Hello! New here, leak question

[amshy723]

Hello!
I’m so excited and grateful to have found this forum! I’ve learned so much already, a great help to a newbie  The 2 care providers I’ve dealt with both have been very dismissive and discouraged me having any role in treatment (recommendations in the Edmonton, Alberta, Canada area are welcome). I SO want to take an active role in my treatment and this looks like an excellent group of people to learn from. Overall I think I’m adapting well to the machine 
Diagnosed in May after cardiologist said my heart was OK but I probably had sleep apnea causing palpitations. Sleep study= AHI 53 with severe drops in SpO2 and mouth breathing. With treatment AHI=3 Using ResMed AirSense 10 For Her for 6 weeks . I’m using the Airfit P10 for her with the medium pillow. I have ordered a Contec CMS 50F and waiting for it to be delivered.
Downloaded Sleepyhead but a bit lost in interpreting my data. If I understand correctly I can’t post images as a brand new member?
A couple questions I’d love some help with if anyone is willing:
1) How can I tell if I have a problem with mouth and/or mask leak? Reading about the leak from each mask and machine has left me confused how to interpret my data in Sleepyhead.
2) I tried the small nasal pillow size(because of some nose soreness), and was waking up with a dry mouth and had a higher AHI so my care provider said to go back to the medium. Would it be worth ordering a large size to try too? I tend to have some nasal congestion all the time, but this is better now that I’m using the nasal pillow.
Some stats:
Last 30 days Last 7 last night
Avg AHI 1.16 1.17 1.25 (range 0.5 to 3.5, RERA, OA, Central, Clear Airway)
Avg.Leak Rate 1.06 0.81 0.57
90% leak rate 3.6 2.4 1.2
% above leak
Threshold 0.1 0 0
Avg Pressure 10.46 10.29 10.91
90% Pressure 12.64 12.18 12.84
Max Pressure 15.8 14.4 14.4

Not sure what other stats would be useful for others to see…please let me know!
Looking forward to “meeting” others with sleep apnea, as I’m the only one I know with it!
Thanks! Lisa

[OpalRose]

Hi amshy723,
Your numbers don't look bad at all. Your leak data looks good too.
Here is a link to help you organize your screenshot
https://sleep.tnet.com/resources/sleepyhead/

When you have a bit more data, go ahead and upload here. You can use an outside source like imgur.com.....seems to be the easiest to use.

As far as nasal pillows, use one size larger than you think you need. They shouldn't go up into the nose too far, but sit more at the bottom of nose inserted just a bit.

[amshy723]

Thanks OpalRose, I am looking into how to post a screenshot Will post it when I get it figured out!

[amshy723]

I "think" I've now got a link to a snapshot of last night's detail data in Sleepyhead.
I need to have a minimum of 8 posts before I can post a clickable link.

http://
imgur.com/kBEFowa

This looks like a pretty average night.
Thanks!

[OpalRose]

You only need 4 posts.

[OpalRose]

I "think" I've now got a link to a snapshot of last night's detail data in Sleepyhead.
I need to have a minimum of 8 posts before I can post a clickable link.

http://
imgur.com/kBEFowa

This looks like a pretty average night.
Thanks!

If that's an average night, you are doing pretty good. The only thing is that your minimum pressure is a bit low. It should start about 2 to 3cm below your 95% number, which brings you up to 10cm.

Even though your AHI is low, you still have flow limitations and RERAs and a higher minimum pressure will help with that. They don't count toward your AHI, but RERAS are mini arousals that disturb your sleep.

I would start to inch up the minimum pressure slowly by .5 or even 1cm a week until you reach 10 and see if there is an improvement in the numbers.

As far as leaks, I don't see a problem at all.

Here is a link to the Beginners Guid to SleepyHead which you can study in your spare time. . Don't let it overwhelm you, just read up on some of the articles that interest you and compare to your graphs.
http://www.apneaboard.com/wiki/index.php...SleepyHead

[trish6hundred]

Hi amshy723,
WELCOME! to the forum.!
It sounds like you are off to a good start. I know there is a lot to learn, but you'll get it, just keep on reading the many threads here on this board and ask as many questions as you need to better help you understand this therapy, and you will do fine.
Hang in there for more responses to your post, keep up the good work, and much success to you on your CPAP journey.

[amshy723]

Thanks OpalRose,
Learning a ton, but have a couple questions yet...

I've made a screenshot of last night.


I increased my minimum pressure two nights ago, from 6 to 8 (I now know, that is too fast!! I didn't follow your advice to go slow...I thought it was just being cautious and didn't realize it was potentially harmful. I was impatient. And wrong. AND I'm sorry.) And I switched the EPR of 2 from "always" to "ramp only".

Should I decrease the minimum pressure now closer to where I started? My heart palpitations disappeared with the changes. I'd like to keep it where it is.

Also, any guidelines on "acceptable" and "ideal" flow limit targets are?

Any advice is much appreciated...(and will be heeded).
Thank you.

[OpalRose]

It's a learning process. That's why we recommend making changes in small increments.

You went from 6 to 8, so if the higher pressure bothers you, put it back down until you are used to it. When you are ready to make a change, move it up by .5cm.

The flow limitations are more than likely keeping your pressure up. That's why I was looking at a slightly higher minimum pressure. It's seems your medium and 95% pressure is staying between 10 and 11.

Also, if you felt it was easier to breath out, put the EPR back on. There is no point in being uncomfortable.
Your AHI is very good.

If you have heart palpitations, bring this up to your doctor. It may just be anxiety from not being used to the pressure, but if that continues, please call your doctor.

An afterthought....what size nasal pillow are you using? Sometimes you need to go up a size to get more air flow.

[amshy723]

Thanks for your concern...the heart palpitations are something I've already had checked by a cardiologist, in fact he sent me for my sleep test - sees it more that sleep apnea triggers palpitations. Said I have no heart problems, just "benign" PVC's (they feel awful though).

I didn't notice the min pressure change or EPR so I will keep things as they are for now.

When should one address flow limitations? My AHI is good, and I feel better than before CPAP but not GREAT. I will keep working towards great

Looking forward to learning more about flow limitations. I will try the large nasal pillow for the P10 when I can get my hands on one. Med was better than small so large may be better yet (just learned there is a large size). Great suggestion!