AHI skyrocketed with Fitlife mask

I'm just 2 weeks into therapy on my second go round and really struggling to find a mask that I can use. I used ResMed Swift FX for Her and Swift LT for Her the first time. Started out fine but didn't last. They make me feel like my nose is stopped up and I can't breathe (particularly one nostril, deviated septum), and they collapse on me. I ended up just taking it off during the night (only sometimes aware of doing so).

From my last sleep study I got the Wisp and really like it but after a couple days it starts to give me a pressure sore on my nose. Then they gave me an AirFit N10 for Her - same problem and less comfortable than the Wisp. I tried LiquiCell cushions but my skin is very, very sensitive and the adhesive was a problem. I also tried a Boomerang Gel Pad but still got the pressure sore starting all over again.

My face is small - the sleep tech referred to it as kid size- so I can't imagine a nasal mask bigger than the Wisp or N10 but also can't see how any of them will not cause the pressure sores.

So I went to a CPAP clinic at my sleep center where they have reps bring various masks so you can try different ones. (One problem is that even one night of use isn't enough to see how it will work out - it took about a week each time for the problems to develop.) I tried both the Fitlife and the Amara View. The Amara View felt like it pushed up against my nose and I expect even that slight discomfort trying it on would develop further with use. (I did have a cauterization a couple days before but my nose is still sensitive 2 weeks later). Finally, the Fitlife felt like the best solution for me. Until ...

I tend to struggle a bit with fit on any mask. I keep having to remind myself that small leaks are expected and okay, and that too tight can make it worse, but I do worry when I feel any leaks, and the Fitlife seems susceptible every time I move. Sleepmapper is reporting no leaks. I'm not experienced enough to understand all the details from Sleepyhead but for the past 3 nights (with Fitlife) bottomline says time over leak redline is 0.544%, 0.000%, and 0.000% respectively. On those same nights my AHI was reported as 5.55, 19, and 13.37.

Over the past 2 weeks I used the Wisp more than any of the others, N10 once or twice and nasal pillow a couple times. I hadn't thought to keep track of which I used on each night. My time over leak redline numbers were all 0.000% except for one night that was 0.220%, and my AHI only went as high as 3 on 3 nights. So the 5.55 seemed high but not outrageous. The 19 really caught me off guard but it seemed like a possible outlier (in the short time I had used CPAP a few years ago with only nasal pillows, I had one of those readings as well). But then another high AHI at 13.37.

I could understand if, for some reason, I might need higher pressures with the whole face mask (my pressure is min. 4, max. 8 and it's been more consistently at 8 the past few days). But what I really don't get is how I am getting these high numbers when my full sleep study 5 years ago showed an AHI of 8 and my home sleep study a few weeks ago was a 10. Regardless of the full effectiveness of the mask, how can I be getting a higher AHI with therapy than I had without?

Is it possible that the machine is flagging awake/semi awake breathing irregularities as some sort of apnea event and thus causing the higher than usual AHI? That would be my first thought for an AHI that is higher than pre cpap therapy....most likely awake/semi awake stuff getting flagged. These machines don't know if we are awake or asleep...they just measure air flow and they are easily fooled by normal breathing irregularities that happen when we are awake and we simple don't realize it.

You need to use the software and actually see when those events are happening and also see what kind of events you are having that make up that AHI. SleepMapper can't give you those details.

Hi,

I have nothing to add to Pugsy's excellent advice but wanted to mention that when I previously used the FitLife mask, my AHI skyrocketed also. This was also true with other full face masks I tried. I always had to increase the pressure to deal with this issue.

I feel in my case, because I had to severely tighten the straps to avoid leaks, it led to my jaw being pushed back. But I have no scientific proof to offer to back up my theory so keep that in mind.

Good luck in resolving your issues.

49er

curems wrote:I'm just 2 weeks into therapy on my second go round and really struggling to find a mask that I can use. I used ResMed Swift FX for Her and Swift LT for Her the first time. Started out fine but didn't last. They make me feel like my nose is stopped up and I can't breathe (particularly one nostril, deviated septum), and they collapse on me. I ended up just taking it off during the night (only sometimes aware of doing so).

