Mouth Leaker?

[DariaVader]

My father was at my vacation house last week, and I took the opportunity to snag his SD card and make him a sleepyhead profile. His numbers look great, and pressures are not going up much at all from his min however, his leak rate is high consistently, so those numbers may not be valid. I told him he needs to wear his chinstrap; pretty sure the mouth is open... but he said he hates it. He also hated the face mask... wears big eye shields that won't fit with anything more than the P10. Does this look like a mouth leaking profile to you?

RemStar Auto with A-Flex (560P)
A-Flex x3 APAP (Variable)
Min 9 Max 20 (cmH2O)
P10 Airfit

[justMongo]

He's leaking somewhere!

[DariaVader]

when I leak, my blower maxes out. his is so nice and calm... is that a diff between the PRS and Resmeds?

[justMongo]

What I've seen on ResMed's, at high leak, is the blower maxes out; and the high data rate flow data shows a drop in pressure.

[retired_guy]

Hi DV, where the heck ya been?

This is a pretty small sample, so it's a bit hard to draw any conclusions. However you're probably right that he could use a chinstrap.

I don't blame him for "hating" his chinstrap. For some reason most of them are a little too big, or whatever. So as with masks, he might investigate different ideas for a chinstrap. Some that might appeal to him are ace bandages "gently applied," a sweat band, or whatever.

[Sleepster]

Need to see a leak graph for the entire night. Look for periods of time lasting an hour or more where there are no leaks, and then periods lasting an hour or more where there are large leaks. That's what mine look like when I mouth-leak. If he's leaking all night you should be able to observe him doing it.

Check the on-screen display to see the percent time in large in leak. I bet it's high.

[JVinNE]

Need to see a leak graph for the entire night. Look for periods of time lasting an hour or more where there are no leaks, and then periods lasting an hour or more where there are large leaks. That's what mine look like when I mouth-leak. If he's leaking all night you should be able to observe him doing it.

Check the on-screen display to see the percent time in large in leak. I bet it's high.

Sleepster, does your Simplus cause deep lines in your face? I can't sleep on my back, so it's digging in, even when it's not too tight, and I use a Pad-a-cheek on it.

[quiescence at last]

DV - from the plot, which you probably posted because it was the interesting part, there is no correlation between leaks and expected attenuation in flow rate. while the pressure setting is 9-20, his apnea is well controlled and constant at 9 (plus the standard PRS1 pressure spikes to 10.5). The plot shows no adjustments to pressure throughout this clip. it is interesting that the snores happened when leak was low. you might expect the flow rate to be attenuated at those points - which does not seem to be true, and you might expect that he is mouth breathing when he snores which would increase the leakage (theoretically). if he could somehow not leak when mouth breathing, it would probably show an increase in TV and flow rate. so, based on this, I would be willing to believe he is not mouth breathing. This leaves leaking at mask to face interface. Would he be willing to try pad/liner for a trial?

QAL


btw. Did his resp get bumpy between 23:35 and 00:25? If so, he may have been REM sleeping and pretty un-disturbed by the skin interface leakage which would normally awaken him.

[DariaVader]

Hi DV, where the heck ya been?

This is a pretty small sample, so it's a bit hard to draw any conclusions. However you're probably right that he could use a chinstrap.

I don't blame him for "hating" his chinstrap. For some reason most of them are a little too big, or whatever. So as with masks, he might investigate different ideas for a chinstrap. Some that might appeal to him are ace bandages "gently applied," a sweat band, or whatever.

I have been up at Wallowa Lake for the majority of May... The internet here is horrible sometimes and we have had a lot of company!
but my house there is a short walk from this:

[DariaVader]

Need to see a leak graph for the entire night. Look for periods of time lasting an hour or more where there are no leaks, and then periods lasting an hour or more where there are large leaks. That's what mine look like when I mouth-leak. If he's leaking all night you should be able to observe him doing it.

Check the on-screen display to see the percent time in large in leak. I bet it's high.

That little clip is how long he spent on the machine that particular night. He goes to bed with the machine, and then gets up and sleeps in a chair without it when he wakes. He says he can't sleep on his side with any mask he has tried, including the P10, and that sleeping on his back hurts too much unless he is at an incline. Trying a mask liner is a good idea (for pillows???) He has psoriasis - which could be a contributing factor to mask discomfort. He is almost 80, has congestive heart failure following several heart attacks and he sports something like 8 stents. He wasn't using his CPAP at all until my sleep DR sent a text message to a Kaiser RT who is now managing my dad's case more diligently - he got a brand new machine, new masks and followup appts that they plan to continue - they are working with him in spite of his non-compliance. They are helping him, I am helping him, but he's stubborn I don't generally watch him sleep, but while he was here at the Wallowa house I watched him nap and hang his mouth open.

apparently photobucket is too far of a reach this morning for my link so I attached more screenshots that might be more representative and are longer stretches. I hadn't noticed how short the night I first attached was. (hope that bandwidth improves, I am supposed to be working from here. Lol. )