Problem with fullface masks

[bchdata]

I have used cpap for about 7 years, but during the last year I had increasing number of Central apneas.
Now I have had a Respironics Bipap Avaps C series 30, and I use it with my old Swift nasal mask.
I'm mouthleaking, but I have used it with my cpap machine, because I have found out that I can't use fullfacemasks.

I tried to use a Mirage Liberty fullface mask with the Bipap machine, and I had a AHI on about 40-50, with a few obstructive and a lot of Centrals.
So I keep using my Swift nasal, unless someone can tell me what to do about my fullface problem.

My doctors can't tell me why that happens, but maybe someone here have seen that before.

I would like to insert an image here, but I can't see how to do it.
Help!!!!
After help from Pugsy, I found out. Thanks!!!!

Here is my use pattern:



As you can see, there are great blach areas in the pattern, and the time is 6.53/1133.
I can see that the detail curves disappear where there are black areas.
What does that tell me?

Here is detals from last night:


I can tell that after that sleeping, then I have been very tired and sleepy today.
Where is the problems?

[Pugsy]

How to insert images explained in this thread.
Screen shot thread viewtopic.php?f=1&t=81072&p=737779#p737779

[Guest]

Under the picture "usepattern" I mention the time 6:53/11:33.
That is the time it is used on june 16 2014.
I'm not sure what the two numbers mean.

[Pugsy]

This is an Encore Pro report???
Looks like the time zone is a bit off. Did you make the time zone correction before using the software? It's set to GMT time.

If you didn't and don't know how...this is how
The default Time Zone is GMT and if you don't change it the reports will be split and look weird. Go to Company Settings tab. Then double click on the blue Encore Company under office names to open this page area where you can click on the "EDIT" button and change the time zone to your time zone. DST time observed will bring it within one hour. For some reason before the recent DST change the time was perfect but now it is one hour early. I am hoping that when the "normal" DST change comes around this will fix itself. Otherwise, this is what we have and this fall changing it back to not observed will correct it. It is close enough either way. It is in this area you can create a new user if you wish.

I am not sure I understand your original question. Could you restate it please and this time include the entire detailed report image...I don't see the events graph that should be a the top of this report.
I can tell you are using the Respironics ASV machine. Your AHI is primarily Hyponea which is fairly common with this machine and the condition that it is normally used to treat.
I don't know if they are enough to be the cause of not feeling so great but if your sleep is fragmented like this report seems to show...that itself can do it.

[icipher]

This is an Encore Pro report???
Looks like the time zone is a bit off. Did you make the time zone correction before using the software? It's set to GMT time.

If you didn't and don't know how...this is how
The default Time Zone is GMT and if you don't change it the reports will be split and look weird. Go to Company Settings tab. Then double click on the blue Encore Company under office names to open this page area where you can click on the "EDIT" button and change the time zone to your time zone. DST time observed will bring it within one hour. For some reason before the recent DST change the time was perfect but now it is one hour early. I am hoping that when the "normal" DST change comes around this will fix itself. Otherwise, this is what we have and this fall changing it back to not observed will correct it. It is close enough either way. It is in this area you can create a new user if you wish.

I am not sure I understand your original question. Could you restate it please and this time include the entire detailed report image...I don't see the events graph that should be a the top of this report.
I can tell you are using the Respironics ASV machine. Your AHI is primarily Hyponea which is fairly common with this machine and the condition that it is normally used to treat.
I don't know if they are enough to be the cause of not feeling so great but if your sleep is fragmented like this report seems to show...that itself can do it.

Pugsy, what do you mean when you say that hypopneas are common with this machine? I ask because I use a respironics ASV and 90% of my events are hypopneas.

[bchdata]

Hi Pugsy

Now I have corrected the timezon, but it was only 1 hour wrong
I live in Denmark, and that means GMT+1.

My primary question is this:
When I use my Bipap machine with my Swift nasalmask, then I have AHI about 5-6 (Most of them hypnoes).
That is what you see in the detailed report.
I have tried a couple of times to use a Mirage Liberty fullface mask with the Bipap machine, and then I get an AHI on about 40-50.

I have also tried that earlier when I had a cpap machine, and exactly the same happened.
With the fullface mask I had a leak on 0, and with the nasal mask it was very high (40-50).

My doctors have never been able to explain that to me (They don't even try), so I guess that they don't understand it.

I hope that someone in here has seen this before, and know what to do about it.

I don't want to have all that leak, because I guess that the treatment will be much better with less leak.

That was my primary question, and let us start with that.

[Pugsy]

Pugsy, what do you mean when you say that hypopneas are common with this machine? I ask because I use a respironics ASV and 90% of my events are hypopneas.

Yes, but not because it is a problem with the machine itself but just a byproduct of the therapy itself from what the original problem is/was.
ASV machines are of course primarily used to treat excessive centrals...either CompSA or Central Sleep Apnea.
From what I have read the hyponeas might be central in nature and thus just a not quite so optimally treated central.
They can of course also be obstructive in nature.
When central in nature sometimes it's just a matter of time (months likely) for the body to adjust to the therapy and not have the "baby centrals...hyponea" pop up or be a leftover. Hence the "give it time" thing especially when using ASV
When those hyponeas are obstructive in nature then maybe a little more EPAP to better prevent them but we have to be careful with people who have CompSA with any pressure increase because it might make the centrals worse and create addition problems that are bigger than what a few hyponeas might bring.

So hyponeas being the primary event type leftover when using ASV therapy is fairly common no matter which brand of machine gets used.

