Leak rate super low, Low AHI ..waking up with brain fog?

[tierdal]

Hey see my chart below... should be feeling refreshed but feel like crud this morning... what could be going wrong?

[sheepless]

your stats look good but your flow rate is hairbrushy (compact is better) suggesting you're working hard to breathe, and you have some very minor flow limitations which you might be sensitive to. epr is already at 3 so what I would try is raising your min to 10 (and incrementally up after a few nights if necessary/possible). the reasoning is this: epap treats obstructives, including flow limitations to some extent, and you've already maxed out the potential for epr to address flow limitations. with epr at 3 your epap in this chart is 5.82 cmw when it appears you need something more like your med pressure of 8.82. increasing min to 10 gives you epap of 7. try that and see what happens and how you feel. or, if you want to do it all at once, increasing min to 12 will get you epap of 9 (or, if you prefer epap 8.82, set min to 11.8 cmw). I can't say this will be better than your already good chart indicates but if you're still feeling tired, it's worth a try.

[tierdal]

Can you explain that in a bit more laymans terms for me? The forums keep telling me to raise pressure (specifically because of EPR? i dont understand this is supposed to help you breath out easier but people say it does nothing if you are at a low min preasure??). Meanwhile my sleep doctor has warned me not to keep raising preasure as I am in danger of central apneas... I am just trying to understand the advice being given here.

[staceyburke]

EPR (exhale pressure relief) does 2 things. First makes it easier to exhale. Next helps with flow limits.

Your min pressure is your inhale pressure.

The min- EPR is your exhale pressure.

The LOWEST possible pressure your machine can go is 4. So let’s take what many people have their pressures set to - min 4 max 20 Epr 3.

That won’t work. Why? Because the exhale pressure is min(4) -EPR(3) would be 1. Your machine can not go that low - remember 4 is the lowest.

You need a min of 7 to have the EPR of 3. Min(7) - EPR(3) =4 (exhale pressure) which again is the lowest your pap machine can go.

[tierdal]

My machine can be set to 1 though? Is this min 4 thing for other machines?

[staceyburke]

Your min can not be set lower than 4. Your EPR can be set at 0, 1, 2 or 3.

Remember your min is the inhale pressure. If it were 0 you would not be able to breath through the mask.

[sheepless]

there's no harm in trying higher min pressure. your machine's max is set to 20 cmw so it's already able to go as high as it will go. if you try raising your min it will either prove beneficial or it might result in more leaks, aerophagia or central apnea. if the results are not to your liking, simply return to your current settings. there are additional options if you do get some ca: you can reduce epr &/or set a fixed pressure. if you're not comfortable with (somewhat) methodical trial & error, there's no way to try to improve your situation. your choice, of course.

[Sleepster]

Remember your min is the inhale pressure. If it were 0 you would not be able to breath through the mask.

The issue is that to purge the hose of exhaled air, the pressure needs to be at least 4. Without this purge you run the danger of inhaling your own exhaled air and not getting enough oxygen.

[Sleepster]

Hey see my chart below... should be feeling refreshed but feel like crud this morning... what could be going wrong?

I see two things. You have the flow limitations that have already been discussed and they need to be addressed. Your doctor is correct that, generally speaking, raising the pressure increases the chances of central apneas. But you have software to monitor that, and the willingness to do so, something that perhaps most patients don't.

The other issue is the leak rate. I know your leak statistics look good, but when you look at your leak rate graph you want to see smooth horizontal lines. See those bumps in your graph? Those are times when you're leaking enough to perhaps disturb your sleep, and you likely have no memory of these disturbances.

To address the leaks there are several things you can try, such as a chin strap or a full face mask. It may be a simpler solution such as a CPAP pillow will work. You just have to try different things and monitor your leak rate graph.

[tierdal]

I see two things. You have the flow limitations that have already been discussed and they need to be addressed. Your doctor is correct that, generally speaking, raising the pressure increases the chances of central apneas. But you have software to monitor that, and the willingness to do so, something that perhaps most patients don't.

The other issue is the leak rate. I know your leak statistics look good, but when you look at your leak rate graph you want to see smooth horizontal lines. See those bumps in your graph? Those are times when you're leaking enough to perhaps disturb your sleep, and you likely have no memory of these disturbances.

To address the leaks there are several things you can try, such as a chin strap or a full face mask. It may be a simpler solution such as a CPAP pillow will work. You just have to try different things and monitor your leak rate graph.

taping mouth, so no leaks there

how is it these leaks are disturbing my sleep so badly?! what do other peoples leaks look like? no leaks? Ive tried 4 masks at this point, nothing is stopping the leaks

the full face mask was the WORST of it the bunch, it was farting in my face, constnatly leaking spewing out air if i dare moved my head...just awful