Me vs Sleepyhead - Leaks? What leaks?

[lhfarm]

I'm just over a month into treatment and it seems I'm going backwards.  Early on I was having AHI readings south of 3.0.  I wrote here about trying to get rid of my CA events and experimented with lowering my IPAP to 16.  My overall AHI went up and so after a week reverted to 12/17 pressure settings.  Things moved along until I started having leaks.  Being new, I didn't recognize the signs that my cushion on my AirTouch need to be replaced.  Final called the supplier who said yes, it should be replaced monthly.  Since this was my first time ordering supplies, I kept waiting for the company to call me.  They didn't and I finally called and should be getting the new cushion "soon".

In the meantime, I tried an AirFit mask that was sent home with me after my second test.  It was a terrible fit, but I did have an AHI 0.36 one night.  I think it was because I didn't sleep!  Anyway ordered a cushion off of Amazon and last night I had what I thought was my best night with the mask.  No mid-night adjustments, no machine back pressure noise (that keeps waking my wife) and it didn't feel to me as though it had any leaks.

I was expecting my Sleepyhead data to be super - I check first thing each morning - and was shocked to see I had, according to the summary major leaks.  and and average AHI for me.   I remember waking during the night for a bathroom break and thinking "finally I know how the mask should feel."

Now I'm questioning my whole experience.  How should this CPAP thing "feel"?  Should I always feel the pressure of the mask straps?  I thought that the "correct" sensation was when I was only aware of the air flowing around my nose (in a full face mask) - what I had achieved last night.  

Sorry just need to vent - or maybe leak is the correct term.  Just feeling stuck and depressed with so little progress.

Barry

[Walla Walla]

Looking at your leak stat's I don't really see a problem with leaks. 1% over leak redline is nothing to worry about.

[lhfarm]

Looking at your leak stat's I don't really see a problem with leaks. 1% over leak redline is nothing to worry about.

As often happens when I rant, I didn't really articulate the issue.  After a month in, I don't seem to be making progress on reducing my CA count,  In fact I feel like I'm on a roller-coaster.  Again, I am assuming that 1 month may be too soon, but I expected to be at least "stable" if not improving.  

Are there "milestones" I might work toward?  Are there things I might try to reduce my CA events?  Or do I just need to shut up and try to sleep?

Barry

[Walla Walla]

Increase your EPAP by 1cm so it reduces your pressure support from 5 to 4. Too wide a range on pressure support can sometimes cause CA events.

[Gideon]

How well did you sleep?

I see disturbances in your flow chart at the same times as most of your CA events.  When we turn over or roll in bed (some exertion), we tend to hold our breath which frequently is interpreted as a CA Event.  You have as many obstructive events as Central (roughly), the fix for those is typically to raise pressure, the fix for CA events is to lower pressure, see a conflict.  Getting good numbers for you is a fine balancing act.

You are running fixed with an effective PS of 5, I would suggest decreasing to 4 by changing your settings to 12.5/16.5,  Lowering the IPAP to help with the CA and raising the EPAP to help with the obstructive apneas.

I did not review your prior threads,  You should keep all posts about your therapy in a single thread to maintain a history of what was tried.


Fred

[lhfarm]

Thanks.  I am a mouth breathing side sleeper.  I do turn often during the night.  I'm using a CPAP pillow.  I thought I slept well last night, better than I have been sleeping for sure.  As a little background, I was a heavy snorer and had no other sleep apnea symptoms.  I (but not my wife) slept much better before the treatment.

Your analysis is helpful.  I've been very concerned about the CA events.  I'll try the changes and report back in this thread.

Barry

[JesseLee]

If you've been experiencing sleep apnea for a long time prior to treatment, most of us here have, then sometimes it's not a quick turnaround to get to your goal of good sleep every night. It's a process and it will certainly get you closer to your goal. There are ups and downs over time but that is normal. This treatment is fixing one facet of all the complications possible that affect sleep, and sleep apnea is a big big issue. Try not to be overwhelmed.

[lhfarm]

[attachment=7723]So here I am six months in and still fighting my mask.  My numbers seem pretty good, but lots of leaks.  The cushions that everyone says should last a month are only good for about 3 weeks.  My supply provider is worthless. Have just decided to purchase extra cushions and live with it.

I have not changed my pressures in months.  In fact I pretty much gave up following my numbers.  But thinking it might be time to try lowering them to see if it helps with the leaks.

Suggestions?

Barry

[Sleeprider]

Barry, I think you may be mis-interpreting your leak data. The Philips machines all report total leaks, and you need to subtract the designed leak rate from the total to get a net excess leak rate. Your median leak rates all appear to be in the normal range for a full face mask. The leak rate design for any mask is available in the mask owner's manual and varies by pressure. Please note that the option to flag leaks over a certain threshold in Sleepyhead is an editable field in the menu File/Preferences/CPAP. The default is 24 L/min. In your case, you should determine what the design leak is for your mask and use that value plus 24 L/min. Note the lower line on the graph you posted in March. The lower line is near zero and does not suggest any excess leaks at all. Perhaps you've been worried over nothing?

[MitchS]

Sleeprider is right, you don’t have a leak problem. Even if your leak rate was being reported correctly you would only be over the large leak threshold 1% (about 6 minutes) of the time you were using your machine, which is nothing to worry about.  Using the 17 cm maximum pressure your screenshots show, your mask’s vent rate is 49.5 L/min. Setting the leak rate threshold in SleepyHead that Sleeprider mentioned to 74 L/min will result in SleepyHead reporting your leak rates much more accurately.