Assistance needed - higher AHI with full face mask

DreamOn - so maybe Biotene products would help your situation as well as the slight increase in humidity.

I think drooling might just happen when we sleep more deeply! I remember, when I was MUCH younger, I would drool in the night almost every night. I slept really well when I younger - probably deeper and better.

I didn't see this post and posted my own experience here....
viewtopic/t48962/Quattro-FF-vs-NasalDifferent-AHI.html

Hawthorne wrote:DreamOn - so maybe Biotene products would help your situation as well as the slight increase in humidity.

I think drooling might just happen when we sleep more deeply! I remember, when I was MUCH younger, I would drool in the night almost every night. I slept really well when I younger - probably deeper and better.

The humidity level that I used last night seemed to take care of the mouth dryness, but I'll consider trying the Biotene. I used Oasis moisturizing mouthwash right before bed when I first started mouth-leaking with the nasal mask (before I got the PAPCap chinstrap) and that seemed to help with mouth dryness some.

I don't know what's up with me and drooling. It seems to come and go. And it often starts as soon as my head hits the pillow, even before I'm asleep. I'm not sure, but I think I was doing it with the Quattro last night too.

LSAT wrote:I didn't see this post and posted my own experience here....
viewtopic/t48962/Quattro-FF-vs-NasalDifferent-AHI.html

Thanks for posting a link to your thread, LSAT. I'll watch your thread too because I do think it's entirely possible that the lower jaw could be pulled back, causing airway blockage. Have you tried experimenting with humidifier settings? I suspect that's important with the full face masks.

At least in my case, I'm having to wear the bottom straps quite tight with the Quattro, to minimize leaking. With my Activa LT, I wear the straps very loose, so that would lessen the pressure on the jaw. I usually use the PAPCap Plus straps to secure both masks. You probably saw JohnBFisher's suggestion to try a sports bite plate to see if that may lessen jaw movement. I haven't tried that yet. I have a mouth guard intended to prevent damage from teeth clenching/grinding. Would that do the same thing? I'm not yet sure if I'll be able to wear it, though, due to boney growths on my lower palate (under the tongue). Since last night's results with the Quattro were SO much better than the previous two nights with it, I'm going to try a few more nights without changing anything, except maybe one more bump up in humidity.

I think what really has blown me away was the drastic increase in AHI and apneas on the first two nights with the Quattro, over what I usually experience:

February 2, 2010 (first night with Quattro)
AHI...................5.8
AI.....................0.8 (9 apneas)
Leak..................0.14 L/sec

February 3, 2010 (second night with Quattro)
AHI...................9.6
AI.....................2.8 (27 apneas)
Leak..................0.12 L/sec

February 4, 2010 (first two-thirds of the night with Quattro, last third of the night with Activa LT)
AHI...................1.4
AI.....................0.2 (2 apneas)
Leak..................0.06 L/sec


....contrasted with a typical night lately with my Activa LT nasal mask, with chinstrap:

January 30, 2010
AHI...................1.3
AI.....................0.1 (1 apnea)
Leak..................0.08 L/sec

I don't think I've ever had more than 3 apneas in a night with my nasal and pillows masks. In fact, I usually have 0 or 1 apnea. It was a shock to see 27 apneas on the second night with the Quattro! Could I really have been moving the jaw back THAT much more the second night? Or perhaps it was a combination of things -- strap tightness/jaw movement, getting used to something new, neck position, humidifier level, etc. It'll be interesting to see what happens with the Quattro over the weekend. I hope I can keep it on for a full night and sleep well!

~ DreamOn

Dream on, also consider that its possible for whatever reason that you feel more comfortable sleeping on your back with the Quattro and you sleep on your side more with the Activa (or that you are less comfortable sleeping on your side with a FF mask. I know I am more comfortable with the nasal mask on my side than a FF mask on my side.)

There are just so many variables. Your numbers look so great with the Activa, well, I'd probably just stick with it... as long as your feeling good.

GaryG wrote:Dream on, also consider that its possible for whatever reason that you feel more comfortable sleeping on your back with the Quattro and you sleep on your side more with the Activa (or that you are less comfortable sleeping on your side with a FF mask. I know I am more comfortable with the nasal mask on my side than a FF mask on my side.)

There are just so many variables. Your numbers look so great with the Activa, well, I'd probably just stick with it... as long as your feeling good.

