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+--- Thread: [CPAP] Is my leak rate a problem? (/Thread-CPAP-Is-my-leak-rate-a-problem)
Is my leak rate a problem? - Kevstuf - 01-24-2024
I have been struggling to stay asleep with my CPAP. At the advice of some users on this board, I turned up the minimum pressure to 8 and also cut the EPR to 1. I recently also made an adjustment to only have EPR during the ramp phase. At the suggestion of some users, I also tried a few nights turning off ramp, but the air would end up blowing up my cheeks and jolt me awake right as I was about to fall asleep. That jolt would then make me miss my sleepiness "window," so to speak, and I would lie there wide awake. However, I'm now barely able to sleep for an hour (with a ramp of 45 min) before I rip the mask off. I notice the leak rate in my OSCAR seems quite jumpy; could that be the cause? I've attached my last 3 nights of data. Appreciate any advice.
RE: Is my leak rate a problem? - Sleeprider - 01-24-2024
Change your EPR from Ramp Only to full-time. My preference is that you turn off ramp so you can adjust your mask for leaks at therapy pressure, but if you don't tolerate therapy pressure while awake, then change ramp to auto. A 45 minute ramp just undermines your therapy. The fact your EPR switches off at the end of ramp is what is wrecking your therapy. Your minimum pressure of 7.0 is fine, and you never even approach your maximum pressure of 12. I think change the EPR to full-time at 2 will make a big difference, and turn off ramp if you can. Finally, try to maintain therapy all night. An hour and a half isn't going to cut it.
RE: Is my leak rate a problem? - Kevstuf - 01-24-2024
Thanks for the reply. I originally had my EPR at 2 or 3, but I was displaying CA events, so people suggested I turn it off completely. I thought setting it to 1 would be a good middle ground. However, I do remember being able to wear the mask longer with EPR of 2. I will try setting ramp to auto, but I had a similar struggle in the past where right as I was on the verge of falling asleep, my throat would relax and air would suddenly gush into my cheeks and jerk me awake. Are there any ways of dealing with that burst of air in my cheeks?
RE: Is my leak rate a problem? - Sleeprider - 01-24-2024
The first objective needs to be to use therapy longer. CA events are not usually that disruptive when they occur due to CO2 washout. we want to avoid that and I'll try to help you find settings that minimize it. My thoughts for now are to get you into a comfortable therapy, and if CA events are a problem with EPR 2, we may look at reducing minimum pressure, going to fixed pressure or reducing EPR...give me a chance to do my thing before you judge. I have no problems if you want to try setting minimum pressure 6, maximum pressure 6, EPR 2, which will produce fixed pressure and might get you past that 1-1/2 hour barrier.
You're using a full face so air in the cheeks is kind of part of the expectation when you don't do nasal breathing. I prefer to see new users begin with a nasal pillows mask which enforces a better air control discipline. Most people I coach can use nasal pillows, sip and swallow water through a straw and even talk with mask pressure. Sounds crazy if you don't have those skills, but once you learn them, air in your cheeks doesn't happen.
RE: Is my leak rate a problem? - Kevstuf - 01-24-2024
Got it, I'm totally ok with taking it one step at a time. I'll try your recommendations and report back. Appreciate the help.
RE: Is my leak rate a problem? - Kevstuf - 02-08-2024
Hey Sleeprider, just wanted to give an update as well as ask for some further advice. Like you suggested I changed my min pressure to 7, turned ramp to auto, and set EPR to 2. At first, I continued to struggle with keeping the mask on. I decided to dial the min pressure down to 6. In the past few nights I have found better success, being able to sleep for 5 - 6 hours. However, I am concerned about a couple things: 1) I see a lot of CA events, even seeing a CSR event for the first time. Some threads say CA is part of normal toss and turn, but a few CA events are ~20 seconds long. 2) I have been waking up extremely groggy, so fatigued that this morning it took me an hour to get out of bed because I just couldn't open my eyes. Again I have heard some people claim this is my body catching up on sleep, but I don't know if that's the case with my higher number of CA events. I've added 3 screenshots from recent nights. Any advice on my situation is greatly appreciated, thanks.