Does Wrong Mask Setting Affect AHI?

kteague · Post by **kteague** » Tue Oct 15, 2019 10:42 pm

I know it's been discussed that pressure needs might be different with different style masks. And that needing more pressure can cause an increase in AHI. But my question is does having the wrong mask setting cause the machine any confusion that could result in miscalculations? Just wondering if that's something that should be a first step in trouble shooting an AHI that's just a little too high or if it's a negligible effect.

palerider · Post by **palerider** » Tue Oct 15, 2019 10:48 pm

kteague wrote: ↑
Tue Oct 15, 2019 10:42 pm
I know it's been discussed that pressure needs might be different with different style masks. And that needing more pressure can cause an increase in AHI. But my question is does having the wrong mask setting cause the machine any confusion that could result in miscalculations?

Nope.

kteague wrote: ↑
Tue Oct 15, 2019 10:42 pm
Just wondering if that's something that should be a first step in trouble shooting an AHI that's just a little too high or if it's a negligible effect.

Some people will say that the mask setting affects the leak calculation... maybe, I've seen no proof of that in *modern* machines, but I *have* measured small pressure differences (less than one cmh2o) between FFM and pillows setting, which makes sense, pillow masks have a little more resistance to airflow, so they need a little higher pressure at the machine to get the most exact pressure at your nose.

I have also seen that setting affect whether the machine would turn off when removing the mask (ie, with pillows, mine wouldn't turn off for me when it was set to 'full face', but shuts off fine in pillow mode)

ragtopcircus · Post by **ragtopcircus** » Wed Oct 16, 2019 7:20 am

The most noticeable effect of the mask setting is how the machine responds to high flow rate. The pressure drops in the hose and mask are proportional to flow, and they stack up. At zero flow, the pressure in the mask is the same as in the machine.

If the mask sucks in when inhaling and pushes out when exhaling, the machine is not adequately compensating for the flow. OTOH, if you feel a whoosh of air when you start to inhale, it may be overcompensating.

I use a large size Resmed pillow mask. Although Resmed does not break down the specs by size, the large is probably close to a nasal mask in flow characteristics. I use the “nasal” setting on the Airsense because it seems to smooth out the pressure changes compared to “pillows”. I don’t feel a lot of difference between “nasal” and “full face” though.

The Respironics recommendation of X0 for all non-Respironics masks is utterly absurd (unless you are breathing directly from the end of the hose). For me, that causes the mask to pump in and out excessively as I breathe, and taking a deep breath can feel like breathing through a straw. X1 is a more reasonable default choice (maybe X2 for small pillows).

Pugsy · Post by **Pugsy** » Wed Oct 16, 2019 7:30 am

I don't see how mask selection makes any difference in AHI.
Past experience using the wrong mask choice and not seeing any change in the data confirms it.
I have used nasal pillows at full face settings and full face masks at nasal pillow settings....no difference in AHI that I could tell beyond normal slight nightly variations that we would have anyway.
I have also used a Respironics machine at all the settings for Resistance control (and using non Respironics masks) and saw zero difference in the data as well.

If there is any variation...it's statistically so small that it doesn't matter.

ragtopcircus · Post by **ragtopcircus** » Wed Oct 16, 2019 7:52 am

I haven’t seen significant changes in the data either. It does affect comfort noticeably though, at least for me.

Also, for travel, switching to a higher setting on Respironics makes an HME easier to live with. For Resmed, I’d probably try enabling the “bacterial filter” setting to compensate for an HME, but haven’t yet. Switching from “nasal” back to “pillows” may be enough. I just had to spend a night without the humidifier last week though due to a power failure, so I need to get some more HMEs and try it.

Whether you notice a difference in comfort or not is going to depend on your flow rate / tidal volume. Lower flow is less affected. For that reason, it may also have less effect on sleep than on getting to sleep.

peelunkins · Post by **peelunkins** » Wed Oct 16, 2019 7:02 pm

ragtopcircus wrote: ↑
Wed Oct 16, 2019 7:20 am
The most noticeable effect of the mask setting is how the machine responds to high flow rate. The pressure drops in the hose and mask are proportional to flow, and they stack up. At zero flow, the pressure in the mask is the same as in the machine.

If the mask sucks in when inhaling and pushes out when exhaling, the machine is not adequately compensating for the flow. OTOH, if you feel a whoosh of air when you start to inhale, it may be overcompensating.

