Nasal to FF, #'s have gone WILD!

Komodo · Post by **Komodo** » Mon Dec 21, 2009 7:29 am

About a week ago I switched from a Comfortgel Nasal mask to a Mirage Quattro Full Face mask.
My AHI has gone through the roof!!!!!

The averages are:

Nasal leak: 0.4
FF leak: ~0~

Nasal AI: 0.45
FF AI: 6.8

Nasal HI: 4.8
FF HI: 25.5

Yes, I did change the setting on my machine from "standard" for the nasal, to "Mirage Fullface" for the FF.

I was doing pretty well on my nasal mask, but now I feel like I'm receiving ZERO benifit from my therapy.
Is there some rational reason for such a change? I doubt that my apnea has gotten THAT MUCH worse literaly overnight.

GaryG · Post by **GaryG** » Mon Dec 21, 2009 12:25 pm

First of all if you were doing well with your nasal why did you switch?

Its possible you might require a different presssure setting for the FF vs the nasal. Also, did you remember to change the settings on your CPAP machine from the nasal to the FF?

Gerryk · Post by **Gerryk** » Mon Dec 21, 2009 11:16 pm

Komodo, it looks like you have a leak and it's not showing up in your leak numbers. That mask has a high vent rate or leak rate depending on what you want to call it. Normally when one goes from good numbers to bad it is because of a leak. I am not sure but you will have to check the numbers for the leak rate for the quattro and the mask your machine has in it's settings. Perhaps they use a different setting for the quattro but it does have a high leak rate or vent rate.

Gerry

Y REM · Post by **Y REM** » Mon Dec 21, 2009 11:36 pm

Do your nostrils collapse when you take a deep breathe? Maybe the full face is not for you. If your nostrils collapse but you also have problems with your mouth dropping open, then the ResMed Liberty might work? Another issue is whether your humidification needs might be different with the full face mask. I really dislike full face mask and always try to avoid them. Why did you switch?

Komodo · Post by **Komodo** » Tue Dec 22, 2009 7:40 am

To answer your questions,

GaryG
I switched for two reasons. First, because of serious nasal congestion due to my COPD. Second, I was trying to eliminate ALL my leaks from using the nasal mask. The nasal fits me fine, but I leak from my mouth when my nose clogs up.

YES, I did change the machine settings for the FF.

GerryK
The mask fits like a glove The only leaks I can think of would be coming from the vent. Since my machine is set for "Mirage Full Face" mask, I'd think that it would compensate for that leakage?????

Y REM
Nostrils are fine (except when they clog), but I do breathe thru my mouth alot, thus the reason for the FF.

Over the next few nights, I'm going to try different mask settings, and raising my pressure (I'm at 16 now), to see if that helps. I'm also, going to use my nasal mask again to make sure my "old numbers" w/that mask are the same. Just in case my OSA did get seriously worse, which I doubt.

Y REM · Post by **Y REM** » Tue Dec 22, 2009 8:26 am

Request an evaluation by an ENT. Sometimes turbinate reduction with radiofrequency can improve airflow through your nose. This would allow for lower pressures and possibly less congestion. It is an office based procedure. Increasing the pressure of the CPAP may lead to worsening congestion. Make sure you are getting good use from your heated humidfier since this may also decrease nasal congestion.

roster · Post by **roster** » Tue Dec 22, 2009 8:31 am

Komodo wrote:About a week ago I switched from a Comfortgel Nasal mask to a Mirage Quattro Full Face mask.

What positions are you sleeping in?

Komodo · Post by **Komodo** » Tue Dec 22, 2009 9:31 am

rooster wrote:
Komodo wrote:About a week ago I switched from a Comfortgel Nasal mask to a Mirage Quattro Full Face mask.

What positions are you sleeping in?

ALL of them!

Due to failed back surgery, I can' stay in any one position for long. I'm more active in my sleep than when awake. I toss around like a fish out of water!

