My journey to eliminate leak induced arousals

[Benjamin]

Thank you estgad!

[PeterJohn]

Can you do another screen shot showing the following graphs:
flow rate
pressure
flow limit
resp rate
insp time
exp time
leak rate

This would help to show the breathing patterns happening before, during and after these events you are having.

This morning as I looked at the last screen shot it made me think about my own breathing pattern.  Even during the day I will be going along taking normal breaths, and then I have to take a deep breath.  And most of the time it is a deep mouth breath.  When I first lay down to go to sleep this happens a lot, and several of those deep breaths are big yawns.  I have noticed on my data that when I take these deep breaths that it can produce a leak.

here you go.
   

Separate to the above screen shots, I did a test when I was awake with the mask and therapy on, and intentionally inhaled fast and deep 8 times with delays between each fast inhale to see if it was detected as a phantom leak, and it wasn't.  For one of those deep breaths, some  real leak did happen and it flagged it as leak OK.   The Leak detection algorithm is smart as it looks to see when expiratory and inspiratory flow are not balanced over some min period of time.   I have yet to verify the temporal accuracy of the leak signal, if I do that I will let you know.       So it seems that I am having a deep inhale for some reason (positional change per G.Szabo?), which (more often that not) initiates some leak concurrent with an increase in HR (sometimes just before the leak) then a CA, and an arousal.

Both yourself (estgad) and G.Szabo had good insights, but I think it is more than just moving, because I get a big shot of adrenaline, sometimes enough to keep me awake for 1-2 hours which means I cannot get back to sleep if it happens 1-2 hours before I am due to wake up.    When I am lying down I know my HR only increases the amount documented here (from 60bpm to 75bpm)  if I get a shot of adrenaline and I thought my brain was doing that to wake me up for some reason.  (either leak or hypocapnia ?) .   If I just turn over when awake my HR barely budges.  This is why I think it is more than just me waking myself up when I turn my head from one side to the other (I sleep on my tummy ALL night with no pillow ! ).

Is it still likely to be movement induced ?  If so then I can do little to "fix" the inbuilt arousal I experience when moving.   Any thoughts on what else I could measure (audio or accelerometer on a phone app that is time synchronised to the flow generator ?), or something else to investigate ?

[estgad]

PJ,

First I have no idea how you sleep on your stomach with no pillow and wear a mask. I just tried it with my Brevida (Nasal) and FlexiFit432 (Fullface) and I could not turn my head from side to side without either being face down on top of the mask or having to make a big body shift to pick my head up and turn it. How do you do it?

Thanks for the new graphs. Look at how the insp & exp flows change before a leak shows up. To me it is looking like the leak is the result of something that is going on, not the cause of it, and then the CA is a transitional apnea as you re-enter sleep.

Finding out what this something is can be the million dollar question. This is where a full on sleep study with the cameras and multitudes of sensors would be handy to review to see if it is positional (movement, chin tuck, etc, brain wave, outside disturbance (noise, light, etc). This is one of the things that makes it hard to dial in the treatment, because we don't have good ways to capture what is going on when an event takes place. About all we can do is trial and error, experiment with one thing at a time for a few nights and see what happens.
Case in point a few days ago I posted a question and G. Szabo gave me a suggestion. Because I am so sensitive to epap pressure I am making very small incremental changes, and so far that first step has been a positive result, I am getting ready to make the next step as this first one is doing good for several days.