Hi Gary,

I don't think I've been sleeping on my back any more with the Quattro than I do with the Activa, but I'll pay more attention to that this weekend because that could definitely affect things. The Activa and the nasal pillows masks are definitely more comfortable for side-sleeping than the Quattro, but I've been forcing myself to side-sleep as much as possible despite the tendency for the bed pillow to push into the Quattro more. I have a buckwheat pillow that I may try with the Quattro too. If I suspect back-sleeping I can use my homemade tennis ball belt that prevents that and see if the results are any different.

You're right, there are so many possible variables! I have a feeling that I'll end up going back to the Activa LT and nasal pillows masks for regular sleeping, but if I can get really good results with the Quattro too I'll use it from time to time for a change.

Here are last night's results with the Quattro. Another bad night! I had it on for 8:49 hours, and the only thing I changed from the night before was that I bumped the humidity up from 2.5 to 3.0 for most of the night. That was a bit too much, so in the wee hours of the morning I set it back down to 2.5. I slept with my oximeter, so you can see those results here too.



I woke up at about 4:25 a.m. and noticed that I was on my back, so I do think that may account for the large cluster of apneas! But I do occasionally roll onto my back with the nasal and pillows masks and I have never had results like this! Remember, with the nasal/pillows masks I usually have 0-2 apneas per night. My theory is that because the Quattro is heavier, maybe it's forcing my chin down towards my neck in the supine position, blocking the airway. Any other ideas regarding that?

I was surprised that I didn't have more oxygen desaturation with all those apneas clustered together! The lowest SpO2 was 92%. But you can see that oxygen saturation was very unstable during that apnea cluster period. For anyone not familiar with the SpO2 pulse oximeter report, the vertical black bars mark both oxygen and pulse rate "events". I have a headache today and don't feel all that great, and I think the reports explain why.

I will continue the Quattro Experiment over this weekend at least, and probably into next week. Tonight I will sleep with my homemade tennis ball belt, which will prevent me from rolling onto my back. I probably won't make any other changes until I see the results of a few nights of side-sleeping with the Quattro.

I initially posted my questions to get answers for myself. But the more I think about this, the more I realize that this information may help others too. It's possible that if therapy results aren't as good as expected that it could be due to the type of mask and how it affects the airway, especially when in the supine position. I think that's the case with me and the Quattro, since my results with the nasal and pillows masks have always been excellent, both in the numbers and the way I feel during the day. It's something to consider, anyway, especially if apnea events are clustered like this. But my experiment continues, so we'll see what happens....

~ DreamOn

This is very interesting, DreamOn. I admire your persistence.

DreamOn wrote:
I initially posted my questions to get answers for myself. But the more I think about this, the more I realize that this information may help others too. It's possible that if therapy results aren't as good as expected that it could be due to the type of mask and how it affects the airway, especially when in the supine position. I think that's the case with me and the Quattro, since my results with the nasal and pillows masks have always been excellent, both in the numbers and the way I feel during the day. It's something to consider, anyway, especially if apnea events are clustered like this. But my experiment continues, so we'll see what happens....

~ DreamOn

This is indeed a very interesting thread for the rest of us. (Namely, me.) I feel I've reached a balance of using a nasal pillow mask and tolerating a known possibility of some mouth leaks via chipmunk cheeks. Now that I've migrated to a System One I'm not going to know much more than large leaks and whether I have cotton mouth. But I truly feel that the minor leakage as you described doesn't necessarily compromise therapy. I got my leaks down to almost nil with the papcap also, but I've found there can be too much of a good thing--I managed to tweak neck nerves. So balance is the key. Maybe, as I think Katie referenced, it won't be bad that I can't chase the elusive leak numbers for a while.

Anyway, I look forward to more of your postings. Someday I may need to figure out if I want to try a FFM.

DreamOn wrote:... I initially posted my questions to get answers for myself. But the more I think about this, the more I realize that this information may help others too. ...

Sweet! This is a PERFECT example of how you should use the numbers! My compliments, DreamOn, for a fine job. You proposed an experiment to monitor both how you felt and the numbers from several sources. You are running the experiment over several nights without changing things. You want to see if it is consistent. And your diagram is EXCELLENT, since it ties together both the cluster of events and the Pulse-Ox data. Plus, it shows the detail of the events. And then you note in your log that you woke on your back at the time of the events, so you suspect that is contributing to the events.

