Post-Titration Study - AHI up, need advice

[lauradeaton]

Thank in advance for your support. I had an in-lab titration study done on Wednesday, 7/5 and was given two new masks  - one is an AirfitN30i nasal cushion (I had been using DreamWear), and the other is an F&P Evora Full.  The tech told me that my quality of sleep and leak rate was WAY lower with the full face, but still sent me home with both to try and suggested I get a chin strap if I use the nasal cushion.  

Last night was the first night I tried the F&P Evora Full at home, and it was awful.  I set it in CPAP mode at 10.4 (per the titration advice) though for some reason it is show as APAP mode on the screenshot (perhaps it can't tell if I change settings more than once a day?). My O2 was horrid as well.

I woke up after 5+ hours and my AHI was 7.28...way higher than the AHI of 1.8-2.4 that I had been getting with the DreamWear.  I didn't like that at all, and switched to the AirfitN30i nasal cushion for the next 3 1/2 hours. I also switched back to APAP with a min of 9.0 and a max of 11.0.  AHI was much better at 2.55. O2 was also much better.

What am I doing wrong?  Leaks were way down with the full mask but H, CA, OA and RE were all up. Leaks were much more frequent with the nasal cushion, but H, CA, OA were lower and RE was non-existent.

All help much appreciated.  I'm not sure what to do here.

Thank you!

First screenshot is Full Mask.
Second is Nasal Cushion.

[Melman]

It's clear that the APAP mode provides more effective therapy. I suggest you increase EPR to 3 which should reduce your flow limitations and pressure fluctuations.

[Sleeprider]

I agree with Melman. When EPR is taken away, floe limits go up as well as hypopnea and arousal.

[staceyburke]

Your flow limits can be better controlled by increasing your EPR to 3.

[lauradeaton]

Thank you all for your help.  I followed your advice last night and went back to APAP settings and upped the high end of the pressure since it looked like the Evora Full was heading toward higher pressures so, range of 9-13 cmH2O. I also set the EPR to 3 cmH2O.  

• Flow limits dropped dramatically on both the first mask (Evora Full) for 6h46m, and then after waking up and seeing a high AHI score, switching to the second mask (AirFitn30i nasal cushion).
  
• spO2 was worse on the Evora Full and improved on the AirFitn30i. Why would that be?  It's a full mask...shouldn't O2 be better controlled?
  
• AHI was 8.87 on the Evora Full and 10.33 on the AirFitn30i.
  

I'm really baffled. Before the titration study, I was managing things myself since I had to wait almost 6 weeks for any clinical support and the 5-15 Rx wasn't working at the low end (spO2 too low and difficulty breathing) or high end (blowing the masks off my face and large leaks).  With the DreamWear nasal cushion, I had it set to APAP 9-11 CMH2O and EPR at 1 cmH2O. AHI was at so much better at 1.36 but my spO2 was still hanging too low - rarely getting above 95. I've put in a screenshot from that day after these two new ones.

Grateful for any and all helpful thinking.  I'm particularly concerned about all of this CA increase, which was in the past just usually an artifact of being awake for awhile with my mask on (and that is not the case here, I'm sleeping only on these masks and shutting off upon wake up).

Thank you!