Still snoring even with NASAL MASK....

[dexter_go]

I would like to seek advice on my situation.

I was using a RESMED MIRAGE ACTIVA NASAL MASK. One night I thought of using my IPHONE voice recorder to record if I was snoring or not. To my surprise the next day, I found out from the recorded sound, that I was still snoring. It was not very loud. But the snoring was constant and continuos the whole night. How can this be? I thought that applying CPAP will stop me from snoring. Does this mean, the CPAP therapy is ineffective? I checked the results (AHI), they are not below 5. Or this is normal with a NASAL MASK - slight snoring.

After learning about this... I thought of using a FULLFACE MASK. The first one I got was the RESMED MIRAGE QUATTRO. My size is a medium. This was totally useless for me. Because at settings 10 or 11, all the air leak out from all sides of the mask.

I was advised by my CPAP dealer to try RESPIRONICS COMFORTGEL FULL FACE MASK. So I bought this mask which had a GEL TYPE SEAL. And indeed this mask had better sealing properties compared to the MIRAGE QUATTRO. But there are times, I wake up in the night and the air is also leaking out heavily from the mask. My question is, is it still possible that I am still snoring with the full face mask. I have not yet used the IPHONE VOICE RECORDER to see if I still snore at night.
What if I go down to a smaller size of RESPIRONICS COMFORTGEL FULL FACE MASK, will it have a better seal and less chance of leaking?

What brand of fullface mask has the best sealing? From my experience RESMED FULLFACE MASK has inferior sealing compared to the RESPIRONICS which has a GEL TYPE SEAL.

[rested gal]

I'm not a doctor or anything in the health care field, so this is just my layperson's opinion:

I checked the results (AHI), they are not below 5.

With a ResMed machine, it's important to note what just the AI (apnea index) is. If the AI is very low, that's good. That would mean it's the HI (hypopnea index) making up most of the total AHI (apnea/hypopnea index.)

I mentally cut the HI in half when I look at my results with a ResMed machine. Then I re-add the AI and HI together to get what is probably a closer estimate (imho) of whether my AHI is "below 5" or not.

We often see on the message board that the AHI should be under 5 to indicate getting effective treatment. With other brands, yeah... "under 5" is a pretty good rule of thumb to go by. But because different manufacturers use different definitions of when to call a limited airflow a "hypopnea", ResMed machines might be calling some flow limitations "hypopneas" when other brands would still call them "flow limitation" and not score them as hypopneas.

That does not mean one brand is wrong or another brand right. Nor does it mean one brand is letting "hypopneas" slip through and another brand is preventing them. Nor does it mean one brand is better at identifying "hypopneas" or another brand misses seeing them. It's simply a difference in the various manufacturers' definition of "hypopnea."
Velbor's chart -- several manufacturers' "definitions":
viewtopic.php?p=353046#p353046

I think it might be better to consider an AHI under 10 to be effective treatment with a ResMed machine. That is, IF most of that AHI is comprised of "hypopneas" (the HI -- the hypopnea index) -- and IF the AI (apnea index) is extremely low (like under 1.0)

As for the residual snoring, a likely cause is that you are doing some mouth-breathing during sleep since your nasal mask doesn't cover the mouth the way a "Full Face" mask would. Check your leak rate. Ideal leak rate with a ResMed machine is zero. Any leak under 0.20 would be very acceptable, imho. A leak rate that is 0.30 or higher...well, I'd go to work on that.

If leaks are well under control, it's possible that the snoring indicates a therapeutic pressure that's not high enough... either the CPAP pressure if you're using your autopap in CPAP mode... or the minimum pressure if you are using auto mode.

You're using a ResMed autopap. Needing a higher minimum pressure could especially be true if you have EPR turned on. EPR drops the pressure each time you exhale. Drops it by exactly one, two, or three cm H2O. That could be letting your airway collapse somewhat during the pause before you start to inhale again. EPR continues to keep the pressure down then, too...during the pause. It keeps the pressure down until you start to inhale again, or until EPR "times out" and lets the regular pressure back in even if you haven't started another breath. The repetitive snoring you heard on your recording might be happening when you start to inhale again, before the returning pressure can get the airway well and truly open again.

Either raising the minimum pressure of your autopap (or turning off EPR if you don't want to raise the minimum pressure) would be my guess for how to get rid of the residual snores. A higher minimum pressure could possibly lower your AHI some, too.