Best mask to address RERA

[reinvigorated]

robysue and Pugsy, thank you so much for sharing your thoughts! If you don't mind I have one quick follow-up question regarding P10 vs Swift FX. I really like sleeping in a so-called "crawling solider" position, like on this picture:


So basically it’s a stomach position with the head turned slightly to the right or left. But unlike the guy in the picture, I always put one of my arms under my head. If my head is turned left, it would be on the right arm and vice versa. Usually, the head is placed so that the forehead is on my forearm and my cheek is on my bicep more or less. So the hand position is similar to this picture only that my arm is internally rotated instead of being externally rotated like on this picture (my palm is facing down not up).


Sorry, I know it’s a lengthy explanation, but I wonder which mask would be most comfortable in this position in your opinion? The I’m trying right now is not super comfortable in this position because of the side straps. I see that both of these masks have side straps too but perhaps one is more comfortable than the other?

Thanks so much!

[Pugsy]

I live in the US, so Airsense Autoset should be fine if my understanding is correct.

I don't know where ResMed is releasing regular AirSense 10 AutoSets that flag RERAs. I am in the US and when the AirSense models were released here NONE of the regular autoset models flagged RERAs...only the for Her model.
Since the release though I have seen reports of people with the regular AirSense 10 Autosets flagging RERAs. I don't always know where people got their machines. We have forum members from all over the world so I don't know for sure which country gets the updated Auto Sets for RERA flagging.

And I don't know how to tell you to find out. I don't know if the US is now getting those machines or not and I don't know how to try to determine either by serial numbers or machine coding or software installed on the machine. It likely is a software thing since I firmly believe that the guts of all the AirSense machines are the same and the only real difference is the software installed but I can't prove it.

Whomever you are getting your machine from should be able to tell you though...ask them and if the machine you get doesn't do what you want then scream bloody loud about it.

I wish I could tell you for sure that all those AirSense 10 AutoSet machines sold in the US will flag RERAs but I can't. Even if it is now we don't know how long a machine was sitting on a shelf somewhere before it gets dispensed to a patient.

I have never seen anything official about this change. Doesn't mean it's not out there but I haven't seen it.

So quiz whomever you are getting your machine from...I can't tell you anyway to check ahead of time with any certainty.

[Pugsy]

I wonder which mask would be most comfortable in this position in your opinion? The I’m trying right now is not super comfortable in this position because of the side straps.

Which mask are you trying out now? Knowing what straps you are talking about would help me compare those straps to the P10 or Swift FX straps.

In terms of position...either of the 2 masks would work very well with the position you describe. Easy peasy.
Heck I even sleep on my stomach with my face buried in the pillow for the most part and I use a rather firm buckwheat hull pillow. Almost totally face down if you can picture that. Not quite but almost.

If you want "nothing" straps...the P10 beats the Swift FX silicone side straps IMHO. I never feel those straps at all no matter what position I am in. The Swift FX...yeah I can sometimes feel the silicone..not uncomfortable but more noticeable if I think about it.

What size hat would you wear?

[reinvigorated]

Right now I'm trying this mask.
https://ibb.co/fkCjUa

And here is the leak data from the last night.
https://ibb.co/h76dpa

[reinvigorated]

I would wear M.

[reinvigorated]

Also, after looking at the data, I've noticed one interesting thing. My AHI was 0.4 in the diagnostic study and 0.2 in the CPAP study. However, based on the two nights of data collected at home, my AHI is 4.56. I wonder if this is some type of error or accuracy issue.

Here is the chart: https://ibb.co/mxmm9a

I think I was moslty awake between 2pm and 4pm (woke up and had a hard time falling asleep which almost never happens – probably because I went to bed earlier than usual and because of adjusting to CPAP).

[Pugsy]

Okay...you are using the original DreamWear mask with the side thingies that are filled with air...they are more noticeable than either the Swift FX or the P10 side straps.

I am now trying the nasal pillow version of what you are using.
Side note...if you ever want to try the gel nasal pillows with your current headgear/frame all you need to buy is the nasal pillows.
No need to get a totally new headgear and frame.
https://www.cpap.com/productpage/pr-dre ... -pack.html
So you can try essentially a different nasal pillow mask for the cost of the replacement nasal pillow.

I know what you mean about noticing the side things on the DreamWear. They aren't hard but they can feel a bit bulky sometimes and I have to use the fleece side wraps or I get some rather ugly looking dents on my cheeks.

