Need Help Optimizing Therapy

Have you ever allowed your APAP to operate in auto mode? I agree that the hypopneas and OA need additional pressure. It might be worthwhile to put the unit in auto mode with a minimum pressure of 8.0 and a maximum pressure of 20 (your choice if you want to limit). The machine should give us some better clues where you have the best therapy, and you can resume CPAP mode there, or allow it to move in a narrow range.

An alternative is to switch off A-Flex. I only want to do one change, so choose pressure or flex. I am one of the few that has higher AHI with variable inhale/exhale pressure, so it can be worth experimenting with Flex as a fine-tuning exercise. I recommend you start with a pressure change. +1.0 in CPAP or APAP mode, and if you don't have concerns with APAP mode, I'd do that and allow the machine to titrate.

OkyDoky wrote:Gearhart, the PR machines don't have the easy mask settings that the Resmeds do. See my reply above. I do remember Palerider comparing the two and got this from another thread.

Palerider wrote: also, what the new respironics machines DO have is a 'resistance setting', and numbers marked on masks so you know what to set the resistance setting to.
all their full face, and nasal masks are x1, then pillow masks vary based on size... large, x1, medium x2, small x4..

So if you wanted you can try out the Resistance settings. Remember these numbers were on the Respironics masks and not the Resmed but should be similar.

That is the setting I was referring to, You have to get the leak rate for each mask and find a P-R mask that is close to the same leak specs and use that number.

donewithbeingtired wrote:So its better to increase the pressure on the FFM, than try to make the nasal mask work?

Why such a disparity on pressure? I can get low single digit AHI on the nasal at 7cm, and am hitting 25 AHI sometimes on the FFM with pressure all the way up to 10cm?

I don't get it.

You have a PRS1 Auto with Resmed mask so your mask resistance setting is basically zero. What happens in a nasal mask is that the effective pressure on the airway is more than with a FFM. So even though you may be running 8 fixed, in an FFM, it is acting close to a 7 fixed or something. In a Nasal/Pillow mask, its acting as a 8 fixed. This pressure difference may be making all the difference in the AHI reading.

Another thing you can try is:
1) Get machine out of CPAP mode and get into APAP mode. If you can tolerate some variation in pressure, set your range to
min pressure = your current set cpap pressure.
max pressure = min + 4 OR min+2 or Whatever you can tolerate.

Watch other events on your graph like RERA and Flow Limitations. Sometimes, the higher RERA index defeats the low AHI, when it comes to feeling rested.

Adjust from there.

Well, now that you've got a whole spectrum of advice and recommendations, I guess it's up to you to figure out which path to follow.

The P/R "Resistance Settings" are only supposed to be set if using a P/R mask. The setting should be noted in the manual that came with the mask. All other masks like ResMed should have the Resistance Setting at "0" (zero).

Somewhere in my quick reading of this thread, I overlooked the fact that you were using two different masks in those reports you posted. Sorry 'bout that.

But, as I said, the "numbers" discrepancies between different types of nasal and full face masks have been discussed many times in the past but with virtually no logical reason for those differences. And, it seems to vary from person to person.


Den

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Cool this is making sense. Will try the pressure change w/ APAP mode tonight.

Any comments on the leak question in the mean time?

SGearhart wrote:That is the setting I was referring to, You have to get the leak rate for each mask and find a P-R mask that is close to the same leak specs and use that number.

Resistance setting is NOT the same as the intentional vent rate at so and so pressure...
Resistance setting will NOT make any difference in the leak rate reported be more or less correct...
It is NOT the same thing as mask selection on a ResMed machine.
If using a non Respironics mask we are told to turn it off or set it to 0 which turns it off.
http://www.healthcare.philips.com/main/ ... ontrol.wpd

More in depth discussion a while back on the forum where Molette (I think it was) clarified things....I don't have time to go look for it but you all are welcome to go looking. Changing the Resistance setting will NOT affect how the leak is reported or the leak graph.

Your leaks with either mask on the 2 reports shown are actually extremely good....pretty much minimal to none excessive leak rate.
Large leak territory for your machine is up around 80 to 90 L/min....you were well below that area.
SleepyHead and your machine will tell you if you have a large leak....that's what the LL line is on the events graph at the top.
Leaks are not a problem and no where near a problem unless they are waking you up.

The discrepancy between the AHI and the 2 mask types a the same pressure.
Either the pressure simply needs to be more with the full face mask than the nasal or maybe you had so much problems with the nasal you didn't sleep well and without sleep the airway doesn't collapse.
My bet is on you need a little more pressure with a full face mask. In theory X amount of pressure should work the same with either mask type but in real life it doesn't always go according to theory. I have seen it too many times where a person could use from 1 to 3 cm less pressure with a nasal mask than they needed with a full face mask.

Pugsy wrote:

SGearhart wrote:That is the setting I was referring to, You have to get the leak rate for each mask and find a P-R mask that is close to the same leak specs and use that number.

