One good night, now leak issues?

[sleepyguy99]

Normal tidal volume in a young healthy person is 7 mL/kg, or for your 77 kg weight 539 mL, which is considerably higher than your 340. Lower night tidal volume is to be expected, but you are still below average. It's worth noting here, that you are both young, fit and not overweight...just for those that like to stereotype this problem is a condition of old fat guys. This may well be normal for you, and I would not be too concerned as long as you feel good in physical activity. On the other hand, it cold be that you have problems exhaling against pressure and this limits your volume on CPAP. That is the reason BiPAP is a very good thing for people that may have tidal volume affected by CPAP use. Again, if you are comfortable, I would not give this a second thought as we really don't know how reliable this aspect of the data is, however my personal experience was that I realized about a 150 mL boost on bilevel compared to CPAP.

The questions you didn't answer are, 1) did the last pressure increase result in a lower incidence (AHI) of apnea? and 2) How do you feel relative to before starting therapy?

Payton, I don't pay much attention to the inspiration:expiration ratios anymore, especially with the Respironics machines. I do notice when they are out of whack, and like to look at the wave forms to confirm. I have observed that most of the time when ratios are 2:1 like this (rather than the normal 1:2), it us usually some kind of machine error. I don't know what causes it. The respiratory wave form is perfectly normal to my eye.

Could the lower tidal volume be caused by limited airflow in my nose?

The last pressure increase has helped a little bit, last night I put it even higher to 16.5 as when it was at 18 max it almost never went over 16 or 16.5.. So I'm going to try out 16.5 - 20 for a little, I had really bad leaks last night though (despite the Dreamwear being extremely tight, I woke up to my upper lip bleeding.. lol)

Got Obstructive: 1.45
Hypopnea: 2.50

So I was able to reduce my Obstructive events to the lowest yet. I just gotta be able to consistently prevent leaks without waking up from it being so uncomfortable

CPAP has been a mixed bag so far, on the nights where I can get like 3.5 - 2.5 AHI (haven't really gotten lower) it has been amazing. If it's over it can either be the same or a little worse probably from waking up still in my sleep.

I want to try the P10 again, but if I sleep on one side it seems to leak out the side. I'm gonna try using the clips that came with it to tighten it, but is there anything else I can do?

[MitchS]

Hello, sleepyguy. Your leak charts look like mine did before I finally got the leaks under control.

I found I have to wear my P10 somewhat tighter than recommended.

I am an active sleeper, which tends to cause the head gear to slip. Wearing my chin strap over my mask's headgear helped keep the head gear from slipping as much and reduced leaks a great deal.

I have also found keeping a pillow tucked under my chin when possible helps.

A soft cervical collar didn't work out for me. While it did lower my leaks a little, my AHI increased a great deal and I didn't feel as well when I woke up as I do when I don't use the collar. I also tended to roll over on my back while wearing the collar.

Don't get me wrong. I still have higher leak levels than I want. They are, however, at a level I can live with. I haven't had a large leak in several months.

Sleep well.

[sleepyguy99]

Hello, sleepyguy. Your leak charts look like mine did before I finally got the leaks under control.

I found I have to wear my P10 somewhat tighter than recommended.

I am an active sleeper, which tends to cause the head gear to slip. Wearing my chin strap over my mask's headgear helped keep the head gear from slipping as much and reduced leaks a great deal.

I have also found keeping a pillow tucked under my chin when possible helps.

A soft cervical collar didn't work out for me. While it did lower my leaks a little, my AHI increased a great deal and I didn't feel as well when I woke up as I do when I don't use the collar. I also tended to roll over on my back while wearing the collar.

Don't get me wrong. I still have higher leak levels than I want. They are, however, at a level I can live with. I haven't had a large leak in several months.

Sleep well.

Hey pupcamper,

Your advice seems pretty good, I never thought about putting the chinstrap over the headgear.

You just slip the headgear over the tube and put the headgear on and then the chinstrap right?

