BIG change in AHI almost overnight

[alanbc]

you have a serious leak issue (large leak events), doubt much of the numbers are very accurate. 90%, 85% & 55% of the time you are above the leak threshold the machine can handle. it's also why the tank is emptying in 3h you're trying to humidify your entire room

what mask are you using? how long have you had it? are you sure the humidifier is plugged in properly? what happens when you run a mask seal test?

The mask is a Resmed Airfit F30i.  I've had it for about a month, but have used one for several years now.

I'm sure the humidifier is plugged in correctly .. pretty hard not to.

I have to admit that there's something (lots in fact) about CPAP and masks in general that I don't understand.

For example, there are ALL KINDS of vent holes in the F30 mask, both by my mouth and at the top of my head, and ALL KINDS of air comes out of the those holes when the pump is running.  Breathing with the pump not running is no problem at all, there's so much in the way of .. venting?

However, with my wife's nasal pillow mask, there is NO chance of breathing without the machine running.  There ARE vent holes in the mask, but they allow very little air in and almost no air out.  I have to PUSH HARD to exhale.

It's difficult for me to see how these two seemingly completely different masks could do the same job ...

Again though, I was getting AHIs of 5 a week ago, and much much higher numbers since then, with no change on my part.

[staceyburke]

You have already talked about the leak but you can not get any therapy with leaks that large.  The machine can not supply enough pressure to keep airways open.

The other real problem you have and why the AHI has gone up is Positional Apnea. You can see positional apnea where either H or Oa (Ua) events are clustered together.  Getting rid of as many as you can will lower your AHI.  Positional apnea can NOT be controlled by pressure changes.  You have to find out what position you are getting into and cutting off your own airway.  Have you changed your sleep position?  Sleeping on your back?  Using more (or new) pillows?  These things can cause positional apnea by chin dropping to your sternum and cutting your airway.  Think of it of a kinked hose – nothing can get through – you have to unkink the hose…

[Narcil]

you'd be surprised the amount of ppl that don't plug in their humidifier properly, all the way in and then complains about leaks...

clearly the mask is not fit right it's not suppose to leak everywhere. like stacey said you're getting no therapy for most of the night, the machine cannot give you enough air with those leaks.

[SarcasticDave94]

Which machine are you using now for therapy? Asking because charts show ResMed, your board user info says Philips Respironics.

For ResMed, 24 L/min and above means serious, unintended leaks. This is what shows in OSCAR for ResMed. This unintended is the portion ResMed calculated is where it's not included in intentional leaking that must exist with an open circuit such as those on CPAP. Air flows from the CPAP inlet through the machine and humidifier up the hose and mask to the user. Masks have vents to expel the air. This is a complete designed leak circuit. Some ventilators use this too, other times the ventilator uses double, closed circuit with air going to the user for inhale and return to machine for exhale on a second hose. Note this particular kind isn't used on CPAP.

Anywhere along that circuit, between air inlet and the mask vents is going to allow air to leak, and be removed from the total available for your therapy.

Much like trucks and CPAP high leaks, pulling a load uphill that's too heavy for the design, and you'll not make it up the hill. Trucks can use more throttle until it's on the floor, then that's all there is (intentionally leaving out shifting gears). ResMed for example tying to that 24 L/Min, this means your machine is likely maxed out on throttle and can no longer compensate for high loads. Philips Respironics machines show both unintentional and intentional. Intentional is design speculation for the amount expected due to mask leaking which must occur to complete the leak circuit.

[Dormeo]

Just to be sure we're on the same page, here's the link to the Wiki entry on how to format your Oscar charts:

https://www.apneaboard.com/wiki/index.ph...SCAR_Chart

You'll see there the graphs I specified.

It'll be very helpful to see your revised chart, plus the zoomed-in view.

[alanbc]

I tried something new last night (tonight), I tried a new mask, a "nose pillow" I think they're called.

It felt .. restrictive .. but it was also silent.  All my other masks were NOISY.

Woke up after three hours for a bathroom break, which was somewhat unusuaI .. I often wake up, but rarely have to get up .. and noted the AHI reading of 2.5 and a mostly full water container.   Yay!

