First Appointment with Sleep Doctor

[DariaVader]

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[green wings]

Hi, Sautee. Good job on getting your graphs selected and uploaded to imgur.

From your graphs, I'd say that you are going to need a pressure higher than 11 cm for your obstructive events.

More urgent than that, though, is the large leaks that you are having. I'd guess that the leaks are probably coming from your mouth while you are sleeping. Your jaw may have dropped enough that your tongue moved forward and caused you to lose the "seal" between your airway and your mouth. When that happens, air from the CPAP machine rushes out your mouth during your exhalations.

The other possibility is that the leaks are coming from the mask being dislodged. Do you feel like the nasal cushion in the mask fits comfortably? The nasal cushion would have to be losing contact with your face pretty badly to cause sustained "large leak". I'd say that that would probably wake you up, but it might not.

I think you should take a look at the Overview page in SleepyHead and find the bar graph for Large Leaks there to see if you are having a problem with large leaks every night.

If you are consistently having large leaks and it's happening through your mouth, that will mean that you will either need to try using a chin strap with your nasal mask to help to keep your jaw in the right position, or you will need to switch to a full-face mask.

I'm giving you my take on things. I would wait to get more opinions, because I'm still fairly new to CPAP as far as giving advice goes.

Did your sleep doctor say anything about leaks during your visit?


Additional information about leaks, the vent from your mask, etc, just for the purpose of understanding:

- Your machine knows the total flow rate of air to the mask. It also knows how much air is leaving through the mask vent (it uses an equation to estimate this.) Any additional air leaving the system gets tagged as "excess leak" and will show up on your leak graph.

- When the excess leak is greater than 24 liters/min, it gets marked as "large leak". When a large leak is happening, the machine is not able to give you effective therapy.

- Somewhere in the area of 30-40 liters/min is leaving through your mask's vent when all is going well. If you compare that to your minute ventilation numbers, you'll see that the amount of air being vented from the mask is much larger than the amount of air that you are breathing. A typical minute ventilation rate is 7 liters/min.

[sautee]

Hi, Sautee. Good job on getting your graphs selected and uploaded to imgur.

From your graphs, I'd say that you are going to need a pressure higher than 11 cm for your obstructive events.

More urgent than that, though, is the large leaks that you are having. I'd guess that the leaks are probably coming from your mouth while you are sleeping. Your jaw may have dropped enough that your tongue moved forward and caused you to lose the "seal" between your airway and your mouth. When that happens, air from the CPAP machine rushes out your mouth during your exhalations.

The other possibility is that the leaks are coming from the mask being dislodged. Do you feel like the nasal cushion in the mask fits comfortably? The nasal cushion would have to be losing contact with your face pretty badly to cause sustained "large leak". I'd say that that would probably wake you up, but it

I think you should take a look at the Overview page in SleepyHead and find the bar graph for Large Leaks there to see if you are having a problem with large leaks every night.

If you are consistently having large leaks and it's happening through your mouth, that will mean that you will either need to try using a chin strap with your nasal mask to help to keep your jaw in the right position, or you will need to switch to a full-face mask.

I'm giving you my take on things. I would wait to get more opinions, because I'm still fairly new to CPAP as far as giving advice goes.

Did your sleep doctor say anything about leaks during your visit?


Additional information about leaks, the vent from your mask, etc, just for the purpose of understanding:

- Your machine knows the total flow rate of air to the mask. It also knows how much air is leaving through the mask vent (it uses an equation to estimate this.) Any additional air leaving the system gets tagged as "excess leak" and will show up on your leak graph.

- When the excess leak is greater than 34 liters/min, it gets marked as "large leak". When a large leak is happening, the machine is not able to give you effective therapy.

- Somewhere in the area of 30-40 liters/min is leaving through your mask's vent when all is going well. If you compare that to your minute ventilation numbers, you'll see that the amount of air being vented from the mask is much larger than the amount of air that you are breathing. A typical minute ventilation rate is 7 liters/min.

Thank you green wings! You have given me lots of "homework" - and I really appreciate it! The sleep dr. Never mentioned leaks.

[OpalRose]

sautee,
I would hesitate to advise to raise pressure with the high amount of clear airways you have.

What I do recommend is first, change your EPR setting to 2, and eventually 1 to see if some of the clear airways settle down.

The number one priority is to get your leaks under control. You can try mask liners with your wisp, and add a chin strap. As long as you have a high leak rate, your AHI readings may not be accurate.

Also look at Daria's post above and start practicing her tongue suck technique. This is the one thing that helped me keep my mouth closed. You may not think you are mouth breathing, but you more than likely are. See if you can determine if air is leaking from your mask and correct that first.
Don't over tighten straps, that can be as bad as too loose.

You may be better off on Auto mode 9.5 to 13.5 with an EPR of 2 and ramp set to start at 6.5.


You don't seem to be getting clear instruction from your doctor and I'm only giving my opinion. One thing, when you make a change, you have to give it time. You shouldn't bounce back and forth between Cpap and Apap mode. Choose one and stick with it for a couple weeks.


Besides taming your leaks, the clear airways need watched.

[sautee]

sautee,
I would hesitate to advise to raise pressure with the high amount of clear airways you have.

What I do recommend is first, change your EPR setting to 2, and eventually 1 to see if some of the clear airways settle down.

The number one priority is to get your leaks under control. You can try mask liners with your wisp, and add a chin strap. As long as you have a high leak rate, your AHI readings may not be accurate.

