Requesting your help with deciding best therapy direction

I'm trying to figure out which direction to go in as I search for the best therapy. Here's what I know (I have data to back the following points):

1. At my prescribed pressure of 14 cm and full face mask I snore too much and have more apneas. Overall AHI isn't bad (average between 2 and 4). However, when using a nasal mask at cpap 14 cm (I tried one out for a week) my AHI was always less than 1 and snore was minimal.

2. At a range of 14-20 cm with full face mask I have a lot less snore and lower AHI (between .5 and 1.5 on average). However, I spend much of the night at pressure close to 20 cm (95th percentile pressure is usually between 19 and 19.6).

I am controlling leaks most of the time so that is no longer an issue.

Should I.. (1) keep experimenting with nasal masks to see if I can find the best one and stay on cpap at 14 cm, or (2) keep doing apap w/full face mask even though I might spend most of the night at close to 20 cm? or (3) get more data to see if I should be at a higher cpap pressure?

Is it correct to think that I should strive to be at the LOWEST effective pressure?

I should mention that I don't noticeably FEEL different (or better) on apap or cpap. I have mostly good nights on either therapy (and some bad nights on either) and in general feel a lot better than before therapy. So should my chief concern be achieving lowest possible AHI?

Thanks in advance for any input.

Hi Randy,
If you are feeling rested and well and your AHI is <5, if you are not battling negative effects from higher pressures, if it were me I would be happy with scenario 2. Have you tried nasal pillows? I have straight cpap pressure of 14 cm and I love the Swift FX nasal pillows. I am getting great results and it is comfortable for me. I alternate between a chin strap or taping my mouth or chin up strips because I do tend to open my mouth when sleeping deeply.

apneawho wrote:Hi Randy,
If you are feeling rested and well and your AHI is <5, if you are not battling negative effects from higher pressures, if it were me I would be happy with scenario 2. Have you tried nasal pillows? I have straight cpap pressure of 14 cm and I love the Swift FX nasal pillows. I am getting great results and it is comfortable for me. I alternate between a chin strap or taping my mouth or chin up strips because I do tend to open my mouth when sleeping deeply.

I haven't tried nasal pillows. Thanks for the thought, I may decide to do so. I need a chin strip w/nasal mask as mouth breathing can be an issue.

Thanks again

Just curious as to what happens (or what it feels like) when you do open your mouth with a nasal mask?

Perrybucsdad wrote:Just curious as to what happens (or what it feels like) when you do open your mouth with a nasal mask?

Weird...all the air going up the nose blows out your mouth. Usually with ugly sounds too.

Unfortunately when this happens the pressure needed to maintain an open airway is significantly reduced and will no longer be effective...hence the things we do to keep mouth shut.

Randy posed this question to me last night and I told him to post it here to see how others felt.
I had to think on it a bit.

I decided if it were me .. I have 2 goals...rest well and hopefully feel superhuman and low AHI.
If I couldn't feel any better with either scenario I would go with the one that gave me the lowest AHI.

Now since both scenarios give acceptable AHI if I could see a huge difference then I would choose the one that let me feel superhuman... if neither...than I go with lower AHI.

Thanks again, Pugsy.

I really think I am going to pursue trying more nasal masks to see if they give me AHI results of <1 at cpap 14 cm like the Mirage FX mask did. Once I have tried a few, if results are consistent I will get Dr to write prescription for new mask. For anyone interested in trying different masks, I highly recommend the Mask Trial Program at cpaplibrary.com.

I have achieved my lowest AHI's (0.5 to 0.7 average) with the only nasal mask I've tried so far, the Mirage FX.

I am still open to suggestions however... as far as feeling "superhuman," I'm still waiting on that!

Pugsy wrote:Randy posed this question to me last night and I told him to post it here to see how others felt.
I had to think on it a bit.

I decided if it were me .. I have 2 goals...rest well and hopefully feel superhuman and low AHI.
If I couldn't feel any better with either scenario I would go with the one that gave me the lowest AHI.

