[Treatment] Switched from Nasal to FFM, higher AHI, help!

[staceyburke]

You probably have had little comment because we can't see any data.  You need to put up the OSCAR of night(s) that you want to know about.  All we know is what you explain about but we can not see what has happened - if you are still having positional apnea or not - pressures and why they rise...

[buffeh]

Fair enough, I'll do an experiment tonight and sleep with a FFM, no SSC, but with my mouth taped and see what I get in the morning. Then I'll post up some graphs over the last few nights and tag them with what conditions they were taken under. Then hopefully you (or someone else) could be so kind as to take a look with your expert eyes and see if you can tell what's going on!

[buffeh]

Ok, I have some data from recent nights.

First some old data: back when I used to use a nasal mask with my mouth taped shut, before I got fed up and quit due to not really feeling much better (now I know this is likely due to PLMS), a typical night would be around 1.5 AHI, broken down as follows:

H Count: 1
OA Count: 3
CA Count: 6
Median Pressure: 8.48
Median EPAP: 5.48
95% Pressure: 9.12
95% EPAP: 6.12
Peak Pressure: 9.46
Peak EPAP: 6.46
Peak Flow Limit: 0.09

This was with pressure range set to 9-12, with EPR set to 3. As you can see, the machine average pressure was only just over the minimum I set. So looking pretty good.

I stopped using the CPAP because I didn't feel any better and I didn't really like taping my mouth shut, which I had to do with a nasal mask. It just wasn't very nice.

Recently (last month) I decided to give it another go with a FFM, so I tried an Airtouch F20, which I actually found comfortable. I was under the impression that a FFM was a good solution for people who couldn't keep their mouths shut, and would ensure that treatment was effective, mouth open or not.

But my AHI went up quite a lot, despite changing nothing except the mask. A typical night using the FFM would look like the first image I have attached below (FFM Sep-23.png):

   

I posted here asking for help in this very thread and the consensious was that I had positional apnea and I needed to adjust my sleeping position or use a soft cervical collar. First thing I tried was going from two pilows to one. I honestly felt my neck was very in line and chin wasn't tucked - but the resulting Oscar data was basically the same as the FFM Sep-23.png data. So going down to one pillow made no difference.

So on the advice on the members here I purchased a SSC and tried it out. In the morning I was pleased to see that my AHI was back down to 1.6! This nights data is the second attachment, FFM SSC Sep-23.png:

   

So I thought this was the solution! But then I had a thought. If the issue was me tucking my chin, how come it wasn't a problem when I was using my nasal mask with mouth tape? The bed, mattress and pillows are all the same and I was using no SSC back then. So I thought, maybe my AHI was only low with the SSC because it was holding my mouth shut by pushing my chin up?? 

So I did an experiment for last night, and DIDN'T use the SSC, I DID use the FFM, but I also TAPED MY MOUTH SHUT. So I'm sorta using the FFM as a nasal mask.

And lo and behold, last night, with NO SSC, but with my mouth closed, my AHI was low, as per attachment "FFM Mouth Taped No SSC.png":

   

So the situation appears to be, the SSC isn't making a difference. What makes a difference is simply whether my mouth is open or not. So I am confused. I was under the impression that for people who couldn't keep their mouths closed, a FFM was the answer, and the mouth could be open, and treatment would be effective. But this doesn't seem to be true with me. With an open mouth, even when receiving airflow via a good seal, I get a poor AHI.

And thoughts / advice? The fewer things I need to attach to my body before I go to sleep the better. I don't want to tape my mouth shut, and I'd rather not wear a chinstrap or SSC. I just don't understand why I get bad AHI with a FFM with my mouth open. At this point I wonder if I even need a machine, maybe I just need a closed mouth and all my apnoea problems are solved (leaving me with only the recently diagnosed PLMS - fun times!)

Many thanks

[Jay51]

Thank you for posting that.  You make some good points; and your points are supported by data.  

I tried 2 similar experiments but had different results than you did.  Experiment #1:  On my S9 ASV, I tried napping in my recliner with and without a cervical collar.  With collar was 0 AHI.  Without collar was 20 AHI (and ASV did all it could be raising my pressure to the max to lower the O's and H's but to no avail).  

2nd experiment:  Same as yours.  FFM + taping mouth shut = SPO2 (and ODI score) that was worse than using FFM + mouth wide open (this combination got a much better SPO2 score (and ODI score).  

I am sorry my results were totally opposite of yours, but you do have data to back everything up.  I cannot figure out why you had these results.

[buffeh]

Thanks for your reply and for your experiments. 

Is it at all possible that my physiology is such that just keeping my mouth closed pulls my chin up enough to keep my airway straight, so even just taping it closed works? Not sure that makes any sense...!

[Jay51]

I think it could be something anatomical like what you described.   I have had trouble breathing through my nose at times also.  Maybe that is why I did better with my mouth open and FFM.  Maybe you breath very well only through your nose.  After all the experiments, I keep going with the best plan I can each night (best set up, etc.).  I hope you find your best set up and best individual therapy.