Activa Mask & AHI

roztom · Post by **roztom** » Fri May 12, 2006 7:04 am

I might have read this before?

Those of you who have switched to the Activa have your AHI numbers changed?

My numbers have jumped up, almost doubled !! from around 2.0 to 4.0+

That's quite a difference. While I'm leaking less I've had some bad nights and have felt crummy.

It may be a coincidence but that much abrubt change has me wondering.

HAs anyone else had that experience with the Activa?

reval · Post by **reval** » Fri May 12, 2006 7:45 am

Changing to the Activa had no effect on my AHI (using a PB420E).

Ric · Post by **Ric** » Fri May 12, 2006 9:13 am

Tom,

3.6 AHI before Activa (mostly UMII, about 5 months).
3.2 AHI with Activa. (about 10 days only)

Looking at the OA and H graphs (EncorePro) I can tell you that the numbers are all over the map, and any differences are squarely in the "noise" range. I'd say it's a "wash".

Daily Mask Leakage statistic:
Activa (10 days) 38 avg.
UMII (5 mo avg) 33.

again, pure noise, not significant, imo..

Guest · Post by **Guest** » Fri May 12, 2006 9:39 am

I just started on CPAP this past Sunday and use the Activa mask. I have not had leaks that wake me up, but one thing I noticed the last two nights is that a couple times when I woke up during the night it felt like there was no pressure to breathe against. Note: I was side sleeping when I woke and woke because my arm was asleep. Once I got on my back the pressure felt like it came back and I was able to fall back to sleep. Not sure if this is very responsive to your question, but thought I would contribute my brief experience.

TM

snork1 · Post by **snork1** » Fri May 12, 2006 9:52 am

No significant difference with the Activa as compared to the Swift that I also use.

Actually, where I see a greater difference is between my Remstar Auto and my PB420E. The 420E has slightly lower OA numbers and significantly lower hypopnea numbers.

Guest · Post by **Guest** » Fri May 12, 2006 11:33 am

snork1 wrote:No significant difference with the Activa as compared to the Swift that I also use.

Actually, where I see a greater difference is between my Remstar Auto and my PB420E. The 420E has slightly lower OA numbers and significantly lower hypopnea numbers.

Do you feel any different the next day using these machines?

snork1 · Post by **snork1** » Fri May 12, 2006 11:44 am

Anonymous wrote:
snork1 wrote:No significant difference with the Activa as compared to the Swift that I also use.

Actually, where I see a greater difference is between my Remstar Auto and my PB420E. The 420E has slightly lower OA numbers and significantly lower hypopnea numbers.
Do you feel any different the next day using these machines?

roztom · Post by **roztom** » Fri May 12, 2006 4:14 pm

Thanks for the replies.

Last night, to give you an example my SI was at 30!!! Usually it avg's around 6.

Usually I'm mostly Hypop's and a few OA's now I'm screaming OA's

MY treatment has as they say, Gone to Pot....

I'm considering going back to my previous mask UM Nasal and see if things don't go back - otherwise I'm in deep do-do.

Tom

rested gal · Post by **rested gal** » Fri May 12, 2006 4:30 pm

Tom, what range is your machine set for?

Looking at only the Encore Pro data, not the MyEncore data, what was the leak rate -- both the "average", and the time spent in Large Leak (if any) -- on the night you got such a terribly high number of OA's?

roztom · Post by **roztom** » Fri May 12, 2006 4:49 pm

Hi RG:

On the night in question, night before last with AHI 4.8,

my APAP was set 4.5 - 9.5 My avg leak with the Activa was 24.15 with no large leaks. OA & HI was split evenly 2.4 & 2.4. SNore was 7.2.

I should add that the data shows that my OA increases with my pressure over 9.0 cm while my HI drops - Doc suggests OA over 9 are Centrals.

Last night I decided to go fixed pressure where I was originally titrated at 9cm. MY AHI was 3.9, OA 3.0 HI 0.9 and SNore was 30 ! My leak avg was 31 at 9cm with no large leaks.

I avg 6 for snore typically and my AHI typically bounces around 2.0.

Previously on CPAP at 9cm I my AHI was under 1.5 so I find all of this strange. The only variable; that I have in here is the mask.

Possibly my pressure also but That seems unlikely to me - what do you think?

Thanks,

Tom

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Snoredog · Post by **Snoredog** » Fri May 12, 2006 5:06 pm

Doesn't really surprise me all that much, the Activa has lousy CO2 washout compared to other Resmed masks I have used for comparison. The UltraMirageII and UltraMirage FF are much better in my opinion with the UMFF being the best when it comes to CO2 washout.