Resistance setting is NOT the same as the intentional vent rate at so and so pressure...
Resistance setting will NOT make any difference in the leak rate reported be more or less correct...
It is NOT the same thing as mask selection on a ResMed machine.
If using a non Respironics mask we are told to turn it off or set it to 0 which turns it off.
http://www.healthcare.philips.com/main/ ... ontrol.wpd

More in depth discussion a while back on the forum where Molette (I think it was) clarified things....I don't have time to go look for it but you all are welcome to go looking. Changing the Resistance setting will NOT affect how the leak is reported or the leak graph.

My Bad. . . Sorry!

donewithbeingtired wrote:So its better to increase the pressure on the FFM, than try to make the nasal mask work?

... I struggle to tolerate the mask/straps, etc. (nasal interface)

Since the FFM is comfortable, the nasal mask/chin strap is not comfortable and your leaks with the FFM are very low, I would go with the FFM. It sounds like a little tweaking of the machine settings will get you a good therapy with the FFM.

If you catch a cold or have any type of nasal congestion, you will really like the FFM. Many people who use nasal masks, keep a FFM handy for use with nasal congestion.

Wulfman... wrote:He's got a Philips Respironics machine and they don't have the mask settings like the ResMed machines do.

the 60 series do have a mask setting.

SGearhart wrote:That is the setting I was referring to, You have to get the leak rate for each mask and find a P-R mask that is close to the same leak specs and use that number.

as pugsy says, it's not the leak rates, it's the resistance specs... and those are in the manual.

Welcome. You're in a great place for help! I'm 44 as well, and I could just as well be you. These guys will lead you down the right path.

In any case, what Pugsy said about the masks sometimes resulting in different pressure requirements. Sometimes just a little change in minimum pressure can make a big difference in events. It's the sweet spot we all look for when optimizing treatment.

As to your nights, you did have a pressure of 8.5 on the good night and 8 on the bad night. This coupled with what Pugsy stated means you had more therapy available on the good night. I would also guess that you didn't sleep well this night as you mention that the nasal mask gives you lots of issues. If we don't sleep well and do not hit all sleep stages, we may show well because the obstructions may not have occured.

This happened to me a lot in the beginning. I wasn't comfortable with the mask, etc. and thought my numbers looked great at certain pressures. In reality, I was just sleeping lightly or not at all. After I got comfortable, I had to increase the pressure because I was actually sleeping deeper and I assume hitting different sleep stages like REM where OSA can be worse for some. You already note how much more comfortable you are with the ffm. It's natural that you would sleep better on those nights.

I will also mention that even now when I have a big day of activity I will have more events and auto adjust to higher pressures. Any chance your bad night was after a busy or active day where you naturally might have slept better even accounting for the new hose beast Also, the guys here will tell you and you already mentioned supine. Any chance your bad night might have had some back sleeping? I'm really a disaster if I get on my back, and my event patterns look a lot like what you show on your bad night. Just a thought. If you can stay off your back, things "might" be a little easier. Not always easy, but some of us manage.

The guys give great advice about getting into auto and seeing what each mask and sleeping position might require. As mentioned, you will need to make one change at a time and give each scenario a little time, unless some are just dreadful right out of the gate. If you sleep better with the ffm and can get effective therapy without running into leak or other issues from the pressure required, you may be well on your way.

Good luck! You're here and looking at your data, Thus, you are already ahead.

Best,

Mike

palerider wrote:

Wulfman... wrote:He's got a Philips Respironics machine and they don't have the mask settings like the ResMed machines do.

the 60 series do have a mask setting.

No mention of them in any of the 60 series provider manuals I have.
I'm not talking about the Resistance settings. Those only apply to P/R masks.

At the following link, I posted a text version of the 60 Series Auto setup instructions and options. If you find it in there, please let me know.

viewtopic.php?f=1&t=101747&p=951212&hil ... ng#p951212


Den

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Wulfman... wrote:

palerider wrote:

Wulfman... wrote:He's got a Philips Respironics machine and they don't have the mask settings like the ResMed machines do.

the 60 series do have a mask setting.

No mention of them in any of the 60 series provider manuals I have.
I'm not talking about the Resistance settings. Those only apply to P/R masks.

At the following link, I posted a text version of the 60 Series Auto setup instructions and options. If you find it in there, please let me know.

yes, they have a resistance setting, which is changed based on which mask you are using.

now, while it doesn't SAY 'mask' on the setting... the fact that you change it based on what mask you're using pretty much says that it's a mask setting.

Resistance settings are in both patient and clinical settings. They are intended to be set according to the mask if a respironics mask is selected, otherwise, enter 0. Here is a link to mask resistance settings: http://www.healthcare.philips.com/pwc_h ... ontrol.pdf

All full face masks are set to X1. That would probably be a safe bet for the Quatro. Pillows masks are all over the map, but feel free to draw your own conclusion.