[CPAP] Trouble with leaks and pressure

[Sleeprider]

Looks fine, and nothing alarming about the CA at 22 seconds. Feel free to set maximum pressure at 12.

[Kristin]

Thanks, Sleeprider! Good to know.
I still Wonder if the two closeups in post 40 really are OA's?

Kristin

[Kristin]

I have been quiet for a while.
I choose to continue writing in this thread instead of starting a new one. 

In the last posts back in june, I was adviced to change min/max pressure trying to control my CA's. I did so. I have also changed mask from full facial mask to a more comfortable under the nose mask. 
By reducing maximum and minimum pressure, I have been able to reduce the duration of the CA's, and the duration are now shorter than 30 sec. 
I received my full sleep report which said I didn't have any CA's at all. But I know that they have been there from day one on Cpap.
 While I have been treated for obstructive sleepapnea, I assume I have had mixed apnea all the time. 
The numbers of apneas are good (0,8-2.0 pr hour, mostly CA's), but my sleep quality wont improve. I am tired.
At this point I have decided to apply for a rehabilitation stay, hoping to meet a doctor who sees beyond the number of anpeas like you guys do. It may take 6-8 months waiting, but I need a doctor to get any further. Unless you guys can help me again?

My challenges are as follows; Flowlimitations followed by rising pressure, leaks and fragmented sleep.

1.)Sleeprider has earlier mentioned that bilevel may help reduce the flowlimitation. I need your help to make a doctor concider this option. I need good arguments, because I believe I should have had bilevel from day one due to my health situation.
2.)I have reduced max pressure as far as I dare to do without your guidance. I reach the max pressure every night, but as far as I can see, it rises because of FL. And the result is leaks. I really like the under the nose mask, it's so much more comfertable. But when the pressure get close to max pressure, I get too much leaks. I am wondering if I can reduce the max pressure further? I also wonder if it is possible to have the same max/min pressure on the machine? If so; Would that be a better choice at this point?

I am posting a couple of screenshots that might show the situation. Most nights I get 4-5 hours sleep. Sometimes I get more sleep, and sometimes I fell asleep again without the mask on, which is a bad solution.

Appreciate your knowledge and help!
Kristin
               

[Sleeprider]

Kristen, your results look okay by the numbers, but you have an unbalanced inspiration expiration time, and the flow rate graph has an unusual appearance. It might help if you provide a close up of the flow rate. Just zoom to about a 2-minute period where we can see typical wave form. It would help to hear your subjective opinion on how you feel and your comfort with the therapy. Other than that you have some leaks that may be disruptive, but they don't affect efficacy.

[Kristin]

Hello Sleeprider.
I am adding two closeups from two different days. When it comes to comfort I am tired and feel unrested. When I first changed type of mask I felt much better and I felt more able to breath through the nose. After a month I started to wakeup after a couple of hours sleep beeing unable to get more sleep. I felt I succed getting the CA's under Control (reduce the duration), but I felt the min pressure was lower than I would have prefered. It feels like I don't rest while sleeping, but it might be because my sleephours are half the hours I need. The last two weeks I have ripped of the mask when I have woken after a few hours and fall asleep again without it. And it seems like it soesn't matter whether I use it or not. 
I have been taping my mouth to get used to breath with mo nose. I struggle keeping the motivation up, and wonder if this maschine is the wrong one for me. Or if I will have to og back to the full facial mask insted. 
My doctor can't help me, because as he says, I know more than him about this. It should be mentioned that these few months has been busy to. I have mixed apnea, haven't I? The soft collar has almost made the OA's dissapear, but I stilt get them.
In a preveus post you mention bipap to me, and I would like to try it, to see If the machine would be better for me. Thats my main goal With the rehabilitation I have Applied for. I will need a docotor to recommend it before I will have a chance to try it. The hospital only see the figures. Under 5/h, and everything i good. The situation affects my ability to remember Things, I forget alot of Things, which I don't. Maybe I am about to give up.
You have always made a point about the Comfort, and I feel I should be able to use the machine and get some good sleep, but I don't. And I hope that you can tell me what I need to do to get my quality sleep back.

