10-28-2024, 07:18 AM
(This post was last modified: 10-28-2024, 07:25 AM by PeterJohn. Edited 3 times in total.
Edit Reason: pics came out as base64 encoded instead of pics, had to add as attachments and embed
)
My journey to eliminate leak induced arousals
Hi folks,
I would like to share my journey with you as I fine tune my CPAP therapy to treat my UARS. My latest goal is to minimise, ideally eliminate leak induced arousals to , well, stop waking up !! If I get too many of those within say 120-90mins before I an due to wake up, I'm fully awake and am in for a yuk day having had "only" 5-6 hours of sleep.
Firstly let me say that I read elsewhere on this forum how EPR would be great to reduce flow limitations, and wow, I can testify that it really helps and I feel more rested because of it. I can publish evidence of that later. My narrow nasal passages plus already large turbinates swelling during REM sleep really caused me 20 years of poor sleep until diagnosis plus CPAP plus a Nasalaid dilator came to the rescue.
On to the current issue. I was struggling to understand why I kept getting arousals plus Central Apneas (CA) when I had the flow limitations and RERAs sorted using CPAP+EPR, and all obstructive apneas (OA) sorted with CPAP. It had only been 4-6 months since I resumed CPAP therapy (after a long break while I used an AveoTSD) and I had assumed I was getting treatment emergent CA. So I tried out ASV for one night and it was terrible and did NOT eliminate any CAs.
I was wondering, did I have RLS ? What was causing these arousals ? I decided to try out recording my SpO2+HR (using a Nonin 3150 plus Oscar) to look for anything unusual. Thankfully I had great Oxygen levels, very stable around 95%. But I noticed peaks in my HR as it jumped quickly from 58bpm to 75bpm exactly when I aroused. So I thought, OK perhaps the CA is arousing me with adrenaline which increases my HR. But what was casing the CAs ? Then voila !! I found the culprit ! Mask leak !!! I found undisputable proof of cause and effect. I found that most leaks were followed within 2-5 seconds by an increase in HR, then within 10 seconds a CA of 10-15 seconds duration. And sure enough others have reported that CAs follow arousals. Not many of you will have the benefit of using a pulse oximeter to diagnose this, but in my case thankfully I can and here a pic is worth 1000 words, so check this out,
I have many many like the above to thoroughly convince me of the problem. that was a high leak for me as most of my arousing leaks are only 3-5 L/min per below. Also not all leak+arousals are followed by a CA, just a noticeable pause per here
So now I am looking fwd to trying out fixes, here is what I tried that so far has helped decrease the leaks. In most of the FFM scenarios below I also use a Nasalaid dilator
I am reminded that the first CPAP mask by Prof. Sullivan and Dr Farrell were glued to the patient's faces !! A few hundred people endured that, would I be game enough to try that out ?!?!
Any ideas are very welcome. I hope what I have documented so far will help others in their journey.
I would like to share my journey with you as I fine tune my CPAP therapy to treat my UARS. My latest goal is to minimise, ideally eliminate leak induced arousals to , well, stop waking up !! If I get too many of those within say 120-90mins before I an due to wake up, I'm fully awake and am in for a yuk day having had "only" 5-6 hours of sleep.
Firstly let me say that I read elsewhere on this forum how EPR would be great to reduce flow limitations, and wow, I can testify that it really helps and I feel more rested because of it. I can publish evidence of that later. My narrow nasal passages plus already large turbinates swelling during REM sleep really caused me 20 years of poor sleep until diagnosis plus CPAP plus a Nasalaid dilator came to the rescue.
On to the current issue. I was struggling to understand why I kept getting arousals plus Central Apneas (CA) when I had the flow limitations and RERAs sorted using CPAP+EPR, and all obstructive apneas (OA) sorted with CPAP. It had only been 4-6 months since I resumed CPAP therapy (after a long break while I used an AveoTSD) and I had assumed I was getting treatment emergent CA. So I tried out ASV for one night and it was terrible and did NOT eliminate any CAs.
I was wondering, did I have RLS ? What was causing these arousals ? I decided to try out recording my SpO2+HR (using a Nonin 3150 plus Oscar) to look for anything unusual. Thankfully I had great Oxygen levels, very stable around 95%. But I noticed peaks in my HR as it jumped quickly from 58bpm to 75bpm exactly when I aroused. So I thought, OK perhaps the CA is arousing me with adrenaline which increases my HR. But what was casing the CAs ? Then voila !! I found the culprit ! Mask leak !!! I found undisputable proof of cause and effect. I found that most leaks were followed within 2-5 seconds by an increase in HR, then within 10 seconds a CA of 10-15 seconds duration. And sure enough others have reported that CAs follow arousals. Not many of you will have the benefit of using a pulse oximeter to diagnose this, but in my case thankfully I can and here a pic is worth 1000 words, so check this out,
I have many many like the above to thoroughly convince me of the problem. that was a high leak for me as most of my arousing leaks are only 3-5 L/min per below. Also not all leak+arousals are followed by a CA, just a noticeable pause per here
So now I am looking fwd to trying out fixes, here is what I tried that so far has helped decrease the leaks. In most of the FFM scenarios below I also use a Nasalaid dilator
- Using Nasal Mask (NM) and taping mouth shut
- Using NM plus this Seatec chin and mouth strap (no mouth tape needed as it covers mouth)
- Moving from NM to FFM, eliminated mouth leak
- Always sleeping on my tummy with no pillow allows me to use lowest CPAP setting (as my tongue doesn't fall back) to eliminate leaks. I have somehow trained myself not to roll onto my back or sides, no need for a tennis ball.
- Thinking my CAs were due to hypocapnea as the therapy flushed out too much CO2, I tried EERS per here which is partial vent blocking plus placing a fixed leak about 10cm down from the mask per here. Made no difference after about a week of trying that I recall.
- Moving from a ResMed Quattro FX FFM to Airfit F20 FFM greatly reduced leaks.
- Washing the silicone cushion in soapy water to get the oils off (each 2nd night). Wiping oils off with a tissue on nights I don't wash it.
- Washing my face with soap before bed to remove oils
- Tightening the mask straps to achieve the balance between discomfort and minimal leak
I am reminded that the first CPAP mask by Prof. Sullivan and Dr Farrell were glued to the patient's faces !! A few hundred people endured that, would I be game enough to try that out ?!?!
Any ideas are very welcome. I hope what I have documented so far will help others in their journey.
