[Equipment] Switched from nasal pillow to full mask - huge AHI increase

[pstrjds]

I have a Devilbiss Blue (IntelliPAP 2 in the US).  I am using the Philips DreamWear headgear.  The doctor started me with a nasal pillow.  After a few weeks and making tweaks to the pressure, etc, I settled into a nice pattern of AHI between 3.75 and 4.75.  From the APAP data it appears I am still breathing through my mouth at times while sleeping, and I have woken up a few times to find my mouth open and a torrent of air pouring forth.  I also wake up with an extremely dry mouth, even though I have a humidifier for my APAP.  All of this led me to the conclusion that I probably should switch to a full face mask.  So I ordered the full face mask attachment for the Philips headgear.  I do recall the clinician telling me that there are settings that need to be changed if I changed from the nasal pillow.  I have read through the clinician manual and have searched through the clinical menu in the APAP and I can't find anything related to mask type, outside of potentially an "algorithm" change that might be needed to adjust the sensitivity when computing apnea events.  So here is the issue.  I switched out the mask and the first night with it I slept well, but reading the data in the morning it showed my AHI was 19.75.  Second night the AHI jumped to 21.5.  At that point I decided to switch back to the nasal pillow and see if someone here would have any idea on what could be going on or what other setting I might need to change.  The full mask seemed to fit good with no air leaks and I used the built in "Mask Fit Check" under the clinical settings to verify a good fit with the mask.  Any thoughts, suggestions, ideas would be appreciated.

[Gideon]

Please post your nightly chart. I'm looking for clusters of obstructive events first.

[pstrjds]

I am attaching two screenshots from OSCAR.  The first is from a night with the full mask, the second is for a night with the nasal pillow.

[Sleeprider]

Gideon's hunch was right. To prepare for his next advise, preview these wiki articles:
Positional Apnea: http://www.apneaboard.com/wiki/index.php...onal_Apnea
Soft Cervical Collar: http://www.apneaboard.com/wiki/index.php...cal_Collar

[Gideon]

And there it is, large and serious clusters of obstructive events.

Read the articles Sleeprider suggests. That is a classic case of positional apnea from cervical position, something your medical team would not recognize if you put it in front of them and labeled it.

You are tucking your chin and mechanically kinking the hose going to your lungs, yes, very much like Kinking a garden hose. You could set your machine to the full 20cmw it is capable of and that will have NO effect on those obstructive events.

Are you resting your head in a different way with the new mask?,. Using the pillow differently?

Because this is sudden onset, if you can identify the cause, it is not the mask, at least not directly, you can make a correction and avoid using a soft cervical collar which is very effective for this.



Did anything other

[Gideon]

Point of fact. The same thing Is happening with the pillow mask, but not nearly as severe.

[coldfeet7]

I don't know how the units of measure compare from your machine to a Resmed A10 but those leak rates and flow limits are at tremendously high levels for an A10. Does OSCAR normalize readings or just chart what the machine reports?

[Crimson Nape]

Resmed's subtract the intended leak out and only reports anything above the intended leak. I believe Philips reports both the intended leak and the total leak. It seems Devilbiss does the same.

[Hydrangea]

I don't know that my comment is helpful, but I'll add it anyway.

I, too, experienced the mouth gaping open with a nasal pillow (while still getting a great AHI), and then switching to FFM got a higher AHI. I have to assume that my mouth gaping open with air rushing out had been throwing off my AHI score.