4 months in, horrible OA after changing from nasal to full face. Please help.

[aquamike]

Hi everyone,

I'd appreciate any ideas or insight/advice about an issue I've been having in transitioning from nasal N20 to full face F20. I thought it would improve, but it seems to have worsened my apnea.

I definitely feel like I'm getting more air and have fewer snores, but have had some terrible episodes of OA and feel like a bus hit me in the morning.

A few nights ago, I had about an hour of severe OA and flow limit, - about 15 episodes, some of which lasted about 40 seconds or more. I actually had a dream that I was sprinting and couldn't run fast enough. Screenshot below of the hour when I had a problem and a zoom in on one episode that lasted 51 seconds (!). Oscar data says fixed 11.4cmH20 but pressure was apap 11-13.6 at the screenshot time.

I never had this issue with the nasal mask (or even before CPAP therapy) and was wondering what the problem might be.

Any insights would be appreciated- thanks!

Michael

screenshot-20230916-110724.png (93.25 KiB) Viewed 5333 times

OA of 51 seconds.png (82.25 KiB) Viewed 5333 times

[chunkyfrog]

Nasal masks, especially nasal pillows, contact the face over a much smaller area
than full face masks, meaning consistently better fit/fewer leaks for most patients.
Bad leaks mean you may not be getting enough air to prevent as many obstructive apneas.
Why the mask change?

[aquamike]

Nasal masks, especially nasal pillows, contact the face over a much smaller area
than full face masks, meaning consistently better fit/fewer leaks for most patients.
Bad leaks mean you may not be getting enough air to prevent as many obstructive apneas.
Why the mask change?

Hey there- thanks for the response!

Yeah I've read quite a bit about the advantages of nasal vs. full face. Apparently aerophagia is worse with full face as well.
If you take a look at the OSCAR screenshot, you'll see that I really only have a leak for one of the episodes.. which is puzzling.
I made the switch because I have experienced EPO or expiratory palatal obstruction with the nasal mask- palatal prolapse- and thought full face would allow mouth exhales when/if necessary. I am a large human with an enormous lung capacity too, and just didn't feel like I was getting enough air through the nasal mask either. Especially if I was congested.

Someone on the other forum just replied and said that he thinks its positional apnea/chin tuck, because I'm on my back and the 'hose' is fully kinked. Said also that there's no cpap fix for it- I need to use a cervical collar, or change position?

[ozij]

Some people simply need higher pressure when using a full face mask.
The chart you uploaded is weird, as far as pressure settings are concerned, but it it's obvious from the snip that your pressure isn't high enough to keep your airway from collapsing.

I'd set the max at 20 to see what pressure the machine wants to go up to now that you're using an FFM

[aquamike]

Some people simply need higher pressure when using a full face mask.
The chart you uploaded is weird, as far as pressure settings are concerned, but it it's obvious from the snip that your pressure isn't high enough to keep your airway from collapsing.

I'd set the max at 20 to see what pressure the machine wants to go up to now that you're using an FFM

hey thanks for the reply~

Yeah the readout seems weird- I don't understand how I'm ending up with a series of brutal 40-50 second OAs, but the top of many of the the inhale waveforms leading to and after each episode are smooth and rounded at the top- no partial obstructions.

Solid advice RE: pressure- great idea! I'll give that a go and see what happens.

Thanks again

M

[Max46]

Nasal masks, especially nasal pillows, contact the face over a much smaller area
than full face masks, meaning consistently better fit/fewer leaks for most patients.

Is there study evidence of of this (nasal=better fit, fewer leaks)?

Bad leaks mean you may not be getting enough air to prevent as many obstructive apneas.
Why the mask change?

By "enough" I assume you mean "pressure" rather than volume. Unless the "leak" is MASSIVE the fan should be able to keep up, but perhaps not at the same pressure.

[Max46]

Some people simply need higher pressure when using a full face mask.

Trying to imagine why that would be.
Assuming equivalent leakage between nasal and FFM, why would additional pressure be required to achieve equivalent splinting?

[chunkyfrog]

Faces have many more variables than full face masks.
Some of us simply cannot wear them.
Our faces are too different from the "normal" faces used by the designers.
Poor fit means lots and lots of leaks.
Unless we crank it down to extremely painful--NO, THANK YOU!
Some need to use a larger size nasal pillows than they think because of restricted airflow.

