help, way too many leaks last night

[PaytonA]

This brings up a question that I think is interesting. For example, if you set the min EPAP to 12, the max IPAP to 15, and the pressure support to 4, how will the machine handle it? Spit in your eye?

Best regards,

PaytonA

[Clementine]

lol.
Now I'm confused.

[PaytonA]

Sorry Clementine, the question was just my curiosity and does not really have anything to do with your situation.


Best Regards,

PaytonA

[PhyllisBalboa]

Clementine, my only thought was about the size of your nasal pillows. I use the extra small pillows (FX for her), and tried the small (larger) to see if they were better, but they raised my AHI and gave me lots of leaks. I returned to extra small and am back to fine, except the persistent swallowing of air. My AHI is almost always under 1, usually .3.

I've read that the pillows should rest nicely at the entrance to the nostrils, but that doesn't seem to work for me. The extra small goes in a bit, and stays put. I'm 5'5", slender, with small features, so that could be why, but even my husband does the best with small pillows. Are you sure you need large? Maybe a possible, easy fix.

On another note, with my air swallowing, I'm struggling with pressure ranges with the vpap, and pressure support, like you. It takes small changes. I usually get three great/pretty good nights, then an uncomfortable one, yet my AHI's are still great. Maybe just the nature of the beast.

[Clementine]

I have had 3 not-too-bad nights now, with at least 7 hours of sleep.

Feeling halfway human.

Hope I don't jinx things.

However, AHI is still a bit high at 6.8 last night. And the leaks still look not so great, to me, anyway. But ..... I'm just gonna keep on keepin' on. Making teeny adjustments to the PS. Back to using the medium mask. Large is comfy but really just too large for me, thank goodness. I agree, Phyllis, that the mask seems to need to fit inside the nostrils just a tad in order to stay put. However, at some point during the night it's not staying put.

here's last night:

[surferdude2]

It looks like you need more pressure on the top end to combat the apnea events. I know you have that leakage problem but it looks like it may be more due to your movements than to the pressure you are running. A full face mask may be something you should consider, at least as an alternate to help you get a handle on things.

[Clementine]

Thanks for your reply, SD. I truly cannot use a FFM, and I even have a very difficult time with a nasal mask, due to claustrophobia. I agree, I'm moving a lot and that's probably what is moving the mask around.
I will try the higher pressure.

[surferdude2]

I'm sorry to hear that the FFM doesn't suit you. It's just so obvious from your usage graph that once you settled down and fell asleep, the leaks stopped and then the apnea events started scoring. Then when you awakened, the leaks sprang back up. It looks like you had a good run of over 4 hours of sleep albeit full of apnea events that could possibly have been prevented if the pressure was available. During that same period, leaks were minimal.

Good luck with the new pressure setting. Maybe 14 cm ?

[APAAW]

It really looks like things are improving for you!

Looking at your S9 settings from last night: it looks like the 12.4 cm IPAP maximum was inhibiting the S9 from more fully controlling obstructive apneas.

I agree with surferdude2 that in the long term, 13 will not prove to be high enough a max IPAP setting for you. But if you feel things are better already, you can take your time getting to your long-term optimum settings.

So if I were in your situation, I'd nudge my max IPAP to 13.0, min EPAP to 8.0, PS to 3.4, and let things settle down over several days without further changes. Ideally these settings would reduce both leaks and AHI a bit over the long term. Realistically I wouldn't expect much change either way, but things should stay steady, and quite possibly improve.

I'm not much of a believer in the Holy Grail of a xPAP machine-scored 0.0 AHI - yes, I've had a couple such nights, but no, I didn't feel any better the following days. It's remarkable what the machines can do and even more what they can record, but I can also see mine _not_ scoring breathing disturbances when there really wasn't significant airflow. Getting AHIs down to low single-digit averages over the long term will do us the most good, and I believe that's where you're headed.

Good luck and keep hanging in there!

[PaytonA]

Do you have some indication that the masks is getting moved around and that is what is causing the leaks? Do the leaks wake you up and do you find the mask has moved out of position?

If the answer to these questions is no, then I would suspect (once again) that you may be mouth leaking especially if you did not wake up and readjust your mask to end those leaks.

Best Regards,

PaytonA