[Equipment] Stumped. Please help.

[bwexler]

It might help to show us the actual graphs rather than a spread sheet. Short term leaks and pressure spikes can cause events but not shop up in the nightly or weekly statistics.
If you see spikes in leaks or pressure on the graphs at the same time the centrals occur that would be important info to have.

[AllenM]

It might help to show us the actual graphs rather than a spread sheet. Short term leaks and pressure spikes can cause events but not shop up in the nightly or weekly statistics.
If you see spikes in leaks or pressure on the graphs at the same time the centrals occur that would be important info to have.

Here is a pdf showing graphs for one recent bad night.

[attachment=889]

[retired_guy]

In this example your leak rates are a little high, but still in the acceptable range.

It is interesting that as the leak peaked, so did the the ahi's especially centrals.

So I would suggest this:

1. Use a chinstrap gently applied to encourage the jaw to stay forward in the wee hours when you are sleeping nicely. Try to smooth out the leaks a bit. You don't need zero, but it would be good to get them a little more under control.

2. I'm not seeing what your pressures are doing during these peak periods, but since you have such a preponderance of centrals showing up I'd venture to guess it's rocking a bit high. Have you changed your pressures back to the 9/12 area? You might even want to drop the minimum pressure a little bit.

I think you'll do well once you get the leaks down a bit, and keep the pressure to a level where it controls the apneas but doesn't trigger the centrals.

[AllenM]

In this example your leak rates are a little high, but still in the acceptable range.

It is interesting that as the leak peaked, so did the the ahi's especially centrals.

So I would suggest this:

1. Use a chinstrap gently applied to encourage the jaw to stay forward in the wee hours when you are sleeping nicely. Try to smooth out the leaks a bit. You don't need zero, but it would be good to get them a little more under control.

2. I'm not seeing what your pressures are doing during these peak periods, but since you have such a preponderance of centrals showing up I'd venture to guess it's rocking a bit high. Have you changed your pressures back to the 9/12 area? You might even want to drop the minimum pressure a little bit.

I think you'll do well once you get the leaks down a bit, and keep the pressure to a level where it controls the apneas but doesn't trigger the centrals.

Here is graph detail with pressure. The graphed night is from last week, before I reduced pressure to 9-12 on Tuesday night this week.
[attachment=890]

Last two nights (Tu, Wed), the first two nights with pressure set at 9-12, have produced this:

Pressure 95% -- 11.4 11.6
Leaks/min ------ 10.0 16.0
AHI -------------- 8.9 14.8
Total AI --------- 7.6 13.0
Central AI ------- 6.2 12.1

I agree on reducing the leaks, and will adjust pillows fit to be tighter but not overly tight.

I don't have a chin strap. Will consider buying one.

[retired_guy]

Yep, you're still having mostly centrals. So other than working on the mask a little, just leave everything alone for a day or two and see if they subside. If not you may want to discuss a different machine with your doc. But you're close to being where you need to be, so it would be premature at this point.

On the chinstrap... Mrs. Retired_guy gave me some elastic to make a simple chinstrap out of. I think it might work fine. So that would be an easy way to try one out perhaps.

Kudo's to whoever it was that came up with that idea.

[bwexler]

I would say leaks and pressure must be the culprets.
If you have already reduced the max pressure, I would focus on the leaks.
I just got a chin strap. it cured my leaks (mouth leaks appearently) and droped my AHI from 6.9 to less than 0.5. best score ever last night 0.12. I never thought I was a mouth breather or leaker but my results are indisputable.

[Sleepster]

I never thought I was a mouth breather or leaker but my results are indisputable.

I see people confusing mouth-breathing with mouth-leaking a lot.

I'm not a mouth breather (thank you sinus surgery) but put a nasal mask on me and I'll start mouth-leaking. I may not do it for several nights in a row, or I may do it several times in one night, or anything in between.

I find that I have to keep my chin strap adjusted. After a few weeks of use the elastic is stretched and I have to cinch it up a bit. Washing makes this worse. Eventually they lose all of their elasticity and have to be replaced.

Sometimes I'll wake up with air leaking out of my mouth, sometimes the data will tell me I've been mouth-leaking. Either way, I have to be vigilant in adjusting or replacing the chin strap. I'm getting to the point where I'm pretty well able to adjust it by feel. I can tell when it's getting loose and catch it before it becomes a problem.

[AllenM]

Thanks for this.

I know before my APAP days, I would sleep bunches with my mouth open. I reckon that, since my AHIs were consistently below 5 up until a month ago with the same pillows and fit as I have now, that I must have, for some reason, started to sleep with my mouth open. Only thing I can think of.

My wife has had orthopedic injuries, and we have a small role of material that is elasticized, gauze-like, and best of all, sticks on itself. I put that on last night, but took it off at 3 am, because it was so long I had to double wrap it, and it made my face hot. I've since asked "permission" to cut the thing in half, and will have another go at it tonight. Good news is that last night, despite it being doubled up, it was surprisingly not uncomfortable to have both it and the pillows mask on, other than the wrap being hot.

[AllenM]

I would say leaks and pressure must be the culprets.
If you have already reduced the max pressure, I would focus on the leaks.
I just got a chin strap. it cured my leaks (mouth leaks appearently) and droped my AHI from 6.9 to less than 0.5. best score ever last night 0.12. I never thought I was a mouth breather or leaker but my results are indisputable.

Pressure is at 9-12. Both during the recent bad month and the preceding months, the actual range of pressure has been remarkably stable. It is in a pdf of a table on maybe the 2nd page of this thread. I think it inadvisable to take the max pressure below 12.

I know before my APAP days, I would sleep bunches with my mouth open. I reckon that, since my AHIs were consistently below 5 up until a month ago with the same pillows and fit as I have now, that I must have, for some reason, started to sleep with my mouth open. Only thing I (or better said, others here who are more knowledgeable than me) can think of.

My wife has had orthopedic injuries, and we have a small role of material that is elasticized, gauze-like, and best of all, sticks on itself. I put that on last night, but took it off at 3 am, because it was so long I had to double wrap it, and it made my face hot. I've since asked "permission" to cut the thing in half, and will have another go at it tonight. Good news is that last night, despite it being doubled up, it was surprisingly not uncomfortable to have both it and the pillows mask on, other than the wrap being hot.

[retired_guy]

My wife has had orthopedic injuries, and we have a small role of material that is elasticized, gauze-like, and best of all, sticks on itself. I put that on last night, but took it off at 3 am, because it was so long I had to double wrap it, and it made my face hot. I've since asked "permission" to cut the thing in half, and will have another go at it tonight. Good news is that last night, despite it being doubled up, it was surprisingly not uncomfortable to have both it and the pillows mask on, other than the wrap being hot.

That might work very well. Remember, don't put it on too tight. The idea is to "encourage" the jaw to stay forward when you get super asleep, not to force it so much that your upper and lower dentures trade places.

This isn't the kind of elastic stuff that gets tighter the longer it's on is it? Probably not.

Anyhow, let us know how this works out for you.