While I have no scientific data or way to measure this, I can only go by my own autopap reports and/or the way I feel from using them. Poor CO2 washout leaves me sluggish and/or with headaches.

Resmed started out with a fantastic design with the Activa, then screwed it up by putting on that dud Vista mask 360 swivel elbow and leader hose.

This elbow design wasn't any good for CO2 washout on the dud Vista mask either. It all has to do with how the cpap air enters the mask and how it exhausts your exhaled air. The reason I feel the UMFF is the best at this is the incoming air pushes your exhaled air straight up as it leaves the nose where it exhausts out the holes located near the nose bridge. It can be compared to airing out your house, works much better opening both the front and back doors vs just the front.

With the Activa (and the Vista) there seems to be too much air "collision" or turbulence which seems to effect its ability to washout CO2 and the collision of this air makes this mask more noisy than others.

I much prefer the UltraMirageII over the Activa any day, it seals just as well, much lighter & quieter and a lot easier to clean, not to mention lower cost. The MirageII doesn't have the separated exhaust ports like the UMFF, but it has a design that has worked well for many years.

I have a difficult time with nasal congestion due to allergies, I had a nose job reaming done many years ago so there is not much they can do on that front. But if I use a nasal mask that seems too small for me, it seems to make me even more congested which contributes to mouth breathing and other problems. Same for the Activa, in the Std size it seems to put pressure around my nasal area which contributes to nasal congestion (for me anyway).

I was originally fitted by the sleep lab with a UM standard cushion. They did this as I was told to reduce mask leaks since a smaller cushion tends to leak less. So for years I purchased replacement UM nasal cushions in the Std size. After using a UMFF I realized they fitted me too small so I switched to a UltraMirageII in the large size, boy did that make a difference, much better and less congestion. I also use a BreatheRight strip on my nose under the mask every night which also helps.

roztom · Post by **roztom** » Fri May 12, 2006 5:14 pm

What I find strange about the concept of CO2 washout is if pressure is still being pushed on exhale than most of the CO2 should go out the exhaust ports.

Do the masks give CO2 latency numbers?

Thanks,

Tom

Snoredog · Post by **Snoredog** » Fri May 12, 2006 6:46 pm

roztom wrote:

What I find strange about the concept of CO2 washout is if pressure is still being pushed on exhale than most of the CO2 should go out the exhaust ports.

Do the masks give CO2 latency numbers?

Thanks,

Tom

some of the CO2 you breathe out gets rebreathed right back in once it is mixed along with the incoming air. The higher the concentration of that exhaled air to the incoming air ratio, the poorer the CO2 washout is considered.

Some research seems to suggest that this is not all bad as discussed in that megathread on TAS.

The only real data I have seen on this is mask exhaust rates and I cannot even find that paper as the link is no longer valid. Think my machine manometer kit has more info regarding mask leak/exhaust rates than what I can currently find.

I guess to get a visual on it, you'd have to have some kind of simulator and induce different color smoke into the air to see what is actually happening.

snork1 · Post by **snork1** » Fri May 12, 2006 8:39 pm

[quote="Snoredog"] But if I use a nasal mask that seems too small for me, it seems to make me even more congested which contributes to mouth breathing and other problems. Same for the Activa, in the Std size it seems to put pressure around my nasal area which contributes to nasal congestion (for me anyway).

I was originally fitted by the sleep lab with a UM standard cushion. They did this as I was told to reduce mask leaks since a smaller cushion tends to leak less. So for years I purchased replacement UM nasal cushions in the Std size. After using a UMFF I realized they fitted me too small so I switched to a UltraMirageII in the large size, boy did that make a difference, much better and less congestion. I also use a BreatheRight strip on my nose under the mask every night which also helps.

rested gal · Post by **rested gal** » Sat May 13, 2006 12:40 am

oops, roztom, I misread something you had written.

"Last night, to give you an example my SI was at 30!!! Usually it avg's around 6.

Usually I'm mostly Hypop's and a few OA's now I'm screaming OA's"

Thought you meant your OA's had jumped to 30, but I see now that you were talking about your snore index.

Variations that are all staying under a 5 AHI for the night sound fine to me, but if you aren't feeling as well that's the important part. Dunno.

Perhaps try gradually bringing your minimum pressure up off that 4.5. Keep using the Activa, but with a range of 6 - 11 for a few nights, then a range of 7 - 11 for a few more nights, and then 8 - 11. I wouldn't pay any attention to the snore index while using the REMstar Auto...just see how the AHI does at those settings.

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