Different AHI with ASV machine and different masks?

[tomma]

I normally use a nasal mask, a chin strap and an ace bandage to cover my mouth, like this:

viewtopic/t53666/Controlling-mouth-leak ... -glue.html

That's been working ok for a long time, but, recently I've had a huge problem with nasal congestion. I've tried raising the humidity, lowering the humidity, taking cold medicine, allergy medicine and just about all the other suggestions I've seen, but none seem to help. So, I went back to using my full face mask, that helps a little with the congestion but my AHI goes through the roof. With the nasal mask my AHI normally runs between 1.5 and 3. With the full face it's been from 6 - 12!

I was originally thinking this was due to me sleeping on my back more often when I have the full face on, but now I'm convinced that's not it since the mask leaks pretty bad on my back and instantly wakes me up.

So now I'm between a rock and a hard place. I can't use my nasal mask because of the congestion, and I can't use the full face because of the AHI. Given those options I suppose the full face is the way to go, but, there has to be a reason for the increase in AHI although I can't figure it out.

Is it possible that I need the chin strap even with the full face, would my mouth falling open after I fall asleep change the pressure? If not that, any other suggestions/ideas?

Thanks

[johnthomasmacdonald]

I get very different ahi scores depending on the mask I use and i tend to swap around between a fitlife, a resmed full quatro fx, nasal pillow swift fx and another resmed nasal mask. What's weird is that regardless of which mask i'm using, the ahi seems to crawl up over time but once i switch to another mask it's back down again - yet i don't see any leaks or anything else on sleepyhead to explain the ahi rise. I also switch because i seem to get breakouts and rashes and using a mask with a different profile lets it heal. All the masks i use i have to overtighten to keep them from leaking - but i use an asv machine and my pressure is often shooting up to 24 during the night. This, let the mask "float" as explained in the brochures and videos is something i've never been able to get to work, wrenching them on is the only thing that works for me. I also find that since using cpap I have occasional problems with my sinuses which i never had before - seems to be better at 80 degrees and high humidity but i haven't really quantified it well.

Also, have you considered slightly increasing the pressure when you are using the ffm to see if that helps? I know that they claim it doesn't make a difference but it really doesn't make sense as I would guess that your breathing architecture is different when mouth verses nasal breathing.

[tomma]

I'm also an ASV user and my pressure hits the max of 25 pretty often. No matter which mask I use I have to have it pretty tight.

I think I'm seeing something pretty similar to what you are. I switch between a Quattro FX nasal and Mirage Quattro full face. I get a consistent 1-3 AHI with the nasal mask. The full face on the other hand behaves very oddly. The first day or 2 the AHI seems pretty good, a little higher than with the nasal mask but still under 5. Then, something happens and the AHI goes through the roof after those first couple days, sometimes up as high as 12. I then go back to the nasal mask, and I'm back down to 1-3 again. My issue right now is that I like the full face better because of recent nasal congestion and the fact that I don't have to wear that damn chin strap and ace bandage.

Has anyone else seen this kind of thing?

[JohnBFisher]

... Is it possible that I need the chin strap even with the full face, would my mouth falling open after I fall asleep change the pressure? If not that, any other suggestions/ideas? ...

I think you are on the right track. I suspect .. but can't prove it in your case .. I just know this happens to me during my sleep .. that with the full face mask your the bottom edge pushes against your lower jaw. This would tend to push your tongue down into your airway. And Voila! An obstructive sleep apnea.

The chin strap might help keep this from happening. You might want to try the full face mask and chin strap to see if that helps.

[JDS74]

I think JohnB is right on point.
I once (and once was more than enough ) tried a chin strap for my Oracle 2 mask and the OSA's went right through the roof. I think that is why, buried in the literature for the mask, they say don't use a chin strap.

My pressures pop up to 24 ( the max pressure setting ) frequently but I have zero leaks. The Oracle mask controls leaking extremely well if (big if) you don't have mouth drop during the night. A really soft cervical collar controls that and my leaks have been down near zero for about 4 months now since I have been using a collar.

[tomma]

Thanks JohnB, that explanation does kind of make sense. I certainly can't think of anything else.

I might try the chinstrap tonight and see what it does, although the comment by JDS74 about what happened to him with a full face and a chin strap worries me a bit. Only one way to find out I guess.


On an unrelated topic, does anyone know why my machine isn't showing up in my sig? I just checked my settings and it's there. JohnB - I notice yours isn't there either.

[JDS74]

Tomma.

My mask is an oral mask, not a FFM.
Mileage may vary

[Tom W]

On an unrelated topic, does anyone know why my machine isn't showing up in my sig? I just checked my settings and it's there. JohnB - I notice yours isn't there either.

I know when I entered the Respironics 950 it didn't show up all the time...I entered the 960 and now it's always there.

It's not a perfect work around but it's close enough.

[Pugsy]

does anyone know why my machine isn't showing up in my sig? I

It used to be that all the links to the "older" models of whatever equipment a person was using would show up in the equipment profile.
Now it seems like all but the latest models that cpap.com carries will have a good link and show up.
Every choice in the drop down menus for anything equipment wise is something that cpap.com either has now or has had in the past.
If they haven't ever offered it then it won't be there.
The the PR System One machines...the 50 series models are discontinued so cpap.com doesn't carry them anymore so their links are broken. Only the 60 series machines that cpap.com carries in stock have good links.

We usually tell people whose equipment links are broken and thus won't show up just to manually add them in the equipment comments section. See how I have my extra machine noted in my profile. I suspect you chose the PR S1 Auto ASV machine model 950 and that machine has now been replaced by the 960 model so that link is broken.

[tomma]

Thanks Pugsy, I just changed to the 960 in my profile, and now it's showing up. Close enough.

JDS74 - I misread before, thought your mask was a FF, thanks for the clarification.

[Apneanderthal]

Have you tried using a neti pot to clear things out before going to bed?

I've been using nasal pillows for about three weeks now and I've had to use the neti pot 3-4 times due to being plugged up tight. That gets me going and then the humidifier seems to keep things good enough through the rest of the night. If that fails, I keep a bottle of saline nasal spray on my night stand so I can quickly huff it at 3am. Seems to be helping.

I've used a neti pot for years and it does wonders. I recently got the squeeze bottle type because when I'm plugged up solid the ability to add pressure gets things moving. Awfully soothing too.

As an aside, thanks for the tip on the ace bandage. I've been using it for about 5 nights now and it has done wonders for keeping the "chipmunk cheeks" at bay. I'm going to make up a couple more and let my kids draw on them. My son already has dibs on vampire teeth and dripping blood!