[Miss Emerita]

I see that your machine is still set for a nasal mask. Do change that to FFM. I doubt, however, whether that has much to do with your problem.

Are your OAs and FLs usually clustered? If so, your position in bed may be a culprit. Try to stay off your back, and be sure to use a fairly flat, firm pillow. If you tend to tuck your chin down toward your chest, you might want to try using a soft cervical collar to keep your head and neck better aligned. More information here:

https://www.apneaboard.com/wiki/index.p ... cal_Collar

Oh, and next time you post charts, would you include one that shows the while night? That helps us see patterns and context.

[palerider]

Some people simply need higher pressure when using a full face mask.

Trying to imagine why that would be.
Assuming equivalent leakage between nasal and FFM, why would additional pressure be required to achieve equivalent splinting?

It has nothing to do with leaks.

When using a nasal or pillow mask, the pressure can push your jaw a little forward which opens up your airway more. a FFM keeps the jaw pressed backwards, narrowing the airway.

My pressure needs went down when I switch to a pillow mask.

[aquamike]

I see that your machine is still set for a nasal mask. Do change that to FFM. I doubt, however, whether that has much to do with your problem.

Are your OAs and FLs usually clustered? If so, your position in bed may be a culprit. Try to stay off your back, and be sure to use a fairly flat, firm pillow. If you tend to tuck your chin down toward your chest, you might want to try using a soft cervical collar to keep your head and neck better aligned. More information here:

https://www.apneaboard.com/wiki/index.p ... cal_Collar

Oh, and next time you post charts, would you include one that shows the while night? That helps us see patterns and context.

Hi there!

thanks for chiming in. my events are usually not clustered like this. very unusual for me. I had it set to FFM until I had the issue and woke up. I then switched back to my nasal mask and I think oscar is showing that because it's the last mask I used that night.

last night I tried sleeping on my side, which is painful sometimes, and it really did help. The attached screenshot shows 3 sessions- the first is side sleeping, the second is prone, and then I switched back to my side for the third. The difference is pretty stark. I actually had AHI of zero.. for the first session. That's encouraging.

I'd really really like to sleep on my back because both my shoulders are destroyed by mountain biking and snowboarding accidents. It seems I will need to look at finding a creative solution. Maybe one of those beds with the arm holes in them or something...

Thanks again

screenshot-20230917-111024.png (96.54 KiB) Viewed 5206 times

[Max46]

When using a nasal or pillow mask, the pressure can push your jaw a little forward which opens up your airway more. a FFM keeps the jaw pressed backwards, narrowing the airway.

Not sure why the nasal would push the jaw forward, but a tight FFM could surely press the jaw towards the spine, unnecessarily narrowing the airway. Seems like a logical explanation!
Thanks

[aquamike]

Faces have many more variables than full face masks.
Some of us simply cannot wear them.
Our faces are too different from the "normal" faces used by the designers.
Poor fit means lots and lots of leaks.
Unless we crank it down to extremely painful--NO, THANK YOU!
Some need to use a larger size nasal pillows than they think because of restricted airflow.

Yeah I'm beginning to discover that. I might want to try the F30 as that seems to be confined mostly to the mouth area and would avoid some of the facial quirks that I might have further up on either side of the nose- I have cheek indentations that seem to hit right where the mask is.

So they haven't created a mask for frog faces yet?

[aquamike]

When using a nasal or pillow mask, the pressure can push your jaw a little forward which opens up your airway more. a FFM keeps the jaw pressed backwards, narrowing the airway.

Not sure why the nasal would push the jaw forward, but a tight FFM could surely press the jaw towards the spine, unnecessarily narrowing the airway. Seems like a logical explanation!
Thanks

That's really interesting. speaking of jaws- has anyone had success with some of the dental devices? I ordered one on scamazon and received a knock-off made from cheap plastic that was the size of a toddler's mouth.

[ozij]

That's really interesting. speaking of jaws- has anyone had success with some of the dental devices? I ordered one on scamazon and received a knock-off made from cheap plastic that was the size of a toddler's mouth.

The only FFM's that work for me are the hybrid ones, that is those that cover your nose like a pillow or nasal mask, and your nose
That said, I have to add that I came to that conclusion many years ago, when the choice of "real" FFM's was smaller.

I've been using F30's since 2020, when I have to, and don't have the sealing problems I had with FFM's that go over your nose.