general questions/therapy

General Discussion on any topic relating to CPAP and/or Sleep Apnea.
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zonker
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Re: general questions/therapy

Post by zonker » Sat Aug 07, 2021 10:06 pm

1speechpick wrote:
Sat Aug 07, 2021 7:23 pm

Zonker: Starting back at ground zero (4 cm) and inching up in .2 increments made the difference in being able to tolerate CPAP (versus giving up). Many, many thanks! Right now, straight CPAP mode (with use of EPR) also seem to help manage aerophagia. I seemed to have more aerophagia in APAP mode, though I'm unsure why. I will have try APAP mode again in a few weeks.
there are people here that will say that NO you can't use cpap and apap is better.

but YOU are the one in charge of your therapy. and you ain't gonna get ANY sleep if gas pains are keeping you awake. you do what you need to do to get the sleep. then we can work on improving your therapy.
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Re: general questions/therapy

Post by 1speechpick » Thu Aug 12, 2021 1:08 pm

zonker wrote:
Sat Aug 07, 2021 10:06 pm
1speechpick wrote:
Sat Aug 07, 2021 7:23 pm

Zonker: Starting back at ground zero (4 cm) and inching up in .2 increments made the difference in being able to tolerate CPAP (versus giving up). Many, many thanks! Right now, straight CPAP mode (with use of EPR) also seem to help manage aerophagia. I seemed to have more aerophagia in APAP mode, though I'm unsure why. I will have try APAP mode again in a few weeks.
there are people here that will say that NO you can't use cpap and apap is better.

but YOU are the one in charge of your therapy. and you ain't gonna get ANY sleep if gas pains are keeping you awake. you do what you need to do to get the sleep. then we can work on improving your therapy.
Thanks Zonker! Once I work through the aerophagia, I'm certain APAP would have many advantages.
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Re: general questions/therapy

Post by 1speechpick » Thu Aug 12, 2021 1:43 pm

I'm continuing to get condensation in my Resmed N20 Airtouch (and the Airfit) masks. I tried prior suggestions of lowering the humidity and lowering the tube temperate, to no avail. I still get condensation and a lot of it. Using the search bar, I saw an older post that recommended getting a tube cover for the short tube that connects to the N20 mask. We keep our bedroom at 67 degrees at night. I have the humidity set at 3 and tube temp at 73. I assume when the air leaves the heated tube and enters the short tube that's when the condensation is forming? Is it also necessary to get a pad-a-cheek cover for the actual mask, in order to get rid of the condensation?
Last edited by 1speechpick on Thu Aug 12, 2021 1:45 pm, edited 1 time in total.
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Re: general questions/therapy

Post by Pugsy » Thu Aug 12, 2021 1:44 pm

A word about the apap is "better" than cpap argument....apap can be better depending on circumstances but there is no reason that a person can't be successful with fixed cpap as well. It all depends on if a person has a need for changing pressures or not. Some people might simply never have much of a need for more pressures...
Wouldn't work well for me because of the pressures I need in REM which are a lot higher than non REM but not everyone will have a need for more pressure. REM doesn't always cause a need for more pressure and sleeping supine doesn't always cause a need for more pressure.....it's nice to have it available just in case but some people just won't ever need it.
Remember that YMMV sticker....it's on everything.

There's nothing wrong with using fixed or even a really tight pressure range if allowing the machine to roam with its pressures causes a problem of some sort. The goal is prevent most apnea events and sleep well and feel good during the day...not kill 100% of them especially when the killing causes more sleep problems than it fixes.

As for flow limitations...the machine will sure want to kill them because they might grow up to be full grown apnea events of some sort but they don't always grow up and become a problem. Just because the machine wants to go killing something doesn't mean we just have to let it when the letting it causes more problems than the FLs are causing.
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Re: general questions/therapy

Post by Pugsy » Thu Aug 12, 2021 1:50 pm

1speechpick wrote:
Thu Aug 12, 2021 1:43 pm
I tried prior suggestions of lowering the humidity and lowering the tube temperate, to no avail.
Wrong way to go with the hose/tube temperature change to reduce condensation....needs to be increased and not decreased.
Warm air will hold on to more water than cool air.

The idea with the short hose cozy is to prevent the warm air from the heated hose from cooling off once it leaves the long heated hose due to the ambient room temps being cooler. The short hose cozy helps slow down the cooling off of the air once it leaves the heated hose.

