[Treatment] Are leaks the problem or do I need BIPAP?

[TiredDude]

Hey there,

I'm hoping to get some help with what to do with my cpap therapy.

I'm able to fall asleep and stay asleep through the night with my current set up which is an F+P Simplus mask, AS10 Autoset and some noise cancelling earplugs. I posted previously a few months back, describing how I felt pretty awful after using my cpap and I was advised to set EPR to 3 full time and see how I got on. I've done this and have been sleeping consistently with it on, but I still just feel tired and unwell when I wake up and I need to nap a few hours after I get up.

My charts show pretty high leaks with the Simplus mask, so I've ordered a Resmed F30 mask to try out instead, I'm hoping that the F30 will leak less and I'll feel better.

However, I just wanted to check if the leaking is the only clear problem with my therapy. Should I increase/Decrease pressure? Should I be seeking out Bilevel treatment due to my flow limits?

Thanks in advance for any help!


           

[Sleeprider]

Your leaks are very low and show an excellent fit for your mask. There are occasional spikes which show a seal leak, but most of the night, your leak rate is excellent. With 10 to 13 pressure, your results appear to be very good. There is not much we can do with the CA events, which are often just arousal, shifts in position and sleep stage changes. A closer look using a zoomed image would let us see the progression of those events and explain it. There are a few OA events, and they might clear up with a minor increase in pressure.

[TiredDude]

Hey Sleeprider,

Thank you for the info. I've attached a couple of close ups of the CA's from different days.

So with these results, would you advise to just keep trying with these settings and set up and hope it starts to feel better as I get more used to it?

           

[Sleeprider]

In the first chart from 08:57 to 09:12, we see two CA events. The first event starts with flow limitation and a recover breath that exceeds your respiratory needs, resulting in a brief pause, flagged as CA. Normal breathing resumes with some flow oscillation typical of a feedback loop until respiration stabilizes and flattens out showing flow limitation with a repeat of the previous event. While this is flagged central, the origin is obstructive flow limitation. In the second chart we see flow limitation (flat tops on inspiration) leading to an arousal, breath-hold and flagged CA. This is an arousal and position shift or movement. Again not a CA, but respiratory volume fluctuates on recovery. The third chart seems to show an OA and CA and I can't really make out what's happening. You;re using EPR 3 so without bilevel we don't have more pressure support for the flow limits, and I think that is where most of the events originate. 95% flow limts ranges from .03 to .05, so not very severe, but a bit disruptive. Inspiration time is reported as longer than expiration, and that does not seem accurate looking at these charts. Respiratory volumes are relatively high and indicate someone in good health.

With 10-13 pressure and EPR 3, your pressure in bilevel expression is 10/7 to 13/10. If you want to try increasing minimum and maximum pressure by 1, we would look for an improvement in flow limit. With bilevel, we would probably just increase pressure support I can't predict what you will get, but might be worth a trial.