I suggest you keep an eye on whether you awaken with your mouth open and the lower jaw pushed back. I suspect that when you are on your back the pressure of the mask presses the lower jaw toward your throat, allowing obstructions to occur more readily. You might need to increase you pressure ... or go back to the nasal interface.

Though as I've noted before the numbers should only be our "windsock" to help guage our sleep. Yet, but combining the numbers and your feelings of your sleep carefully, you can see if that windsock can help reveal underlying issues. This gives you a chance to manage your sleep better than with just the numbers or just the feeling.

Exceptional work. Thank you. I learn from your work. I know others will learn as well.

KatieW wrote:This is very interesting, DreamOn. I admire your persistence.

My long-suffering husband will attest to the fact that I have a long history of being persistent! I don't give up easily, but I do try to compromise.

Scarlet834 wrote:This is indeed a very interesting thread for the rest of us. (Namely, me.) I feel I've reached a balance of using a nasal pillow mask and tolerating a known possibility of some mouth leaks via chipmunk cheeks. Now that I've migrated to a System One I'm not going to know much more than large leaks and whether I have cotton mouth. But I truly feel that the minor leakage as you described doesn't necessarily compromise therapy. I got my leaks down to almost nil with the papcap also, but I've found there can be too much of a good thing--I managed to tweak neck nerves. So balance is the key. Maybe, as I think Katie referenced, it won't be bad that I can't chase the elusive leak numbers for a while.

Anyway, I look forward to more of your postings. Someday I may need to figure out if I want to try a FFM.

If you try a FFM at some point, I'd be interested in yours results, Scarlet!

I do hope that this little experiment does help other people because I don't want to make it all about me. I decided to try the full-face mask partly out of curiosity. I don't really enjoy having to wear a chinstrap, although I do have to say that the PAPCap hasn't been too uncomfortable for me. I had hoped that a full-face mask might give even better results than the other mask types. Even though my results with the nasal/pillows masks have been excellent, I want therapy to be as good as it can be because my health is very important to me. I really need to give my body the best chance I can to heal from the years of abuse and (hopefully) prevent more problems from developing.

JohnBFisher wrote:Sweet! This is a PERFECT example of how you should use the numbers! My compliments, DreamOn, for a fine job. You proposed an experiment to monitor both how you felt and the numbers from several sources. You are running the experiment over several nights without changing things. You want to see if it is consistent. And your diagram is EXCELLENT, since it ties together both the cluster of events and the Pulse-Ox data. Plus, it shows the detail of the events. And then you note in your log that you woke on your back at the time of the events, so you suspect that is contributing to the events.

I suggest you keep an eye on whether you awaken with your mouth open and the lower jaw pushed back. I suspect that when you are on your back the pressure of the mask presses the lower jaw toward your throat, allowing obstructions to occur more readily. You might need to increase you pressure ... or go back to the nasal interface.

Thanks for your kinds words, John, and all your help! Even though our sleep-related problems are quite different, I have learned SO much from you!

I will try to notice the position of my jaw when I awaken, but that's such a subjective feeling and difficult to ascertain when you're a little groggy! I think I did notice that my chin was down toward my chest when I was on my back, though.

I'm going to take my time and try different things. I'll work with the Quattro for a while, to see if I can figure out if it really is the supine position that's responsible for the terrible results. I'll probably return to the nasal and pillows masks and try those both with and without the chinstrap to see if there really IS any difference in my results (both in the numbers and the way I feel). I also plan to bump up my pressure in a week or two.

I'm thinking that I may be having to tighten the bottom straps so tight on the Quattro because the mask itself may be a bit too big for me. When I see my sleep doctor and the RT on Friday I'm going to switch this small Quattro for the extra-small. Maybe I wouldn't have to tighten that size so much? By then I should know whether it is back-sleeping that's responsible for these Quattro apnea clusters too. If the extra-small Quattro doesn't work out, then I'll switch to the FullLife, which seemed to fit pretty well. And if that doesn't work, I'll probably give up on full-face masks!

~ DreamOn

It's the back-sleeping that raises my AHI and increases apneas with the Quattro!

