Feedback on leaks/AHI

[gshock]

sleepyhead output

I'm a newbie to trying to interpret the data looking for some feedback.
 flex is turned off, I don't use ramp, zero comfort issues from pressure.
My leak rate seems erratic. a Chin strap helps a little, even that + taping its still a bit erratic.

I probably have some air bubbling through my mouth.
In this output I start with both tape and chin strap, around 1am I just could not stand it anymore and removed both.

I never show any large leak, 21% "over red line" though

It seems like when I'm just using my tongue to block air that the leaks may be limiting the efficacy of the treatment resulting in more events.
A FFM is problematic for me, I had a stroke  and drool on the affected side as a result. This gets the FFM wet. Also my jaw drops out of the FFM resulting in a massive leak that wakes me up.
My current AHI seems reasonable, and the current mask is the most comfortable Ive been in a year so higher compliance, My gut instinct tells me that this is "sufficient" but not quite good.

My 9% EPAP is almost my max, so it seems like a slight increase might help from min 13 to min 15? I'm hesitant to fiddle with that though.
Thanks all!

My doc never says anything about the data or expectations, even when my mask leak rate was > 50% I'm learning a lot  but just looking for other input. As is I'm giong to look for a more comfortable chin strap.

[Sleeprider]

It almost looked like you were running your auto BiPAP in fixed pressure mode, and the reason is your minimum EPAP and maximum IPAP and PS of 5 means you are running in fixed mode. If you want to run in auto mode, you need to increase the IPAP max 20 at least 20, and you could back off the EPAP min a bit, and consider using a range for pressure support.

All in all it's working okay, and the cluster of OA, and continuing events after 01:45 may be related to leaks. With regard to leaks, a nasal pillow mask seems to avoid mask leaks, but if these are mouth leaks as they appear, then maintaining the seal with the back of your tongue may be something you are still developing. It almost looks like you start off great, then get fatigued or more relaxed and have higher leaks later.

If you're looking for some alternate settings, it looks like the EPAP min is a good starting point, you can change IPAP max to 20 to see if you can get some control of the OA, and use a variable PS by setting PSmin to 3.0 and max to 5.0. These settings should reduce the events assuming you can control the leaks.

Any idea why you were issued an auto BiPAP rather than CPAP?

[PollCat]

I'm somewhat confused.  Are you using a nasal mask or a full face mask?  
As much as the data is useful, the real issue is how do you feel in the morning and are you staying awake during the day?

[gshock]

Not sure why the bipap, my doc really dislikes auto units or settings. I'm hesitant of changing something like the mode esp given the docs dislike.

By controlling leaks, do you mean not getting any large leaks at a slightly higher pressure or getting rid of the erratic leakage entirely? A chinstrap helps smooth it out a bit. (currently shopping for a more comfortable one). the 95% is still close to max though.

The leaks are a bit confusing as the 95% total leak is near the max making it seem out of control, but no large leaks.
Using Dreamwear. I wake up around 7am and usually take a 1hr nap around 12pm, half a tablet of provigil around 4am.  Prior to the provigil I had excessive fatigue and would nap all day(taking a full tablet does no improve results).  Recently switching from a FFM to the dreamwear after septoplasty/ turbinate reduction switched to the dreamwear, much less fatigue, the nap is an "almost dont need it" but I pay if I don't.

Thanks for the feedback PollCat you've given me something to chew on

[Sleeprider]

An alternative to the chin strap is a soft cervical collar available at most drug stores. For some people, obstructive apnea are caused by allowing the chin to tuck forward towards the chest cutting off the airway. It also doubles as subtle pressure on the jaw to keep your mouth closed. A number of people here use them.

As far as settings, as I said, no compelling reason to change, just a curious use of an auto bipap. Most insurance won't cover bilevel until a patient does not tolerate CPAP. Consider yourself lucky, it's a nice unit.

[trish6hundred]

Hi gshock,
WELCOME! to the forum.!
Good luck to you with your CPAP therapy.

[Beej]

gshock, I had an idea that might help with the drooling some - what about using a piece of a disposable diaper or a woman's minipad to absorb it? It might reduce chapping of the skin, too. It may or may not allow you to use a full face mask.