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I switched back to using my UMFF last night & whilst 1 night is no proof, it did feel different to sleeping with the quattro.
I am pretty sure the quattro has a larger leak rate than the UMFF & al larger deadspace area.

Will use this combo for the near future & see if I can get consistently good daytime results.
(With this Bipap Auto SV, the data always looks good even if I end up drowsy in the daytime - so
the real test is good data + consistent daytime alertness).

I am hoping this test nails this issue for me as the next item I'll try to buy is a recording PCo2 monitor.
There are a growing number of affordable devices now coming to market.

DSM

Seems the new process for therapy management might become ...
> Get your AHI below 5 at same time get machine & mask acceptable (min leaks from mask & mouth)
> monitor SpO2 to get a baseline for good results
> If needed (tiredness returning) monitor PCo2 & get a baseline for good results incl monitoring daytime drowsiness
> if daytime drowsiness & PCo2 data show it, then start playing with mask machine combo until PCo2 is acceptable

dsm wrote:I switched back to using my UMFF last night & whilst 1 night is no proof, it did feel different to sleeping with the quattro.
I am pretty sure the quattro has a larger leak rate than the UMFF & al larger deadspace area.

Will use this combo for the near future & see if I can get consistently good daytime results.
(With this Bipap Auto SV, the data always looks good even if I end up drowsy in the daytime - so
the real test is good data + consistent daytime alertness).

I am hoping this test nails this issue for me as the next item I'll try to buy is a recording PCo2 monitor.
There are a growing number of affordable devices now coming to market.

DSM

Seems the new process for therapy management might become ...
> Get your AHI below 5 at same time get machine & mask acceptable (min leaks from mask & mouth)
> monitor SpO2 to get a baseline for good results
> If needed (tiredness returning) monitor PCo2 & get a baseline for good results incl monitoring daytime drowsiness
> if daytime drowsiness & PCo2 data show it, then start playing with mask machine combo until PCo2 is acceptable

Just the other way around for me, Doug. Even on my Encore reports, my Quattro will show a leak rate in the low 30's and the UMFF in the high 30's (to around 40 on a "good" night).

Den

Den

You may be right - I just checked last nights data using the UMFF & it showed massive leak for the entire night & thus the air I was feeling from the mask (putting fingers over the vent holes) was probably well under what it might have been if there was no leaking..

Part of my complication is at the time I switched masks I grew a beard & the Quattro appears to tolerate the beard better that the UMFF - maybe it needs a new seal.

The figures from the Bipap SV for leak are so broad it is hard to really read the values so I can't really compare there.

One other possible test would be to block 20-25% of the vent holes in the quattro & see if that changes the daytime results. I tried an experiment like this once before when FrequenSeeker used to post at cpaptalk.

I need to do some careful think on how to come up with results that can be verified & trusted.

DSM

#2

Last night I trimmed my beard & stayed with the UMFF - I think the leak was controlled but won't know untill I check tonights' data. Not feeling any tiredness today but 1 day is not enough to tell.

D

I'm glad this thread was on here.
I am also feeling tired again.

I've been on CPAP for about 2 months now. At first I was like a new born kitten full of energy but lately I'm getting very tired by mid evening. I've had this awful cold that's been going round the UK for about 2 weeks now and although the headcold part is only mild now I'm getting to the end of the chest infection stage. I have the ear infection to look forward to apparently

I have a Resmed swift with humidifier and started on the Resmed Quattro and then the "P&F" (or similar) full face mask but couldn't get on with them due to the bridge of the nose soreness so switched to the Resmed Hybrid which I like but I am a mouth only breather as my nose is 90% blocked all the time due to sproting inuries in my youth.
I have to tape the nose cushions to my nose to hold them in place during the night and believe that I don't get any leaks although I do not have the computer software nor inclination to download and monitor my stats.
My wife tells me I sleep smoothly through the night with the odd snore.
I wake about 4 times or so a night in order to turn over as I sleep on my side and am "concious" of tugging on my pipe which will pull the mask askew and cause leaks.

I did start to wonder about sleep debt. I know that my sleep has been poor for at least 5 years and so I must owe my body a lot of sleep. I've read reports that suggest we have to pay back at least 50% of the lost sleep and the average person needs about 8 hours sleep a night so.. could it be that after a few months of decent sleep on CPAP my body has decided now is the time to get back that lost sleep and is making me tired earlier in order that I go to bed earlier to get extra sleep and make up the defecit?

Well I have been watching my data. A significant leak or two each night from a mask-tug event, but nothing unusual. AI is 1-3, total AHI is under 5, pretty normal for me. Except for the larger leaks, the leak line is pretty flat.

