New to This - ASV, Bi Level, Mask Questions

I'm 37 and am fairly healthy, although I'm sure I've had sleep apnea since High School. My wife finally convinced me to get a sleep study done and it basically says that I have "Severe Sleep Apnea". It says that I had 94 events per hour due to 104 obstructive, 10 central, 6 mixed apneas and 15 hypopneas. My oxygen levels dropped to 75%. I'm not sure what all of that means but apparently it isn't good! My doctor is recommending a "bilevel" or an "ASV" machine instead of a standard CPAP machine. I go back in for another sleep study to test both of these machines in about a month.

In the meantime, they've loaned me an APAP machine...and I'm having a terrible time with it. I wake up feeling worse using the machine than I do without. In the beginning, I would usually rip the mask off of my face at some point during the night and not remember doing it. But now, after a few weeks, I'm finally getting used to the mask. Now, my problem is that after 4 hours my mask starts leaking. The first 4 hours it's fine. Then it starts leaking and I can't get it to stop no matter how tight I adjust the straps. I breathe through my mouth and cannot breathe through my nose, so I'm stuck with the full face option. The first mask was a ResMed Quattro FX, after 4 hours it leaked above my nose. The mask I'm trying now is a ResMed Quattro Mirage. It seems to fit a lot better and even has a nose dial thing for tightening...but after about 4 hours it starts leaking really bad also, but it leaks around my chin. Just like the first mask, after it starts leaking I can't get it to stop no matter what I try. I looked at the display after it started leaking last night and it said "15.7". Are masks just not meant to withstand that much pressure without leaking? I do have a beard, but that wouldn't explain the first mask leaking around the nose. And why would both masks not leak for the first 4 hours? It doesn't make sense to me.

Will the Bilevel machine or the ASV machine be any different in this regard? Do they use the same mask?

Any advice you might have would be GREATLY appreciated! I'm determined to figure this out.

Thanks!

You will likely still have the leak issues after 4 hours no matter what machine you are using.
Wonder if facial oils are making things worse later in the night?
I would look at maybe trying a mask liner of some sort to see if it helps. Many people use them with great success and if it is some facial oil adding to the problem then it will help absorb some of those oils.
Padacheek makes some nice ones
http://www.padacheek.com/PAC_Maskliners.html

You can also try making your own liners out of an old T shirt to give yourself an idea if they might help or not.

Probably wouldn't hurt to evaluate your machine software reports to see if anything unusual is going on at that 4 hour mark that might be affecting things. Most apap machines have easy to obtain and use software....so tell us which machine you are using and we can hopefully point you to the software.

Thanks Pugsy for the quick reply! The machine is a Phillips Respironics System One "60 Series" RemStar Auto with A-Flex 560P. They have it set at 10 to 20 cm H20.

I did download the Sleepy Head software and it pulls up the information from the SD Card...I just don't know how to read it yet. Although I did see something that made sense to me which said "Your latest AHI was 11.97 which is considered Horrible, please consult your doctor." LOL

That AHI that was horrible....what was the index (average) for each category?
Clear Airway (Central) Index
Obstructive Airway Index
Hyponea index

If they are already talking bilevel or ASV then I would not be surprised if the CA index was high but let's check it out to make sure.

Basic mono-level CPAP and APAP machines essentially have the same Inspiratory (IPAP) and expiratory (EPAP) pressure. ResMeds (AirSense) have Expiratory Pressure Relief and Respironics (REMstar) have Flex Pressure Relief which can lower EPAP up to 3 and 2 cm, respectively, to make it easier to exhale. This difference between IPAP and EPAP is called Pressure Relief, and with these basics machines, it isn't very much.

Bi-level machines (known as VPAP or VAUTO with ResMed, and BiPAP with Respironics) allow a larger Pressure Relief, which can help you breath deeper. Perhaps your low oxygen level calls for this. However, if overdone, excessive Pressure Relief can cause your CO2 level to drop too far causing you to pause your breathing even with an open airway and this will be seen as a Clear Airway Apnea. CAs can be caused by other things though. Basic BiLevels can also be had in automatic versions.

Beyond the basic BiLevels are those that can help breathing problems by responding to Spontaneously triggered or Time triggered breaths. These are known as BiLevel with Backup Rate, and include the AirCurve 10 ST and the Respironics AVAPS models. The ASV models such as the ResMed AirCurve 10 ASV and the Respironics autoSV, take this a step further and are mostly targeted toward Complex Apnea.

Your mask leak problem is entirely separate from this and you've received some good suggestions.

Stewart194 wrote:In the meantime, they've loaned me an APAP machine...and I'm having a terrible time with it.
...
Now, my problem is that after 4 hours my mask starts leaking. The first 4 hours it's fine. Then it starts leaking and I can't get it to stop no matter how tight I adjust the straps.

What's the APAP range set for? And what is the pressure level up to when you wake up with the leak problems? And have you tried turning the machine OFF and then back ON to see if that helps the mask reseat itself?

If you have a good seal at the beginning of the night at something like 4-6cm of pressure, but the pressure has increased to the 12+ range by the time the leaks wake you up, that may be part of the problem: Getting a good seal on a mask at pressures above 12+ can be difficult if you're fitting the mask at 4-6 cm.

And pugsy's idea about facial oils being part of the problem is also worth investigating.

Here is what SleepyHead reports for the last night that I downloaded the data a few days ago.

Average Hours per Night 05:15
Compliance 100%
Therapy Efficiacy
AHI 11.97
Obstructive Index 3.42
Hypopnea Index 5.89
Clear Airway Index 2.66
Flow Limitation Index 1.14
RERA Index 4.56
% of time in Cheyne Stokes Respiration 0.33%
Leak Statistics
Average Leak Rate 6.26
90% Leak Rate 13.00
% of time above Leak Rate threshold 1.27
Pressure Statistics
Average Pressure 12.46
Min Pressure 4.00
Max Pressure 17.00
90% Pressure 14.50

Looks like your AHI is primarily obstructive and your pressure needs appear to be in the upper teens.
It also appears that the minimum pressure is starting out at 4 which is typical for apap trial.
If the minimum pressure was higher the AHI would likely come down. How much higher is hard to say without seeing the detailed pressure graphs is hard to say. Sometimes when the minimum pressure is more optimal and does a better job holding the airway open and thus preventing the airway from collapsing in the first place we find that the pressure doesn't have to go so high.

Thanks everyone for the great advice. I will wash my face before bed and try the t-shirt thing also. I won't get too worked up over the settings on this loaner machine...but I'm sure I'll have a lot of questions after I get my permanent one.

Thanks again!