Do different masks = different pressure needs?

[jasont]

I just switched to a different nasal mask and it appears my auto pressures are running much lower. This new mask is larger and does show greater flow rates on the graph (in the instruction pamphlet), so I suspect this may be typical behavior, but I am curious what others think.

Background story - started 3 weeks ago with a PR S1 Series 60 Auto (and nasal pillows). I liked the nasal pillows, but found i knocked them loose at higher pressures, so I went back to the Pico nasal mask from my sleep study. I also initially thought I liked the PR S1, but the used unit (long story) I received had an annoying motor sound (which may or may not have been normal), so I managed to have my DME switch it out for a new Resmed Airsense 10 for Her (which I love).

That PR S1 had data issues with sleepy head, so I only was able to retrieve a few days use, but in these examples you can see the PR S1 detected a smattering of CA, OA, H, RE, etc...




After switching to the A10 I curiously noticed a marked decrease in OA, H and RE. Not sure whether to attribute this solely to a different detection algorithm than the PR S1 (better?, worse?) or to better therapy from different algorithms for ramping up pressure. First nights on the new machine:




Realizing I was removing my mask in my sleep (at almost the identical time) each night, I decided to switch to standard APAP mode (instead of "APAP for her")and increase the minimum pressure from 6 to 7 - with remarkable results showing near "perfect" scores.




Only complaint at this point was that I tend to be an active sleeper early morning, wanting to turn on my side and get off my back, and the Pico mask would spring leaks every single time I turned - so I decided to try a new mask in hopes I could remain asleep. My DME recommended I try the Respironics True Blue nasal mask - it is quite a bit larger (which does not bother me), but also built with springs and a flap to help it remain sealed for active sleepers. I have only used it two nights now (and took it off part of the night of the first sleep) and I have noticed markedly reduced pressures used - especially in the middle of the night after returning from a bathroom break. My understanding is that the auto pressure increase is heavily tied to flow rate, so my guess is the greater volume pushed through this mask allows me to sleep at lower pressure - but with worse AHI scores. Should I give it time and see if the A10 "learns" to adjust to the new mask and brings my scores back down? Switch the internal setting to full face mask (even though it is still a nasal mask) so the A10 recognizes the mask will have greater flow than a typical nasal mask? Or maybe switch back to APAP for her, which I understand ramps pressure up more quickly in response to detected flow limitations?




Thanks in advance for any helpful tips!

[chunkyfrog]

Sometimes it does make a difference; but usually it is related to differing leak rates.
In my case, it was only a couple cm or so. Everyone is different.

[Wulfman...]

Looking at your reports, I've wondered how you came up with those settings........
Are you actually getting any sleep?
Maybe your difference in AHIs is due to sleeping in lighter or deeper sleep stages.
Did you have an in-lab sleep study?
Are those the settings they prescribed?


Den

.

[jasont]

Looking at your reports, I've wondered how you came up with those settings........
Are you actually getting any sleep?
Maybe your difference in AHIs is due to sleeping in lighter or deeper sleep stages.
Did you have an in-lab sleep study?
Are those the settings they prescribed?


Den

.

Completed a prescribed at-home sleep study, followed by an in lab titration study. MD prescribed the auto settings at 5-12cm.

My first week I felt like a walking zombie every day, the most tired I have felt during the daytime in years, however, I felt like I was sleeping soundly through the night and my fitness monitor was reporting twice as much 'restful sleep' compared to before cpap. After about a week my scrores and fitness monitor stats remained similar, but the weird daytime exhaustion began to wane.

Given my removal of the mask early in the night I took the suggestion of some forum members here and upped the minimum pressure to 6, then later to 7. So far each tweak has improved everthing - my satisfaction, my ahi scores, etc.

It wasn't until this switch to the latest mask that my ahi scores began to decrease again, but the weird thing is I still feel like I'm sleeping great (actually better). Same fitness monitor scores and I don't wake up fighting the mask back into place anywhere near as often as before. The only 'negatives' I can find are the worsened ahi scores and the weird decrease in logged flow limitations once I switched to the true blue mask.