From my last sleep study I got the Wisp and really like it but after a couple days it starts to give me a pressure sore on my nose. Then they gave me an AirFit N10 for Her - same problem and less comfortable than the Wisp. I tried LiquiCell cushions but my skin is very, very sensitive and the adhesive was a problem. I also tried a Boomerang Gel Pad but still got the pressure sore starting all over again.

My face is small - the sleep tech referred to it as kid size- so I can't imagine a nasal mask bigger than the Wisp or N10 but also can't see how any of them will not cause the pressure sores.

So I went to a CPAP clinic at my sleep center where they have reps bring various masks so you can try different ones. (One problem is that even one night of use isn't enough to see how it will work out - it took about a week each time for the problems to develop.) I tried both the Fitlife and the Amara View. The Amara View felt like it pushed up against my nose and I expect even that slight discomfort trying it on would develop further with use. (I did have a cauterization a couple days before but my nose is still sensitive 2 weeks later). Finally, the Fitlife felt like the best solution for me. Until ...

I tend to struggle a bit with fit on any mask. I keep having to remind myself that small leaks are expected and okay, and that too tight can make it worse, but I do worry when I feel any leaks, and the Fitlife seems susceptible every time I move. Sleepmapper is reporting no leaks. I'm not experienced enough to understand all the details from Sleepyhead but for the past 3 nights (with Fitlife) bottomline says time over leak redline is 0.544%, 0.000%, and 0.000% respectively. On those same nights my AHI was reported as 5.55, 19, and 13.37.

Over the past 2 weeks I used the Wisp more than any of the others, N10 once or twice and nasal pillow a couple times. I hadn't thought to keep track of which I used on each night. My time over leak redline numbers were all 0.000% except for one night that was 0.220%, and my AHI only went as high as 3 on 3 nights. So the 5.55 seemed high but not outrageous. The 19 really caught me off guard but it seemed like a possible outlier (in the short time I had used CPAP a few years ago with only nasal pillows, I had one of those readings as well). But then another high AHI at 13.37.

I could understand if, for some reason, I might need higher pressures with the whole face mask (my pressure is min. 4, max. 8 and it's been more consistently at 8 the past few days). But what I really don't get is how I am getting these high numbers when my full sleep study 5 years ago showed an AHI of 8 and my home sleep study a few weeks ago was a 10. Regardless of the full effectiveness of the mask, how can I be getting a higher AHI with therapy than I had without?

Are these images helpful Pugsy?

Holy crap...snores and OAs all over the place.
The machine thinks they are real airway collapses and wants to use more pressure but can't.

Some people just need more pressure when using a full face mask. Looks like you are probably one of those people.

How come higher AHI now than when you had the diagnostic sleep study? I don't know unless sleeping position might have played a part in the recent ugly reports. If you were on your back more when using the FitLife mask the supine position could have impacted your OSA and made it worse and/or caused more pressure to be needed.

I suspect that if you want to continue to use the FitLife then you will need to make some pressure adjustments...probably in both the minimum and maximum settings.

curems wrote:Are these images helpful Pugsy?

Looks to me like you're pinning your top pressure of 8 when all of those obstructives are happening, and the machine isn't able to do much about them as it's constrained by the pressure settings. If that were my data, I'd try a higher range of pressures (maybe 6-12 or 7-14) for a few nights to see how high the machine wanted to go to stop those obstructives (so long as there was no issue with central apnea, as more pressure can make that worse for some people). The lower pressure number on an APAP is more important than the upper setting; and since you're pinning at 8 for much of the night, I'd want to start out at 6 or 7 and see where the machine went from there. But that's me...

I'll let Pugsy reply, as she's more educated about these things.

ETA: And I see she beat me to it.

Thanks for the replies! There's so much data in Sleepyhead and I'm still learning by baby steps!

