with Umidifier and two masks Quattro FX: one size G and other M. My actual pressure is 5 (starting ramp in 4).

My wife said that sometimes, with my G-Size Mask, she hears some low snore.
With this G-Size mask, my AIH was about 26 ~ 28 in LCD machine. My LPM was about 25.6 ~26.3.

So, I bought a smaller size, M, from Quattro FX. In face, the sizes gives a good shape too.

The snore stopped a little and my diagnostics became different, much higher: AIH about 32 ~33 and LPM about 26.5 ~27.
With the smaller mask, size M, I noticed that i woke up in the morning sleepy and tired. (Yes, the AIH proves it too).

Whats is happening here ? Does Size-M leaks more than Size-G? or the low space in mask M compromises even more my therapy ?

Im thinking in changing my pressure to 6 or 7 too ... but im afraid for LPM increase!

Any help ?

(Sorry any text error - English is not my first language).

Tks in advance,

[Pugsy]

Your English is fine.
Welcome to the forum.

Can you tell me which Respironics Pro machine you have? See if this link helps you figure it out.
viewtopic.php?f=1&t=72302&p=665165#p665165

Which one makes a slight difference with large leak area numbers (which by the way you are a long way from)

Your machine reports total leaks...which are the mask's expected vent rate plus any excess leak..what you are seeing report for a full face mask isn't a horrible leak at all. In fact probably fairly decent unless you have one of the new PR System One machines that is only reporting % of time in large leak...that's why I need to know which machine.
In Brazil...I am thinking probably the M series machine.

If you do have a M series machine that AHI is a 7 day average and it is way too high and you need more pressure and probably a lot more than 6 or 7.
If you do have a M series machine the large leak territory is up around 90 L/min so you have a long way to go before you have to worry about that.
When you increase the pressure the expected vent rate will also increase...so don't worry about that.

[standke]

Hi,

Thanks for your fast answer and post.

My machine is "M Series Pro C-Flex CPAP Machine" with heat humidifier.
I´ve tried to set in Control Panel, but even it set there, it doesn´t appear correctly in my signature (only appeas mask and Humidifier?).

My actual pressure (5) was given from my doctor, after night sleep. I dont use RAMP mode. I prefer use 5 directly, since the the difference is to little.

The AHI is presented in 7 day and 30 days.

When I used the smaller size of Quattro FX, my apneia was a little higher since AHI increased too. Is this a signal its not my best size ? Do I have to keep using just G-size ?

tks in advance.

[hyperlexis]

Hi,

Thanks for your fast answer and post.

My machine is "M Series Pro C-Flex CPAP Machine" with heat humidifier.
I´ve tried to set in Control Panel, but even it set there, it doesn´t appear correctly in my signature (only appeas mask and Humidifier?).

My actual pressure (5) was given from my doctor, after night sleep. I dont use RAMP mode. I prefer use 5 directly, since the the difference is to little.

The AHI is presented in 7 day and 30 days.

When I used the smaller size of Quattro FX, my apneia was a little higher since AHI increased too. Is this a signal its not my best size ? Do I have to keep using just G-size ?

tks in advance.

The best size for you is the closest size per the manufacturer's sizing template or gauge. If your face needs a medium, get a medium, not a large or a small. Messing around with sizes may cause problems like leaks when you move, or pressure sores.

You will drive yourself crazy trying to figure out AHIs etc. Numbers can change wildly even when using different models of masks. My Quattro has different AHIs compared to my Quattro FX compared to my Hans Rudolph V2. No idea why, because each mask fits ok and was properly sized. They just do. Maybe its the vent or the fact the dead air space inside the masks are different. Who knows. And my experience is that nasal masks lower my pressures even more than do my FF masks.... Go figure.

[Pugsy]

Mask size is not going to make that big of a difference in AHI. It will make a difference in comfort and maybe leak.
Your AHI needs to be less than 5...obviously it is way above that number.
The problem with the AHI is not mask size...it's the fact that your pressure is too low. No mask even if it was glued absolutely perfectly to your face is going to fix that AHI without a pressure increase.

There is software available to see more than that 7/30 day average AHI and leak but you need a special card reader and the smart card. Is there a little blue card in the back of the machine that is about the size of a credit card?

I am familiar with your model machine. I used a M series machine similar to yours when I first started therapy.

