New, please help with what are OK numbers and Quattro FX

[mhj]

My husband was diagnosed with severe OSA in March, and he has adjusted fairly well to treatment, but we are working through what I am guessing are inevitable mask problems. The DME company set him up with a RemStar Pro with C-Flex +, System One Humidifier (I guess it says all this below) and a Respironics ComfortGel Full mask size L. His pressure is 16. I have not yet been able to get my hands on the EncoreView software, so my knowledge of how he is doing is limited to the information I can get off the machine, and I've kept a running log of his therapy and blower hours and from time to time the large leak, AHI, and periodic breathing averages too.

With a little practice, we were doing very well getting a seal on the mask, but he had major comfort issues: the mask ripped up his nose, and he got headaches in the morning from the pressure of the forehead pad over his eyes. We tried a method with silicone ear plugs to try to make him more comfortable, improvised liners out of several different fabrics, and finally settled on a band-aid on his nose which at least made the nose better. After a few weeks, we contacted the DME company for a refit, and he came home with a F&P Forma mask size XL (he is a big guy). This was a disaster. The mask was painful to wear, I suspect because the bridge of the nose was too narrow for him, and it leaked like a sieve no matter what we did. We tried it on two nights for about an hour each, and it was so uncomfortable that he was no longer interested in trying. Back to the drawing board and the ComfortGel Full.

I did some research on what masks do not have a forehead pad, and of those the Quattro FX seemed the best accepted from what information I could find. When the ComfortGel started to leak badly, I once again called the DME company and asked them if it was possible for him to get the Quattro FX. It was, and he has had the mask in L since Friday.

The good news is that the Quattro FX is much more comfortable - no headache, and his nose is fine without anything to protect it. The bad news, which I suspect no one reading this will be surprised to hear, is that it leaks. Apparently, it leaks much more that either one of us was aware. The 7 day LL% averages for the three nights he has worn the mask have been 15, 14, 15. Of course this is no exact measurement as it is an average which includes the last 3 measurements I have for the ComfortGel: 20, 18, 20. Earlier readings for LL with the ComfortGel were as low as 1 and 3. We have tried various suggestions for how to get a better seal on this mask with varied success, but at what %LL is treatment really compromised?

The next question I have is about AHI. His averages have been a bit higher than ideal (which I understand is <5), mostly around 7, but have been 9.2, 9.6, 9.7 with the Quattro FX (remember that's 7 day average, but the numbers were not high early in the week). Are these numbers to be concerned about, or just not ideal? Finally, periodic breathing - I've read up on it, I know what it is, but I don't know how much of it is worrisome. He was averaging around 12% (between 6 and 14) with the ComfortGel, and the 7 day averages since he started with the Quattro FX have been 16, 19, 17. Is this an artifact of the mask leaking and nothing worth thinking about, or should it be investigated further?

We really want this mask to work (and yes, I know there are lot of masks out there, but very few that I think will work for him), but I don't want to keep trying it if the eccentricities of the mask are compromising his treatment. He was finally starting to feel a lot better (other than the headaches and the sore nose) and I want to see that continue. We have been leaving the headgear pretty loose, which I thought was helping, though I'm not sure now, and I think it might be worth trying the large headgear as he is pretty big and the straps are pretty short. Otherwise, I'm kind of at a loss.

Thoughts? Suggestions? And thank you for reading this far.

[Pugsy]

Mask leak reported on the PR System One machine is ONLY time in Large leak status so any leak showing is really bad because it takes a huge leak to be counted as a large leak on the Respironics machines.

So.... the leak is bad, very bad. So bad, we can't really trust the other AHI averages.

http://www.onkor.net/
Check out Onkor for online data analysis. It will work with the SD card and show daily details and the real leak. This is so much better than the limited data that is available on the LED screen.

You can use this analyzer while waiting to decide on which software you want to use. Or just use it all the time if you wish.
Data reported is same as with software, just visually offered differently. Instructions step by step "how to use" link is also there at the website.

[TimWK]

What size is the headgear? I had the Quattro FX large that came with the medium headgear. It seems to fit better with the large.

Best Regards

[redjoe]

I don't understand why they would pair a medium headgear with a large mask. Am I the only one who thinks that doesn't make much sense?

As for the leaks, are you putting the mask on the way the video shows, a kind of downward rocking motion, starting at the bridge of the nose? When I looked into it, they put a strong emphasis on that.

Good luck!

[bayourest]

I am having very good success in both comfort and "numbers" with my quattroFX which I have had since mar 21.
I think that it's important to watch the video on the ResMed site about how to put it on. I think the question about adjustment is also very important. I find that if I make the lower straps a little tighter and leave the upper straps a little more "relaxed' I get good results. I do have some strap marks in the a m on my face but they fade quickly and the lower straps are not so snug as to be uncomfortable or tight. I also think that anytime you change masks you have to give it a week or so before you know how you are really doing with it. It might also be a good idea to try out different adjustments during the day when you are awake and can practice and change the straps if needed. Just adjusting to ANY mask is HUGE when you are starting this. and a mask liner from padacheek.com increases comfort for me.
I think the quattro fx is far more comfortable than the quattro mirage or quattro ultramirage, both of which have the forehead piece. And if your husband is not a mouth breather there are lots of nasal masks that could be worth trying. I have never tried them because I know I need a full face mask.

[mhj]

Thanks to everyone for your kind responses.

I have considerably more information since I posted the other day: I now have not only the EncoreView and his results for the past 59 days, but the full reports for both sleep studies, and all I can say is wow (it helps when he does work at the sleep study center). Compared to the AHI of 90.9, 120 supine, in his initial study, with sats dropping into the 50's, AHI's in the 9's don't seem so bad. We actually met with the head respiratory therapist, who thinks he is doing remarkably well, even with a leaky mask. However, she feels that we don't have a chance of a good fit with the Quattro FX until we get the Large headgear. Besides the leaks, the side supports have been bothering his eyes, and I think this headgear is holding the whole mask up too high for him.

Accordingly, we are putting the Quattro FX aside until the DME company gets that for us, and she gave us two other masks to try in the meantime, Respironics ComfortFull 2, which he used in his titration study (unfortunately the nasal masks did not work well for him, hence the full face), and Respironics FitLife. He says he feels like he's in a fishbowl in the FitLife (the total face mask), so I expect we'll be returning that to her, but he's using the ComfortFull 2 tonight, and other than a loud leaky period a little while ago (how I came to be up at this hour), it seems to be working OK. We'll have to see how his nose is in the morning, though he used the new mask for a nap early this evening, and it was fine. I'm encouraged by the fact that the ComfortFull 2 hits significantly higher on the nose than the ComfortGel that bothered his nose so badly. I hope the numbers will bear out my subjective sense that the seal has been mostly good. I actually think that the leak that woke me up, while loud, was not in fact very big.

Once again, thank you for sharing your knowledge and experiences with me. You make starting out the CPAP experience seem less frustrating.

[katcw]

Once you get the new headgear, do give the FX another chance. Watch the video on how to put it on - that makes a huge difference. Also, my RT told me to really tighten down the straps, which made things better. Best of luck to you both!

[mhj]

Thanks, do intend to try again, assuming I can get my husband to cooperate (he just wants something that lets him sleep through the night and doesn't care which one). I did watch the video, and I think we were doing as well as possible with this headgear. How they expected a 6'3" large guy to wear medium headgear I'm not sure. But I did really like the mask, and I do hope it works out with headgear that fits.