The only reason I hesitate to adjust pressures myself at this point is because it is only a couple weeks and my machine will be monitored by both the doctor and the insurance company for a few months at least.

My next appt. isn't until 9/8 - I'm out of town for the upcoming week and my doc is on vacation the next week! I'll call the office when I have some free time this week and see what they say. I'll be taking all of my masks with me while I'm away so I can try switching day by day. I don't want to not use it, thinking the Fitlife is worse than not using it, but I don't know if they may not want me to adjust the settings myself at this point.

The good thing is that my doctor wants to work with me to do whatever is necessary to help me be compliant! I had gotten crap for follow up the first time so that really added to why I gave up on it. Five years older, more medical issues and now I'm much more determined to make it work!

Did they give you the 4 to 8 range for a specific reason?
Or was it a guessitmate starting point? If it was a guesstimate I don't see the doc getting all upset if you just maybe raised the maximum a little though I am with BB...I think that more minimum and maximum is going to be needed in this situation. 4 to 8 is a tiny range to try for home titrating.

Part of the clustering looks like it might be related to REM stage sleep. It wouldn't be impossible for the mask fit to sort of put the airway in a position to make matters worse. I have tried the FitLife...it was a dismal failure because I couldn't ever get a seal to last more than 15 seconds but I can see that the way the lower straps pull things backwards a bit that it could maybe cause the airway to be more in a bind.
So there's a good chance that what you see is a combination of factors at work causing more pressure needs.

If you were asleep when all that ugly was happening then we have to trust the data. I was thinking maybe you might have spent a lot of time awake fiddling with the mask but usually when that happens we get more Clear Airway flags. So unless you tell me that you know you were awake for a good bit of the time where all the ugliness happens...mask farts could fool the machine into thinking snores but if that were the case I don't see anyone sleeping through that many mask farts.

Were you on your back a lot last night? If you were you might try staying on your side and see if these current pressure settings can keep up.

What is the mask setting on your machine? You have jumped from nasal to full face. Are you changing the mask setting on the machine when you go from nasal to full face? I use the Fitlife Total mask. The industry considers it a full face mask - any mask that covers the mouth and nose. Changing the mask type on the machine (when you change masks) will affect your vent rate and may interfere with the AHI readout. I also suggest you bump up the lower pressure setting. Also, please know that a lot of folks on this forum will also try and talk you out of the Fitlife Total mask. Especially folks that don't use it. Stick with it if you like it. I also use the F10 fullface. I have to put on a small bandaid on my nose, then a small strip of medical tape on top.

Sheriff

A brief review of my results from the studies: My home sleep study (all that was approved by insurance) indicated 4 hypopneas, 59 obstructive apneas, and 3 central or mixed apneas. Overall AHI was 10. 45% supine with AHI 14. Titration study was done at the center with a Wisp mask. Overall AHI was 1 at a setting of 4. There was 1 central apnea and most of the time was supine. My old CPAP machine had been set at 5.

I really don't know how much I slept on my back last night. I do know that the leaks I felt were likely while on my side so I may have tended to try to stay on my back. Perhaps the leaks would have been a better outcome! I've never had success with trying anything to keep in a particular position! And I know I wouldn't handle compliance well with that!

Sheriff Buford: Some of your earlier posts were very helpful in encouraging me to try the Fitlife! And I still see it as hopefully being a good option for me. The only setting I could find on my machine related to the mask was the System One setting which matches what is on the mask (X1). I've tried the bandaid type solutions, including the liquigel and gel cushion. The adhesive ones are a problem because my skin is so sensitive and I still got pressure sores with the gel cushion. I am still hoping this mask will solve the problem.

Sheriff Buford wrote:Also, please know that a lot of folks on this forum will also try and talk you out of the Fitlife Total mask. Especially folks that don't use it. Stick with it if you like it. I also use the F10 fullface.

Sheriff

+1! I also use the FitLife and the F10, but also the Quattro FX. My experience with the FitLife is that I needed more substantial headgear to keep the mask in place. The headgear that comes with the Fitlife would allow the mask to shift on my face no matter what. I bought the blue mesh headgear, which has a cap instead of a couple of head straps. It really does the job of keeping my mask in place. I am not over tightening it either. I now have co pledge success with the FitLife.