Crank UP the hose air temp first...if that doesn't help then we consider short hose cozies or mask cozies of some sort....
finally if nothing helps...increase the ambient bedroom temps if at all possible so that the air in the hose/mask doesn't cool off so quick.
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Re: general questions/therapy

Post by Pugsy » Thu Aug 12, 2021 1:53 pm

Also remember that our own exhaled breath contains moisture and if the moisture that is condensing in the short hose or mask is from your own breathing....lowering the humidity setting on the humidifier isn't going to help at all.
I know people who don't use a humidifier at all and get condensation in the mask or hose...all moisture comes from their own breaths.
That's why I don't recommend lowering the humidity setting (at least at first) for condensation complaints at the mask level. There's a high probability it won't help because the moisture is very likely coming from just exhaling.
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Re: general questions/therapy

Post by 1speechpick » Thu Aug 12, 2021 2:19 pm

Pugsy wrote:
Thu Aug 12, 2021 1:53 pm
Also remember that our own exhaled breath contains moisture and if the moisture that is condensing in the short hose or mask is from your own breathing....lowering the humidity setting on the humidifier isn't going to help at all.
I know people who don't use a humidifier at all and get condensation in the mask or hose...all moisture comes from their own breaths.
That's why I don't recommend lowering the humidity setting (at least at first) for condensation complaints at the mask level. There's a high probability it won't help because the moisture is very likely coming from just exhaling.

Thanks for your help, Pugsy!

You commented back to me in a different thread about the Fitlife Total Face Mask. I didn't comment back, as I didn't want to hijack the thread with my issues. I'm in desperate need of a FFM during allergy season. I tried the Resmed FFM but it significantly drove up the Ahi (like to the upper 20s and increased pressure or cervical collar didn't help). You suggested it was likely due to pressure from lower straps on the lower jaw creating more airway obstruction (and I'm certain you are right). My question is...do you think the Fitlife total face mask would have this same kind of pressure? I tried the F&P Flexifit HC432 because it comes below the jaw, but I couldn't get a good seal.
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Re: general questions/therapy

Post by Pugsy » Thu Aug 12, 2021 2:50 pm

1speechpick wrote:
Thu Aug 12, 2021 2:19 pm
Pugsy wrote:
Thu Aug 12, 2021 1:53 pm
Also remember that our own exhaled breath contains moisture and if the moisture that is condensing in the short hose or mask is from your own breathing....lowering the humidity setting on the humidifier isn't going to help at all.
I know people who don't use a humidifier at all and get condensation in the mask or hose...all moisture comes from their own breaths.
That's why I don't recommend lowering the humidity setting (at least at first) for condensation complaints at the mask level. There's a high probability it won't help because the moisture is very likely coming from just exhaling.

Thanks for your help, Pugsy!

You commented back to me in a different thread about the Fitlife Total Face Mask. I didn't comment back, as I didn't want to hijack the thread with my issues. I'm in desperate need of a FFM during allergy season. I tried the Resmed FFM but it significantly drove up the Ahi (like to the upper 20s and increased pressure or cervical collar didn't help). You suggested it was likely due to pressure from lower straps on the lower jaw creating more airway obstruction (and I'm certain you are right). My question is...do you think the Fitlife total face mask would have this same kind of pressure? I tried the F&P Flexifit HC432 because it comes below the jaw, but I couldn't get a good seal.

OMG yes the FitLife would very likely cause the same kind of pressure from the straps ...if not more than the other full face masks. Plus it's a bitch to even get sealed.

The simplest fix for you if you find the AHI increases with a full face mask ....I would just increase the pressure a bit and let the machine sort it out. Just about any full face mask out there is going to have to anchor with a lower strap and has the potential for altering the airway positioning every so slightly so that you need more pressure to hold the airway open.

I don't know what pressure you are using or mode...but if it were me I would just increase the baseline pressure a bit (like maybe 2 cm) and use the FFM that you happen to sort of like and have some success with and see if the AHI comes down to an acceptable level. I don't know of any full face mask that doesn't use lower straps to anchor the bottom of the mask except the Oracle and that's a totally different beast.

