One good night, now leak issues?

[Sleeprider]

What size cushion are you using, and how does it feel? You've gone from less than 2% over leak redline to over 20%. Pressure is considerably higher, and there are more events, however the same distribution of event types. Nothing too alarming here as long as leaks can be brought under control. Are you aware of leaking through your mouth or direct mask leaks?

[sleepyguy99]

What size cushion are you using, and how does it feel? You've gone from less than 2% over leak redline to over 20%. Pressure is considerably higher, and there are more events, however the same distribution of event types. Nothing too alarming here as long as leaks can be brought under control. Are you aware of leaking through your mouth or direct mask leaks?

I'm using the large cushion, I heard that it's better to go for the larger piece than being too small. It feels better than the medium because there is more airflow, it seems to be in my nose pretty tight and it's pretty hard to cause a leak.

I could swear the first half of the night I didn't have any issues with mouth leaking because the tape was still on and I didn't end up drooling on it at all. The second half I might've had a little leaking through the mouth, but I pushed the tape back on and went to sleep.

The leaking just seems super random to me and I only woke up like 2, maybe 3 times.

[sleepyguy99]

I don't get it :S

I went back to the Dreamwear last night hoping to get a good nights sleep, because I have been able to reduce the leaks on that (but it is uncomfortable being that tight), this is probably the 4th night that looks like this.. I also dropped the A-Flex setting from 3 to 1 (when I woke up, maybe keep trying this?). I did wake up with a bit of air in my stomach, but even after this sleep I passed back out without the mask on and slept for 13 hours total..

I think the leaking is caused by my deviated septum (the ENT never fixed this, wanted to go the non-invasive route at first) With the P10 I can fully submerge my face in my pillow with one side and the other side causes leaks. At least with the Dreamwear I can just tighten it really tight to stop leaks.

I never got a real sleep study done (in home, kinda vague results), which I am getting scheduled ASAP, just have to see my Doctor first next week.

[Sleeprider]

If you know how to take a zoomed image, I'd like to see a 2-minute shot of the breathing waveform. Try to get one with what seems like normal sleep breathing, and one with a group of events like around 7:00.

[sleepyguy99]

Hey again Sleeprider, thanks for all your help.


2 Minutes of Regular Breathing



2 Minutes of Events



Also, here's ~3 Minutes of Events for extra if that helps.

[Sleeprider]

I don't know that I am going to be much help. The normal breathing looks great, and the event charts show the events are of minimal duration, and do not end in recovery breathing, which would suggest they are stressful. In these charts the OA are clustered and look a bit like REM or positional related OA.

One of the reasons I wanted to see the closeups is the machine is recording your average inhale time as much longer than inhale, which is the opposite of a normal person. The chart shows the machine is wrong. Your respiration looks very normal, although your volume is not very large for a male. If you are a fairly small person, a tidal volume of 360 is pretty acceptable, otherwise, it is below average. That said, your respiration does not show any flow limitation, and leak rates are very good.

Usually with OA and no apparent cause, we would suggest throwing more pressure at it. You could remove the 18 cm cap, and let the machine go to 20. It depends on your comfort level and whether you got better results from the previous pressure increase (your profile shows 12-16). Alternatively, you have probably seen some of the soft cervical collar discussions on the forum. They are very effective for people that may get themselves into a tucked chin position that can cause the kind of apnea we see here. They are inexpensive, and you might want to give something like that a try. Events are on the high side numerically, but are very short in duration and may not be very disruptive. If you feel okay, this is acceptable. If you're tired or feeling ongoing symptoms of apnea, you could try the cervical collar, pressure, or even do some oximetry to evaluate if this is a problem to be concerned with. One last observation. With these pressures and low tidal volume, I would be asking your doctor about bilevel. It could address a lot of comfort issues, improve ventialtion and resolve the hypopnea through pressure support, rather than just brute force minimum pressure.

[PaytonA]

Sleeprider,

It just occurred to me that this longer inhale shorter exhale could be a zero line problem depending, of course, on what sleepyguy thinks. The machine must calculate the zero line for the flow line. The flatter portion of the flow line for normal breaths is often just barely on the expiration side of the flow chart. If the zero line is miscalculated, it could put most or all of that portion of the flow line on the inspiratory side of the flow line. That would appear to make the system think that the inspiration is much longer and the expiration is much shorter.

Just my thoughts

Best Regards,

PaytonA

[sleepyguy99]

Thank you guys for the responses!

@Sleeprider, I'm 24 and weight about 170lbs and am 5'9", should the Tidal Volume be much higher than 360? I flipped through my past data and only found it hit 400 once (highest)

@PaytonA, would this zero line be calibrated at the start of putting the mask on? Almost all of my Insp. Times are quite a bit higher than my Exp. Times overall.

I'm hoping once I get this sleep study done I can figure out what is exactly going on. I've had a couple good nights on CPAP which have been significantly better than my sleep before. A lot of the time in my life I could just sleep 12 hours and wake up feeling somewhat okay, but I can almost never sleep 8 hours and feel refreshed.

If I can get CPAP to work that would be amazing, I also kinda hope of a more permanent solution overall eventually (I'm still pretty young), not sure if sleep doctors can pinpoint what exactly is causing the Apneas?

I do sometimes end up tucking my chin in when I sleep on my stomach, so I will try my best to not do that or just sleep on my side.

[Sleeprider]

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.

[PaytonA]

It looked perfectly normal to my eye too which is what got me thinking about it. As sleeprider says, don't sweat the technical detail for now. Your other issues have a higher priority.

@Sleepyguy
It would make the most sense to me if it were calculated on a running average, which would mean that it would be calculated over and over.

Best Regards,

PaytonA