I feel like crap. I almost believe the CO2 issue, except the engineered leak rate in the Quattro is so high< i cant imagine a buildup. I don't buy the deadspace arguement. There is enough turbulance in the mask from normal breathing that the air is well mixed.

And the dog woke me at 4:30Am licking my toes. Normally I appreciate the attention, but not at 4:30AM

elader wrote:The whoosh of air marks off the hours of each night,
standing watch for events which I hope will not come.
A splint made of nothing keeps my life intact,
and allows me to dream once more.

Eric, your imagery is (forgive me) breathtaking. I have printed your exquisite poem and put it with other inspirational thoughts I refer to from day to day. I found your third line to be especially moving. Thank you so much.

Unfortunately, I don't have much in the way of thoughts or suggestions for your troubles except this... I, too, still feel like crap, despite being a thoroughly compliant hosehead since last August. It's so easy to be myopic and forget that not everything physical is apnea-based (although I do believe the apnea makes ALL other conditions worse, even if it hasn't brought them on). I've been investigating other avenues and have identified at least one medication that was apparently disrupting my sleep (Adderall, so stopping it wasn't any kind of medical risk, although it has upped the superball-like qualities of my ADD-affected brain... rah), and (thanks to Kiralynx's thoughts in something she posted a few weeks ago) I'm about to embark on dealing with lymphedema, which I've learned doesn't always come from having had cancer surgery.

So I encourage you to examine everything physical in your life, not just the sleep apnea. As I remember Snoredog said so often, for instance, if something hurts during the day, it's going to hurt while we sleep and disrupt our sleep. Might there be other things (aside from your loving pup) that could be disrupters without your knowing it?

Marsha

Well Elader, I hope you feel better soon. Good luck with the pup.

I enjoyed the discussion and theory with the pCO2. However, I don't buy it either. For example consider a typical FFM mask with a (leak) flow rate of 30 lpm @ 8 cmH2O. Also, consider the dead space of the FFM, about 200 cc or 0.2 l.
(Even less with big nose, fat lips, etc.) Thus, the mask volume is flushed with 150 times within a minute of use;
30 l/min * 0.2 l = 150/min Where would all this CO2 be accumulating?

The Quattro has the air inlet at mouth level, and the exhaust at the top. With normal nose exhalation, the breath
is encountering the air flow stream from the CPAP. This CO2 is immediately dissipated in the stream and routed to exhaust. Fresh ambient air from the CPAP is at the ready, upon the next inhalation.

[quote="dsm"]


One other possible test would be to block 20-25% of the vent holes in the quattro & see if that changes the daytime results. I tried an experiment like this once before when FrequenSeeker used to post at cpaptalk.


Made sense to me, so last night I blocked+- 30% and it lowered oa, but raised hi. Leak dropped from low 40s to low 30s, and felt really comfortable. Today, I felt a bit groggy, probably because of too much co2, but seemed to sleep great. Tonight, I'm gonna try around 20% and see what happens. The relationship of co2 saturation and lazy breathing, matching mask and machine, is a topic worth much consideration. Once again, you and Den are onto something big (I hope).....Will keep you posted.

Thanks,
James...who will try anything once, twice if I like it.

I'm bringing back this thread because I'm reading it for the first time and would love to hear updates from those involved. (The thread was referenced by Wulfman Den in the current thread "ResMed Mirage Quattro - Like No Treatment at All?"). At the time this discussion started, I was happily and very successfully using my Swift LT with mouth tape (AHI less than 1.0) until the LT's manufacturing demise by ResMed....so did not see that the need to read about FFM's at the time.

DSM, did you ever do the experiment you were considering re blocking some of the vent holes on the
Quattro? And has anyone done extended studies about DSM's ideas of the CO2/dead space? Ever since feeling forced to go from the Swift LT to a FFM (Quattro is better than UMFF for me), I for many months have consistently averaged 2-4 points higher AHI, with leak rate right where it's supposed to be on the mfg chart. And I have definitely not felt as well as I did with the LT and mouth tape.

elader wrote:I frequently feel when semi awake like I forget to breathe deep and then have some deeper breaths.

I am right there with you. I went to my doc a few years ago (before OSA diagnosis) and told him that when I am trying to sleep sometimes I am startled to full alertness because I forgot to breath. My PSG and titration study showed no central apneas, I think those events were just airway collapse occurring at the beginning stage of sleep. IDK.

And I never understood my experience with the UltraMirage Shallow FFM (viewtopic.php?f=1&t=46486&st=0&sk=t&sd=a. I just put it on with the hose, for the first time in many months, and there is clearly more effort involved in breathing out than with the Quattro I've been currently using). So what's it all mean?

Sorry folks. Bumping this to the top in hopes of responses.