Just how much higher AHI are we talking about here anyway?
What is the AHI with a nasal mask and what is it with FFM?
Are you using apap mode or fixed? What settings?
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Re: general questions/therapy

Post by 1speechpick » Thu Aug 12, 2021 3:19 pm

Pugsy wrote:
Thu Aug 12, 2021 2:50 pm
1speechpick wrote:
Thu Aug 12, 2021 2:19 pm
Pugsy wrote:
Thu Aug 12, 2021 1:53 pm
Also remember that our own exhaled breath contains moisture and if the moisture that is condensing in the short hose or mask is from your own breathing....lowering the humidity setting on the humidifier isn't going to help at all.
I know people who don't use a humidifier at all and get condensation in the mask or hose...all moisture comes from their own breaths.
That's why I don't recommend lowering the humidity setting (at least at first) for condensation complaints at the mask level. There's a high probability it won't help because the moisture is very likely coming from just exhaling.

Thanks for your help, Pugsy!

You commented back to me in a different thread about the Fitlife Total Face Mask. I didn't comment back, as I didn't want to hijack the thread with my issues. I'm in desperate need of a FFM during allergy season. I tried the Resmed FFM but it significantly drove up the Ahi (like to the upper 20s and increased pressure or cervical collar didn't help). You suggested it was likely due to pressure from lower straps on the lower jaw creating more airway obstruction (and I'm certain you are right). My question is...do you think the Fitlife total face mask would have this same kind of pressure? I tried the F&P Flexifit HC432 because it comes below the jaw, but I couldn't get a good seal.

OMG yes the FitLife would very likely cause the same kind of pressure from the straps ...if not more than the other full face masks. Plus it's a bitch to even get sealed.

The simplest fix for you if you find the AHI increases with a full face mask ....I would just increase the pressure a bit and let the machine sort it out. Just about any full face mask out there is going to have to anchor with a lower strap and has the potential for altering the airway positioning every so slightly so that you need more pressure to hold the airway open.

I don't know what pressure you are using or mode...but if it were me I would just increase the baseline pressure a bit (like maybe 2 cm) and use the FFM that you happen to sort of like and have some success with and see if the AHI comes down to an acceptable level. I don't know of any full face mask that doesn't use lower straps to anchor the bottom of the mask except the Oracle and that's a totally different beast.

Just how much higher AHI are we talking about here anyway?
What is the AHI with a nasal mask and what is it with FFM?
Are you using apap mode or fixed? What settings?
Thanks for your response, Pugsy!

With ResMed AirTouch N20:
CPAP mode, IPAP 5, EPAP 4 (low pressure due to aerophagia)
AHI: always lower than 2.5

With Airtouch FFM
CPAP mode, IPAP 6, EPAP 5
AHI ranges from 25-30 and I feel like crap the next day
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Re: general questions/therapy

Post by Pugsy » Thu Aug 12, 2021 3:57 pm

1speechpick wrote:
Thu Aug 12, 2021 3:19 pm
With Airtouch FFM
CPAP mode, IPAP 6, EPAP 5
AHI ranges from 25-30 and I feel like crap the next day
Increase in OAs or Centrals?

If OAs...you just need higher than IPAP of 6...how much higher I don't know.

If centrals we need to have a different discussion.

Which model machine....AirSense or AirCurve? I forget but the model tells me if you are using EPR to get the difference or PS.

The aerophagia greatly complicates dealing with OAs because for OAs more pressure is needed but most likely the amount needed is going to worsen aerophagia. The proverbial rock and a hard place to be caught in.

I don't remember...did you ever try a cervical collar with the FFM?

How often or how long do you anticipate ever needing a full face mask?
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Re: general questions/therapy

Post by 1speechpick » Thu Aug 12, 2021 4:35 pm

Pugsy wrote:
Thu Aug 12, 2021 3:57 pm
1speechpick wrote:
Thu Aug 12, 2021 3:19 pm
With Airtouch FFM
CPAP mode, IPAP 6, EPAP 5
AHI ranges from 25-30 and I feel like crap the next day
Increase in OAs or Centrals?

If OAs...you just need higher than IPAP of 6...how much higher I don't know.

If centrals we need to have a different discussion.

Which model machine....AirSense or AirCurve? I forget but the model tells me if you are using EPR to get the difference or PS.

The aerophagia greatly complicates dealing with OAs because for OAs more pressure is needed but most likely the amount needed is going to worsen aerophagia. The proverbial rock and a hard place to be caught in.

I don't remember...did you ever try a cervical collar with the FFM?

How often or how long do you anticipate ever needing a full face mask?
Thanks again, Pugsy!

