Help with Interpreting Mixed Results

I truly hate the set up that I have, so I've been trying to get a more comfortable sleeping situation going. (Not to mention, the noise drives my wife insane).

I typically use a Resmed P10 along with a chin strap. But, I have the chinstrap moved forward more to apply a small amount of pressure to my lower lip to keep it from cracking open.
I was trying a Resmed F20 (airfit and airtouch). I've also tried a Dreamwear Full face (the under nose) and the Resmed F30.

The full face is much more comfortable (all the ones I tried), but I wake up feeling just awful. So I pulled out OSCAR and have been trying to make sense of the reports and then further, interpret what might be causing me all the problems.

When I switch to the full face mask, i have tried it with EPR off altogether and even all the way up to 3. The strange thing I've noticed is that when use the P10 and chin strap combo, my jaw, face and nose all hurt in the morning, however my sleep seems to work. I feel rested and don't wake up foggy and with a headache. But, the leaks are off the chart (likely what's bothering my wife). With the full face masks (any of them). Almost no leaks... but my AHI goes up and I wake not feeling rested at all and usually have a headache (akin to the headache of hangovers, dehydration and sunstroke).

Here's a chart with the P10 (lots of leaks, low AHI, but I wake up feeling fine... never great, just fine)


And this is what it looks like with a Full face mask (in this case, I was wearing and AirTouch F20. Woke up feeling terrible. Foggy, headache, etc)


I've been on CPAP therapy for more than 10 years now. Never had my pressure adjusted (still at 15). I have had my weight and activity levels (Exercise and such) go up and down several times during the more than a decade. Had a lot of life changes too. It seems weird to me that my therapy is working better when the mask is leaking. Is it possible my pressure needs to be reduced?

Even though I've been "on the mask" for so long, I've never taken the time try to interpret the results until recently. Looking for any help/advice I can get. I do have an appointment coming up to see a Sleep Doc (it's been a while and my last one was rather... unconcerned... with anything or anyone)

Try raising your pressure a couple cmh2o when you use the FFM... they tend to push the lower jaw back, narrowing your airway, and thus requiring more pressure.

This should bring your AHI's down, and get you better sleep.

palerider wrote: ↑

Sat Oct 12, 2019 9:11 pm

Try raising your pressure a couple cmh2o when you use the FFM... they tend to push the lower jaw back, narrowing your airway, and thus requiring more pressure.

This should bring your AHI's down, and get you better sleep.

He's ALREADY at 15/15, I really doubt higher pressure will help.

There are already too many leaks.

SDBud wrote: ↑

Sat Oct 12, 2019 9:49 pm

palerider wrote: ↑

Sat Oct 12, 2019 9:11 pm

Try raising your pressure a couple cmh2o when you use the FFM... they tend to push the lower jaw back, narrowing your airway, and thus requiring more pressure.

This should bring your AHI's down, and get you better sleep.

He's ALREADY at 15/15, I really doubt higher pressure will help.

There are already too many leaks.

then what would you suggest?

SDBud wrote: ↑

Sat Oct 12, 2019 9:49 pm

palerider wrote: ↑

Sat Oct 12, 2019 9:11 pm

Try raising your pressure a couple cmh2o when you use the FFM... they tend to push the lower jaw back, narrowing your airway, and thus requiring more pressure.

This should bring your AHI's down, and get you better sleep.

He's ALREADY at 15/15, I really doubt higher pressure will help.

There are already too many leaks.

reuterlongos wrote: ↑

Sat Oct 12, 2019 8:31 pm

With the full face masks (any of them). Almost no leaks

SDBud wrote: ↑

Sat Oct 12, 2019 9:49 pm

palerider wrote: ↑

Sat Oct 12, 2019 9:11 pm

Try raising your pressure a couple cmh2o when you use the FFM... they tend to push the lower jaw back, narrowing your airway, and thus requiring more pressure.

This should bring your AHI's down, and get you better sleep.

He's ALREADY at 15/15, I really doubt higher pressure will help.

SO? Ask someone who knows something, there's a *reason* that CPAPs go up to 20cmh2o, and bilevels go up to 25.

If he had an auto machine, it would increase pressure, so your "doubts" are... unhelpful.

SDBud wrote: ↑

Sat Oct 12, 2019 9:49 pm

There are already too many leaks.

No, there aren't.

Adjusted the pressure up to 16 (from 15) and am using the F20 AirTouch.

Not as bad, but still waking up with a headache.
Should I go higher? (this would be so much easier if I had a autoset instead!... next machine)

reuterlongos wrote: ↑

Tue Oct 15, 2019 12:58 pm

Should I go higher? (this would be so much easier if I had a autoset instead!...

Yes, more

Will jack it up another level tonight (to 17)

I'm swallowing a lot of air with the full face mask. Makes the mornings fairly uncomfortable.
Any tips on that?

reuterlongos wrote: ↑

Tue Oct 15, 2019 2:27 pm

Will jack it up another level tonight (to 17)

I'm swallowing a lot of air with the full face mask. Makes the mornings fairly uncomfortable.
Any tips on that?

Depending on machine brand, it may be called CFLEX, AFLEX OR BIFLEX on Philips Respironics brands and EPR (expiratory pressure relief) on ResMed brands. This feature automatically reduces air pressure upon exhalation and can help reduce or eliminate aerophagia.

Worth a try.
May have to raise pressure more later to compensate.

JPB

After some messing around with, well, everything.. I think I found a "magic bullet" here.
I added a cervical collar and increased pressure to 16, it's dropped my AHI WAY down (reached 0.15 on the weekend).
It's not the most comfortable, but I did buy the cheapest one I could find. Will have to try a nicer one.
Regardless of the mask I'm using, it's keeping things consistently low and I'm definitely feeling better.
I also disabled the EPR completely and that seems to be helping with the aerophagia. It doesn't make sense, I know, but I read somewhere that a high EPR displaces more air than a constant pressure. It made sense to me... whether the science makes sense or not, I'm not suffering through it anymore.

thanks for the help.