Switch to nasal mask, and AHI increases

[rhyman]

I have been using the Resmed F30 and F30i interchangeably for about 6 months.  My numbers have been very good (AHI <1.0).  I wanted to try a mask that was a bit less cumbersome, so I have been trying a nasal mask, in conjunction with Somnifix mouth tape.  I tend to mouth breath throughout the night.

For the past 4 nights, I have been using the F&P Evora mask.  Very comfortable and allows be to breath in and out very easily.  But my AHI with this mask is between 2.0 and 4.0.  I know those numbers aren't that bad, but considering I was consistently below 1.0 with the hybrid masks, I am questioning why.

I also have the Dreamwear nasal and Resmet N30i masks.  I would like to try those with mouth taping, but those don't seem to give my enough air on intake. Feels like I would suffocate.  Finally, I do have the Dreamwear pillows, which seems to give me really good airflow, just like the Evora or F30.  

my questions:

1) why would my AHI increase with the switch to nasal?
2) why would the Resmed F30 give me good airflow, but the N30i doesn't?

Thanks for any help.

[staceyburke]

We need data to give anything but guesses. Please post OSCAR charts and I’m sure we will be able to give you some advice.

[Melman]

We need to see data to help you troubleshoot the past 4 nights. please post OSCAR charts. See links below for how to organize and post data.

[Geer1]

Yup data is king. We need full night data and some zoomed in 3-4 minute duration views of the apnea that is occurring.

Can't guess further because we don't know if they are obstructive, central, if leaks are occurring or not, apnea are real or post arousal etc.

[rhyman]

Thank you for the help in getting my data posted.  I have included the data from a recent night using the F&P Evora nasal mask (mouth taped) and 2 zoomed in screen shots of different events.  I will try to post a typical night using my F30i hybrid following this.

           

[rhyman]

And here is the data from a night with the Resmed F30i hybrid.  I cannot add a zoomed in screen shot, as I have exceeded my limit.  Would that have been more helpful?


   

[staceyburke]

I don’t think the increase has to do with your mask. The night with higher events looks like you had 2 bouts of positional apnea. That is when you sleep in a position that you cut off your own airway. Maybe you rolled to your back or changed to a higher pillow. 

That leads to chin tucking where your chin drops to your Sternum cutting off your own airway by find out why this happens and stay out of that position.

[SarcasticDave94]

As Stacey mentioned, the higher AHI night has a few Apnea clusters. The full face sample had lower AHI, but flow limits were higher, Max leaks were a bit higher too.

At AHI 2 or less, it's all down to your comfort. AHI 2 is less than half the medically treated levels. Zero events isn't the goal regardless. Either 1 night sample is acceptable therapy, which did you feel better with?

Just an example, when I had used ASV, the diagnostic test results were about 73 AHI and most were CA. On ASV I could get treated to AHI 0-3 and be fine. I didn't feel worse at 3 or better at 0. Both were OK to me. After realizing that fact, I let AHI skip about between 0 to 3 and didn't care a bit. Because I was sleeping better with less symptoms and complaints, and comfort was fine.

[Geer1]

Interesting. I assume these examples are representative of average night so the question is why are you having more obstructive apnea, some of which appear to happen in mild positional apnea way.

Positional apnea is often associated with chin tucking. Best theory I can come up with is that perhaps the full face mask and extra straps hold your chin up/in a position helping avoid apnea. A test to potentially confirm would be to use chin strap or some mouth tape to see if it holds your chin up and avoids these apnea.

Otherwise it's possible you need a higher pressure but usually you need higher pressure with a full face mask not nasal.

[rhyman]

Tried a different mask last night - the Respironics Dreamwear Gel Pillows.  My observations:

• Leak rate was the best since I started therapy 6 months ago (95% was 3.6)
  
• Flow limit also looked good (95% - 0, 99.5% -0.5)
  
• AHI was higher than with my FFM, but not significantly (1.82)
  
• Loved the freedom of a nasal mask vs FFM
  

Of note:

• I did mouth tape
  
• I just didn't feel the nice constant flow of air that I get with the F&P Evora (I wonder if the front hose on Evora has something to do with this)
  
• I don't think it is as easy to breath with the tube on top of my head.
  
• I may try the P10 and / or F&P Brevida
  

Can't attach my data from last night because it says I exceeded my 8MB of data (how do I work around that?)