leaks - how, what, why...

[Sleepster]

I have had that uncomfortable feeling associated with waiting for the pressure to change when switching from inhalation to exhalation and/or back. I found it was psychological, though, in the sense that it would go away when I relaxed and starting breathing normally because I was thinking about something else, something other than how I was breathing. Have you tried reading with the machine on? Or watching TV or listening to music. Whatever relaxes you.

My doctor prescribed trazodone for the fragmented sleep. It helps, but I make sure I don't take it every night. Eventually all sleeping pills stop working and then you're trapped, so I am cautious. I managed to wean myself off amitriptylene. It was very difficult. I am slowly weaning myself off trazodone. After a year I've used less than half the pills prescribed and the doctor was surprised when I declined her offer to raise the dose.

It looks like you are one of the people for whom the pressure-adjusting algorithm doesn't work. And it seems you have understood why correctly. So it would seem that you do better at a fixed pressure. If I were you, though, I would still pay attention to flow limitations. They may not advance to hypopneas and apneas, but they might still be causing arousals. So, for example, if a pressure of 8.6 seems to minimize your AHI, see if raising it just a bit can lower your flow limitations without substantially raising your CA index. Even if your CA index does go up, wait and see if it goes back down on its own, because that is the more common occurrence by far.

I've spent a year of monthly tweaking. Set it at a pressure, measure a month -long average value for the indices. Adjust again, and so on. I was trying to adjust the two pressures of my bi-level machine to minimize my CA index without raising the OA and H indices. My situation is complicated by aerophagia and the fact that too high of a bi-level pressure difference (pressure support) induced CA's. I then switched to the auto bi-level machine I have now so that I can try to minimize my AHI without raising the pressure so high that I start swallowing air.

I am now committed to a diet and exercise regime to lose weight. I'm convinced it's the best way for me to lower my pressure and reduce the fragmented sleeping. Even before I started losing weight the fragmented sleep was gradually improving. Switching from a nasal mask to a full face mask to stop mouth leaking helped a lot, too.

It's long and slow journey that requires attention. But it's worth the efforts.

[AshSF]

My thoughts:
1) Make nasal pillows work for you with or without chinstrap. You typically need less pressure with pillows than FFM.
2) you still need to get leaks under control. They look like mouth leaks. So chinstrap or getting some muscle memory training of the tongue should work.
3) Your EPAP (Set pressure - EPR) looks good enough to ward off Obstructive Apnea events.
4) your IPAP (Set pressure) looks good to ward off Hypos.
5) your AHI is below 1. So I wouldn't worry about it by tweaking pressure to ward off FLs.

You should stay on straight pressure and if possible lower it 0.5cm at a time for 1 week and see if any OAs are introduced. If not, make it your new level for 10 more days and then tweak it down 0.5cm again in the same fashion. Lower pressure makes you less leak prone as well. And may reduce pressure induced microarousals that may be causing the untested feeling even though AHI is in good range.

My 2 cents.

[worn_out_in_lebanon]

I have had that uncomfortable feeling associated with waiting for the pressure to change when switching from inhalation to exhalation and/or back.

Eventually all sleeping pills stop working and then you're trapped, so I am cautious.

If I were you, though, I would still pay attention to flow limitations. They may not advance to hypopneas and apneas, but they might still be causing arousals... Even if your CA index does go up, wait and see if it goes back down on its own, because that is the more common occurrence by far.

I've spent a year of monthly tweaking...

I am now committed to a diet and exercise regime to lose weight. I'm convinced it's the best way for me to lower my pressure and reduce the fragmented sleeping.

Switching from a nasal mask to a full face mask to stop mouth leaking helped a lot, too.

It's long and slow journey that requires attention. But it's worth the efforts.

Thanks for your input and sharing your situation. It's always helpful to know everyone (most everyone anyway) goes through these various adjustments and difficulties, getting it all ironed out.

I switched from medium to large pillows, and changed EPR 1 to EPR 2 last night. I left the pressure alone for now. It was so much better. After about five minutes, I realized that for a couple of minutes I had the sensation that I didn't even have the mask on or the machine running.

Usually (especially here lately) I drift off pretty quickly, probably within 15 minutes or so. Prior to cpap I was using a 1mg melatonin tablet (sublingual). I haven't needed that anymore. (maybe because I'm so tired by bedtime... we'll see after I get rested up)

I'm still open to a ffm, but going to give the nasal pillow every opportunity first. Not looking forward to having to try a bunch of different masks to find one that works.

Good point on nudging the pressure up later, to work on flow limitations, and how CA's often dwindle over a period of time. My immediate problem is how to get back on track for restful sleep. Right now it's affecting both job and home life. I think going up a size on the nasal pillow is a good step in the right direction. Leaks around the outer edge of the medium were waking me up lately.

I could probably stand to lose another 10 lbs.

[worn_out_in_lebanon]

1) Make nasal pillows work for you with or without chinstrap. You typically need less pressure with pillows than FFM.
2) you still need to get leaks under control. They look like mouth leaks. So chinstrap or getting some muscle memory training of the tongue should work.

You should stay on straight pressure and if possible lower it 0.5cm at a time for 1 week and see if any OAs are introduced... Lower pressure makes you less leak prone as well. And may reduce pressure induced microarousals that may be causing the unrested feeling even though AHI is in good range.

Definitely trying to make the pillows work. Going up to a large last night helped a lot.

I did see a big pressure difference when I switched from ffm to pillow. I used an ffm the first week, and was at 10-15 on it. I'm 7-9 ish on the pillow.

I was getting some pillow leaks from the medium, but I think going to the large will solve that. Which leaves the mouth leaks.

My leak report was a little better this morning but not much. SleepyHead still said I'm leaking way too much. I wake up several times from the noise and/or the sensation of the tongue lock not working. Often it takes just a _little_ extra pressure to close it off again. Sometimes it feels like I don't need any pressure to keep it closed. Except when I roll to my side, I can tell I have to work at it more. Sometimes it feels like I'm "tired" of holding my tongue in place, sometimes it just works. Hoping it becomes second nature soon...

The graph shows leaks almost continuously. I'm pretty sure I'm not mouth leaking continuously, so I don't know what to make of that.

I am using a ruby chinstrap. I keep it pretty far forward on my head, to keep the pressure up instead of back. The side straps are about as close to the front as I can get them, without them starting to go around the brow ridge.

[Sleepster]

Thanks for your input and sharing your situation. It's always helpful to know everyone (most everyone anyway) goes through these various adjustments and difficulties, getting it all ironed out.

That's the reason SuperSleeper devotes so much of his time, effort, and resources to this place. Without it we'd not have the support needed for success. Lack of compliance is by far the biggest obstacle to treatment of this affliction and support has been shown to be a remedy for that problem.

It was so much better. After about five minutes, I realized that for a couple of minutes I had the sensation that I didn't even have the mask on or the machine running.

Soon you will wake up and wonder if the machine is still running. I still put my hand in front of the exhalation port jets to feel the air. It's the easiest way to confirm that the machine is running. Otherwise I don't feel or hear it. It's amazing that it can go from something that bothers us so much we can't sleep to something that we don't even notice is there. The human capacity to adapt is awesome!

I'm still open to a ffm, but going to give the nasal pillow every opportunity first. Not looking forward to having to try a bunch of different masks to find one that works.

Don't think about it that way. Go to the DME for a fitting. Maybe the next mask will be the one for you!