PRS1 A-Flex X2 vs. X3 w/Nasal pillows

This has probably been talked before and if someone can point me to a link or info, that would be appreciated.

Trying to figure out if changing the X "resistance" settings to something other than what is recommended for a particular mask is potentially helpful or if I should try something else first.

On my PRS1 A-Flex I can change from X1 thru X3.
Some masks give the suggested settings, some don't.

My DME said I should use:
X1 for my particular nasal mask
X2 for my medium nasal pillows
X3 for my small nasal pillows

I prefer the "X3" small nasal pillows for personal comfort.

The "X2" mediums give me better "perceived" air flow, but can lead to more mouth breathing (I'm not using the software yet to see the measured difference).

Is there any reason I should try adjusting to the "higher" X2 setting with my small pillows or should I just bump of my minumum setting, which I'm assuming would basically do the same thing?

I'm trying to adjust one thing at a time and wait a week before changing anything else. I was amazed when I saw a week's worth of printouts at my 30 day checkup. With no known changes to mask or settings (with the nasal mask), I was anywhere from an AHI of 2.5 to 9 for various one night averages. My AHI and the patterns throughout the nights seemed to be really different from night to night even thought all mask and pressure factors were unchanged. Because of this, I'm planning on printing daily info, but still looking at a weekly trend before making any changes. I may even need to wait a couple of weeks between changes. Otherwise it will be hard to tell if I'm improving or just experiencing "normal" (for me) variation.

Java Time wrote:1) Is there any reason I should try adjusting to the "higher" X2 setting with my small pillows or should I just bump of my minimum setting, which I'm assuming would basically do the same thing?

Resistance settings have nothing to do with pressure settings or needs. For that matter it has nothing to do with leak reporting either (it doesn't do the same leak report variable that mask selection in ResMed machines do). Respironics say for non Respironics masks set it to zero. A while back I played with all the settings using my Swift FX nasal pillow mask. Zero change that I could perceive in any of the data whatsoever. I also could not perceive any change in what it felt like while I was awake.

They (Respironics) don't really explain how this feature is really a benefit.
http://systemoneresistancecontrol.respironics.com/ but it seems to me to be more for the variable resistance in masks. If you look at mask literature all masks have a resistance with a plus or minus variable. Mask resistance has nothing to do with mask vent rate.

You can do what you want with the Resistance settings but don't try to adjust minimum pressure as being related to whatever Resistance setting you have chosen because it has nothing to do with pressure.

Now if you feel like the smaller openings with small nasal pillow masks is not moving as much air as the larger openings then that is a different thing. Some people do seem to notice a difference and feel like "more air" with larger openings.

When you get the card reader..look for leaks, AHI and do pressure increases correspond to leaks or not. APAPs will try to fix a leak with increased pressure sometimes. So watch the leak line, AHI, and pressure needs. The other stuff you will pick up on with time.

Thanks Pugsy, very helpful.

I probably should put this on a separate thread, but is it weird that my nightly averages for the week that was printed out at my 30 day checkup are anywhere from 2.5 up into the 9 range during a single week with no changes to mask, pressure or anything? I don't mean the variation within a night, I mean Tuesday is a 2.5 AHI night and Friday may be an 9 AHI night. For the first month I was averaging 6.7 AHI.

The sleep doctor and the tech that printed my data didn't seem to react to the variation from day to day, but people on this forum seem to dig a lot deeper into the data than the sleep techs.

My sleep doctor did bump up my minimums from 8 to 10. I'm waiting on my card reader to arrive this week to see if the new higher minimum has leveled out my AHI "nightly average" from one night to the next. After 5 days it has not improved my "7 day avg" AHI.

Funny that you ask about the resistance setting.

I checked with my Primary Care Physician who referred me to cpap.com. This is what they told me for our machines (same machine, yours is auto and mine is not).

x1 = nasal and FFM
x4 = pillows

NOTE: It didn't matter if the mask size was small, medium or large.

Starlette

Nightly variations in AHI are normal. I might have AHI of 0.5 tonight and tonight a AHI of 4 with no changes in anything. It just can happen that way. Even after all the time I have been doing this.

Once you can see the nightly details every night you will soon get a sense on what is normal for you.

90% pressures can be affected just by a leak so don't worry so much about those. Again easy to spot on the details.
Heck on APAP I might see 90% of 12 one night and next night 90% of 16... Leaks and/or event needs can impact the % number.

Don't worry about the 7 day average AHI...It takes substantial changes to impact it until you are using the new pressure for 7 nights to get any sort of feel for results to pressure change. Even if you had AHI of 0.0 tonight...it won't make a huge impact on the 7 day average. Law of numbers won't let it.

Starlette,

Sounds like your machine also has more resistance settings than mine. As far as I can tell for mine there is only X1 - X3.

I looked at the link Pugsy sent and looked all over Respironics' website for more info.

They imply they are doing something different depending on the size of the mask. I get it that a nasal mask like you and I have versus our small "pillow" would be different. I was a little surprised that my DME said my medium pillows, that are only a little bit bigger than the small, push the resistance up to the X2 setting.

Like Pugsy said, it is somewhat mysterious what the resistance setting does. If it doesn't adjust pressure, the only other thing I could see it modifying is the relationship of when air is blowing in full strength versus the time that the machine backs the pressure off for exhalation.

Since I feel like I can breathe slightly better with the medium at X2, although they fit a little loose, I may try adjusting the resistance with my small pillows to X2 which would normally represent a larger mask and see if that makes breathing seem better.

I'm trying to make adjustments to the nasal pillows because they feel more comfortable for me. The downside of the nasal pillows is I seem to average 3 or 4 AHI higher per night with the pillows than with the nasal mask.

I'm struggling to decide if perceived comfort or AHI is more important.

Java Time wrote:I'm trying to make adjustments to the nasal pillows because they feel more comfortable for me. The downside of the nasal pillows is I seem to average 3 or 4 AHI higher per night with the pillows than with the nasal mask.

I'm struggling to decide if perceived comfort or AHI is more important.

If comfort equals feeling better generally and sleeping more soundly and resting better...then comfort wins hands down.
AHI is just a small piece of the big pie here.

If I had AHI of 0.5 consistently but my mask was uncomfortable and I couldn't rest well and woke often from leaks or discomfort and I generally felt like crap..

or

If I had AHI of 4.5 and slept soundly, no wake ups, quite comfortable and felt well rested....I would take that choice any day of the week.

It's all about getting good quality restful sleep and feeling better. It isn't a test where we get a gold star if we have a night with 0 AHI or something when it is at the expense of comfort that might mess with our sleep quality.

This is why doctors tell people not to chase the numbers all the time.

Thanks for the follow-ups Pugsy. I'll try not to get too buried in the details once I can access my own printouts from the SD card.

It's probably good I only had the 7 day averages from the info screen and no SD card access at first, I think the full daily reports may have given me too much to think about during my first 6 weeks.

Thanks again.

Java Time wrote: I'll try not to get too buried in the details once I can access my own printouts from the SD card.

We all do it for a little while...some more than others. Just don't focus solely on a number.

Way back when I had been on the machine maybe 3 months I woke up feeling hugely better, like amazing. Got a lot done that day, felt great. I thought "this is the miracle every one talks about" Didn't even bother to look at the data until that evening. I just knew that I must have had a awesome AHI number....like 0.2 or something as I had been running around 2 AHI.. Could have knocked me over with a feather...AHI 10.4 yep ten. On paper the night looked like I should have felt like death warmed over. That was the only time I ever had the "miracle" and only time AHI was way out of line. If I could repeat how much better I felt and have an AHI of 10 again...I would do it in a heart beat.