Thanks for helping!

[Sleeprider]

There are some pretty strong indications that flow limits are a continuing problem, in spite of EPR 3. Your AHI is low and these results are probably as good as it gets with CPAP. Bilevel would provide a number of additional tools including more pressure support, and respiratory timing. my impression is you may benefit from more PS and a longer inspiration time and possibly increased cycle sensitivity. The biggest concern with increasing pressure support is that it could increase CA events.

It appears you might tolerate lower minimum pressure ans max pressure on your current APAP. You are at 9.4-11.6, what has your experience been at lower pressures like 6-9?

[Kristin]

Sleeprider, When I first started using the cpap a year ago, the pressure was 6-9 EPR 3. At that time it felt hard breathing. It made me use a couple of hours every night to adjust before falling  asleep. I believe the problem would be the same if I tried min pressure 6 again. However, at that time I used a different mode (autoset for her) and a different mask. When I worked on reducing the min/max pressure this summer, I went as low as 9.2-12.0, but felt more comfortable with min pressure at 9.4. The only thing I have changed this autumn is the max pressure which now is set at 11.6. 

I will try anything you suggest. I have been thinking about lowering the max pressure, try EPR 2 or, if possible, use the same max/min pressure. My knowledge is limited, so I don't want to change anything on my own. 
I am adding last night chart. I slept for three hours. Then I woke up, removed the mask, and slept two more hours without the mask. And I can't even remember I woke up and removed the mask. Closeup shows the two last minute before removing the mask. What is this?

Thank you for helping

Kristin

       

[DaveL]

Congratulations on staying with it!

This forum and its participants have really helped me.

I've tried all kinds of devices to keep my mouth shut so I don't mouth breath.

I've just started using the Dr Dakota pad. It's incredible. I'm doing better than before.
It keeps my jaw closed, and pushes it slightly ahead.

Participants here recommended it to me.

DaveL
Toronto

[Sleeprider]

Sleeprider, When I first started using the cpap a year ago, the pressure was 6-9 EPR 3. At that time it felt hard breathing. It made me use a couple of hours every night to adjust before falling  asleep. I believe the problem would be the same if I tried min pressure 6 again. However, at that time I used a different mode (autoset for her) and a different mask. When I worked on reducing the min/max pressure this summer, I went as low as 9.2-12.0, but felt more comfortable with min pressure at 9.4. The only thing I have changed this autumn is the max pressure which now is set at 11.6. 

I will try anything you suggest. I have been thinking about lowering the max pressure, try EPR 2 or, if possible, use the same max/min pressure. My knowledge is limited, so I don't want to change anything on my own. 
I am adding last night chart. I slept for three hours. Then I woke up, removed the mask, and slept two more hours without the mask. And I can't even remember I woke up and removed the mask. Closeup shows the two last minute before removing the mask. What is this?

Thank you for helping

Kristin

The reason I asked was for bilevel.  If you do go to bilevel I think you will easily be able to use a low EPAP pressure, and use pressure support for comfort and flow limits.  Your reply reinforces my opinion you will thrive on bilevel with lower overall pressure and a lot more comfort.

[Kristin]

Sleeprider I am going to start a possible longer dialogue with the medical staff in the hospital about gettiing the bilevel you mentioned earlier in post #27. I hope to get what I need in the long run. but I have experienced that my challenges have been irrelevant to them  since my numbers are good. The rehabilitation stay I hopefully will get next spring might be of help. If not, I will have to pay for it myself.

I have one question left for you; Can I lower the max pressure further? I It seems to me that the higher pressure on my cpap is a result of leaks and flowlimitation. Does it matter if I set the max pressure to 10.5 (9.4-10.5) ?

I appreciate your help

Kristin