I use a large size Resmed pillow mask. Although Resmed does not break down the specs by size, the large is probably close to a nasal mask in flow characteristics. I use the “nasal” setting on the Airsense because it seems to smooth out the pressure changes compared to “pillows”. I don’t feel a lot of difference between “nasal” and “full face” though.

The Respironics recommendation of X0 for all non-Respironics masks is utterly absurd (unless you are breathing directly from the end of the hose). For me, that causes the mask to pump in and out excessively as I breathe, and taking a deep breath can feel like breathing through a straw. X1 is a more reasonable default choice (maybe X2 for small pillows).

"If the mask sucks in when inhaling and pushes out when exhaling, the machine is not adequately compensating for the flow. OTOH, if you feel a whoosh of air when you start to inhale, it may be overcompensating."
Mine does exactly this and I hate it. How to fix?

ragtopcircus · Post by **ragtopcircus** » Thu Oct 17, 2019 8:54 am

peelunkins wrote: ↑
Wed Oct 16, 2019 7:02 pm

ragtopcircus wrote: ↑
Wed Oct 16, 2019 7:20 am
The most noticeable effect of the mask setting is how the machine responds to high flow rate. The pressure drops in the hose and mask are proportional to flow, and they stack up. At zero flow, the pressure in the mask is the same as in the machine.

If the mask sucks in when inhaling and pushes out when exhaling, the machine is not adequately compensating for the flow. OTOH, if you feel a whoosh of air when you start to inhale, it may be overcompensating.

I use a large size Resmed pillow mask. Although Resmed does not break down the specs by size, the large is probably close to a nasal mask in flow characteristics. I use the “nasal” setting on the Airsense because it seems to smooth out the pressure changes compared to “pillows”. I don’t feel a lot of difference between “nasal” and “full face” though.

The Respironics recommendation of X0 for all non-Respironics masks is utterly absurd (unless you are breathing directly from the end of the hose). For me, that causes the mask to pump in and out excessively as I breathe, and taking a deep breath can feel like breathing through a straw. X1 is a more reasonable default choice (maybe X2 for small pillows).
"If the mask sucks in when inhaling and pushes out when exhaling, the machine is not adequately compensating for the flow. OTOH, if you feel a whoosh of air when you start to inhale, it may be overcompensating."
Mine does exactly this and I hate it. How to fix?

Which machine do you have?

peelunkins · Post by **peelunkins** » Thu Oct 17, 2019 11:41 am

ragtopcircus wrote: ↑
Thu Oct 17, 2019 8:54 am

peelunkins wrote: ↑
Wed Oct 16, 2019 7:02 pm

ragtopcircus wrote: ↑
Wed Oct 16, 2019 7:20 am
The most noticeable effect of the mask setting is how the machine responds to high flow rate. The pressure drops in the hose and mask are proportional to flow, and they stack up. At zero flow, the pressure in the mask is the same as in the machine.

If the mask sucks in when inhaling and pushes out when exhaling, the machine is not adequately compensating for the flow. OTOH, if you feel a whoosh of air when you start to inhale, it may be overcompensating.

I use a large size Resmed pillow mask. Although Resmed does not break down the specs by size, the large is probably close to a nasal mask in flow characteristics. I use the “nasal” setting on the Airsense because it seems to smooth out the pressure changes compared to “pillows”. I don’t feel a lot of difference between “nasal” and “full face” though.

The Respironics recommendation of X0 for all non-Respironics masks is utterly absurd (unless you are breathing directly from the end of the hose). For me, that causes the mask to pump in and out excessively as I breathe, and taking a deep breath can feel like breathing through a straw. X1 is a more reasonable default choice (maybe X2 for small pillows).
"If the mask sucks in when inhaling and pushes out when exhaling, the machine is not adequately compensating for the flow. OTOH, if you feel a whoosh of air when you start to inhale, it may be overcompensating."
Mine does exactly this and I hate it. How to fix?
Which machine do you have?

Resmed AirSense 10 AutoSet Min pressure 8 max 20 on auto
and the mask is AirTouch F20

ragtopcircus · Post by **ragtopcircus** » Thu Oct 17, 2019 12:48 pm

Well, unlike Respironics, Resmed does not have the brain-dead “no mask” (X0) setting, so it shouldn’t be too far off. There’s not much pressure drop with the F20.

I would double check your tubing size first. The Airsense supports “standard” (22mm) and “slimline” (15mm).

Verify that “bacterial filter” is off (unless you are using one).