I had a couple of nights on FFM when centrals were between 5-6 per hours, but on most nights they were below 5 per hour. It was mostly the OAs that increased terribly. when using FFM. I tried a cervical collar with FFM a couple of nights and they OAs did not decrease. I would only need a FFM during allergy season when nasal congestion is out of control. I have the Airsense 10 Auto Set for Her. I wish I had an Aircurve so I could get a higher IPAP and lower EPAP (more than the 3 that EPR gives). At least while I'm working through the aerophagia. The aerophagia is getting some better as long as I don't increase the pressure more than .2 cm at a time.
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Re: general questions/therapy

Post by Pugsy » Thu Aug 12, 2021 5:05 pm

Ah....so essentially using EPR at 1 for now. What happens if you use more EPR?

What was the max IPAP and max EPR you have ever used with the FFM? Did you ever try more IPAP than what we are seeing now? Did that max cause aerophagia? Did it reduce the AHI very much if at all?

Bilevel machines...you can make your current machine function within limits
On the AirCurve 10....EPAP 4 and PS of 3 is essentially the same as
on the AirSense 10 IPAP 7 and EPR of 3
Both will end up giving a person exhale of 4 and inhale of 7

A person really needs to want to use more than 3 cm difference between inhale and exhale to make bilevel be all that better option.

How much experimenting have you done with EPR?
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Re: general questions/therapy

Post by 1speechpick » Thu Aug 12, 2021 5:35 pm

Pugsy wrote:
Thu Aug 12, 2021 5:05 pm
Ah....so essentially using EPR at 1 for now. What happens if you use more EPR?

What was the max IPAP and max EPR you have ever used with the FFM? Did you ever try more IPAP than what we are seeing now? Did that max cause aerophagia? Did it reduce the AHI very much if at all?

Bilevel machines...you can make your current machine function within limits
On the AirCurve 10....EPAP 4 and PS of 3 is essentially the same as
on the AirSense 10 IPAP 7 and EPR of 3
Both will end up giving a person exhale of 4 and inhale of 7

A person really needs to want to use more than 3 cm difference between inhale and exhale to make bilevel be all that better option.

How much experimenting have you done with EPR?


Thanks Pugsy! I've experimented some. In looking back through my Oscar here are some stats I have using the FFM:

*Initially when I first started I was on Auto Set 5-15 cm with EPR of 3, with AHI in the 30s (mostly obstructive), and machine was maxing to 15 most of the time.
*I then lowered the pressure to straight CPAP of 7 cm with EPR of 3, AHI still in the 30s.
*I recently tried CPAP 6 cm with EPR of 1, with AHI in the upper 20s.
*All FFM trials have been with Airfit or Airtouch FFM.

When I went to a nasal mask, the AHI dropped. It didn't even look like the same chart. It's crazy!
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Re: general questions/therapy

Post by Pugsy » Thu Aug 12, 2021 5:54 pm

Have you ever even tried one of the FFM that are of the hybrid variety....like the ResMed AirFit F30 or F30i or Respironics Dreamwear FFM?
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Re: general questions/therapy

Post by Pugsy » Thu Aug 12, 2021 8:01 pm

Another thought....have you actually had an allergy attack since starting the machine? Are you just trying to plan ahead for "just in case" with the FFM?
You know it is entirely possible that with the added humidity and additional things that can be done to clear the nasal passageways that the allergy attack can be managed well enough you can still use a nasal mask.
Even a little mouth breathing leak might be preferable to an AHI in the 20s. These machines can compensate fairly well for quite a bit of leak no matter where it comes from. I have an example some where of some known mouth breathing leak and it actually was quite minimal and well within the machine's ability to compensate. I was awake when I did the mouth breathing leak experiment...so I know that mouth breathing doesn't always mean MASSIVE LOSE ALL YOUR THERAPY big leaks. I have proof.

Your aerophagia issues really complicates the situation. You may have to be willing to maybe compromise a bit on leak management and AHI vs having AHI in the 20s with a FFM because you need a lot more pressure with the FFM but the more pressure also creates significant problems. We might have to think about which problem is a worse problem and let something slide a bit. I have had bad aerophagia twice in my cpap life. It's a horrid experience I would only wish on someone I hated with all my guts ( :lol: and there are a few that qualify)....so I totally understand wanting to avoid it.

At least until down the road you maybe work through Zonker's routine and work your way up to being able to use higher pressures without it causing major aerophagia issues.
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