Last night I slept with the Quattro and used my homemade tennis ball belt to prevent back-sleeping. Check out these beautiful results, which is what I'm used to seeing with my nasal/pillows masks! I feel good too -- first time in 5 days I didn't wake up with a headache! Yay!!!

February 6, 2010
AHI...................1.5
AI.....................0.1 (1 apnea)
Leak..................0.00 L/sec




Contrast that with the other three nights that I've slept solely with the Quattro, when some of the time I was probably on my back:

February 2, 2010
AHI...................5.8
AI.....................0.8 (9 apneas)
Leak..................0.14 L/sec

February 3, 2010
AHI...................9.6
AI.....................2.8 (27 apneas)
Leak..................0.12 L/sec

February 5, 2010
AHI...................7.5
AI.....................3.0 (26 apneas)
Leak..................0.06 L/sec

The ResScan charts were posted earlier here for all previous nights with the Quattro. There were large clusters of apneas, apparently associated with sleeping in the supine position during those periods.

I still don't know if the apneas were occurring due to the airway closing because the Quattro bottom straps are very tight (which pulls my chin back) and/or if my chin is closer to my chest while in the supine position. This does appear to be something unique to the Quattro, though, because I've never had more than 3 apneas in a night using my Activa LT nasal or Headrest/Opus 360 nasal pillows masks, even when I sleep on my back some.

I'm learning a lot from this experience, and I hope it'll help others to troubleshoot their therapy challenges too! I've always known that the supine position was a problem for me (and probably most people), as my sleep study revealed. I'm thinking now that occasional back-sleeping may explain some of the variability I've had with the nasal and pillows masks. Makes me wish I had an APAP even more, if for no other reason than to see how much of a pressure difference is needed for me in the supine position! This has also made me appreciate ResScan software even more. Without seeing the results via the software, I wouldn't have known that the apneas were occurring in large clusters. For those of you with suboptimal results, it's worth looking for clusters and trying to figure out why the apneas occur more at certain times. Could be due to REM sleep, mask (strap) adjustment, sleep position, or airway blockage due to other factors (neck angle, tongue, etc.).

I'll continue the Quattro Experiment for at least a few more nights. Tonight I'll keep things the same and use the tennis ball belt again. I may try the extra-small Quattro after I see the RT on Friday, to see if it fits better, because this size small may be too big for me. Maybe I won't have to wear the bottom straps so tight with that smaller size. We'll see how it goes!

Thanks again, everyone, for helping me with this. I owe you guys!

~ DreamOn

DreamOn wrote:It's the back-sleeping that raises my AHI and increases apneas with the Quattro!

Brilliant experiment! Congratulations on that nice straight leak line. I learned alot from this thread, thanks.

I was about to come and post about the possibility of elbow leaks and the teflon tape solution, but perhaps this isn't necessary now. But I'll mention it anyway.

Another night with the Quattro, side-sleeping only, using the tennis ball belt. AHI about the same as the night before, which was also side-sleeping only, and this time I didn't have any apneas!

These results look very much like I see with my nasal and nasal pillows masks, whether sleeping on my back or side. I still don't know for sure why I have 26 or 27 apneas while on my back for a short time with the Quattro, but at least I know that it's the back-sleeping that does it!

February 8, 2010 (mask on at 1:00 a.m., so that's why it shows today's date)
AHI...................1.6
AI.....................0.0 (zero apneas)
HI.....................1.6
Leak..................0.06 L/sec
Hours.................8:54



What this illustrates to me is how much sleep position can affect some people. But since I do not have large numbers of apneas when in the supine position with nasal and pillows masks, this also shows that it may be the mask type itself (or adjustment of the mask, such as tighter straps?) that contributes to increased apneas in the supine position. I hope that this will help someone else to optimize their therapy!

~ DreamOn

ozij wrote: And no, most mouth openings are not a response to a H or A.

I'd like to know more about this. Can you explain?

A newbie to this - I've only had mine for a week. The first few night with a nasal mask, my AHI was under 8 every night. The first night with a full face, it went to 49.7, but I had a lot of leaks. I felt HORRIBLE all that next day - very sleepy and achy. The next night my AHI was 26.5 with no leaks. And I felt HORRIBLE that whole next day - very sleepy and achy. There MUST be something about the full face mask that causes this, as we both have experienced the same thing. I'm going to try it a couple more days before I go back to the nasal mask. I hope the best for you.