Switched masks - AHI higher - feel more tired

Hello,

Been a long time lurker but first time poster. I started CPAP treatment about a year ago now (maybe less, not sure exactly). I am compliant every night, I wouldn't dream of sleeping without a CPAP. I was originally using Mirage Quattro full face mask and switched to Activa LT nasal about 1.5 months ago.

I switched because I really could never get the Quattro mask to properly seal, I had to constantly adjust it or just ratchet it down so hard that my face ended up with bright red lines all over it. It also wore a scar in my nose bridge.

My ENT had prescribed 16 cm and I had been using that for the longest time. My AHI used to be around the 4.0 - 6.0 range (As reported by ResMed). AI was around 1-2.

After switching masks my AHI has been at a constant 10. AI every night seems to be around 0.1 with the rest being HI.

So in summary it seems like my AI has dropped to near 0 but my HI has increased a lot. I'm not sure what this means exactly. I have been feeling more tired lately and it has been very hard for me to wake up in the morning. Also dreaming has been very very vivid and it seems that I want to keep sleeping because I want the dream to keep continuing. I also notice during the night that I am shifting positions like crazy.

A couple nights ago I upped the pressure to 17cm and it seems to help though, I'll try that for a while and see if it makes a difference.

Has anyone else switched from a full face to a nasal mask before and experienced any of this?

What are your leak #s like?

Did you change the mask type when you switched to the Activa LT?

Why didn't you try a different FF mask such as the Ultramirage or Quattro, etc. as you likely need it? Many people have to switch to FF masks after trying nasal ones, but it's less usual for the switch to go the other way.

Might consider the RespCare Hybrid mask. It covers the mouth and has nasal pillows...nothing touching the nose or forehead. Comes with 3 sizes of oral cushion, 3 sizes of pillows, and pillows can be set at 2 heights making getting a good fit as easy as fitting a mask even gets .

mdintx wrote:What are your leak #s like?

Did you change the mask type when you switched to the Activa LT?

Last night it was 0.67 L/s, I did switch the mask type to Activa. The times I have looked at the leak rates it has all been between 0.3 - 0.7

Julie wrote:Why didn't you try a different FF mask such as the Ultramirage or Quattro, etc. as you likely need it? Many people have to switch to FF masks after trying nasal ones, but it's less usual for the switch to go the other way.

Well like I said I was using the Quattro and I hated it. I would prefer to use a nasal if I can get away with it. I don't seem to be mouth leaking, and the damn ENT never really explained why she suggested a full face mask. In my original sleep study I opted for the full face mask because I thought it would be better for some reason, and I get the feeling they just ran with it.

What I would really like is for ResMed to put the Activa seal (the one that kind of inflates) on a full face mask, because like I said with the Quattro I had to ratchet it down really hard to get any kind of proper seal.

RespCare Hybrid mask wrote:Might consider the RespCare Hybrid mask. It covers the mouth and has nasal pillows...nothing touching the nose or forehead. Comes with 3 sizes of oral cushion, 3 sizes of pillows, and pillows can be set at 2 heights making getting a good fit as easy as fitting a mask even gets

I had asked my DME about nasal pillow masks but they said that at such high pressures nasal pillows will just blow out of your nose.

Is there a good way to tell if I am mouth leaking? I don't wake up with a dry mouth.

Paveway wrote: I had asked my DME about nasal pillow masks but they said that at such high pressures nasal pillows will just blow out of your nose.

There are people using nasal pillows that are also using those high pressures. It is not set in cement that they will "blow out your nose".
I use auto machine. It is set wide open and sometimes I hit 18 cm of pressure (I have software to see) and they don't blow out my nose. Often I never know I hit those pressures till I see the reports.

You might or might not be able to tolerate the nasal pillows at your pressure but not everyone fails.
The RT at my titration study told me that I would hate the nasal pillows and that it would take me 3 months for the sore nose to go away. What an idiot. I never had a sore nose. If I had listened to him I would still be struggling and wondering. Some of these RT's just don't have a clue.

Paveway wrote:Is there a good way to tell if I am mouth leaking? I don't wake up with a dry mouth.

Yes, tape your mouth tonight and see what happens. Your leak rates are high and the machine can only compensate so much.

Paveway wrote:Is there a good way to tell if I am mouth leaking? I don't wake up with a dry mouth.

Try the mask I use. I used to think I needed a fullface mask but found out I did not. I now use the ResMed Mirage Activa Nasal (not the LT and not nasal pillows) CPAP Mask with Headgear - Standard – great mask, comfortable, no leaks and leaves no sores on my nose or strap marks on my face. Since I switched to my current mask I'm getting numbers as follows:

Leak in L/s = 0.20
AHI = 2.1
AI = 0.0
HI = 2.1
Use in hrs = 7.45
95th percentile pressure in cm H2O = 12.0

paveway wrote:Has anyone else switched from a full face to a nasal mask before and experienced any of this?

Paveway, I have experienced something similar, although not from full face but rather from nasal.

I swapped from a Mirage Activa (nasal, not full face) mask to a (swift) nasal pillows. I love the nasal pillows, it is so much lighter and easier to use, and I experience less sweating and discomfort, however I cannot get the lower numbers using it. My AHI is much higher - not as high as yours, I'll admit, but 2-3 in total, compared to 0 to 0.5 with the nasal mask. During the day the difference is noticeable energy- and alertness-wise.

Reluctantly, I now use the nasal mask all the time, but my numbers are always great as a consequence. It's a trade off I guess, and I feel better for it.

Good luck in your therapy, whichever way you go, and keep asking questions!