[jasont]

Weird developments:

I started wiping the mask off each morning with alcohol pads (not realizing this is not advised) and within days I had large leaks occurring around the edges of the mask that were near impossible to control. I see that some forum members have used alcohol on their masks without problems, but this particular mask appears to break down rapidly in response to alcohol. The mask also seemed slightly large, so I ordered a replacement cushion in medium-wide and the first few nights are below.

First night - felt great, slept well, fitness monitor recorded my highest level of restful sleep ever at almost 5 hours (out of 7 hours total sleep). Sleepyhead looks 'good', except with large leaks which is something I had not experienced before. Since I wasn't fighting my mask all night, it appears I was opening my mouth for the first time since therapy started. Interesting.



Night two - felt great again, slept well, fitness monitor showed over 4 hours restful sleep. Only one mouth opening showing - thought maybe that first night of mouth openings was just a fluke.




Night three was about the same, 4.5 hours restful sleep with no large leaks (yay!). And then last night happened, only 2 hours restful sleep, large mouth leaks all night long, and CA's through the roof. What the heck? I seemed to sleep similar to the prior nights (a bit more restless early this AM than prior nights), but what's with all the CA's?? Any educated guesses on what happened?

[palerider]

alcohol doesn't affect silicone, I'd look elsewhere for the problem. (usually loose straps)

[jasont]

alcohol doesn't affect silicone, I'd look elsewhere for the problem. (usually loose straps)

That's what I thought, but both of my nasal masks started leaking within days of starting to clean them with alcohol. I use the talon hooks to remove/replace the headgear so the straps shouldn't need adjustment. That being said, the brand new mask started perfectly tight the first night and this morning (fourth night) it was leaking a bit from the sides (hence my restless early morning comment).

Does headgear stretch regularly when it is new-ish? I have been operating off the idea that once I get a night with little/no leaks then leave the straps alone, but maybe that is backfiring on me...

[ChicagoGranny]

leaks

To reduce unintentional mask leak -

- Make sure the mask is fitted properly. (See mask manufacturer's video.)

- Make sure the headgear is adjusted properly (See mask manufacturer's video.)

- If you use a low ramp pressure or a low minimum pressure, you should fit and adjust your mask at the higher pressures it is operating at for most of the night. You would temporarily change the machine pressure settings while you do the fitting and adjusting. It's best to do this well before bedtime before you are tired and ready for sleep. Don't forget to change your settings back to the ones you prefer.

- Make sure to use good hose management - the hose should not pull on the mask. Notice how your hose is positioned between machine and mask. It should be positioned to minimize any pull on the mask. Hose management is an individual practice. How it is done depends on the mask, the position of the machine, your sleeping position and other factors specific to the individual.

- If you still have problems, learn from the forum what mask liners are available.

- If your mask still has excessive leak, try other masks. Many people report trying several masks before they find one that works well for them.

Note: Links to just some of the mask manufacturers' instructional videos can be found on the forum host's website - https://www.cpap.com/cpap-masks.php

- CG

[palerider]

alcohol doesn't affect silicone, I'd look elsewhere for the problem. (usually loose straps)

That's what I thought, but both of my nasal masks started leaking within days of starting to clean them with alcohol. I use the talon hooks to remove/replace the headgear so the straps shouldn't need adjustment. That being said, the brand new mask started perfectly tight the first night and this morning (fourth night) it was leaking a bit from the sides (hence my restless early morning comment).

Does headgear stretch regularly when it is new-ish? I have been operating off the idea that once I get a night with little/no leaks then leave the straps alone, but maybe that is backfiring on me...

headgear stretches... that's part of the reason it's easily adjustable.

all I know is that I used hand sanitizer (which is mostly ethyl alcohol) for years on my cushions/pillows and they're still working fine.