The pillow under the chin seems like a smart idea, I tried it out, only issue is I end up moving so much lol. I finally got the Hose Buddy and used that which makes wearing the P10 a lot easier. Only issue is if I flip over the same way twice it gets curled up, I might eventually need something with a swivel.

I tried those things last night and got the best AHI I ever got (1.63), although the leak rate was still over 19% which is weird..

I think I'm waking up between each sleep cycle feeling fairly refreshed, then I end up taking the headgear off for a minute and putting it back on to sleep.

Large Fast Leak:


Large Long Leak:


I'm really not sure... In both of these I remember taking the mask off for a short period of time and putting it back on (at least a few times).. But last night (first one) doesn't show a quick leak.. Could the machine just be kinda inaccurate sometimes?


I found 2 inches pulled up with both clips seemed tight, 1 inch was a little loose, so 1.5 inches seems ok for me. I might also try out FlashPAP, seems a lot easier than manually taking the SD card out every time I want to see SleepyHead data.

[sleepyguy99]

Quick update:

Seems like most of my problems are related to leaks, still. (lol)

P10 Swivel Issue Resolved:
There is no swivel on the front of the P10 where the mouth is, so if you end up rolling over in the same direction it gets tangled.
There is a small swivel on the end of the tube that connects to the CPAP tubing, but I found this wouldn't really do anything if you flipped over and had the same setup I had (hose buddy, dangling down)

If you route the tube over your head, it makes the distance between the mask tube and the CPAP tube shorter and the swivel has a lot less distance to get the tug it needs to work. I ended up taking one of the hose buddy velcros and duct taping it to one of the straps on my halo chin strap and routing the tube over my head, I can now move around freely with the P10, no problem.

Mouth Leaking (still in progress..):
Even if I use duct tape, it still ends up leaking a lot. The tape gets wet and eventually my mouth blows the tape open in one of the corners..

I know this is probably fairly dangerous, but I just want to eliminate any possible issues temporarily..

I might try tying an extra long bandana around my mouth and around my head (with and without tape)

I also might try this chin strap that covers the mouth, kinda expensive.. lol
Ultimate Chin Strap

Also, the new Airfit F20 Full Face Mask looks pretty good (my brain is going all over the place looking for solutions)

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Almost ALL of my events happen when leaks occur (even these minor leaks), should I just raise my minimum pressure to over compensate for minor leaks?

[sleepyguy99]

Hey guys,

I've finally resolved my leaks.. took a while, but there are a few tricks to know.. lol

Mouth Taping:

I was mouth taping with duct tape, but was having not great success, even with duct tape! Half way through the night it got wet or just blew open out the sides.

What I found out, is a few things.

1. You gotta make sure you don't just tape in one single direction, I was just taping with like a 4" wide piece of duct tape which didn't do the job. Instead you have to use multiple pieces in multiple directions, so I would tape like ~4 pieces up and down on my lips, then tape across over that.

Like this video: https://www.youtube.com/watch?v=8nHhdHm3wgo

When you do this I would try to make sure the tape stops on an even surface, not rounded. Like the bottom of your chin is good to stop the bottom part. Make sure no air can get out or that the tape is crinkling up somewhere.

Putting duct tape on the lips is very painful to take off, so micropore tape is probably the answer for the lips.

2. The tape getting wet.. I started to just lightly tape my lips with micropore tape, then taping a 1" thick size of guaze over my lips (just enough to cover the lips)

3. Keeping it in place. Wrap bandages. Tape one end to the middle of your lips after finishing taping, then wrap it around 2-4 times and tighten it with the velcro end (mine had velcro on the end).

So. This kinda seems super excessive to do everynight, and possibly dangerous, but it did eliminate leaks enough for me to analyze my data better and sleep better.

Probably a better solution:

I did purchase the Ultimate Chin Strap and believe it is superior than doing above, I've only used it a few nights so far, but it seems great. I might not need to tape anymore with it, I've only done a very light taping with micropore tape so far and no leaks at all.

[commercial link removed per rules - instead, search Google for "Ultimate Chin Strap"]

I have no affiliation with the company or owner, but it seems he really stands by his product.

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