Looks like I did everything wrong. I need help

[Sleeprider]

The leak rate is just too high for the machine to make any sense at all out of what is going on. Leaks are not particularly correlated to pressure. The periods when you were near peak pressure, show low leak rates but very high OA.

Your priority has to be to minimize leaks, but I have a hunch that there is more to this picture. I have seen similar results in people with complex apnea, induced by CPAP pressure. A conventional autoPap rapidly escalates pressure due to OA and apnea precursors and the pressure induced apnea events increase. Early in the night, and again from 0:00 (midnight) to 1:15 you have a lower pressure and relatively low AHI and leaks. While I don't think it's a great idea to keep changing pressure settings, I'd be inclined to limit max pressure to 12 from what I'm seeing here. Keep in mind, I don't have a clue what is going on in your therapy, but am making observations of apparent cause and effect. Periods of high pressure and low leaks you have very high OA, while periods of moderate pressure have relatively good AHI. Periods of leaks are simply unable to be determined, but this suggests high pressure is not working for you.

[Tacoma Droner]

Yup, ya gotta get those leaks under control.

[sonicboom]

Jim:

I use both ResScan and SH software. Point of info for you. I know you are using SH now but if you go back to your rescan images you will see the color next to the date shows you have not downloaded detailed data for those dates. (Look at the key on the left and it will show you what a detailed data download looks like.). Go into your download settings and set the download to all detailed data. See if that helps you in using ResScan.

[OpalRose]

okrobie,
Thanks for downloading Sleepyhead.

Agree with SleepRider in his assessment. I was going to suggest bringing that max pressure down, but wanted to see these graphs first.

Number one priority is the leak rate! Have you tried mask liners? Try to feel where the air is leaking when you are laying down. Then tighten or loosen straps to see if it makes a difference.

Those unclassified Apneas correlate with the leak rate on event graph, and the machine probably doesn't or can't flag events with any accuracy.

[okrobie]

Hi all, Sleeprider, I put the max pressure at 12 as you suggested, but I don't understand the results. Please all, help with the interpretation. Thanks, Jim

[Tacoma Droner]

That's totally messed up. Looks like you had a tight fit until 3am and this produced and endless stream of apneas. Then at 3am you started leaking, and all the apneas went away.

I hope some others will chime in here. Maybe somebody will recognize this pattern and say "A-ha! I know what's going on here!"

But if it was me, and I had no good advice from anybody, I'd ignore everything after 3am as spurious data. Then I'd look at the first 4 hours and conclude that a max IPAP setting of 12cm is simply too low to keep my airway open. I'd get radical and change my max pressure setting to something like 18 with an EPR of 3 then try another night. That would allow my APAP machine to flex its muscles and show me what it can do. If all it does is leak all night, well then I'm back to trying to fix the leak problem.

Amazing to me that you only woke up once that whole night.

[Tacoma Droner]

One afterthought. Are you using a full-face mask because a nasal mask didn't work for you? I know the answer to that one. For some of us, full-face is counter-productive. It might be that oral air pressure is simply wrong for you, and is causing your apneas. You might need to switch to 100% nasal pressure.

Any of the other members think this is a legit theory, or is that crazy?

[Sleeprider]

Hi all, Sleeprider, I put the max pressure at 12 as you suggested, but I don't understand the results. Please all, help with the interpretation. Thanks, Jim

Okrobie, did you have a titration study? You need to call your doctor on monday and discuss this. I think you may have CPAP induced complex apnea. You are not responding to PAP therapy in a way that is acceptable for your health. Someone professional needs to take a look at this and help you.

You need to be observed under CPAP therapy and a professional needs to evaluate if the extraordinary number of OA events can be resolved with pressure, or if you need an alternative solution. This would be a good time to try some alternatives for the mask interface to try to deal with leaks. FWIW, your leak data is fine until 3:00 AM.

Reducing maximum pressure did not work to reduce the AHI, and it may be that removing the limit on max pressure will be the answer, but above 15 cm you're in the bilevel therapy realm, and you may need a different solution altogether. It's not fair for us to guess at your expense.

[okrobie]

Hi Ned and Sleeprider, thanks for your input. I can't explain the pattern. As you guessed, I woke up at 2:15 but went right back to bed after the nature call. I can't consciously remember anything after the 3:00 PM time. My guess is that for that much leakage, it would have to be practically falling off. Maybe if it was falling off, it didn't have enough feedback to record OA's as they occurred. Total SWAG.

I did have two sleep studies. The first one was diagnostic and the second one used a CPAP with a Nasal mask (suggested by the Tech). It was the worst nights sleep I ever had since I was opening my mouth all the time. The doctor concluded that I needed another study but that my insurance would only pay for two. I concluded that the doctor didn't know what he was doing so I stopped going to him. I did accept the fact that I needed a machine and eventually bought this ResMed S9/H5i at a thrift shop and it included this Full Face mask, a ResMed Quattro FX Medium. I bought a new cushion and headgear for it and that is where I stand today. My budget is limited so I can't just go trying this and that. I was encouraged that the first half of my night was quite leakless, so I'd like to continue trying this mask for a while.

Maybe I should request my chart from that Doctor and see what it says. He did say that I have mild to moderate sleep apnea.

That's my story and I'm sticking to it. Thanks again. Jim

[Sleeprider]

okrobie I believe the second study may have been conducted incompetently. The objective of a CPAP titration protocol is to identify the the pressure that resolves obstructive sleep apnea. If straight CPAP is unable to resolve apnea, then the study progresses to evaluate bilevel and ASV (adaptive servo ventilation) therapy.

Your data is showing over 40 AHI, mainly as obstructive apnea at pressures up to 15 cmH2O. Under a normal titration protocol, the study would continue to apply pressure as high as 25 cm, but above 15, it would probably use a bilevel with pressure support of at least 4.0. You can roughly approximate that protocol by opening up your auto to allow a maximum pressure of 20 cm.

If obstructive apnea is not resolved at these higher pressures, a doctor would look at physiological issues that are closing the airway, or if the apnea was CA (clear airway or central), the protocol would evaluate ASV.

It's clear that neither 12 or 15 cm maximum pressure on your APAP have effectively dealt with your OSA. You might want to allow the machine to go its full range to 20 cmH2O. You can't continue to accept these very high AHI levels for the long run, and if they continue, you do need to find competent specialist help. Something that might help us understand better what is going on, is to zoom in on the flow rate chart (not included in your image above), so we can see the respiratory pattern associated with these events. I don't have a good example of what yours will look llike, but we're talking about a chart that looks like this over a short snapshot of time. Note we're looking at the Daily tab with the Events open and expanded so the number and duration of events is showing.