Now since both scenarios give acceptable AHI if I could see a huge difference then I would choose the one that let me feel superhuman... if neither...than I go with lower AHI.

Well put. That would be my thinking, too.

RandyJ wrote:Is it correct to think that I should strive to be at the LOWEST effective pressure?

A pressure can be both comfortable and effective and not necessarily be the LOWEST pressure that gets the job done. I might play around with pressure settings for awhile to see what seems to be "lowest effective", but I wouldn't worry at all about trying to find one particular "lowest effective" pressure.

With an autopap, as long as the minimum pressure setting is in the ballpark (within one cm or so) of being high enough to prevent most obstructive apneas right from the get-go and is a comfortable pressure to use, I don't think it's all that important to try to lower a minimum that a person already sees to be effective. I definitely would use the mask I could sleep in most comfortably, regardless of whether that meant the machine had to use more pressure with that mask vs another mask.

Sometimes it's a trade-off of sorts with this therapy. Neither the "lowest effective pressure" nor the AHI number is what it's all about. Both those numbers can vary quite a bit on some nights. I'd go by what Pugsy outlined. And I'd use the mask I liked best.

Thanks for the link Randy... I'll have to look into that trial program.

rested gal wrote:
Sometimes it's a trade-off of sorts with this therapy. Neither the "lowest effective pressure" nor the AHI number is what it's all about. Both those numbers can vary quite a bit on some nights. I'd go by what Pugsy outlined. And I'd use the mask I liked best.

Thanks rested gal. The Mirage Quattro full face mask has been a struggle with leaks, which I finally have mostly tamed with a padacheek liner and can trust my data, but I got crazy super results with the Mirage FX nasal mask on 1 week trial. So I'm leaning towards choosing a nasal mask that I can buy and really use for a longer period of time and compare to full face mask. It's not that the Mirage Quattro is uncomfortable at all, but it seems harder to get good results (for me). When I saw the 0.5 and 0.7 AHI's with the nasal mask, I was shocked. Maybe for me the nasal mask is just more effective at delivering the therapy than the full face mask... ?

[aside: I kind of got stuck w/full face mask because on the night of my sleep study I was a little bit congested and couldn't keep my mouth closed w/nasal mask they tried first. Plus, they started me off at around 6 cm pressure which wasn't nearly enough to satisfy my need for air.]

I appreciate the feedback - I think that you and Pugsy are wise beyond your (therapy) years.

Perrybucsdad wrote:Thanks for the link Randy... I'll have to look into that trial program.

It's a great program. You only pay for shipping ($14 covers both ways) and have a week to try out the mask. The site is great too; Dane makes videos to demonstrate usage of all the masks and machines, giving lots of useful info and tips.

Really dumb question... I assume the mask that is sent to you has been throughly cleaned and sterilized?

Perrybucsdad wrote:Really dumb question... I assume the mask that is sent to you has been throughly cleaned and sterilized?

Yes - although it is recommended that you wash it again yourself before using, and wash again before sending back. The mask I received looked pristine, but I washed it anyway.

Thanks.... and where did you get your Pad a Cheek mask liner? I would like to try one, but I can't find any information on how long they take to ship from the manufacturer and have not had any luck finding other retailers who sell them.

I thought about making a homemade one, but it looks like they have a good record, so I doubt mine home made version would do me any good. I'd just like to try and get a better seal and more comfortable seal.

Randy,

For me, if the AHI was sufficiently low (and I think in both cases yours are), then I'd go for comfort: Which setting lets me sleep most comfortably and wake up and function better during the day?

I'm not sure I would demand the difference be "feel superhuman" to go with the scenario with the marginally higher AHI. I'd simply set the standard at "which mask/pressure setting" lets me function "better"---even if "better" is not "better by huge, fantastic amount."

I'd be in a conundrum if one setting was more comfortable to sleep with, but the other allowed me to function marginally better.