Could mask change = needed pressure change?

[jimstaah]

Hi all!

Since starting CPAP 2 months ago, my pressure (11cmH2O) was prescribed after a sleep study using a full face mask (respironics comfort gel full) with a respironics c-flex system one machine with attached humidifier. I'd noticed a change in energy levels - waking up was easy, and my mood was considerably better. However the mask, despite a myriad of adjustments, was causing sores on my nose bridge. After a few weeks I switched to the Mirage Liberty, which was much more comfortable and did not leak.

The only problem is that since switching I am feeling tired again - I have to drag myself out of bed every morning, and my mood is noticeably worse. With the full face mask the machine was reporting an average AHI of 2.2, but since switching to the liberty it has crept up to 3.8. The new mask does not seem to be leaking -

I guess my question is, while I understand that different CPAP masks are supposed to be to be interchangeable such that the therapeutic effect is maintained at equal pressures, is it possible that this is not the case? Do I have to go back to the doc and get him to retitrate the pressure using the new mask? Has anyone else had the same experience? Are there other factors I have overlooked?

Also I am new to this forum - so apologies if this topic has already been discussed and/or I have posted this in the wrong section!

Jimstaah

[Muse-Inc]

Jim, what are your numbers? What pressures (range, 90thcentile)? Did they change when you changed masks? What is your reported leak and how much over your mask's intentional venting is it? These numbers will help you determine if it's really a problem or just your brain freaking out because you changed something and not letting you sleep as restfully...brains do not like change. How long since you switched?

[SleepingUgly]

In theory the mask you wear should have no impact on your pressure needs. In a titration they often have to switch masks in the middle of the night if there are leaks or other issues.

Are you a light sleeper? Can you tell if you're waking up more with the Liberty?

I found that I woke up more with the Hybrid mask + System One. I didn't know why, and I still don't KNOW... But one theory I have is that the clear airway test puffs of air are more disturbing to my sleep when they occur IN my nose than ON my face. Granted, I don't know if this is true, and it could be something else about the Hybrid (or something that was going on with me at the time, as I was actually experimenting with different pressures). One thing you could do, if you could bear to wear the full face mask again for any time at all, is see if it improves. If you felt good with the traditional full face mask, worse with the Liberty, then good again with the traditional full face mask, you can have a little more confidence that it's the Liberty that's the issue (for whatever reason).

[cobra4x4]

Since you are a couple of months into your therapy, your body is probably just adjusting and your going through what most people refer to as sleep debt.

You will go through this feeling which feels worse than before you were on cpap (Usually lasts a few weeks) as your body adjusts to the new you. All you can do is keep using the cpap as if nothing is happening and you will soon find yourself feeling good again.

[echo]

I had a problem with the liberty that i just couldn't get enough air through the pillows, even though in theory it should be the same as a FFM. If that's the case with you, you may be breathing more through your mouth than through your nose, which can make the therapy less effective... and that small but perhaps significant-for-you change of 1.6 AHI may be the culprit. You might want to try a chinstrap or pap-cap to keep your mouth from blowing open (which is what I got the liberty, moreso than a standard FFM). YMMV!

FYI, you can pretty re-titrate yourself using your data! Normally a mask change (esp from one FFM to another FFM) shouldn't need a pressure change but .....

[jmelby]

You didn't say what kind of machine you have, but it sounds like you are on straight CPAP pressure, not APAP. If your machine is capable of Auto-PAP, you may want to try that instead so that it will adjust your pressure based on need. In theory, I don't think the mask should make a difference in pressure needs, but I too have found that with certain full face masks, my AHI goes up, though I think it is due to higher leak rates. Without looking at your data from the entire night, you don't really know if you are leaking or not--it is possible to get a good seal when going to sleep and then leaking in the night due to sleeping position, etc. and never know it.

I would suggest updating your profile with your equipment information so we can offer better suggestions and know if you have data capabilities.