New F&P Simplus user

[Roy289]

Began CPAP on April 8 2016 and quickly realized was mouth breather. Always waking up with very dry mouth. Tried numerous ffm but finally went back to my original F&P 405 nasal mask. Good AHI around 1 but in the presence of 20% large leaks most nights. Finally arrived at F&P Simplus.

First night used head strap as set by DME. First session 3h 15m with lot of leakage into right eye. Found pushing the mask down would minimize the eye leaks. Many periods of LL and very sore bridge of nose.

Second session adjusted the forehead straps to allow the pillow to fill with air around bridge of nose. Also loosened the side straps so pillow not compressed to face. This resulted in virtually no leakage but had about 4 OA two lasting 33 sec while I normally have 0 OA during the night.

My pressure range is 7 to 14 with average of 9.5 but on second session hit the 14 mark with average 10.5. Would like to hear other experiences with the Simplus

[FrankNichols]

I am not familiar with that mask, but assuming you have no leaks, then the issue is not the mask. I would let things settle down for a week or so with little to no leaks - focus on the leaks. Then I would slowly start adjusting - adjusting low end up a little first, maybe to 9 and then 11 or so. But slowly allowing a week between each adjustment.

[PaulaO2]

With no leaks, both from your mouth and the mask, then you are getting the true AHI. Like Frank said, just concentrate on the mask for now, making it work.

I use the Simplus (I switch between it and the Nuance). I use Remzz liners to help with leaks. The Simplus fits better when it rides low on the face.

[Roy289]

Second night using Simplus ffm had unusual results as in attachment. In the first 3h 30m session had numerous OA in a cycle with typical OA duration 40 sec. followed by approx. 10 breathes then another OA , this went on for one hour. The pressure had risen to its max of 14.
[attachment=2893]

No major leaks in the first session but often around 20. In the second session had a major leak which was likely mask moving up so leaking out of my mouth from under mask.

Would increasing pressure max be recommended or try to get to improve the mask seal?

[Sleeprider]

Roy, I'd be reluctant to make any suggestion on a single data point that you say is unusual. What is typical for you? Are these clusters of OA something you have seen previously? You have increased pressure before; were the results better or worse?

Just need more to go on, and I agree this is pretty unusual.

[Roy289]

Sleeprider, using my older F&P 405 seldom got any OA but around 14 CA during entire night. Attached is another cluster of OA from the second session and has the same cyclic mode.

[attachment=2894]

I believe the cyclic pattern is caused by the high pressure, perhaps like PB due to CO2 sat?

Certainly odd results!

[Roy289]

forgot to mention that during the second cluster of OA the Leakage is quite low.

[Sleeprider]

If you don't mind trying something on a wild guess, I'm going to suggest turning EPR down to 1 and increase max pressure to 15. Try that first and see if there is any difference in a couple nights. Next step if we don't get results we want is going to be an increase in minimum pressure to 9.0 based on current median pressure. I suspect this is a positional apnea problem, or could be REM sleep stage. If it is positional, we can work with sleeping position or some other tricks, but the point of all this is to make the therapy work and for you be comfortable and rested. So, we don't want to manipulate you into less comfortable sleeping positions if we can avoid it. For now, the EPR experiment is just to rule out its influence, and it's the simplest change you can make.

[Roy289]

Tonight will set EPR down to 1 and max pressure 15. Most of the night in the supine position but try to go on my right side and manage any leakage.

The Simplus leaks around my right eye but this can be eliminated by pulling the head band away from my forehead. Looking at finding some foam to place between forehead and the front head straps which hopefully will solve the leakage. Many users of the Simplus recommend pushing the mask down but in my case this results in pressure and tenderness on my nose. i.e. too much compression of the mask pillow.

[PaytonA]

If you loosen up the top straps the forehead stabilizer should move away from your forehead. Some Simplus users recommend that the forehead stabilizer should be a finger's width away from your forehead. I find that it depends on your facial topography.

Best Regards,

PaytonA