Mask conundrum... F20 v P10

[sweetbobby]

I'm in a bit of a dilemma... I am a mouth breather at night, and when I resumed my CPAP treatment with an effort to keep it up, I was using a full faced F20 mask (size Large). I was still getting an AHI of 30, so I switched to nasal pillows with a chin strap and my AHI went down to a much more manageable 2 or less. And it was only after I got the nasal pillow that I joined this board (you guys are great) and started using OSCAR.

Now that I know a little bit more... it seems like the issue wasn't necessarily the full face mask but positional apnea being on my back for times given the insane clustering of events you can see in the charts. In fact, it almost looks like my sleep was better with the full mask whenever I wasn't supine.

So now I am in a bit of a conundrum. Should I go back to the full face mask and adjust the pressures with the knowledge I have now (It had a max pressure of 8 with an EPR of 3 for crying out loud!) to try to get to a reasonable AHI, or do I stick with the nasal mask and deal with all these mouth leak arousals? 

For what it's worth, I also feel like the large F20 is still not large enough. Does anyone have other recommendations?

[CPAPfriend]

A couple things, I would push back and say you're just as equally a nasal breather if you managed the whole night with nasal breathing and chinstrap maintaining your jaw closed.

Second, how do you know you were on your back? It does look like signature positional apnea, but I'm just curious what you're going off of here.

You should do whatever results in higher quality of sleep for you. I know that's a lame answer, but if in both cases, that is full-faced mask on your side or nasal + chinstrap, you're getting objectively good sleep, then you should choose on the basis of how you feel subjectively between the two. Or, at a minimum, you could trial both sets of conditions for, say, a week, and then reflect on which string of nights you found worked better, and we can also review the objective results here!

[Expat31]

You are right, on the face of it it certainly looks typical of positional apnea

However there are two types of positional nal apnea:-

1. Back sleeping when during REM sleep, the body is partially paralysed and the tongue can fall back and block the airways. 

2.The trachea becomes kinked blocking tbe flow of air. This can hammen in any position, supine when it falls back towards the chest, or side sleeping in the "foetal" position. You will see many references on this forum co concerning cervical collars, as well as type of pillow used, especially thick ones. 

Please see these for information:-
Soft cervical collars.
Positional sleep apnea-the case for straightening out upper airways.
Sleeping positions & pillow adjustments (video Mayo)

[Deborah K.]

If the chart on the left is with the full face mask, and the right is with the pillows mask, then it's obvious that the pillows mask is working way better for you.  It is not just your AHI that is better - everything is better.  I would stick with the pillows for sure.