Use the size mask that is the most comfortable for you to use....trust me your AHI is because of the pressure and not the mask.
If you want more information about the software and the card reader I can help you there but if you don't want to do the software thing we can still work on reducing that AHI down to a more acceptable level.
Start increasing the pressure 1 to 2 cm a week....you need 7 nights of data at a new pressure to see if the AHI changes so you need 7 nights to be reflected in that 7 day average. Going up slowly will be an easier adjustment but I suspect you are going to need at least 9 or 10 cm to get much of a reduction in that AHI.
AHI of over 20...and pushing 30...it's the pressure that is the most critical issue...not minor difference in the size of a mask.
We need to see AHI down to 5.0 or below.

Proper sizing is only needed for comfort and seal so you sleep.. Pressure is what is used to try to prevent the apneas.
You could change masks nightly and they won't make that much of a difference in the AHI.

Can you breathe through your nose normally just fine during the daytime? Or do you have a lot of congestion issues..day and night and that is why you are using the Quattro Full face mask? Have yyou ever tried any other maskl
How long have you been using the machin?

Do you know how to change the pressure? It needs to be done. If you want the software I can help you and help you find the card reader that is needed.

Here is an example of a detailed report you could get from the software. This is one of mine from when I started therapy.
My machine allowed the pressure to go up and down...your machine does just a fixed pressure but we an see patterns and such.

How long have you used this machine....do you use a humidifier...How are you sleeping and feeling?
What pressure do you use?
Have you tried any other mask?
I can try to help you which every way you want to try but you need some series direction for sure.

tell me what you want and expect....let's see if we can get you prointed down a directions where are see some improvement.

[standke]

Good Morning,

First, I´ll like to thank hyperlexis and Pugsy for helping answers.

After another night, i woke up tired.

This time, I´ve changed myself pressure from 5 to 7. This means, 2 points since my doctor prescription, one month ago.
The snores stopped. My wife didnt hear any sound or snore. I used both masks this night.

First, I used the Quattro FX size M. The result was, even with a new pressure, I didnt fell the air pressure in "deep sleep".
I woke up in the middle of the night with my son crying in his bedroom. I read the LCD and the AIH continued high: about 35 LPM 26.5.

Tryed the Quattro FX size G mask. Same pressure, 7, in machine. Same result as Size M: even with a new pressure, I didnt fell the air pressure in "deep sleep".

When i Woke up in the morning, LCD showed:

AHI 7 days - 35,4/h, 30 days - 31,6.
Leaks 7 days 25,6, 30 days 25,6.

Nothing changed.

I´ll try to adjust this night to 10.

tks for your patience in this post. But this is making me crazy.

[Pugsy]

Nothing changed.

It won't/can't change on the 7/30 day numbers until 7 days has passed because last night's numbers whatever they are are thrown into the previous 6 nights worth of numbers before you get the 7 day average.
You have 6 nights worth of crappy numbers in there...there is zero way to expect to see anything on the LCD screen after one night.
You would need the software and the card reader.

Same thing if you change the pressure to 10 tonight...you won't see any difference at all until you use 10 cm for 7 nights.

I would suggest you stay at 7 cm for 6 more nights...then evaluate the 7 day average...ignore the 30 day because it won't change.

Even if your AHI last night was 0.0...that isn't going to make any difference in that 7 day number after only 1 night...you have 6 other nights with AHI over 20 in the mix.

Unless you use the software there is zero way to evaluate last night's data. Sorry but that is just the way it is.
You have to allow for more nights of hopefully better numbers to bring that 7 day average down.

[standke]

Hi,

Tks again for your help and support! I'll wait some days as suggested.

Later i'll post some informations about my last night.

[standke]

Hi,

After a week as suggested, my AHI lowered to 18.4. I used pressure 8 for a week in size "M-Medium" mask (Quattro FX).

I think my AHI could decrease a little more in the next days.

I discovered a little about my problem, for higher AHI. I was using humidifier with water in top mark level. This, somehow, affected my pressure and increased my AHI.

I tried to use less water in humidifier (aligned in horizontal, just in the middle of receipt). My AHI decreased day by day until today, listed 18.4 media for last 7 days.
Its not the size mask that resulted my AHI.

Tks for your support and attention.

[sleepstar]

Hi,

I couldn´t find a topic like this and create a new today.