The silicone side strap things on the Swift FX isn't as noticeable as the DreamWear side things but they are firmer so a bit "hard" if you lay directly on them but it's not like laying on a pea or something pointed. There are smooth and flat and don't have as much depth to them as the DreamWear.
The side straps on the P10 are so small and tiny that you really don't notice them unless they are too snug. No depth at all. Think of a flat piece of elastic and that's about how much depth there is.
The reason I asked about hat size was because some guys with big heads have had trouble with the P10 not stretching out comfortably enough. You should be fine if your hat size is a medium with the regular P10 headgear. When it's too tight the nasal pillows will try to crawl up inside your nose and that's no fun. They are suppose to rest gently on the outside of your nostrils.

Pick the one that looks the most interesting and give it a try. You most likely will eventually still want to try the other at some point just to see what it is like.

Your leak line graph is to die for good. I guarantee it's better than mine was last night.

Respironics machines report leaks a little differently than ResMed machines. ResMed reports only excess leak which would be the equivalent of the bottom leak line on your graph. The top leak line is what we call total leak and total leak includes the vent/intentional leak plus any excess leak. For all practical purposes you have minimal to none excess leak. There's a couple of big spikes but I suspect those are mask refitting spikes. Not a big deal. You just probably pulled the mask away briefly to reseat it and quickly put it back in place.

Now any leak that wakes you up (even if it is teeny tiny) because anything that wakes us up is unwanted. So even with your to die for leak graph....if you had a lot of wake ups because of tiny leaks then that's not acceptable.
For someone new to therapy like you are....that's a really good looking leak line. Exceptionally good looking.

[reinvigorated]

Pugsy, thank you very much! This is so helpful. I'll keep an eye on the data and will probably get P10 once my trial is over and I return the Philips machine and mask. Thanks!

[Pugsy]

Also, after looking at the data, I've noticed one interesting thing. My AHI was 0.4 in the diagnostic study and 0.2 in the CPAP study. However, based on the two nights of data collected at home, my AHI is 4.56. I wonder if this is some type of error or accuracy issue.

Here is the chart: https://ibb.co/mxmm9a

I think I was moslty awake between 2pm and 4pm (woke up and had a hard time falling asleep which almost never happens – probably because I went to bed earlier than usual and because of adjusting to CPAP).

Here's the deal with the AHI reported by the machine. These machines don't know if we are awake or asleep. They just measure air flow and when we are awake or semi awake our breathing is much more irregular than we realize but the machine just senses irregular and often will flag awake events. They don't count in the evaluation process but the machine doesn't know that.
We call these awake breathing irregularities Sleep/Wake/Junk for lack of a better term. SWJ for short. It very common for newbies to have a lot of awake time get recorded because let's face it...sleeping with all this stuff attached to us with air blowing up our nose just isn't natural. Eventually it does become natural and you won't spend so much awake time with the machine running and thus less chance of SWJ messing with the numbers.
The machine is accurate but it doesn't/can't remove awake events which get a flag and during a sleep study there is a way to know for sure if you are asleep and the tech removes any awake events from the reporting.

That particular AHI graph isn't particularly useful. It's just a generic total on a per hour basis. Since the bulk of your flagged events seem to be flagged during a known awake time it's a pretty safe assumption that those aren't real and have to be removed from the evaluation process..at least mentally removed.
I am betting the biggest portion of your AHI is Clear Airway/Centrals and also betting that they are SWJ for the most part. The ones in the known for sure awake time definitely don't count.

It is more helpful if we see the entire detailed report from SleepyHead
Like this one except I omitted the flow rate and cut off part of the AHI on the left but it is only Respironics report I have handy to share.

[reinvigorated]

Got it, makes perfect sense.

Here is the full report, just in case:
https://ibb.co/ehFShv

[Pugsy]

Looks like pretty much what I expected with the known 2 hour awake time.

For right now I suggest concentrating on getting comfortable and having better sleep quality and not so much on the AHI.
Those SWJ events will totally trash your AHI and while they are "real" in the machine's eyes they aren't real when it comes to evaluating the therapy itself. Gotta be asleep first before anything counts. That's why it is called sleep apnea and not awake apnea.

I was all over the place myself when I first started therapy. Woke often just to feel the mask on my nose if nothing else.

[reinvigorated]

I see. Well, thanks again! I appreciate you taking the time to respond in detail! Really hope the therapy will be successful.