Another thing I like about the FitLife--it doesn't leave strap marks on my face in the morning! It's really a nice mask.

I was out of town all of last week but was able to get hold of my doctor and she increased my pressures to 6-12. It feels much better (I had felt like I wasn't getting enough pressure at 4 while awake with the mask on) but my numbers haven't shown too much improvement overall (overview image posted) and although I'm not having trouble with leaks, the "small" leaks are bothersome and the mask tends to wake me when I turn. So, I'm still on a quest for the best option in a mask.

Thanks to all for your help.

Update: A FFM just isn't the best thing for me. Except for a couple days, I used both the FitLife and the Amara View between 8/12 and 9/2. I'm not a mouth breather so I don't need a FFM and I do need higher pressures when I use one. Switched to the Swift FX Nano on 9/3 and doing much better. (Wisp and AirFit N10 are slightly larger in height placing them in a position that caused pressure sores.)

While I had no large leaks with the FFMs, the small leaks were a bit bothersome - unusual since I can usually sleep through almost anything (17 lb. dog jumps on the bed and I never know it but a little leak wakes me!) I'm sure I could get used to them if I had to and I'm really glad to have those masks as backup for when I have a cold or other issue that may make the Nano a problem. I actually liked both masks since they didn't rest on my nose.

Moral of the story for newbies - get as many masks as you can through your sleep center/doctor/insurance/DME and keep trying things until you find something that works. I bought the Nano cushion on eBay and used it with old headgear and tube from Swift FX pillows that I can't use. I wanted to get the full package as there are slight differences with the headgear and tube but it was past my month for mask switching so when I had my first follow-up with my doc she was so impressed she went out to the clinic to find me one so I wouldn't have to buy it. Listen to others' experience but don't rule out anything unless you've tried it! And, of course, appreciate all the feedback and support from folks in this forum.

I am so glad that the Nano has worked out well for you. It really is a nice little mask for those people who prefer a nasal cushion mask. I am a pretty tough critic when it comes to any mask that covers my nose and I liked it well enough to keep it just in case something ever happened and I couldn't use my nasal pillows (I was thinking like maybe a bit pimple on my nostril area which I sometimes get) and for me to keep it means I really like it. I wasn't so lucky with the Wisp which is very similar but it caused too much nasal congestion and I couldn't sleep with it. I have some special needs when it comes to masks that touch the nasal bridge area of my nose. It takes a lot for me to keep a mask for a just in case scenario. Normally I give away my experiment failures because I know that just because a mask doesn't work well for me that it doesn't mean it won't work well for someone else and I don't like to waste these masks.

Anyway...glad you also got the real package. While the headgear is identical to the Swift FX headgear (you can always swap that out) the short hose that comes with the Nano package is just a little superior IMHO because it is more flexible and has that different swivel.

Now you have something that you like and works well for you.
If you do catch a cold and need full face mask you also have a couple that would get you by in a pinch.
My thoughts about if this happens...don't worry too much about the AHI and needing a little more pressure with a full face mask than you need with with the nasal. You won't be using them unless you are ill and when you are ill the AHI and therapy as well as sleep quality generally takes a nose dive anyway. It's still acceptable (or close to it) unless you want to try to compensate with a little more baseline pressure and when a person is ill I don't think that it's a good time to be playing with pressures unless there is a critical need and from your reports I don't think that qualifies as critical need.

You actually have done better than me....I still don't have a full face mask that would work for me if the situation arose and I just HAD to to use one. Fortunately after over 6 years I really haven't ever had to to face that problem. I always have been able to get my nose opened just enough to start the night with my nasal pillows and the humidity max has never failed to actually make my nasal breathing easier even with a cold or flu going on.

Congratulations on finding the right mask and your recent data supports your success in both AHI and how you are sleeping and feeling. Doesn't get any better than that.