I use CPAP for about 1 month. A have a Respironics Pro with Umidifier and two masks Quattro FX: one size G and other M. My actual pressure is 5 (starting ramp in 4).

My wife said that sometimes, with my G-Size Mask, she hears some low snore.
With this G-Size mask, my AIH was about 26 ~ 28 in LCD machine. My LPM was about 25.6 ~26.3.

So, I bought a smaller size, M, from Quattro FX. In face, the sizes gives a good shape too.

The snore stopped a little and my diagnostics became different, much higher: AIH about 32 ~33 and LPM about 26.5 ~27.
With the smaller mask, size M, I noticed that i woke up in the morning sleepy and tired. (Yes, the AIH proves it too).

Whats is happening here ? Does Size-M leaks more than Size-G? or the low space in mask M compromises even more my therapy ?

Im thinking in changing my pressure to 6 or 7 too ... but im afraid for LPM increase!

Any help ?

(Sorry any text error - English is not my first language).

Tks in advance,

You definitely need to adjust your pressure. You ideally want your AHI below 5, right now it's in the severe range.

[Pugsy]

Did you ever get the software for your machine? If not, you really need to do that.
AHI of 18 is NOT acceptable and like Sleepstar says....we want it to be below 5.0 and you are a long way from that goal.
Most likely it is your pressure that is insufficient but it would REALLY be helpful if we knew what the individual event category indexes for that AHI of 18 happens to be.
AHI is composed of 3 separate event categories.
Clear Airway
Obstructive Apnea
Hyponea

If your AHI is primarily Obstructive and/or Hyponea then you definitely need more pressure.
If your AHI is primarily Clear Airway then we need to have a different discussion.
Either way it would be really helpful if we had more than the AHI number itself off the machine to go on.

Which Remstar Pro do you have? Can you look on the bottom of the blower unit for a 3 digit number which may have a couple of letters before or after the 3 digit model number? Tell us the model number and we can tell you about what software you can use and if you need anything else to use the software.

[standke]

Did you ever get the software for your machine? If not, you really need to do that.
AHI of 18 is NOT acceptable and like Sleepstar says....we want it to be below 5.0 and you are a long way from that goal.
Most likely it is your pressure that is insufficient but it would REALLY be helpful if we knew what the individual event category indexes for that AHI of 18 happens to be.
AHI is composed of 3 separate event categories.
Clear Airway
Obstructive Apnea
Hyponea

If your AHI is primarily Obstructive and/or Hyponea then you definitely need more pressure.
If your AHI is primarily Clear Airway then we need to have a different discussion.
Either way it would be really helpful if we had more than the AHI number itself off the machine to go on.

Which Remstar Pro do you have? Can you look on the bottom of the blower unit for a 3 digit number which may have a couple of letters before or after the 3 digit model number? Tell us the model number and we can tell you about what software you can use and if you need anything else to use the software.

Hi,

Really, my AHI is high but its the half (18) than I had a week ago (35), same pressure, same machine, same mask.

All I did was control water level in humidifier.

No, I didnt get the software and neither know where to buy it, adaptors, cables, ...

But, my machine is:



CPAP
REMstar Pro MSeries - Model 401M
S/N M002269246 Vers. 2
http://remstarpromseries.respironics.co ... tions.aspx
http://remstarpromseries.respironics.com/Parts.aspx

Humidifier
M-Series Heated Humidifier - Intl
Model 1051157 - J-tube chamber
S/N H003235858

Where I can purchase the software ?

Tks in advance ...

[Pugsy]

I can help you out with the software...so check your private message box in a few minutes.
The M Series machine that you have I am familiar with because that I used the M Series APAP machine when I first started therapy almost 4 years ago.
SleepyHead software won't work with your machine but I will send you something that will work.

You will need a special smart card (if your machine doesn't have one in the back)...it looks like this.
https://www.cpap.com/productpage/respir ... -card.html

and you need a special card reader and this is the only one that works...the Infineer DT3500 smart card reader.
https://www.cpap.com/productpage/Respir ... r-USB.html
Generic won't work.

Your machine shows only a 7 and 30 day AHI average. So if you make changes to anything that is going to affect the AHI then you will have to wait a week to see if there is much impact.
You should also have a 7/30 day average leak number.

