Change from nasal to full face mask, higher AHI, big aerophagia

[jaspm2004]

Hi there,

I am new member, started to use OSCAR recently. Is a very nice tool. English is not my first language, I will try to do my best.

I changed from Dreamwear nasal mask to Dreamwear Full mask on Dec 5th. I was wearing nasal mask since 2018 when I started to use CPAP machine with no issues, but recently my wife told me that I was opening my mouth when sleeping and a strong air flux was escaping making a lot of noise, almost every night.

Trying to deal with that issue, I changed to Dreamwear Full mask recently but I am having a hard time to adjust. After the change:
- AHI went high
- Leaks are more often
- big aerophagia, i need to wake up in the middle of the night and expulse gas for 20 minutes or more before comeback to sleep

I made some changes on machine settings:
- mask setting, to Full
- pressure to 6 - 14, then 6 - 13 (pressure was 5 - 10 before the change to full face mask)

I am posting OSCAR screenshots to give more details.
- dec 02 2024 - using nasal mask
- dec 21 2024 - higher AHI after full mask change
- dec 25 2024 - a "good" nigth after the mask change

I tried to use a collar for one night, but was very difficult. Maybe I got the wrong one.

Well, i hope to find some answers here. Thanks in advance!

[G. Szabo]

I have the same experience switching between the nasal and full-face dreamwear masks. My AHI is consistently higher with the full-face mask. 
There could be two reasons. (I) The full-face mask pushes my jaw backward and increases the chances of the airway narrowing, causing obstructions. (I) I am a slide sleeper. The more I avoid back sleep, the better my AHI. The full-face mask prevents me from turning my head fully sideways despite using a CPSP pillow.

Advice: return to the nasal mask and use mouth taping.

Commenting on the DEC 2 setting: 
I would set the minimum pressure to 7 cm and use EPR=3, full-time
Would you mind uploading 2-3 minute wide flow rate windows at 6:00  a.m. and 6:24? You might have palatal prolapses or mouth-leaks

[jaspm2004]

Hi G. Szabo, 

Thanks for your reply.

I am a side sleeper too but during the night sometimes I move to back sleep position. 

When you said "mouth taping" is literally to puto some kind of tape on my mouth to avoid open it during sleep? I was thinking to return to nasal mask and try a chin strap.

Dec 2 i was still using the nasal mask. My EPR is set to Off, since forever i think. I will try EPR=3 as you sugest.

I attached the info you requested about Dec 2. Let me know is you need any other data.

Thanks!

[Deborah K.]

You have a couple of different things going on.  You have very bad Positional Apnea some nights.  PA can not be fixed by a setting change.  It shows on your chart when hypopneas and/or obstructive apneas are clustered together.  This means that your chin is dropping towards your chest and causes your airflow to decrease, much like a kinked hose causes water flow to decrease.  Some can solve this with a flatter pillow but most find they need to wear a soft cervical collar that can hold their chin up while sleeping.

You also need more pressure.  I suggest that you change your settings to 8 to 15.

Again, welcome, and good luck with improving your therapy and comfort!  

P.S. Yes, he is telling you to sleep with tape on your mouth. Many of us do this successfully. I use 2-inch wide kinesiology tape cut to 5-1/2 inches long. Any shorter or narrower and I still leak.

[G. Szabo]

Your settings and mask go together. If you change the mask, you should adjust the settings. Hence,  you should be persistent for a while. Use, for instance, the above suggestions with one of your mask choices and post the results so the settings can be refined. 

Your flow rates indicate either mouth leaks or palatal prolapse. The latter is difficult to treat, so you want to find out soon. You can do this by mouth-taping. If the magnified pattern remains when your mouth is tightly taped, you have a palatal prolapse. 

There is a lot of advice about mouth-taping on this forum. Educate yourself.

The most important thing is not to eat 4-5 hours before bedtime to avoid throwing up accidentally. You can use medical tape. For instance, I use a 3M manufactured 1" wide. I cut two pieces three inches long and taped my mouth vertically, starting from the nose base below my chin. The two pieces are next to each other. Their end under my chin is folded back, so it is easy to grab and remove them with a single stroke in an emergency.   Alternatively, you can tape in an X  pattern.