Hybrid cushion size issues, affecting AHI & AI

Sorry in advance for the long post. I tried to keep it short but failed miserably.

I've been a happy Quattro user for several months, but wanted a back-up mask w/o forehead bar for nights when I have a headache. I got my new Hybrid on Monday and spent a while on Rooster's hybrid fitting thread before going to bed. I settled on the small mouth cushion & small nasal pillows in the tall position. I slept well and was VERY happy to see improved AHI & AI numbers in the morning (3.2, 0.3). I had two more nights of GREAT AHI & AI (5.4, 0.7 and 5.1, 0.5).

In four months of Quattro use I only had 6 nights w/ an AI of less than 2, and only 4 of those nights w/ an AHI of less than 7. I was in a perpetual quest to find the right pressure settings for my VPAP AUTO 25- enough pressure to keep events at bay while avoiding the aerophagia monster. I had no idea a mask change would be THE answer.

So now comes the weird part...

The small cushion on my Hybrid was a bit uncomfortable from the beginning, but the medium seemed like it might be too big. After 3 nights, I couldn't stand it anymore and decided to try the medium mouth cushion. It felt MUCH better and wasn't leaky. Just for grins, I tried the medium nasal pillows and couldn't believe how much easier it was to breathe through my nose. Next morning I awoke feeling groggy with an AHI of 10.2 and an AI of 1.9! Last night I switched back to the small nasal pillow but kept the medium mouth cushion. My numbers were better (2.6, 0.1), but I really felt the reduced air flow through the nasal cushions. I woke up at 5am with my mouth wide open and as dry as the Sahara. I was so aggravated I just threw on my Quattro for my last 3 hours of sleep.

I'm going back to the medium nasal cushion tonight in hopes that Thursday night was some kind of anomaly. If the numbers are crappy again, I'm gonna cry. This was supposed to be the back-up mask, but with the tremendous improvement in therapy using the Hybrid, my Quattro's gonna have to be the back-up. I'm going back to the medium cushion AND nasal pillow for a few nights to see if maybe the crappy numbers were a fluke.

For those who will wonder about the leak data, I have my Resmed machine programmed for a full face mask. I don't know how accurate the leak reporting is with a non-resmed mask.
The 95% Leak & Median Leak data was-
Night 1: 7.2 & 4.8
Night 2: 19.2 & 6.0
Night 3: 6.0 & 4.8
Night 4: 10.8 & 2.4 (first night w/ medium cushion/nasal pillow)
Night 5: 12.0 & 3.6 (med cushion, small nasal pillow)

AHI & AI-
Night 1: 3.2 & 0.3
Night 2: 5.4 & 0.7
Night 3: 5.1 & 0.5
Night 4: 10.2 & 1.9
Night 5: 2.6 & 0.1

Many thanks for listening to my tale of woe. Wish I could say I feel better just for having shared, but that would be a big fat lie.

-K

This is just me wondering... but it seems that when the Hybrid first came out there was an issue with using it on a Resmed machine due to the fact that the leak rate is high. They did come out with a different shell that was supposed to correct the issue though and so I wouldn't expect that this is still the problem, though who knows?

The intentional leak issue shouldn't be in play here, as the leak rate doesn't change with mask seal/nasal pillow selection on this mask. So here are a couple of theories. I am not a doctor, so read this post with this in mind.

The first is that the medium seal is giving you much better rest than the small was. I have noticed (with my body; yours might be different) that when I sleep especially well, my AHI is higher. I have experienced this a number of times now, as recently as last night.

The second is that the change in seal size and increased airflow 'threw your body for a loop'. This, too happens to me if I make a pressure adjustment, especially minimum pressure. A few nights of living with this change might show very different results.

Lastly, the change in the 'architecture' of your face caused by the mask change might somehow be affecting your sleep breathing. Perhaps by slight positional changes of the jaw and mouth, or by some other mechanism. This you might be able to overcome by a pressure adjustment.

If the hybrid medium fits and works well for you, and does not leak, that is all most people here ask for. Work with it in terms of pressure, humidifier setting, etc. (I also find I set my humidifier lower with the Hybrid than with the Quattro.)

I have discovered that not a lot of people use the small or medium nasal pillows. If you make this work, and want to, I will exchange an unusued small or medium pillow set for your unused large

Oh timbalionguy- I appreciate your thoughts.

timbalionguy wrote:The first is that the medium seal is giving you much better rest than the small was. I have noticed (with my body; yours might be different) that when I sleep especially well, my AHI is higher. I have experienced this a number of times now, as recently as last night.

While I do sleep much better than before VPAP, I haven't had much experience w/ sleeping especially well. What you say makes sense though- will keep that in mind as I watch my data.

timbalionguy wrote:The second is that the change in seal size and increased airflow 'threw your body for a loop'. This, too happens to me if I make a pressure adjustment, especially minimum pressure. A few nights of living with this change might show very different results.

That is my hope-- get used to the change, and sleep will improve.

timbalionguy wrote:Lastly, the change in the 'architecture' of your face caused by the mask change might somehow be affecting your sleep breathing. Perhaps by slight positional changes of the jaw and mouth, or by some other mechanism. This you might be able to overcome by a pressure adjustment.

The small cushion was squishing my jaw terribly and holding it an awkward position. Because of the aerophagia w/ my Quattro, I'd had to limit my pressure. I have no aerophagia w/ this mask, and was thinking about bumping up the min EPAP.

timbalionguy wrote:I have discovered that not a lot of people use the small or medium nasal pillows. If you make this work, and want to, I will exchange an unusued small or medium pillow set for your unused large

I can't even imagine using the large nasal pillows. They are massive in comparison to my nares. I'd love to exchange. Check your PM.
-K