Help with settings/leaks resolved

[Charlie Sue]

Hi. I recently had some leak problems, which are resolved. I now need help with settings.

Sleeprider said

The leaks are almost certainly mouth leaks based on the ragged flat-topped leaks. They are mostly just below the large leak threshold. I'm glad you're not getting a dry mouth, but that is a lot of leaking that may be disruptive to sleep. The machine does not really seem to lose control as shown in your closeup of the flow rate. The respiratory flow is well defined here and surprisingly shows quite a bit of what appears to be obstructive flow limitation as indicated by the flat and downward sloping inspiratory peaks.

I think there are a couple things you can do to help be more comfortable. First, you are not using EPR. Your event rate is low, so I think you might find setting EPR to full time at 1 or 2 will lower pressure on each exhale. That may help you to control the pressure better, and might improve the flow limitation on inhale. Be aware your tongue being firmly along the roof of your mouth and if your jaw tends to drop, we need to find a way to comfortably give support. Some people use a soft cervical collar with success, but I'm aware of your sensitivity to too much stuff and claustrophobia. 

I changed masks, started using a cervical collar, and changed my settings to use EPR 2 as suggested by Sleeprider. Leaks resolved, but my AHI has gone up from an average of 1-2 to 4-6 per night and my sleep time and quality have not recovered. In the past I slept about 7-7.5  hours a night with excessive daytime sleepiness and now I am sleeping between 4 and 5.5 hours a night and am falling asleep at my desk at work despite stimulant meds to keep me awake. Sleeprider suggested that events might increase with EPR and I might need to raise my minimum pressure. Looking for advice on that.

I tried to use IMGUR by following instructions in Sleeprider's sig. Be gentle if I screwed it up. Two images follow. 

[url=]Collapsed graphs[/url]
[url=]Expanded graphs to show events in more detail[/url]

Thanks for your help.

Charlie Sue

[OpalRose]

If you want to tackle the Obstructives, you will need to start inching your minimum pressure up to 9cm.

Your leak rate looks good!

[Charlie Sue]

Do I need to increase max as I increase min? How much would you increase min at a time?

[OpalRose]

Do I need to increase max as I increase min? How much would you increase min at a time?

Normally, I would increase minimum pressure by .5 at a time, but for now, I would bump it up to 8. I suspect you will end at at 9cm.

I just took another look at your graphs and you seem to be bumping the max pressure quite a bit.

You could try increasing the max by 1cm pressure, but watch for Clear Airway events.

[Charlie Sue]

Thank-you!

[Sleeprider]

I would increase both minimum and maximum. You didn't mention comfort, and if your're feeling pretty good, the change should be no problem. Your results are really nice in that the events are simple obstructive apnea, so the EPR is not a problem here, other than the exhale pressure is low enough that your're getting OA.

Your closeup graph shows some flow limitation with a recovery breath leading to the OA. At this point your are at 8.2/6.2 pressure. Keep us posted both on your results and comfort.