JohnBFisher · Post by **JohnBFisher** » Tue Dec 22, 2009 11:31 am

Another possible cause (at least I notice this) is that the full face mask tends to push down against the lower jaw. Of course, pushing the lower jaw down toward the throat only makes the tendency to obstruct more intense. If it is very severe, you might want to see if a something like mouth guard to help hold your lower jaw in place might help. Just a thought...

roster · Post by **roster** » Tue Dec 22, 2009 1:58 pm

Komodo wrote:
rooster wrote:
Komodo wrote:About a week ago I switched from a Comfortgel Nasal mask to a Mirage Quattro Full Face mask.

What positions are you sleeping in?
ALL of them!

Due to failed back surgery, I can' stay in any one position for long. I'm more active in my sleep than when awake. I toss around like a fish out of water!

According to the Respironics website, 40% of OSA patients have Positional Sleep Apnea (PSA). This means the apnea is more severe when sleeping on the back and the pressure requirements are likely higher.

It could be that you are sleeping on your back more with the full face mask. This would account for a higher AHI with the full face mask. I suggest to anyone having these types of problems, to restrict sleeping to the sides or tummy for several nights and monitor the results.

Just as example, my condition requires a pressure of 19 cm for backsleeping and only 7.5 cm when sleeping on the sides or tummy.

Slinky · Post by **Slinky** » Tue Dec 22, 2009 6:43 pm

I've been using a nasal cushion mask w/a chin strap for a long time. I really liked this nasal cushion mask, it was comfortable and virtually leak free - BUT - my MOUTH wasn't as leak free as my mask, unfortunately, so we added a chin strap and that helped a lot - but - eventually not enough.

So I recently switched to a full face mask, after trying a couple, includng the Quattro, I've found I really like the ProBasics Zzz-Mask, altho it took some lab-ratting of the too large headgear.

Despite a lot of 0 leak rates and none higher than 18 L/M my data has gone to hell in a handbasket. So its back to playing w/my pressures to find where it needs to be w/the Zzz-Mask.

The nasal cushion I used does have a narrow hose that the VPAP hose attaches to which could account for some of this. And I've read that sometimes a switch from nasal cushion or nasal pillows to full face can require an increase in pressure from 1 cm to, rarely, as much as 4-6 cms.

Surprisingly, the allowed vent rate for the Zzz-Mask and the Swift LT for Her nasal pillows are almost exactly the same !!!!!

Guest · Post by **Guest** » Tue Dec 22, 2009 7:18 pm

I also recently switched to the quatro and my AHI jumped. I like the mask and solved the initial leak issues but still had bad numbers. My previous mask (the fp432) was a bit small and squeezed below the bridge such that there was breathing resistance. I was used to this but when I switched to the quattro which fits better, that resistance went away. Working on the theory that the fp432 required a higher pressure due to the pressure drop across my nose, I lowered my pressure and this improved my numbers but for only one night. I chased pressures but could not find a sweet spot. This is when I got the S8 autoset 2 and my AI, at least, is now back to where I usually am (about 2 to 3). My HI's are now higher but that is a function of the resmed algorithm. I doubt anything real has changed there.

The bottom line, masks do seem to require different pressures and probably for a myriad of reasons. All things being equal, the pressure requirement shouldn't change but this is in a perfect world where things are not equal.

Nasal to FF, #'s have gone WILD!

Nasal to FF, #'s have gone WILD!

Re: Nasal to FF, #'s have gone WILD!

Re: Nasal to FF, #'s have gone WILD!

Re: Nasal to FF, #'s have gone WILD!

Re: Nasal to FF, #'s have gone WILD!

Re: Nasal to FF, #'s have gone WILD!

Re: Nasal to FF, #'s have gone WILD!

Re: Nasal to FF, #'s have gone WILD!

Re: Nasal to FF, #'s have gone WILD!

Re: Nasal to FF, #'s have gone WILD!

Re: Nasal to FF, #'s have gone WILD!

Re: Nasal to FF, #'s have gone WILD!