New User-Trying to Make Sense of Worsening Leak Rate, Low AHI

[LoneStarGator]

           
After experiencing an AFib incident in February, I was diagnosed with moderate sleep apnea. I have gotten used to the CPAP more quickly than I thought I would but am continuing to struggle with a high leak rate. I've switched from nasal cushion to nasal pillows, but am still seeing a high leak rate overnight. Looking at the pattern of the leaks and reading the forum, my best guess is that I am mouth breathing. I tried using a chin strap, but that has not seemed to help things. Not helping things is that I'm a bit off in the wilderness trying to sort this out myself.

I'm hoping that some of the knowledgeable folks here might have some insights into whether this is likely a mouth breathing issue or something else. While I'm willing to try a full mask, I tend to be pretty claustrophobic, so I'm a bit worried that investing in my fourth mask in 3 months may still not solve my problem.

Also, my AHI is consistently pretty low (never above 1 and normally somewhere between .25 and .6). Am I correct that this low AHI value might be a bit of a mirage because of the leak issue? I've attached screenshots of last night's data as well as my settings.

I'm profoundly grateful for any advice that anyone might have. Thanks!

[PeaceLoveAndPizza]

They are likely mouth leaks. Chin straps work for some, but many tend to pull the lower jaw back creating other issues. Consider trying a soft cervical collar like the Caldera Releaf, Core, Velpeau, or other similar products. I have attached an image to help find the proper size.

You are correct that when there are large leaks numbers are somewhat undependable. 

With mask fitting, look at some YouTube videos. The LankyLefty27 typically has good ones helping with getting a proper fitting. I find that when I use a full-face mask like the F40, I like to first make sure my face is clean and I have trimmed my beard where the mask sits. I then hold it up against my face so it if just resting against the skin, then put the headgear over my head and adjust it so it feels the same as when I held it. When I apply pressure the cushions inflate completing the seal. Just my routine, but it works for me.

One may have a good AHI at low pressure, but have a flow rate that implies arousal breaths or very deep breaths to compensate for the low pressure. I do not think you need a lot of pressure, just a bit more than you have currently setup.

Something like:

Mode APAP
Min pressure 6
Max pressure 10
EPR 1 full-time
No ramp (unless absolutely necessary)

That should give us some guidance on what to consider next if needed.

[LoneStarGator]

Thanks! This is really helpful. I appreciate it.

[Deborah K.]

People are different but I did not find a neck collar had any effect on my mouth breathing.  I need to wear 2-inch wide mouth tape cut about 5-1/2 inches long.  Shorter or narrower is not enough in my case.  I thought it would be uncomfortable but I have found that it is not.  Lots here like Cover Roll Stretch tape, and it's cheap.  I like Theraband kinesiology tape the best, even though it is fairly expensive.  If you have sensitive skin, applying a layer of Milk of Magnesia, of all things , letting it dry then applying a good tape makes it not painful to remove in the morning.  Yay!

[HalfAsleep]

IMO have someone address your unit settings, too. I'd be dying on a pressure of 4 and dislodging my mask to get more air.