Air Hunger with Different Masks/CL2?

[happysleeper]

Hi all,

I have just finished my first month on cpap therapy. I've successfully used the OptiLife mask with nasal cushions, and can totally relax and breathe with my diaphragm with it. However, I'm trying out the Comfort Lite 2 (better for side sleeping?), and I'm feeling air hunger with it. I have to use my accessory muscles (chest) to breathe, and I feel that I need to suck in the air. If I relax, I find that I need to breathe in through my mouth about every 10 breaths to get "good air". I can't seem to keep the CL2 on for more than 10 minutes due to the feeling of air hunger. No kinks in the hose, all connections good. Has anyone else experienced a difference in ease of breathing with different masks, and specifically, air hunger with the CL2?

I currently using apap, with the flow settings 6-10. I'm finding that my average air flow is 10. I will probably go back to cpap and just keep 10 as my airflow. However, even with 6 I don't feel air hungry with the OptiLife. I have the humidifier at 2.5, which is the highest I can get without rainout. I have a hose snuggy.

My numbers last night: avg flow: 10 leak 0.16 AHI 6.2 AI 0.2 HI 6 Hours sleep (with OptiLife) 7.45

Thanks,

Happy Sleeper

[harry33]

if you are using the ramp this would be the cause, if not, I dont know whats wrong

[Sleeprider]

You are using an APAP range of 6-10 and your average is 10 cm-H2O. Your range is set too low. Try 8-12 range and see what happens. That should avoid the sense of starving, and gives your APAP some room to move around your current average/max. You mention your AHI is 6.2, and there is certainly room for improvement, Qualitatively you aren't feeling well if you are "starving" for air and straining to intake air, requiring you to mouth breath.

What altitude are you at?

[happysleeper]

Your range is set too low....Try 8-12 range and see what happens...What altitude are you at?

Sleeprider, we're at about 124 feet. Good thought, but we aren't high enough to cause low 02 in the ambient air. Thanks for the suggestion to raise the flow range. It looks like even with the mask where I don't feel air hunger, that's called for.

If you are using the ramp this would be the cause

Harry 33, I am using the ramp, which could contribute, however I don't feel the air hunger at 6 liters with the OptiLife mask. I'm just curious why I would feel it with one mask and not another. Perhaps my mask is defective.

Thanks, friends for the input! Always a work in progress.

Happy Sleeper

[evbirch]

I tried a nasal pillow mask and had terrible problems with air hunger. When I switched to the mask I use now (can't remember the name, but the pic is below) the air hunger disappeared. I think that different masks can affect you differently.

[TerryB]

I have used the Swift LT for some time now and was generally happy until a while back I seemed to have trouble maintaining a seal.
I switched back to my CL2 and felt like I had a good seaL, but felt like it took more effort to inhale although the machine setting was always the same.
The LT of course was pillows while the CL2 was direct seal. The nozzle size seems almost identical.

TerryB

[Slinky]

Well, I regularly use the Simplicity simple nasal cushion. A while ago I opted to try the OptiLife, altho I tried the nasal cradle cushion rather than the nasal pillows.

It felt like I had turned my pressure up 1-2 cms w/the OptiLife over the Simplicity. I also tried the Swift LT for Her. The pressure felt the SAME w/the Swift LT for Her as it did w/the Simplicity.

And now, just recently I've started using the ProBasics Zzz-Mask instead of the Simplicity. The ProBasics Zzz-Mask feels like I turned the pressure up 1-2 cms just as that same sensation w/the OptiLife nasal cradle cushion.

[tillymarigold]

I had that with both the CL2 and the OptiLife.

The Opus is the first mask I haven't had that problem with. I think it's because the pillows are shaped differently on the Opus (more like a trumpet instead of a cone), so the size that fits my nose has a larger opening than on the CL2 or OptiLife. I use a medium on the Opus, small OptiLife, and a 4 on the CL2 (I think .... it's been awhile, the CL2 was my first mask).

[JoyD.]

.
I'm wondering if a larger pillow with the CL2 would work better for you. It would have bigger holes and I imagine that you wouldn't feel the same difficulty getting air - as long as you had a good seal with it. I found I had to go up a size for the same reason. The S and XS have particularly small holes.

Joy

[tillymarigold]

By the way, I slept on my side with the OptiLife for 2.5 years. So it's definitely possible, but the Opus is way better than the OptiLife was (for side sleeping, for air hunger, and for quietness/softness of the venting).

[happysleeper]

I think that different masks can affect you differently.

