UltraMirage FFM question

I've been using the Shallow UMFFM periodically for a few months, and have had a consistent and disturbing marked increase in my AHI from around 1.0 or less over the entire past year with another (nasal pillow) mask, now up to 4-7+ AHI, (and with leak rate at the level recommended for my pressure) using the UMFFM.

I've asked previously here, but have not been able to clarify what might be going on. Recently, my use of this mask has resulted in a huge and frankly scary return to my pre cpap state of being. Unable to get up without forcing myself, totally drugged-feeling all day, cotton-headed, yawning, fatigued, irritable, addle-brained. OMG it's like being thrown back to the beginning!

I have been thinking that the Shallow mask might not be exhaling the CO2 enough....no other idea what's going wrong. So I thought the UMFFM Standard might be larger and allow greater air or exhale space.....

I called ResMed to ask them what the difference is between the Shallow and the Standard UMFFM, and was told that "the Shallow mask is deeper than the Standard." I asked if they were serious. Yes, she repeated it 3 times, without any explanation. Then she told me to contact my DME.
Anyone have any more ideas about what might be happening here?

I had asked that question here a long time ago when my husband was still having leak issues with his UMFF and can't remember who replied that the Standard would probably fit most shape faces while the Shallow might be a better suited for those with somewhat Asian features. As I write this I think I also asked cpap.com and was told basically the same thing. You may be right about the air circulation and CO2.

You think you might need to increase your pressure?

Thanks Dori. Now that you mention it, I do remember reading that here way back when. Thing is, that my leak rate is exactly where it should be for my pressure, so fit of the cushion is apparently not the problem. And mdintx, I had thought the same thing. I have tried going from 10.5 to 11 on several different occasions with this mask and with my nasal pillow mask. Result is that I get a great increase in AHI with both masks every time. So I have concluded that I need to stay at 10.5.

From my observations monitoring Mike's therapy but not actually sleeping with the mask myself, I notice he sleeps better with a little more air volume circulating inside the mask so his leak rate is always a little higher than the stated rate. The manual says he should be at around 40lpm but he's usually between 44-48. In fact his leak rate last night was on target at 41,very unusual, and he didn't sleep as well.

plr66 wrote:I've been using the Shallow UMFFM periodically for a few months, and have had a consistent and disturbing marked increase in my AHI from around 1.0 or less over the entire past year with another (nasal pillow) mask, now up to 4-7+ AHI, (and with leak rate at the level recommended for my pressure) using the UMFFM.

I've asked previously here, but have not been able to clarify what might be going on. Recently, my use of this mask has resulted in a huge and frankly scary return to my pre cpap state of being. Unable to get up without forcing myself, totally drugged-feeling all day, cotton-headed, yawning, fatigued, irritable, addle-brained. OMG it's like being thrown back to the beginning!

Well, one possibility that comes to mind is that you might be consistently breathing through your mouth with your full face masks. Full-face-mask mouth-breathing works well for some people, but IMHO mouth-breathing can pose a variety of problems. This is counter-intuitive, but many of us probably have significantly higher airflow resistance when breathing through our mouths compared to breathing through our noses:

J Am Board Fam Pract 15(2):128-141, 2002. © 2002 American Board of Family Practice wrote:Another cause of OSA is nasal obstruction. The nose, best viewed as a variable resistor, contributes to nearly 40% of total airway resistance.[23] This resistance is greatly influenced by the vasomotor reaction of the nose to several factors, such as hormonal effects, metabolic changes, and numerous pharmacologic agents.[23] Olsen et al[24] measured the respiratory effort in a patient during sleep and suggested that the oral airway resistance was greater than the nasal airway resistance. With the nasal pathway being the preferred route for nocturnal breathing, an increase in nasal resistance will invariably increase the possibility of collapse of the nonrigid portion of the upper airway, namely, the pharynx.

Anyway, full-face-mask mouth-breathing works just fine for some people, and for others mouth-breathing becomes a significantly more resistive airflow route--- given just the right tongue and mandible characteristics and relaxed, occlusive movement. End result: an increased AHI while mouth-breathing is entirely plausible in some cases.

I would suggest experimentally mouth-taping while using your full-face mask. If the problem goes away, then you can assume that mouth-breathing even with a full-face mask is your culprit. Otherwise, I would suspect the greater volume dynamics of a full-face mask somehow might not sit well with your physiology.

SWS, In the entire past 14 months of reading this forum daily, I don't think I have ever read what you have just described; and I thank you so much for enlightening me! What you said is actually not counter-intuitive to me, and makes complete sense of what I've been experiencing. I will try the tape with the FFM tonight to test that.

This news does worry me, however, since I needed a mask I could alternate with the nasal pillow/taping routine at times when my skin gets irritated by the taping (just started happening a couple of months ago when I removed tape too quickly...now a repetitive problem). Any suggestions?

EDIT: I also meant to ask: Since my AHI numbers so consistently jumped a huge amount when I increased my pressure from 10.5 to just 11 (AHI from 3-4 up to about 7-8 range using the FFM), I was assuming I may have pushed myself into centrals. Would that be assuming too much?

plr66 wrote:This news does worry me, however, since I needed a mask I could alternate with the nasal pillow/taping routine at times when my skin gets irritated by the taping (just started happening a couple of months ago when I removed tape too quickly...now a repetitive problem). Any suggestions?

EDIT: I also meant to ask: Since my AHI numbers so consistently jumped a huge amount when I increased my pressure from 10.5 to just 11 (AHI from 3-4 up to about 7-8 range using the FFM), I was assuming I may have pushed myself into centrals. Would that be assuming too much?

I haven't used it myself, but maybe Polygrip wouldn't be as irritating as tape?

