Nasal pillows to nasal mask to FFM

I started out last October with the Swift FX which I love but my AHI’s stay 5>. I tried other nasal pillows and still can’t get my AHI’s <5, even tried the Airfit P10 and my AHI’s went to 7> with 3% large leak. So, I moved on to the Wisp and alternated with the Mirage FX. I did very well with these two. My AHI’s remained <2. Then about a little over a month ago I started waking up with extremely dry mouth, sometimes I felt like my mouth was sealed. I never noticed my mouth open upon awakening and hubby says he never noticed my mouth open. So, went to DME and they gave me the Airfit F10. I love it but still wake up with extremely dry mouth AND on two occasions I woke up with my bottom lip outside the mask and 17% large leak.
Any suggestions??

Not a suggestion, but you can't count on your likely-also-asleep husband or your subjective-while-half-awake perceptions to know if your mouth is open (or even lips parted) while you're asleep... which is not to say it's what's happening, but you can't assume anything either.

Sounds like mouth breathing or at least opening and if you are seeing 17% large leak that means 17% of the night is spent in large leak territory..how far into large leak territory you need to use the software to evaluate..above 100 L/min and the PR S1 can totally miss events and not know what to do if you are using auto adjusting mode.

Often when someone sees that much time actually flagged as a large leak time then a good bit of the other parts of the night are often borderline which while the machine can probably compensate for it...potentially these larger but maybe technically not in large leak territory...the leaks might be big enough to disturb sleep..cause little awakenings or arousals and you might get some centrals flagged during those times.

Your AHI...always evaluate it broken down into categories. For all we know the bulk of it might be clear airway (central) events and not related to pressure or leaks for that matter. Might be awake/semi awake breathing.

It would be helpful if we could see those detailed graphs. Particularly the events graph, pressure graph and leak graph...along with AHI breakdown into categories on the left of the daily detailed reports.

You can of course switch to a full face mask so therapy pressure is not lost but it may or may not fix the dry mouth issues an if your AHI is primarily CA and not OA from loss of therapy pressure it won't fix that either. So be aware of that. This forum is full of people using full face masks and complaining of dry mouth. Mouth breathing dries the mouth out...some people more than others and the humidifier sometimes can't add enough moisture to rehydrate the mouth even with a full face mask and humidity set to max. It's certainly worth a try though.

17 % of the time in large leak...in 7 hour sleep session that would be 17% if 420 minutes or 71.4 minutes...a little over an hour.
If you were barely into large leak territory probably didn't impact the machine's ability to do its job but if you were over 100 L/min..pretty much in the toilet over 100 L/min.

Options are
Tape lips
Chin strap
Full face mask
Each option comes with potential drawbacks and up to you to figure out what you want to do.
For the dry mouth itself...the mouth breathing most likely has to reduced or eliminated no matter which mask you end up using. The full face mask may or may not alleviate that particular issue but it is certainly worth a try.

Don't ask me which full face mask though? While I might mouth breath and get dry mouth occasionally it is never for long (maybe 15 minutes) and rarely reaches large leak territory so I choose to ignore it and just use my nasal pillow mask. For myself a full face mask would create additional issues that to me would be worse than 15 minutes of big leak that I sleep through anyway. So while I have tried some full face masks jut to try them...I don't use one. If I were going to use one it most likely would be the Innomed Hybrid. I don't like anything on my nose and the lower straps on its headgear would stand the least chance of aggravating my neck issues.

I will post some screen shots when I get home tonight. I noticed in one it was 134 L/min. I am using the Airfit F10 which I like but as I mentioned before, I woke up on two separate occasions to find my bottom lip below the edge of the mask so that might have been when the large leak started.

flyingwithoutwings wrote:I started out last October with the Swift FX which I love but my AHI’s stay 5>. I tried other nasal pillows and still can’t get my AHI’s <5, even tried the Airfit P10 and my AHI’s went to 7> with 3% large leak. So, I moved on to the Wisp and alternated with the Mirage FX. I did very well with these two. My AHI’s remained <2. Then about a little over a month ago I started waking up with extremely dry mouth, sometimes I felt like my mouth was sealed. I never noticed my mouth open upon awakening and hubby says he never noticed my mouth open. So, went to DME and they gave me the Airfit F10. I love it but still wake up with extremely dry mouth AND on two occasions I woke up with my bottom lip outside the mask and 17% large leak.
Any suggestions??

You just told my story FWW - right down to the last detail. Just different dates I'd say start looking for different full face masks. You might try a small vertical piece of 3M multipore tape to keep your lower lip from slipping down... ie. tape your top and bottom lip very loosely together, thus allowing some therapy air to get down your throat.

For dry throat in general: I notice you are using a PR machine. You can get lots of humidity in your hose if you run the humidifier in 'classic mode'. Use the search box at the top of this page and enter that phrase in. You'll soon find out how to set that feature in the clinician's menu, plus what it will do for you. You'll also have to fill your humidifier pretty full every night. If you get stuck PM me.