Thanks, evbirch, that's why I love this site. Makes me feel like I'm NOT going crazy!

I switched back to my CL2 and felt like I had a good seaL, but felt like it took more effort to inhale although the machine setting was always the same.

TerryB, It's helpful to know that you had that experience with the same mask. According to the machine's clinical manual and website, both the OptiLife and the CL2 take the same machine mask setting, so I'm fine there...

It felt like I had turned my pressure up 1-2 cms w/the OptiLife over the Simplicity.

Slinky, when you say that it felt like you had turned the pressure up, do you mean that you had less air hunger due to better flow? Or that it was harder to breathe with more pressure? That may help me to know if I should try the Simplicity or not--thanks!

I'm wondering if a larger pillow with the CL2 would work better for you. It would have bigger holes and I imagine that you wouldn't feel the same difficulty getting air - as long as you had a good seal with it. I found I had to go up a size for the same reason. The S and XS have particularly small holes.

JoyD, thanks for the comparisons of the different sizes of CL2. I'm meeting with the DME rep this morning to try the different sizes of nasal pillows, and also to try the direct seal which TerryB has used. I'll let you all know if I find any difference.

Thanks to tillymarigold for the information about the Opus compared to the CL2. As I'm limited to one mask every 3 months through my insurance, and I've already outright bought one mask myself, I think I'll try the Opus when my insurance will pay. It's really good to know that you had the same problem with the CL2, and that the Opus worked better for you.

Now that I know that different people do have different levels of air hunger seemingly randomly with different masks, I'm so grateful that the first mask that I tried, the OptiLife, did not cause the air hunger for me. I had a tough first few weeks, but made it through OK. I spent an hour on my side last night in relative comfort, (the reason that I'm mask shopping in the first place) but I did wake up with a big indent in my cheek from the Optilife plastic headgear. I will try moleskin for that spot on my cheek. Progress is good!

Thanks again, Happy Sleeper

[tillymarigold]

Try Pad-a-Cheek, which are fleece tubes that go around the parts of the mask that touch your face. Or you could make your own.

The Opus is much worse for it than the other two, because the part that goes across your face is hard plastic.

[happysleeper]

Hi all,

I met with my DME provider today; not very helpful.

HOWEVER, I did more computer reseaarch, and found out some very interesting information about the CL2. At this URL
http://comfortlite2.respironics.eu/pdf/ ... tLite2.pdf Respironics has a pdf with patient instructions for using it.

It states that "at low pressures, the air flow through the exhalation port may not be enough to clear all the exhaled gas (C02) from the mask. The patient may rebreathe some of the air previously exhaled."

WOW! I hope to use this mask, but want to use it safely.

I put a call in to Respironics to ask them what is considered "low pressures", as my ramp starts at 6. They will call me back in the next two business days. I think that this is very important information for DME companies to give their patients, especially those starting at low pressures. I'll put off using the ClL2 until I've arranged with my doc to raise my starting pressure to 10 or above.

Happy Sleeper

[tillymarigold]

I don't know what the timeframe of your ramp is, but it seems unlikely that ramping from 6 over, say, 20 minutes would cause a huge problem. I think they're talking about if your prescribed pressure for all night long is low, that would be a problem.

People re-breathe exhaled CO2 all the time ... the most obvious example being if you're wearing a scarf outside because it's cold, or if you sleep with the blanket pulled over your head. You can't do it all day or all night, but re-breathing some CO2 along with the clean air you're getting isn't going to endanger your health.

[happysleeper]

You can't do it all day or all night, but re-breathing some CO2 along with the clean air you're getting isn't going to endanger your health.

Tillymarigold, I think you're probably right about no endagerment to health with short term re-breathing of C02. However, the feeling of air hunger with my CL2 at 6 sure is uncomfortable! My ramp is set for 15 minutes, and keeps me at a flow of 6 until I have a hypopneic event, then the apap kicks in and raises the flow to as high as 10.

I would like to see a study done on what is considered a short term non-health affecting affect of rebreathing c02 vs. what is considered to be too long. Symptomatically, if you have a headache or feel air hungry, that seems to me to be enough exposure to be of concern. I did a short literature hunt on Academic Search Premier and didn't find any research articles on the topic.

However, as my DME company had me as receving Cpap with an all night flow of 5 when they dispensed the mask, I could potentially have had co2 retention all night. I'm looking foward to hearing from Respironics as to what flow they consider as low. All very interesting...I know, I like this stuff...

Happy Sleeper