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05-11-2021, 06:10 PM (This post was last modified: 05-11-2021, 06:11 PM by pygmywhale.
Edit Reason: removed extra 'a'
)
low AHI, still exhausted
Hi everybody. First, thank you to everyone for all the help you provide here. I've learned quite a lot just lurking on these boards.
I was diagnosed with OSA last June via a home monitoring test, and have been using APAP (ResMed AutoSense 10) for nearly 11 months. During this time my AHI has dropped from 29 at diagnosis to usually between 1-3. I used to have headaches each morning, and those have greatly reduced.
However, I feel like my fatigue is mostly unchanged; I typically feel tired and brain foggy throughout the day. I often take 1 or 2 brief naps (10-15 minutes) throughout the day, without the APAP, which seems to work as kind of a reboot and helps me focus for a few hours.
I've tried noodling around with various settings over the past few months - mostly the Min/Max and EPR settings, but haven't really noticed any diffrences. I have been using the P10 nasal pillows throughout this time, except a few nights where my nose has been completely blocked up. Those nights I have used an F20 full face mask, although I've had a really hard time getting it to stay on my face without leaking. Using the P10, my partner has said that I occasionally seem to have mask leaks and/or open my mouth, but I have no awareness of this, and typically sleep through the night without waking. I'm a 40 year old male.
I've attached an OSCAR screenshot that is representative of a typical night. Looking at it I notice 1) a higher number of Clear Airway events than anything else and 2) a number of leak events, but I'm not sure what to do about this.
05-11-2021, 06:31 PM (This post was last modified: 05-11-2021, 06:32 PM by Geer1.)
RE: low AHI, still exhausted
The leak events look like mouth leaks. What causes the leaks with F20? Have you tried different size cushions or the airfit (foam) style? The airfit might seal a bit easier but I prefer silicone ones even though I have to snug it down fairly tight.
How much does a pygmywhale weigh? Curious to get an idea of what your tidal volume should be as it appears to be on the low side but that might be because of your pygmy stature lol (or a sign of mouth breathing perhaps, especially if it increases when using full face mask).
(05-11-2021, 06:31 PM)Geer1 Wrote: The leak events look like mouth leaks. What causes the leaks with F20? Have you tried different size cushions or the airfit (foam) style? The airfit might seal a bit easier but I prefer silicone ones even though I have to snug it down fairly tight.
How much does a pygmywhale weigh? Curious to get an idea of what your tidal volume should be as it appears to be on the low side but that might be because of your pygmy stature lol (or a sign of mouth breathing perhaps, especially if it increases when using full face mask).
About 150 pounds. Actually I am a person of short stature (<5ft) so if that's useful information, then there it is.
How can you tell if they are mouth leaks? With the F20, I just never seem to get it to stay on my face without leaking from the sides, and I end up basically bolting it to my face to stay on.
I do have some facial hair and I know that doesn't help, so maybe I should get rid of it and try again. Thanks!
Mouth leaks are common especially if you have nasal congestion (it is the reason I used FFM), they often have that slower rise then plateau as well that yours show. Yours aren't horrible(no large leaks) but I think you might be mouth breathing which means you aren't getting full benefits from PAP. I started out with P10 and couldn't stop mouth leaks so eventually bought the F20 and it improved my treatment quality (I prefer its quietness and less venting too as I am a light sleeper, the mouth leaks used to wake me up). If you are waking up with a dry mouth at times then that is a good sign of mouth leak as well.
If you just have some scruff that should go anyways I would say shave it off and try FFM and you will probably see leaks go away/minimize. If you would prefer to keep facial hair you could try the foam airfit cushions which seal better around facial hair, I personally prefer the silicone ones but everyone is different.
Tidal volume is the volume of air you breath during a single breath. Your average at 260 ml is at the lower end for your height/weight (6-8 ml/kg is a common reference range but that is often from predicted weight based on your height and I don't know exactly how weight factors in. This could potentially be because you are mouth breathing (note how your flow rate is lower when your leak rates are higher). If you look at tidal volume chart you might see that it is lower during periods of leaks.
I have the F20 airfit and a goatee and I find it seals well. Watch out to make sure the mask doesn't slide down your face so that the nose portion pinches your nostrils and affects the flow. I much prefer an N30i or P30i. Perhaps the large leaks are disturbing your sleep? Do you have a chin strap?
I've tried both AirFit silicone and AirTouch memory foam and couldn't get a consistent controlled leak state. I went over to the Fisher & Paykel Vitera and it is much better than the F20. I would tend to believe the leaks need controlled first then we can dive into other areas.
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I don’t believe your leaks are serious. With that being said, any leak does effect your therapy and please do try Eliminate as many as possible
I think I would try to limit your centrals (most events) and your obstructive apnea. It may help to cut back on your EPR. I would go to 2 and move up your min by one. That will narrow the difference between the two pressures, helping with centrals. Plus moving up the min would make the machine help obstructive event more quickly.
For interest sake the leak rate level isn't that bad, the main thing that caught my eye is how often it increases/decreases. What this likely indicates are sleep disturbances being caused by the air flow through your mouth (mouth leak starts, body reacts shutting mouth, repeat). These disturbances might not be enough to wake you up but they can still affect your sleep quality.
My chart looked similar before I made the change to FFM and it was getting worse. I was aware mine were mouth leaks though because they were waking me up at times and causing dry mouth issues.
If nothing else your partner will appreciate reduced leaks.
