Sierra

I will try going without shaving tonight to see if I can get away with a little stubble. I think I will also fold over a corner as I had a little trouble getting it off this AM. My experience with nasal pillows is that they leak less than full face at least up to 15 cm. But the leaks are different. Full face masks don't seem to leak large volumes and exceed the leak redline. Instead they have small annoying leaks that make rude noises and blow air into your eyes. I just can't sleep with them. Nasal pillow masks tend to leak quite a bit if you deflect them off your nose. But if you can keep them on your nose, I like them the best.

I would agree with bonjour's comments. You were asleep but there were flow restrictions as indicated by the somewhat rough cut off peaks on the inspiration half of the cycle. Then you went into a full flow obstruction apnea. You possibly woke up partially and then another obstructive event at 15 cm. After that periodic breathing started. These may be central events that end in a full obstruction. On a ResMed when you plot mask pressure you can actually see the machine pulsing the flow to test for obstruction. Harder to tell on a Respironics. I think a ResMed may have responded to those flow restrictions earlier, and increased pressure earlier, but really hard to say. I don't have much experience with a Respironics, but I see fluctuations in flow between the Periodic Breathing events. They seem smaller on the second OA event, and then larger on the third one, and the next. I'm wondering if those may have been central events. When the machine tries to pulse flow/pressure to test for obstruction flow will go up if the airway is open.

But, the unfortunate bottom line is that the pressure is not high enough to prevent flow limitation that seems to initiate the whole sequence. I suspect if you zoom in on the sequence before the RERA events you see similar cut of tops on the inspiration?

The strange part is that most of your obstructive and hypopnea events happen at 15 cm and many of them cause the machine to bump pressure up to 16 cm. Then the machine goes back down and it starts over again. That was why I thought a fixed 16 might work better. While the PB is appearing, there are no CA events. It seems to be mainly an obstructive issue. Have you tried zooming in on some of those OA events and see what is leading up to them? You might want to look at the ones starting about 6:40.

Strange that you are hearing noise from the DreamStation. It is rated slightly quieter than the ResMed. Should be hard to hear...

There is nothing wrong with any mask that doesn't leak too much and is comfortable. That is all you need. I tried the Mirage Quattro and the F20, but couldn't make friends with either one of them. The F20 was a bit better than the Mirage Quattro, but they both leaked, blew air in my eyes, and kept me awake.

Hi Jim,

I find the nasal pillows keep my nose clear during the night. I suffer from ongoing nasal congestion, but if I can get my nose clear before I put my mask on, it stays that way overnight. I occasionally use Otrivin to get clear, but try to avoid it. Some use a corticosteroid nasal spray like Nasacort on a more ongoing basis. I tried it and it didn't help me.

As bonjour says, with the exception of the travel units, all the masks from different manufacturers and types use the same connection to the PAP machine hose. It is about the only thing standard sized on these things.

On the nasal pillow masks, I have used the ResMed AirFit P10, the Fisher & Paykel Brevida, and the ResMed Swift FX. Of them I like the fit on the nose best with the AirFit P10. However it has flimsy headgear and it wouldn't stay on my head without cutting and shortening the straps by about 1". The F&P Brevida did not fit my nose as well, but does have better headgear that is adjustable. The Swift FX has much better headgear, but it has a strange vent system that blows air like a jet engine taking off. There are probably some ways to work around it, but I went another way. The nasal pillows on the Swift look nearly identical but they didn't fit as well as the P10 either.

My wife used the Mirage FX for about 3 years. It was basically OK, but it was leaving marks on her face, and was leaking more than it should. She took over my discarded F&P Brevida nasal pillow and really likes it. She was having air loss from opening her mouth and has solved that with mouth taping.

On the FX Bella I believe that is the Swift FX Bella? If so, that uses headgear that hooks around your ears. Perhaps intended for women that don't want their hair messed up? In any case if you have detached ear lobes it might work OK. If you have attached lobes, then it could be pretty uncomfortable and not stay on well.

If you read my thread on the P10 Upgrade you will see that I ended up putting the Swift FX headgear on the AirFit P10 mask. It is the best arrangement I have had so far after trying 6 different masks. This hybrid solution is my 7th try! If you want to go there, you could start by buying the P10 fit pack mask for $99 or so as bonjour has suggested. Then if you have trouble with the headgear, you can buy either the Bella version or I think the better Swift FX version for $31 and make the modification to the P10 to fit it.

I tried the Mefix 10 cm tape last night. The adhesive on it is certainly much stronger than on the 3M Micropore. I went with a piece 10 cm x 6 cm as you suggested and did not wear a chin strap. It was not quite as good as I was getting with my P10-FX hybrid mask using the chin strap, but good enough. I suspect the mask without the chin strap over it is moving around a bit more on my face and that is the cause of the leaks. Don't think they are mouth leaks, and the Mefix seemed to have worked. Thank you very much for the tip. Do you fold over part of it to help get it off in the morning?

P10-FX Hybrid mask, 3M Micropore tape, and BreatheWear chin strap:

P10-FX Hybrid mask, Mefix 10 cm tape, and no chin strap:

Wow! I've never seen the happy face before. You must have done something to really impress SleepyHead...

Your leaks are not super bad. Ignore the top green line as it includes intentional venting from the mask. However if you had to tighten the mask super tight it must not be very comfortable. I agree that the Swift pillows are somehow slightly different. I much prefer the P10 pillows. If you have the headgear from the Swift you may want to try my conversion trick. I'm three nights on it now and liking it a lot. I tried the Mefix tape last night that was suggested by Vulegnarts in the thread on mouth taping. I did not use the chin strap and got acceptable leaks. See this Leak Rate chart.

SleepyHead can give you a lot more detailed picture of what is going on during the night. Only basic information gets transmitted to the MyAir app. This is what ResMed machines transmit over the air compared to what is stored on the card.

I have noticed a feeling of slight dizziness about 1 hour after getting up on some mornings. Can't say I have noticed much difference in hearing, but I am getting close to needing a hearing aid. No step change though, and the hearing loss has been gradual over a number of years. I've only been on PAP treatment about 10 months.

I am not a medical professional, but your story reminded me of an article I read and saved a link to. It is about an individual that suffered hearing loss attributed to PAP usage. Some details are missing from the article, but it claims he was diagnosed with an AHI of 58 and a set pressure of 15 cm based on a titration. He gained weight and apparently self titrated to a higher pressure that was not given, other than it said he turned it up to the machine maximum (so could have been 20 or 25 cm most likely). In any case he eventually suffered a hearing loss which was eventually treated with prednisone and cipro. It sounds like he had some kind of inner ear infection which potentially was aggravated by the pressure. In any case here is a link to an article. This is something you may want to get checked by an Ear, Nose, and Throat specialist.

Otic Barotrauma Resulting from Continuous Positive Airway Pressure

I guess the message in all of this is to do everything one can to limit the pressure used to treat apnea, but some conditions do require more. Do you monitor your PAP machine with SleepyHead to see how well it is doing for you? With most Auto machines, SleepyHead can tell you a lot. Could there be any opportunities to reduce pressure? The other route to go would be to get a lab titration test.