[Equipment] Intense air exhaust

[Trojax]

Hey,

I've recently become a CPAP user. It has been a series of mostly psychological hurdles, as my brain is trying to resist undoing 33 years of sleeping without a mask. The most recent hurdle now is that my machine is releasing enormous quantities of air. It occurs after I've fallen asleep for a few hours, then becomes loud enough to wake me up, and can be heard over even my ceiling fan set to high.  I don't believe it's a mask seal issue, as it is still enclosed when I wake up, and the sleep report information does not show the mask seal as anything other than good. The obvious culprit would be the pressure range, or perhaps one of the mask comfort settings. My current pressure range is 4-15. I've tried lowering the maximum pressure, but I noticed that my AHI rises pretty significantly.

Any insight or suggestions would be greatly appreciated. Most relevant information about my machine should be on the left.

Many thanks.

[OpalRose]

Welcome to Apnea Board!
You may have a large leak somewhere or your pressure needs adjusted, but we are just guessing without seeing your data.  

The first thing you need to do is download the OSCAR software.  Be sure there is an SD card in your Apap, anywhere from 2gb to 32gb.  The card must be in your Apap while you are sleeping.

Use the link in my signature line below to guide you in "organizing" an OSCAR chart.
You will also learn to take a Screenshot (use the F12 key) of the Daily page.  

You can use the Attachment Feature to post your data here, and we would be happy to take a look and see what's going on.

[Trojax]

Thank you for your response. Hopefully these are to your specifications. 

   

   

[Gideon]

Welcome to the forum. What's going on is your flow limitations are out of control. We normally like to see the 95% Flow Limits stat at or less than 0.10.

The flow limitations are driving pressure up. The best tool you have is EPR, you have it set to 1, set it to 3. To allow. The EPR to work set your min pressure to 7. This will allow your min exhale pressure to be 4, the machines minimum.

At this pressure you should not need the ramp so consider turning it off.

[SarcasticDave94]

Welcome to the Apnea Board,

I was going to say the same as Gideon. Your very high flow limits are driving pressure up. Edit as he suggests.

I've used an Amara View myself and found it was a source of frustration when it came to keeping leaks down. Leak control came at the sacrifice of comfort. I had to move on to other masks before therapy could become effective. I tried ResMed F20 which was an improvement. Better yet for me is the Fisher and Paykel Vitera. My issue with the Amara View was side sleeping broke seal easily, and made it useless.

[Trojax]

Welcome to the forum.   What's going on is your flow limitations are out of control.  We normally like to see the 95% Flow Limits stat at or less than 0.10.

The flow limitations are driving pressure up.  The best tool you have is EPR, you have it set to 1, set it to 3.  To allow. The EPR to work set your min pressure to 7.  This will allow your min exhale pressure to be 4, the machines minimum.

At this pressure you should not need the ramp so consider turning it off.

I sincerely appreciate your help. I will try these settings tonight, and report back tomorrow.

[OpalRose]

Good job on organizing and posting the graphs. I see you've gotten great advice already. I think the snoring will lessen too with the new settings advised.
Sometimes all it takes is a small adjustment.

[Trojax]

The noise was greatly improved, although not gone. I suppose I can't expect my iron (plastic?) lung to be utterly silent. Although it was only a short use last night, I'd like to get a review of the stats from OSCAR, just to be sure that everything is in order.

   
   

[SarcasticDave94]

My opinion is that there's 2 things holding you back, mask leaks signified by the spikey leak trace and still too high flow limits. And these 2 combined can become a catch 22 where one feeds the other which makes them both worse. More detailed on what I mean, either leaks steal a bit of therapy efficiency and flow limits then go up requiring more pressure to combat flow limits and then it leaks more and flow limits stay up. Or flow limits are up because of mask leaks, then the PAP increases pressure because of flow limits and then it leaks more, and then... The cycle repeats itself.

Just my take but I'd tackle leaks by trying to make it seal better by a redo of the straps adjustment, and make certain the cushion is the right size for you. But do not go tight with the straps. Too tight ain't right. If it hurts, retry the strap tension, get another size mask cushion, or get a different mask.

To combat flow limits further, it's probably going to need more min pressure since EPR 3 is active. But right now that might set up more leaks.

Leaks get you another way too. They can disrupt your sleep.

[Sleeprider]

Describe your sleep environment. Are you using more than one pillow or sleeping inclined? Are you aware of your chin dropping in a way that makes breathing harder? That's what I see. In your case, you just have very high flow limitations, but if we can get your chin off your chest it might get a lot better. Read the wiki http://www.apneaboard.com/wiki/index.php...cal_Collar