[CPAP] Does this new user have leak issues?

[clarkage]

Hi folks!

I am in my 30s and I believe I have been struggling with apnea for the last couple of years, it become really bad a year ago and it has started affecting my memory and concentration. Last week I had a home WatchPat test and it said I have severe apnea.
Test results: pAHI 3%: 91.9;    pAHIc 3%: 2.6;   ODI 3%: 86.7;    pAHI 4%: 87.6,    ODI 4%: 81.4.

I got a ResMed AirSense 10 with a nasal N30i mask, and have been using it since two days ago. The two nights I have had it, it's been comfortable enough but I haven't slept well. I notice I wake up sometimes (I didn't remember waking up without it, even though I probably did), many times I adjust my mask in these moments. The two mornings following therapy I have woken up very tired, heavy eyes, and just very sleepy. My AHI went down to 11 the first night, and to 9 the second night. A substantial amount of those events are Clear Airway (CA) events. From my WatchPat test, it seems it measured 2.6 events per hour of central apnea? But not sure how trustworthy it is considering it didn't directly measure my breathing (it included an accelerometer on the chest, a oximeter on my finger, and peripheral arterial tone with the WatchPat around my wrist). The CA events in OSCAR are more numerous though.

I have noticed that my mask leaks sometimes as I move, it is not massive amounts but I can hear it and feel it if I place my hand around the nose area. It is easy to reaccomodate though. But I have noticed looking at my charts that these little leaks appear before many CA events. Is this the reason why I may have so many CA events? When my flow rate is stable and there are no events, there is basically no leaks. When little leaks creep in, then the flow rate gets unstable and many times an event follows it seems.

I have attached some screenshots of my most recent nap.

[Deborah K.]

The leaks you show are too small to worry about. I wouldn't give them another thought.

Did your sleep study show many central apneas? If not, your CAs are treatment-emergent and will lessen as time passes. If you don't know, post a redacted copy of your sleep study. If you don't have a copy ask your doctor or sleep study people to provide you a copy.

Also, we prefer to see the Oscar chart reporting the whole night. Only post a close up if asked for one.

Again, welcome, and good luck with your new therapy!

[clarkage]

Thanks for the answer and for the good wishes! 

Then you think that my feeling tired after therapy and waking up is just part of the process of getting used to it and nothing to do with the leaks? Tonight will be my third night, maybe I should wait a bit and see how this evolves. My AHI is still >5 but maybe it just takes time for my body to get used to using CPAP.

The WatchPat doesn't measure airflow directly, but instead relies on peripheral arterial tone measures. It identified 2.6 events per hour as central apnea events (if I am correctly interpreting pAHIc). I have attached my home study report.

Report's conclusions:

This study shows an AHI (number of apnoeas & hypopnoeas per hour in bed) of 91.1/hour.
The patients ODI (oxygen desaturation index - number of drops in oxygen saturation >3%)
was 86.7/hour, with a minimum SpO2 of 78%.
Sleep architecture was abnormal, with an inadequate amount of time spent in deep sleep and REM sleep.
The mean pulse rate was 83bpm, with a maximum of 122bpm and a minimum of 52opm.
Significant heavy snoring was evident during the study, with 50.9% of snoring reaching above 45dB and a mean snoring level of 49dB.

In conclusion, this is an abnormal study in a sleepy, symptomatic patient, supporting the diagnosis of Severe OSAHS. Therefore, a trial of continuous positive airway pressure (CPAP) therapy is deemed appropriate. Weight loss management is also advised, in order to minimise symptoms of OSA.