Need Help - AHI's Much Higher With Full Face VS Nasal Cushion

[brianc18t]

I have been lurking on here for a while and have been using my CPAP since last summer.  I have fairly mild apnea but I definitely sleep much better using my machine. I was in denial for a while as I am 6 feet, 175 pounds, and do a ton of cardio and such.... but I for sure have it. I used to wake up in the night from nightmares sometimes with loud hissing noises when I thought I was being attached and I would wake myself up (and scare the hell out of my wife who sleeps in a different room now lol). 

My sleep doctor is about useless and gets upset when I adjust the pressure (but the only reason it got dialed in correctly is because I made adjustments myself).  During my sleep study they said 7 was my optimum pressure but it actually seems to be 12 or 12.5.  I am currently using 12 on my Dreamstation with the auto feature set for up to 15 and my AHI went from in the mid teens down to around 1-3 (sometimes slightly higher or lower) and this seems to be the lowest I can get it which is OK as I sleep well.

I use a Phillips nasal cushion and am really happy with it except I have to tape my mouth or I leak badly and can't use the mask. The leaking was somewhat mild (but still not something I could deal with at a pressure of 7 but at 12 I 100% have to tape).  I don't mind the mouth taping but wanted to be able to use a full face mask at minimum when I am sick but possibly all the time. My first full face mask was a Phillips Dreamwear and I could never get it to seal that well throughout the entire night even when adjusted correctly.  Worse than that, my AHI's using the mask would typically be around 8-16.  I tried many different pressure settings (mainly higher but lower too) and while it helped bumping it up around to 14, it didn't help much (brought it down to 8-16 from say 10-18).  

I was really disappointed but figured about half a year later I would try a different full face mask and upon much research, went with the Resmed F30i.  I really like this mask... I cannot imagine it being much better (for a full face mask) by my pressure issues are the same as with the Dreamwear full face.  I don't know if this is just something about my anatomy or if some of the experts here can help.  My sleep Dr. said when I was using the Dreamwear mask that there is not difference, she has never seen a difference between full and nose cushions in the 5,000 people she has treated over the years, and it must be something with the fitment but offered no more help...  got annoyed when I told her she was wrong and that the data clearly shows there is a big difference for me.... and she sent me off with her assistant. Her assistant was helpful and saw I was adjusting the mask correctly and looked at the data and said she sees what I am talking about but was unsure why I was having such drastic differences.

So, below is an OSCAR printout from a typical night with my mouth taped and a Dreamwear under the nose cushion and one of the Resmed F30i.  i am not sure I am putting up the most useful data so please let me know if there is something missing that I should add.  I am at a loss as what is going to help, but am very open to trying suggestions.  Like I said, my nose cushion works best at 12 or 12.5 with a limit of 15 but the full face.... I have tried anything from 10 to 16 as a base pressure with higher upper limits and I just can't get it much below 10 no matter what I do. I feel tired after wearing the full face. Sucks, I feel I wasted a lot of insurance money at this point but I haven't given up!

Thanks!

[wordjoy]

I can't see your leak graph.  But your leak stats show you are having some occasional VERY LARGE Leaks. So the pressure is not reaching where it needs.  Maybe you are trying to sleep on your side or the tube gets pulled but your mask is probably not sealed at times. 

Look and see if your large leaks match your peak in AHI on the graph.  Then look at hose management, tighter headgear, special side sleeping CPAP pillow with a notch in to so it doesn't press on the mask.

[brianc18t]

Here are a few more graphs (I have only used the Resmed mask a few times so still getting used to it but I think it was just the one night with the bad leaks).  I will post more as soon as I can.

Oh, I mostly sleep on my back for what it is worth.

Thanks!

[brianc18t]

Hopefully this leak info helps.  I will keep in mind my hose management too!

I don't think the leaks are my problem from what I can tell?

[SarcasticDave94]

Hi brianc18t, welcome to Apnea Board. First, I suggest setting the OSCAR chart according to a standard view that you can review and match with the link in my signature. The black lined Flow Rate should be directly below the events at the top. This is the biggest edit to your chart.