Also, the default setting of 4-20 isn’t really right for anyone. It’s common for people to feel air-starved at 4.

The proper setting for your machine with the F20 is “full face”. The “nasal” and “pillows” settings provide progressively more compensation.

There will be some mask movement. You can’t entirely eliminate it. The F20 has a lot of frontal area, so with EPR on, it’s normal for it to push out slightly during IPAP and relax a bit during EPAP.

peelunkins · Post by **peelunkins** » Thu Oct 17, 2019 1:23 pm

ragtopcircus wrote: ↑
Thu Oct 17, 2019 12:48 pm
Well, unlike Respironics, Resmed does not have the brain-dead “no mask” (X0) setting, so it shouldn’t be too far off. There’s not much pressure drop with the F20.

I would double check your tubing size first. The Airsense supports “standard” (22mm) and “slimline” (15mm).

Verify that “bacterial filter” is off (unless you are using one).

Also, the default setting of 4-20 isn’t really right for anyone. It’s common for people to feel air-starved at 4.

The proper setting for your machine with the F20 is “full face”. The “nasal” and “pillows” settings provide progressively more compensation.

There will be some mask movement. You can’t entirely eliminate it. The F20 has a lot of frontal area, so with EPR on, it’s normal for it to push out slightly during IPAP and relax a bit during EPAP.

It is on the full face setting and the pressures are not 4-20, they are min 8 and max 20. The bacterial filter is off and the tubing is set to the heated tube.
This sucking in and out of the mask never happened with the same settings on my PR System One. It died and I got this Resmed one because everyone on this forum says it is the better machine but I cannot make this mask sucking stop and it is difficult to fall sleep with the mask moving so much. Please help!

Pugsy · Post by **Pugsy** » Thu Oct 17, 2019 1:40 pm

peelunkins wrote: ↑
Thu Oct 17, 2019 1:23 pm
It is on the full face setting and the pressures are not 4-20, they are min 8 and max 20. The bacterial filter is off and the tubing is set to the heated tube.
This sucking in and out of the mask never happened with the same settings on my PR System One. It died and I got this Resmed one because everyone on this forum says it is the better machine but I cannot make this mask sucking stop and it is difficult to fall sleep with the mask moving so much. Please help!

Are you using exhale relief?
EPR on the ResMed???? If so, at what setting?
Did you use exhale relief on the Respironics? Called Flex and if so, at what setting?

peelunkins · Post by **peelunkins** » Thu Oct 17, 2019 3:53 pm

Pugsy wrote: ↑
Thu Oct 17, 2019 1:40 pm

peelunkins wrote: ↑
Thu Oct 17, 2019 1:23 pm
It is on the full face setting and the pressures are not 4-20, they are min 8 and max 20. The bacterial filter is off and the tubing is set to the heated tube.
This sucking in and out of the mask never happened with the same settings on my PR System One. It died and I got this Resmed one because everyone on this forum says it is the better machine but I cannot make this mask sucking stop and it is difficult to fall sleep with the mask moving so much. Please help!
Are you using exhale relief?
EPR on the ResMed???? If so, at what setting?
Did you use exhale relief on the Respironics? Called Flex and if so, at what setting?

Yes on the Resmed setting 3
Yes on the Respironic Used the CPAP flex
Please help me, Pugsy!

Pugsy · Post by **Pugsy** » Thu Oct 17, 2019 4:02 pm

peelunkins wrote: ↑
Thu Oct 17, 2019 3:53 pm
Yes on the Resmed setting 3
Yes on the Respironic Used the CPAP flex
Please help me, Pugsy!

Resmed's way of doing exhale relief is not exactly the same as Respironics way of doing exhale relief even if the settings were the same.

Try reducing EPR and/or even turning it off and see if that resolves your mask issues or not.
If it doesn't...I am out of ideas. Sorry.

ragtopcircus · Post by **ragtopcircus** » Thu Oct 17, 2019 4:22 pm

You can try changing mask compensation to “nasal” or “pillows”, but that should not be necessary. You are already on the correct setting for what you have.

FWIW, Resmed EPR numbers are not equivalent to Respironics Flex numbers. Flex does not reduce the pressure as much or as long. If you were using Flex 3 before, you might find EPR 2 or even 1 is sufficient on Resmed.

peelunkins · Post by **peelunkins** » Thu Oct 17, 2019 4:36 pm

Thank you both for the suggestions.
I will try it

Does Wrong Mask Setting Affect AHI?

Does Wrong Mask Setting Affect AHI?

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