[CPAP] High AHI but technician says all OK...

[Benzi]

Just the thought of having to adjust to another type of mask ...
The thing is, all was well till a few weeks ago. I'm thinking it's one of the following:
* My added weight (about 3 kg)
* Lack of exercise in isolation
* Need to replace the mask. According to the primer, I should be replacing the nasal pillows every few weeks. I've been using the same components for 6 months. What do you think? My vendor will only sell the whole mask, not the pillows alone. The technician says the mask need replacing once a year!

[Benzi]

Wow, I wish my medical professionals were as helpful as the people in this forum!

1. The system here is that the doctor looks at the sleep lab report, decides you need CPAP, refers you to a technician/salesman. That's all the contact I have with the doctor. The technician is the one who tells me how to adjust the settings if I have problems. I thought he was knowledgeable but apparently he's better at selling than advising. He's the one who looked at my data last week and said the CPAP was fine and if I wasn't happy, it must be something else. Nothing about EPR or adjusting pressure.

 2. What does "leave your machine in Auto Mode " mean?

[SarcasticDave94]

Point 1 of yours is pretty much what most all of us get in regards to CPAP support from the medical world. My first pulmonary doctor that prescribed a CPAP then BPAP later, said that if I failed to get proper therapy, it had to be that I was doing something wrong. No admission that the pressures were not correct or a wrong machine was given, but that actually was what was wrong. Because we all know the doctor can't be wrong.

Point 2, leaving it in Auto mode is mentioning that your CPAP machine has modes of operation, and that it was suggested you leave it in the Auto mode. This is a setting found in the same area of the clinical menu where you can set pressures.

[Benzi]

Fred
Am I to understand that tightening the mask causes leaks? I thought I needed to tighten it to prevent them.... That's what I do when I notice leaking.

[Gideon]

Tightening the mask too much or having a mask that does not fit right (we are all different) are the two largest causes of mask leakage.  So yes, you are understanding correctly.

Take a good look at your mask, look at the outer layer of the cushion.  See how that is just a flap.  That flap is what makes the seal and that seal is created only when the mask has air pressure as your pressure is what holds the mask seal, the straps are only for holding the mask in position.

I fit a mask first with no straps but under pressure and just hold it on my face as lightly as possible to seal and then and only then do I start with the straps.  The goal is to duplicate the feel the mask has with your hand with the straps.  

My favorite mask for demonstrating fitting is the ResMed Mirage Activa Nasal mask (I use P10 Pillow masks now) as it has a bellows with about 1/2 inch of movement and the air pressure alone seals the mask.  Without pressure, there is absolutely no tension on the straps until pressure is applied.

[SarcasticDave94]

Overtightening has been used by quite a few, and almost always results in more leaks. It is distorting the seal by the additional pressure. Besides, it causes pain, so it's best to tighten correctly. If after proper adjustment, and you still have uncontrolled leaks, this requires a different sized cushion or another mask outright.

[OpalRose]

 2. What does "leave your machine in Auto Mode " mean?

Sorry, it just means Apap mode, not Cpap mode. This is what you are currently using with a pressure range.

[Benzi]

Well, I'm not posting any graphs today.
I took your advice and loosened the mask, I think it reduced the leaking. But at some stage I woke up sneezing into the mask. A real experience. Don't know whether it was hay fever or a cold, but it happened a few times and in the morning I felt pretty lousy. AHI 7.9.
tonight will be better...
Question: it took me a long time to fall asleep, and after an hour I turned it off and went to raid the fridge. But the machine showed AHI 4. After an hour of being awake. Does that make sense?

[Gideon]

4 while awake, that usually means you were tossing around, and when you do that you typically hold your breath. That is what we term SWJ or Sleep Wake Junk.

[SarcasticDave94]

I'd agree with bonjour. This will be SWJ/sleep-wake junk. Since this is a sleep therapy machine, it's not really expected to address waking events. If you were truly awake the entire time, I'd disregard the SWJ.