I've noticed that your pressure settings change with the mask changes according to OSCAR data at the top left. With what is shown so far, the higher pressure charts are showing higher AHI. This may be related to the mask change or the pressure settings. Since a supposed change of both, it's hard to tell which caused the AHI increase. Typically, if one changes masks, the resistance setting on Respironics or mask setting on ResMed should be the only machine setting change necessary.

FWIW you're not the only one that has doc issues with changing your pressures, or not relating to changes they don't really understand. Unless they use CPAP themself, it seems they just don't get it.

[wordjoy]

I don't have an answer for the first high AHI pattern right after you fall asleep.  That is not something I have dealt with.
I suspect it is some kind of issue others have, just guessing.

But to my reading of the graph there are larger leaks pretty much at the same time your AHI numbers spike the rest of the night.
Either the AHI makes you restless and that pulls at mask or leaks are allowing for more incidents. We can't assume cause and effect right away, but I would still recommend working on the leak rate and seeing if it helps.

[brianc18t]

Thanks everyone for the I put.  I have data I can post with using both masks in one night at the same pressure or tonight maybe I will wear the full face at 12 at least starting out.  Really don't want to feel run down tomorrow so I may only do part of a night.  Either way, I will try to preferences format in my next reply and appreciate the help!  I will also try being carful with the hose routing and fitment....

[brianc18t]

Sorry, I was having trouble getting the screen layout exactly how it should be and I have to get working!

Here is last night.  I had trouble getting to sleep (unusual for me) so the AHI is lower than it would have been for the first couple of hours.  I do not feel very refreshed.... : (  Pressure at 12 with a limit of 20, hose was well managed, and very little to any leakage the best I can tell.  The results were similar to what I typically see for a full face mask. 

As usual (with either mask), if I start at a lower pressure, it never ends up as high with the autopap as it would if I started at a higher base pressure.  I could start at a pressure of 7 and then it would only get up to 10 or 11 where my AHI would be a lot lower with a starting pressure of say 12 where it might get up to 15.  If I start at a pressure of 15, it might get up to 17 but my AHI would be no lower or possibly higher.  Seems like the autopap function isn't all that great and it doesn't react as well as it could.

Open to suggestions!  Thanks again!

[SarcasticDave94]

OK here's the list of how OSCAR ought to be in order after calendar and pie chart are Off in the left panel, along with turning off VS2 flags on your Respironics:

How to order the data charts
The most useful charts for diagnostic purposes are:

Event Flags
Flow Rate
Pressure
Leak Rate
Snore
Flow Limit (Resmed only. Respironics includes Flow Limitation in Events)
Each chart has a name displayed on it vertically on the left side of the chart.

You can move a chart up or down in the order by pointing your mouse pointer in the label part of the chart, left clicking and dragging up or down to change the order.

The chart height can be resized by pointing your mouse at the border of a graph until the cursor changes to a double bar with an arrow above and below, then dragging the border up or down.

Then the left panel ought to be scrolled to see settings at the top of that listing should be appropriate.

OK, now to addressing some of your observations according to how I've read it. Disregarding different masks for the moment, you seem to indicate that if pressure settings are lower, you may not have as many events flagged, but you tend to feel worse for it. And then the reverse is also likely true. I think part of this comes back to a nasty habit Respironics machines have and that is these machines respond slowly to events. You would need the pressure set very close to where it needs to be to respond, or it will either not flag them or more likely it will flag but be unable to respond in time. Best solution short of getting a ResMed, you will need pressures set to be just below where events occur, which I think will require a pressure increase from what you've been running.

I think we'll need to get a chart that is set to standard view so we can get on the same page. We includes the pressure gurus on AB, not necessarily myself. I can see things more accurately the more I see the OSCAR but these others are just better at interpretation. This doesn't cancel out the fact that Respironics machines are notorious for slow responses.

[Dormeo]

Just to be sure: when you switch between one mask type and another, do you change the mask setting on your machine?