With respect to the AHI jump, a similar thing happened to me. Going from 9 to 9.5 fixed things (dropped from AHI in the 20s to around 5, later down to 2). Trying 10 to see if it was even better increased AHI to around 8. Based on conversation with my RT (be he right or wrong) I don't think centrals are responsible. I noticed a significant comfort difference with that last .5 cm increase, and assuming it is above and beyond what is needed to keep the airway open, maybe it has a resulting negative rebound for reasons other than CSA. I know that when I toss and turn while I'm awake I get corresponding apnea tics on my data that definitely are not from sleep apnea because I'm awake. Maybe I'm wrong, but I just have a hard time believing that only .5 cm pressure separates me from effective treatment and central apnea.

plr66 wrote:I will try the tape with the FFM tonight to test that.

This news does worry me, however, since I needed a mask I could alternate with the nasal pillow/taping routine at times when my skin gets irritated by the taping (just started happening a couple of months ago when I removed tape too quickly...now a repetitive problem). Any suggestions?

I'm curious how your experiment will turn out. But if mouth-breathing really does cause your increase in AHI, then there are other approaches to try besides taping or relying on full-face masks. I think in that hypothetical case I'd be tempted to try a chin strap and an off-the-shelf dental appliance in tandem. That two-fold approach just might keep the air from escaping through your mouth. And positioning your mandible slightly forward with a dental appliance might even help to reduce your upper airway resistance.

plr66 wrote: Since my AHI numbers so consistently jumped a huge amount when I increased my pressure from 10.5 to just 11 (AHI from 3-4 up to about 7-8 range using the FFM), I was assuming I may have pushed myself into centrals. Would that be assuming too much?

Scarlett834 wrote:Maybe I'm wrong, but I just have a hard time believing that only .5 cm pressure separates me from effective treatment and central apnea.

Well, as it turns out, 10cm is a statistical magic barrier in epidemiology. That 10cm point is the pressure at which some small but significant portion of the population begin to manifest pressure-induced central apneas. As the pressure increases beyond 10cm, more and more of the population will also begin to manifest pressure-induced central apneas. Some researchers think the Hering-Breuer reflex is the mechanism at work for those particular pressure-induced central apneas.

I agree that only half-a-cm change seems extremely counterintuitive regarding substantial AHI spikes. However, sometimes dyscontrol in individual physiology (no longer talking about population-based epidemiology) is a matter of discrete or sudden thresholds of dyscontrol---rather than smooth gradations of increasing dyscontrol.

-SWS wrote:

plr66 wrote:I will try the tape with the FFM tonight to test that.

However, sometimes dyscontrol in individual physiology (no longer talking about population-based epidemiology) is a matter of discrete or sudden thresholds of dyscontrol---rather than smooth gradations of increasing dyscontrol.

Sorry SWS, but can you explain that in simpler terms. I'm not sure what "dyscontrol" means. thanks.

Sorry, about that, DoriC. Dyscontrol is the opposite of control.

While adequate "respiratory control" means biologically well-controlled breathing, "respiratory dyscontrol" results in problems such as apneas, hypopneas, periodic breathing, hypoventilation, etc.

-SWS wrote:I agree that only half-a-cm change seems extremely counterintuitive regarding substantial AHI spikes. However, sometimes dyscontrol in individual physiology (no longer talking about population-based epidemiology) is a matter of discrete or sudden thresholds of dyscontrol---rather than smooth gradations of increasing dyscontrol.

I'm behind Dori here, SWS, and would so appreciate your saying this in another language. Sorry. I followed you well until this paragraph.

Again, I'm sorry about that poor wording. Probably best to strike that cryptic wording from the public record.

Discrete threshold of dyscontrol: the proverbial last straw that suddenly broke the camel's back.
Smooth gradations of dyscontrol: each added straw causes a much smoother progression of resulting physiologic problems instead.

plr66 wrote:I've been using the Shallow UMFFM periodically for a few months, and have had a consistent and disturbing marked increase in my AHI from around 1.0 or less over the entire past year with another (nasal pillow) mask, now up to 4-7+ AHI, (and with leak rate at the level recommended for my pressure) using the UMFFM.

I have been thinking that the Shallow mask might not be exhaling the CO2 enough....no other idea what's going wrong. So I thought the UMFFM Standard might be larger and allow greater air or exhale space.....

I called ResMed to ask them what the difference is between the Shallow and the Standard UMFFM, and was told that "the Shallow mask is deeper than the Standard."
Anyone have any more ideas about what might be happening here?

Dear Resmed,
....SAY WHAT???

On my mask odyssey, I tried the shallow seal w/both a med and small mask.
I had exactly the results you experienced.
In my observations and experience, the shallow is not as deep as a standard seal.
Because of this, I found it much harder to maintain a seal.
I still have a med/shallow seal. It anyone wants to try it, let me know.

-SWS wrote: Full-face-mask mouth-breathing works well for some people, but IMHO mouth-breathing can pose a variety of problems. This is counter-intuitive, but many of us probably have significantly higher airflow resistance when breathing through our mouths compared to breathing through our noses:

This is very interesting. A few months ago, when I experienced my first sinus/chest cold after starting
cpap, I tried to breath through my mouth, and could not do it.
I thought is was just because I had trained my self to keep my tongue in place.

DoriC wrote:Sorry SWS, but can you explain that in simpler terms. thanks.

plr66 wrote:I'm behind Dori here, SWS, and would so appreciate your saying this in another language.

I think that SWS' real job is spinning for the current presidential administration....
doesn't matter who is actually in office. Words mean what he says they mean.

He just posts here to unwind and a few laughs.

carbonman wrote:He just posts here to unwind and a few laughs.

My, whatever gave you that idea?