But then I COULD NOT resume using the CPAP machine!  It's hard to explain, but I felt like I could barely get enough air in and simply could not exhale.  It was like breathing in through a pinhole and breathing out with that pinhole plugged.

And the effect was much much worse laying down .. I simply COULDN'T lay down.  I tried fiddling with every setting that seemed relevant .. ramp, EPR, min and max pressures, but no joy.

So after 30 minutes of trying, I reset everything to my old settings and resumed with my previous apparently leaky full face (nose and mouth) mask.

This didn't work either!

Even this combination felt like I was drowning when I lay down.  Now, I don't actually know what drowning feels like, never having drowned before, but that's what my brain was saying, "you're drowning".

So I said "forget it" and decided to sleep without a CPAP machine.

Only I still couldn't lay down!  Even with no machine, there was still that feeling of drowning.  Only when sitting upright did I feel I could breathe.

Those three hours of CPAP "therapy" had done something to me!

And so here I sit on my Lazy Boy; half reclined, fully dressed  and wide awake, but breathing.

Is this weird?

[Dormeo]

It sounds as though your body flipped into some kind of panic mode at some point. Sounds very unpleasant! Could you check a couple of things? Is your ramp off? Is your minimum pressure 7 or more? Did you have your machine set for a pillow mask?

Also, what kind of pillow mask did you try? Was there any moisture in it when you took it off?

I'd recommend that you try the pillow mask again during the day or evening with your machine set up outside your bedroom. Use it while you watch TV, read, or use your devices. This will help you get used to the new mask and get rid of that "I can't breathe" feeling. (Be sure to set the machine for pillows.)

[alanbc]

It sounds as though your body flipped into some kind of panic mode at some point.  Sounds very unpleasant!  Could you check a couple of things?  Is your ramp off?  Is your minimum pressure 7 or more?  Did you have your machine set for a pillow mask?

Also, what kind of pillow mask did you try?  Was there any moisture in it when you took it off?

I'd recommend that you try the pillow mask again during the day or evening with your machine set up outside your bedroom.  Use it while you watch TV, read, or use your devices.  This will help you get used to the new mask and get rid of that "I can't breathe" feeling.  (Be sure to set the machine for pillows.)

Thanks for the reply.

Initially, I think I woke up because I needed a bathroom break .. not uncommon for this old man, but about 2 hours earlier than usual.  It was after that when things got weird.

There are at least two ramps.  One is the ramp up to pressure, the other is the EPR ramp.  I'm not sure if they should be on or off.  On sounded good, from the description I read of what they did, so they're on.

Yes, I did set the machine for pillow mask.  However, I'm not sure what kind of mask it is .. it's my wife's original mask (we never throw anything out) and she's been using another make and model for quite a while.  This one has no relevant markings any more, that I can see, but I suppose I could go online "mask shopping" and see what looks the same.  I'm sure it's either a Philips or a Resmed, because that's all the "local" Sleep place deals in.  

Is it important?  Because the Resmed only give two options (that I can remember), Full Face or Pillow.


As to moisture, yes, I think there were a few drops in there ...

Good advice about using it during the day .. I'll give that a try.  As a long time CPAP user, I didn't think I'd need "adjustment", but in hindsight, I'm a long time user of a leaky mask, not a good sealing mask.

[alanbc]

OK, tried again last night with my wife's pillow mask, but with the min pressure raised to 9.  Actually felt pretty good.  

Asked the machine about leaks .. it said "good".

Had to get up once for a bathroom break .. common enough for this old man and absolutely expected when I'm having an AFib episode, as I was.

Don't feel too bad this morning, not great, but not bad.  But my AHI is reported as 33!  Huh?  

More interesting was the AHI around 1:00, when I got up to pee both nights.  The night before, more or less the same settings, the AHI was 2.5.  Last night at that time it was 20 .. and got worse.

 (The time is off by an hour .. I think the machine doesn't understand Daylight Savings Time.  Frankly, I can't figure out where the time gets set!) 

Anyway, here's the chart.  Opinions gratefully accepted.