Major issues transitioning from full face to nasal pillow mask

[SleepTea]

Hello all, I've been using cpap for around 6 months now with positive results. When I started, I used a nasal pillow mask, but because I didn't know how to deal with mouth breathing at the time, I quickly switched to an f20 airtouch. I’m now hoping to move away from the full face mask due to issues with comfort and the desire for a more minimal set up in the long term, but I’m struggling to get nasal masks to work for me for reasons I don’t fully understand. 

In my last experiment, I used the bleep dreamports coupled with mouth tape. My experience was better than my initial trial with the p10s, but I still got poor quality sleep. My AHI was significantly higher than normal (about 4 compared to 1.3 with f20) and I woke up feeling exhausted to the point that I found it hard to maintain the trial for more than a few days. Subjectively, I feel like I struggle to get enough air while falling asleep with the nasal mask, and am wondering if I may have an anatomical issue with my nose or whether I just need to push through for a few weeks to adjust to the new mask. My minute vent is a little over 5 compared to the usual 6 I get with my full face mask, which seems to confirm my subjective experience.

Has anyone had any similar experience or have any advice to offer? I haven't been able to find too many similar cases; in fact in my research I mostly found people saying that their AHI improved when switching from FFM to nasal pillows. I've attached a picture of a night with the dreamports as well as an average night with a FFM for more context.

       

[Narcil]

your charts are a bit hard to read. disabling the small (<15min) sessions at the bottom left instead of zooming in and limiting the number of graphs (wiki) would help.

what i notice it's mostly CAs you're getting, which seems odd? somehow the change in mask is triggering treatment emergent csa or did you have csa to begin with?

[G. Szabo]

You switched from EPR 1 to EPR 2, and as a result, your CAs increased, which is in line with the general trend. To have a correct comparison, you should have the EPR setting the same. It is preferable to have EPR= 1 or 0 for the time being because your AHI seems to be lower at lower EPR.

[SarcasticDave94]

Possible issues with masks like the F20 could be the incorrect thinking that very tight will fix leaks. It will not. In fact will do the opposite and create more leaking, while adding discomfort or pain. If any mask can't provide reasonable leak control with at most moderate tension, either change cushion size or move on to another mask.

As is, you'll need to be able to control mouth leaks when using pillows or nasal cradle masks. You can practice the tongue suck exercise to try keeping your tongue in the same place it rests while awake. Failing this you'll need to consider a chin strap or taping your mouth in order to control mouth leaks. Failing these as well means full face, but this has the problem of required more areas to seal effective and consistent.

[PeaceLoveAndPizza]

Or a soft cervical collar. Chin straps are good for some, but for others they tend to pull the jaw back creating other challenges and potentially jaw soreness.

[HalfAsleep]

I suggest using a hybrid mask like the F40.

Yes, I found out my nostrils didn’t have enough capacity to use just a nasal mask; I had a septoplasty. I definitely think you might want a visit with an ENT, but a nasal mask still might not work for you. Hard to say.

[JRuck504]

I know how you feel, I keep going back and forth and cant settle on one. That's my issue.

[SleepTea]

your charts are a bit hard to read. disabling the small (<15min) sessions at the bottom left instead of zooming in and limiting the number of graphs would help.

what i notice it's mostly CAs you're getting, which seems odd? somehow the change in mask is triggering treatment emergent csa or did you have csa to begin with?

Thanks, I have updated according to the guide in new images. I don't have central apnea, but I get a very small amount (usually under 1/hr) from treatment.  I'm suspicious that these events may be improperly flagged - I remember in my consultation with Jason from AXG that he believed a lot of my apneas were mislabeled.

You switched from EPR 1 to EPR 2, and as a result, your CAs increased, which is in line with the general trend. To have a correct comparison, you should have the EPR setting the same. It is preferable to have EPR= 1 or 0 for the time being because your AHI seems to be lower at lower EPR.

I set the EPR to one more so that Oscar stats could distinguish the two for the purpose of calculating averages and to make the nasal mask a bit more comfortable. In general, EPR has a loose association with centrals for me, but I was having no problem a few days earlier at 3 EPR on the FFM so I don't think that's the issue in this case.

Possible issues with masks like the F20 could be the incorrect thinking that very tight will fix leaks. It will not. In fact will do the opposite and create more leaking, while adding discomfort or pain. If any mask can't provide reasonable leak control with at most moderate tension, either change cushion size or move on to another mask.

As is, you'll need to be able to control mouth leaks when using pillows or nasal cradle masks. You can practice the tongue suck exercise to try keeping your tongue in the same place it rests while awake. Failing this you'll need to consider a chin strap or taping your mouth in order to control mouth leaks. Failing these as well means full face, but this has the problem of required more areas to seal effective and consistent.

I was actually able to reduce my tightness significantly when I started using a firm pillow a few days ago. I believe my face can no longer dig into the pillow during my sleep, which I think was dislodging it if it wasn't extremely tight. I'm still not thrilled with the full face mask and would like to move to the nasal mask, but wanted to point this out in case anyone with a similar problem w/ mask tightness sees this thread.

I suggest using a hybrid mask like the F40.

Yes, I found out my nostrils didn’t have enough capacity to use just a nasal mask; I had a septoplasty. I definitely think you might want a visit with an ENT, but a nasal mask still might not work for you. Hard to say.

Interesting, did you notice any improvements from the septoplasty?

Thank you everyone for all your help so far! I've attached a few more graphs that I think might shed more light on what's going on. A pattern I've noticed is that I'll have a leak that disappears and is followed by chaotic breathing. The first image shows several events where a small persistent leak ends and heavy breathing ensues, with or without apneas. The second and third graphs are more zoomed in and show several apneas following the end of the leaks. 

I don't really have any ideas what's going on there so I'm curious if anyones seen this pattern before. I believe the leaks are from the adhesive disconnecting on the dreamports, as I was mouth taping those nights, though the leaks look a lot like mouth leaks.

           

[G. Szabo]

Here you are, my speculation.
Consider the first plot. You have a well-defined leak rate and a normal breathing pattern, which had been established under this condition. The leak ensures the exhaled carbon dioxide is washed out from the mask, and you cannot inhale part of it. ( Nota bene: inhaling some carbon dioxide is the normal operation of the CPAP treatment.) Once the leak stops, the inhaled oxygen/carbon-dioxide ratio decreases, and you increase your breathing effort to compensate for it: breathing becomes irregular; both its frequency and intensity increase, and you are in hyperventilation, which overcompensates for the previous oxygen deprivation. As a result, the inhalation drive decreases in your brain, and CAs emerge.
So, this is a transition period between two steady states (i.e., under leak and no-like conditions).
But, of course, it isn't very pleasant.
You must either stop leaks or make them constant.