(Thanks for letting me know I'm not the only one Sir NoddinOff)


Here are some screenshots. Hope this works, never did this before.
https://dl.dropboxusercontent.com/u/816 ... -05-15.png
https://dl.dropboxusercontent.com/u/816 ... -05-14.png
https://dl.dropboxusercontent.com/u/816 ... -05-13.png
https://dl.dropboxusercontent.com/u/816 ... -05-06.png

Notice that on the 6th the leaks were 127-134
and on the 13th they were 121-125
But even on the days when the leaks were not high I still had the extreme dry mouth. Maybe there's something else going on that has nothing to do with OSA.

The numbers on the statistics side don't seem to match up with the graphs.

Example...May 13...the graph shows only max leak of just shy of 55 L/min yet the max in the statistics shows 125 total leak. Where's the max? I don't see it and certainly nothing that should put the 95% number up at 121 L/min.
Another example...May 15.. graph obviously shows leaks over 100 L/min yet statistics max shows only 70 max total leak.

None of this makes sense. Which is correct? The graphs or the numbers?
Do you have Encore to see what it shows?
Maybe try the new SleepyHead and see what it shows.

You probably are mouth breathing some. I do it. I wake up with dry mouth and sometimes horribly dry and think "well, silly girl, your probably did a lot of mouth breathing last night" so I go look at the report and maybe 15 to 20 minutes is all that is excessive and often I can't even spot it on the leak graph. Did that one morning...woke up and I was definitely mouth breathing gently on my side so I decided to continue breathing that way for 15 minutes or so just so I could have a definite time to look at on the graphs because I was getting up then. Terrible dry mouth and I barely could see a blip on the leak line.

The leak with the plateau...probably mouth breathing on the 13th around 1 AM for about an hour. The rest of the night things look great.

Since your graph line and the numbers in the statistics section are so off base and don't match we need to use stable software and verify what is going on.

Do you have Encore? If not...do you want it.? If your computer won't work with Encore...maybe we can get me a copy of these files so I can check it on my Encore..

At this point I don't know who to believe...the graphs or the statistics...
May 6...only that one block of big leak..for about an hour from 12:15 to 1:15 or thereabouts.
Those statistics seem to match. For May 6...most likely mouth breathing for that hour but the rest of the night was beautiful.

May 14 and 15...the baseline leak graph starts out the night at around 52 L/min...but your May 13 starts out at around 22 or so..which is more in line with your mask's vent rate at your pressure I would think...that's a big difference.

So I don't doubt that you mouth breathing to some extent but this data is unreliable in that is doesn't make sense and we can't tell for sure just how bad it is because of the discrepancy with the baseline. It should never be 30 L/min apart at the beginning of the night..
We need ENcore to compare to.
Or a newer Sleepyhead version to see if this anomaly is a software bug or what.

I did the screenshot for the 13th & the 15th again - I don't know what happened before.
https://dl.dropboxusercontent.com/u/816 ... .40.46.png
https://dl.dropboxusercontent.com/u/816 ... .43.29.png
https://dl.dropboxusercontent.com/u/816 ... .46.41.png

I went back and closed Sleepyhead and opened it up again and the 13th was back to the first screenshot showing just 75 on the graph.
I don't have Encore but if it'll help me understand this better, I'll take it. Just let me know where I can download or buy it. In the meantime, if you tell me how to get the files to you I will.

That's better.
With the exception of the time frame between 12:45 and 1:30...your leak line is fine.
So you had ugly leak for 45 minutes. During that 45 minutes when the leak was over 90 L/min your machine probably couldn't sense or record events or respond properly..especially when over 100 L/min.
The other 6 hours...leaks were extremely well controlled. You were likely mouth breathing pretty big for that 45 minutes.
So your therapy may have been in the toilet for those 45 minutes but the rest of the night looks real good.
May 6th is similar.

The other 2 that are uglier...the baseline starting at 52 or so bugs me...it shouldn't start out there unless there's a hole in the system somewhere.
Your baseline when you first mask up and turn on the machine...shouldn't have that big of a difference with no change in pressures or masks.
I don't know what to think of it other than it doesn't make sense. Your baseline should never be in the 50s and that makes me wonder what's going on.

Let's get you Encore because SleepyHead doesn't seem stable.
Will send you a PM in just a bit.

My leaks are really minor (except those 2 nights and I believe that's when the FFM dislodged and woke me up), and I love the Airfit F10 and the Quattro Air (it's a toss up for me as to which I like better). I still have dry mouth so I guess there's something else going on. So, that being said, I tried going back to my Wisp and suddenly I can't breathe with it on. I'm so comfortable with the FFM. Is there any reason why I can't use the FFM even if I'm not a mouth breather?

flyingwithoutwings wrote:Is there any reason why I can't use the FFM even if I'm not a mouth breather?

None at all.
Use whatever feels best and lets you sleep well.
Mouth breathing isn't the only reason people use a FFM....sometimes they just like them better and it sounds like you are one of those.

Since I don't mouth breathe I could not figure out why I was waking up with such severe dry mouth. Last Sunday I woke up and the light bulb went on. My doctor had just increased the dosage of my thyroid medication and then the dry mouth started. So, he changed my meds and what a relief, no more dry mouth. I still wake up with a little bit of dry mouth but I think that will soon be gone. Down side: new meds cost 4 x as much as the old meds.
Will discuss this at my next visit.