Also look at Daria's post above and start practicing her tongue suck technique. This is the one thing that helped me keep my mouth closed. You may not think you are mouth breathing, but you more than likely are. See if you can determine if air is leaking from your mask and correct that first.
Don't over tighten straps, that can be as bad as too loose.

You may be better off on Auto mode 9.5 to 13.5 with an EPR of 2 and ramp set to start at 6.5.


You don't seem to be getting clear instruction from your doctor and I'm only giving my opinion. One thing, when you make a change, you have to give it time. You shouldn't bounce back and forth between Cpap and Apap mode. Choose one and stick with it for a couple weeks.


Besides taming your leaks, the clear airways need watched.

Thank you, OpalRose. There is just so much new information to assimilate. I really appreciate your input!

[srlevine1]

Good afternoon, On Thursday of this week I will see the sleep Dr. for the first time. I have been on the CPAP every night for about a month. I've not loaded all my data into Sleepyhead.
Background: At my titration I requested an Airsense For Her; I received a standard Airsense - respiration therapist: that's what the Dr. specified.

I would suggest that you ask your doctor to re-write the prescription for an AirSense for Her, heated hose, humidifier, and supplies ... and then go back to your DME and insurance company for the resolution of which machine will be provided. The only difference between the versions seems to be the response algorithm that is tailored for women.

If you read enough posts on this board, you will find that your DME is not always your friend and that res-techs are not always a good source of advice. You need to be proactive about your equipment and therapy.

[PaytonA]

The CAs that you are experiencing may (!) work themselves out once you have become more comfortable with the therapy. The large leaks are a problem and it looks to me like you are mouth breathing/leaking. As Opal said, practicing Daria's tongue suck technique may solve this problem for you. If not, a chin strap might help. If the chin strap does not help, it may be time to switch to a full face mask. Full face masks require more headgear tension than other types to seal and are somewhat "fussier" to get adjusted for minimal leaks If you need a full face mask, please do not hesitate to ask for help and also make sure that you get the correct size. An RT at the DME can help with fitting but not all of them know what they are doing.

When the unintentional mask leaks are higher than *24 liters per minute*, it gets marked as a large leak not 34 liters per minute.

Controlling the leaks is of paramount importance to CPAP therapy. When they are uncontrolled the machine is unreliable in determining when and what kind of events are occurring. It also may be enough to keep the machine from achieving enough pressure to splint your airway open.

If it were me, I would not worry about anything else until I got my leaks controlled and get comfortable (at least kinda) with wearing this paraphenalia to sleep in.

Best Regards,

PaytonA

[sautee]

Code:

[quote='srlevine1' pid='168002' dateline='1467842760']
[quote='sautee' pid='166882' dateline='1466970771']
Good afternoon, On Thursday of this week I will see the sleep Dr. for the first time.  I have been on the CPAP every night for about a month.  I've not loaded all my data into Sleepyhead.  
Background:  At my titration I requested an Airsense For Her; I received a standard Airsense - respiration therapist: that's what the Dr. specified.  [/quote]

I would suggest that you ask your doctor to re-write the prescription for an AirSense for Her, heated hose, humidifier, and supplies ... and then go back to your DME and insurance company for the resolution of which machine will be provided. The only difference between the versions seems to be the response algorithm that is tailored for women.

If you read enough posts on this board, you will find that your DME is not always your friend and that res-techs are not always a good source of advice. You need to be proactive about your equipment and therapy.
[/quote]

Thank you srlevine1, wise advise, indeed.  A lot to learn.  I am discovering your truth about my DME/RT.  My Dr. said the only difference in the Airsenses is the color.  It should not be this difficult.  Thanks again.

[sautee]

The CAs that you are experiencing may (!) work themselves out once you have become more comfortable with the therapy. The large leaks are a problem and it looks to me like you are mouth breathing/leaking. As Opal said, practicing Daria's tongue suck technique may solve this problem for you. If not, a chin strap might help. If the chin strap does not help, it may be time to switch to a full face mask. Full face masks require more headgear tension than other types to seal and are somewhat "fussier" to get adjusted for minimal leaks If you need a full face mask, please do not hesitate to ask for help and also make sure that you get the correct size. An RT at the DME can help with fitting but not all of them know what they are doing.

When the unintentional mask leaks are higher than *24 liters per minute*, it gets marked as a large leak not 34 liters per minute.

Controlling the leaks is of paramount importance to CPAP therapy. When they are uncontrolled the machine is unreliable in determining when and what kind of events are occurring. It also may be enough to keep the machine from achieving enough pressure to splint your airway open.

If it were me, I would not worry about anything else until I got my leaks controlled and get comfortable (at least kinda) with wearing this paraphenalia to sleep in.

Best Regards,

PaytonA

Thank you, PaytonA. I am impressed with the breadth of knowledge here and your willingness to share. It is a gift to those of us who are new and struggling.

[green wings]

Yes, 24 L/min, not 34 L/min. Sorry about that, Sautee.

More confusing info - the ResMed Airsense 10 Autoset for Her model has both the "For Her" auto-adjusting algorithm and the regular Resmed auto algorithm. That gives you two choices of algorithms (software programs, basically) to determine how much pressure you need. It's nice to have if it's available to you.

I have seen posts by a few people on this forum who have the regular Airsense 10 Autoset machine who have said that their machines have the "For Her" algorithm as well as the basic one. So you might want to look in the settings for your machine to see if you have that.

There may be other differences between the two machines, too, but you'll have to ask a ResMed user. I know the "For Her" has flowers on it.

If you want copies of the Clinician's Manuals for these two machines for purpose of comparison, you can find instructions near the bottom of this page to have them e-mailed to you.