Your AHI of 18...that's still too high. That's higher than some people have during their diagnostic sleep studies.
The goal is to have it 5.0 or below...or very, very close to that number.
I really feel that your pressure is not optimal but if your mask is leaking a lot...that will of course affect the impact of the pressure that you are getting...big leaks mean less than optimal therapy.

[standke]

Hi,

Im here to comment some news acording to my AIH / LPM, after some weeks. Im still waiting for my card reader, shipped.

My actual pressure is 9 cmH2O. My AIH 2(two) weeks ago was 8.4 (decreasing). I changed sizes mask, Quattro FX, from G (Large) to M (Medium) few weeks ago.
But, in the last weeks (after reaching 8.4) my AIH changed again and reached 21.5 (last night) - The 21.5 AIH is the Media of 7 days, in LCD (not software).

I decided to ask my doctor, with Doctor Degree in Apnea and who diagnoticated my CPAP need, after night sleep.
My major complaint in pressure 9 was: during my sleep, I could not feel pressure from machine. I needed to breath strongly to catch the air and feel pressure (feedback).

Today, at the doctor, he was angry with me, as I changed the pressure from 5 to 9 (without asking him).

In my night sleep, mixed mode (half night without CPAP, half night with CPAP), my AIH was 36.7 without.
He told me that at my night sleep, the 5 cmH2O pressure turned my apneia to zero, even in REM sleep. Increasing my pressure from 5 to 9 (first 5 to7, then 7~8, the 8 to 8.5 and finally 9) was wrong. I needed just 5 (and period)!

Acording him, the machine could not be at complience with "me". Something like the machine was failure with wrong pressure.

He scheduled my visit to the next month (23/may) to show me that with 5 in pressure my apnea get "zero". So, I decided to accept his recomendation and test my original pressure, 5, with Medium Size Mask during 30 days.
He ended saying that he have 20 years experience, and 8 patients every night (night sleep): the pressure considered in my night-sleep is the recommended for my need. I cannot change pressure like i did,

So, whats your opinion ? Can I decrease apnea in 30 days, with 5 pressure ?

Any bet ?

[RogerSC]

Hi,

My actual pressure is 9 cmH2O. My AIH 2(two) weeks ago was 8.4 (decreasing). I changed sizes mask, Quattro FX, from G (Large) to M (Medium) few weeks ago.
But, in the last weeks (after reaching 8.4) my AIH changed again and reached 21.5 (last night) - The 21.5 AIH is the Media of 7 days, in LCD (not software).

I decided to ask my doctor, with Doctor Degree in Apnea and who diagnoticated my CPAP need, after night sleep.
My major complaint in pressure 9 was: during my sleep, I could not feel pressure from machine. I needed to breath strongly to catch the air and feel pressure (feedback).

Today, at the doctor, he was angry with me, as I changed the pressure from 5 to 9 (without asking him).

In my night sleep, mixed mode (half night without CPAP, half night with CPAP), my AIH was 36.7 without.
He told me that at my night sleep, the 5 cmH2O pressure turned my apneia to zero, even in REM sleep. Increasing my pressure from 5 to 9 (first 5 to7, then 7~8, the 8 to 8.5 and finally 9) was wrong. I needed just 5 (and period)!

Acording him, the machine could not be at complience with "me". Something like the machine was failure with wrong pressure.

He scheduled my visit to the next month (23/may) to show me that with 5 in pressure my apnea get "zero". So, I decided to accept his recomendation and test my original pressure, 5, with Medium Size Mask during 30 days.
He ended saying that he have 20 years experience, and 8 patients every night (night sleep): the pressure considered in my night-sleep is the recommended for my need. I cannot change pressure like i did,

So, whats your opinion ? Can I decrease apnea in 30 days, with 5 pressure ?

Any bet ?

Yes, unless your machine has a broken AHI readout *smile*, I'd be willing to bet that in 30 days your AHI will be about what it is right now. My guess is that the doctor's other patients don't look at their AHI readouts, and you're being proactive and a good patient to do that and try to see how things are going. So your doctor sounds really off base here, he should be encouraging you to look at your sleep data to see how you're doing. But you really do need to get your full sleep data to make progress with this, guessing within reason is fine, but it's just guessing and isn't very effective.

Do you have access to other sleep doctor's? This one sounds like he believes in magic...Does he give you any reason why your AHI should improve over the next 30 days using the same pressure? Or just because he says so? Don't think I'd put up with this myself.