Whether there's enough hyponeas to present a real problem I prefer to leave that up to the doctor to determine as I hesitate to advise much dial a wingin when using ASV unless a person really understands what they are doing and they have a doctor on board to run any changes by.
5 Hyponeas per hour...borderline as to whether the doctors would even worry about them. I think it depends on the patient, the doctor, and the patient's response to therapy as in feel like crap or not for decisions to be made whether the hyponeas need to be reduced further than 4 or 5 per hour.

[icipher]

Pugsy, what do you mean when you say that hypopneas are common with this machine? I ask because I use a respironics ASV and 90% of my events are hypopneas.

Yes, but not because it is a problem with the machine itself but just a byproduct of the therapy itself from what the original problem is/was.
ASV machines are of course primarily used to treat excessive centrals...either CompSA or Central Sleep Apnea.
From what I have read the hyponeas might be central in nature and thus just a not quite so optimally treated central.
They can of course also be obstructive in nature.
When central in nature sometimes it's just a matter of time (months likely) for the body to adjust to the therapy and not have the "baby centrals...hyponea" pop up or be a leftover. Hence the "give it time" thing especially when using ASV
When those hyponeas are obstructive in nature then maybe a little more EPAP to better prevent them but we have to be careful with people who have CompSA with any pressure increase because it might make the centrals worse and create addition problems that are bigger than what a few hyponeas might bring.

So hyponeas being the primary event type leftover when using ASV therapy is fairly common no matter which brand of machine gets used.

Whether there's enough hyponeas to present a real problem I prefer to leave that up to the doctor to determine as I hesitate to advise much dial a wingin when using ASV unless a person really understands what they are doing and they have a doctor on board to run any changes by.
5 Hyponeas per hour...borderline as to whether the doctors would even worry about them. I think it depends on the patient, the doctor, and the patient's response to therapy as in feel like crap or not for decisions to be made whether the hyponeas need to be reduced further than 4 or 5 per hour.

I've often wondered that. whether or not my hypopneas are just baby centrals that never get severe enough to be flagged as a central. interesting.

[Pugsy]

My primary question is this:
When I use my Bipap machine with my Swift nasalmask, then I have AHI about 5-6 (Most of them hypnoes).
That is what you see in the detailed report.
I have tried a couple of times to use a Mirage Liberty fullface mask with the Bipap machine, and then I get an AHI on about 40-50.

I have also tried that earlier when I had a cpap machine, and exactly the same happened.
With the fullface mask I had a leak on 0, and with the nasal mask it was very high (40-50).

Can I see a copy of the full face mask report showing such a high AHI?

Full face masks have a vent rate higher than nasal pillows and unless the Encore is set to report only excess leak you should never ever see a leak rate of 0 with a full face mask. Which you can do with Encore and I can't tell by this example above which it is because I am unsure which choice you have made in the report. The default is for excess only I think..
Which mask is this report above? Nasal pillows? There doesn't appear to be any large leak time flagged so if there wasn't any large leak then we trust the data.
Can you confirm exactly which type of leak data your Encore is reporting....Excess/unintentional leak or average total leak?

Once I see a report using full face mask and that leak...we can try to figure out why such a big difference in both the leak numbers and the AHI.

[Pugsy]

Julie...he says with his FFM his leaks are 0 but AHI is high.
With nasal pillow leaks are higher (but from this report above well below large leak territory I would think) but AHI is lower. From what I have seen on this report here...no where near leak numbers which would cause the machine to lose its sensing abilities.
Once I determine how Encore is reporting leaks exactly and see a detailed report from a FFM night I will have a better idea what might be going on...and also get confirmation as to exactly how Encore is reporting the leak numbers.
With Encore there is a choice available and since I can't speak Danish I don't know what it is reporting but looks like Total leak to me.

[bchdata]

[quote="Pugsy"]Julie...he says with his FFM his leaks are 0 but AHI is high.
With nasal pillow leaks are higher (but from this report above well below large leak territory I would think) but AHI is lower. From what I have seen on this report here...no where near leak numbers which would cause the machine to lose its sensing abilities.
Once I determine how Encore is reporting leaks exactly and see a detailed report from a FFM night I will have a better idea what might be going on...and also get confirmation as to exactly how Encore is reporting the leak numbers.
With Encore there is a choice available and since I can't speak Danish I don't know what it is reporting but looks like Total leak to me.[/qu

I don't have a report with FFM, but I will make one in a few days.
The reason why I don't make it right now is that I expect that it will give me heartproblems.
Last time I used the FFM a had a couple of days with lots of extrasystoles, and it happens often when I have been sleeping bad.
So I will wait till a day where I have had a good sleep.
When I have extrasystoles, then up to every third heartbeat is extra.

I have now change my EncorePro to English language, and the leak till only unintentional.

[Pugsy]

Don't put yourself under stress just to get a FFM report. I thought maybe you had an old one you could show us.

If Encore is reporting unintentional leak then you want low numbers.
If you get low numbers for leak data with FFM then that is good.
Higher leak numbers with nasal mask could mean some mouth breathing going on but as long as Encore doesn't flag any large leak (and it will if it thinks you need that flag no matter where the leak is coming from) then we can probably rely on the data.

I don't know why the AHI would be so high with a FFM unless there is some possible rebreathing of the air going on making the central apnea worse. A really high AHI with a FFM might go along with what you say about the heart palpitations and stress. Until you get it sorted out I am not so sure I would want to experiment. Maybe something is wrong with the mask...vent holes blocked???