Couple noob questions about my data (updated w/ sleepyhead)

[FreeIndeed]

I've been on therapy for 4 nights now and it's just hard to tell if it's really working or if I need to solve some problems first. I use an Airfit F10 mask and I think I may need a different size. In order to keep it from leaking I have to really tighten all the straps down. According to the literature, I should be able to have the headgear secure but not tight and still avoid leakage. Anyway, I've been watching my data every morning and my leak is usually about 15-20m/l. Is that a lot of leakage? Not a lot? I have no baseline for comparison. Then there's the AHI which I understand to be the number of times per hour you have n apnea. My question is this: Is that how many you had, or how many the machine prevented you from having? When I did my sleep study they said I had about 55 an hour and my machine has reported a number close to that every night.

Thanks in advance for any help!

[Julie]

AHI is how many you had per hour overnight. And you're right about not overtightening the mask. Either yours is the wrong size for you or just the wrong mask, but you could also try Pad-a-Cheek.com liners that really help with leaking (they'll make sense when you've seen them).

[Pugsy]

my leak is usually about 15-20m/l. Is that a lot of leakage?

Where are you getting this number? From the machine's LCD screen? Then that's the 95% leak number which means for 95% of the night the leak was at OR BELOW that number. People often forget the "or below" part of the definition.
Large leak territory for the S9 machines is 24 L/min so if the bulk of your night you are below 24 L/min then leaks aren't likely to negatively impact therapy.

When I did my sleep study they said I had about 55 an hour and my machine has reported a number close to that every night.

55 per hour is a lot different than 55 over he entire night....again where are you getting this number? Off the LCD screen again? Then that's a per hour number and of course it is way too high. Something is not working well.
If it is from the software you are using then it might be over the entire night and it is still high unless you are sleeping 10 to 12 hours.

How about posting an image of the software detailed nightly report so we can see for sure what is going on.
If you don't know how we talk about it here in this thread and some examples.
Screen shot thread viewtopic.php?f=1&t=81072&p=737779#p737779
If you don't know about software check out my signature line. SleepyHead will work just fine with your machine and if you want ResScan send me a private message. ResScan is Windows only though.

[FreeIndeed]

Well, that's great about the leakage thing...

And then there's the AHI. The clinician set my machine up to disable viewing a couple of screens. I watched a video provided here (thanks!) that showed how to get to get around that and get a detailed nightly report on the lCD screen. It runs down the data and gives the leak and AHI info. There' also average AH and one other one that I can't remember off hand. I can take a pic tomorrow morning and post it if that helps.

[Nick Danger]

If you really want to know what your detailed data shows, then download the SleepyHead software. The links can be found in Pugsy's signature. The information on the Autoset's screen shows only summary info - but there is detailed information in there. SleepyHead lets you see the detailed info on your computer.

[FreeIndeed]

Here's my shot from last night. My mask is so tight it looks like there's no leakage problem, but it hurts my head so I have to look into something else.
The primary thing I'm wondering about is the AHI. If I'm still having 55-65 incidents per hour I'm not really getting any benefit from the treatment.

[Pugsy]

Holy crap.
Let's get the software reports. Something is not right. I was hoping you maybe missed a decimal point but you didn't.

[palerider]

what the pugsy said, listen to the pugsy, the pugsy is good, the pugsy knows.

[FreeIndeed]

Well, I downloaded Sleepyhead and imported my data. Here's a screenshot from the daily log for last night. Let me know what charts or graphs I should add here.

[FreeIndeed]

I noticed that the snore and leak are almost inverse charts - when there's a big leak the snore volume is low and when there's no leak the snore volume is high. That's true almost all night.

[Pugsy]

Your S9 AutoSet appears to be set in cpap mode at 13 cm with EPR of 3.
Did you ever have a sleep study where they hooked you up to the machine with a mask and attempted to find an optimal pressure? If so, what was it?

These current settings aren't working. The pressure is not sufficient to hold the airway open. You need more pressure. How much more? Beats me but I suspect quite a bit more.
Leak graph isn't ideal but it was ugly before leaks went over 24 L/min.

Are you comfortable altering the settings yourself or do you want the doctor/DME to do it?

[palerider]

I posted that chart to Jedimark as an example of something we were discussing for the new version, and one of his comments was:

jedimark: either that or the persons swallowed a cat.
jedimark: if you play the waveform back I bet you can hear a meeooooooowwwww….

talk about a scratchy throat!

gotta love software developers.

[palerider]

I noticed that the snore and leak are almost inverse charts - when there's a big leak the snore volume is low and when there's no leak the snore volume is high. That's true almost all night.

when the leaks are really high, the machine has much more trouble detecting what kind of event it is, (because it can't feel the small pressure pulses it uses to tell between open and closed airways, and I'd imagine it also can't detect the even smaller variations of snoring... so it would make sense that with a huge leak, it wouldn't be able to sense much of anything beyond breathing, and even not that if the leak is big enough.

[FreeIndeed]

Yep, I did a sleep study and they came up with the 13 setting for me. My local DME programmed the machine from the study recommendations and set it in CPAP mode to 13.

I am 99% sure I need to look at a different mask or at least a different size mask just because this one isn't comfortable. TO achieve low leakage I have to tighten the heck out of the straps, which isn't comfortable. So, I guess step one is to go back to the DME and see if I can't get a better mask for my face. I keep having dry mouth too, and the machine is set for the "climate control" feature which sets the humidifier level and temp together. I am going to have the DME unlock that so that I can set the humidifier level higher independently of the temperature. So far I haven't had any issues with rainout or temperature discomfort - just dryness.

The machine starts to ramp at 7cm and I can tell that's not enough air to comfortably breathe normally, so I'm going to get that jacked up to 9 maybe. I was afraid that the 13 wasn't enough pressure... And I say afraid because it feels like I have a leaf blower in my face already. I'm sure that's just because I'm new to CPAP. Honestly, if the machine ramps up from a lower level, I think I'm asleep before it gets to full pressure and then I don't consciously notice the high pressure. (Other than the dryness.)

[FreeIndeed]

jedimark: either that or the persons swallowed a cat.
jedimark: if you play the waveform back I bet you can hear a meeooooooowwwww….

I don;t quite get that one. Which graph were they referring to? My CPAP sense of humor hasn't been fully developed yet

when the leaks are really high, the machine has much more trouble detecting what kind of event it is, (because it can't feel the small pressure pulses it uses to tell between open and closed airways, and I'd imagine it also can't detect the even smaller variations of snoring... so it would make sense that with a huge leak, it wouldn't be able to sense much of anything beyond breathing, and even not that if the leak is big enough.

That makes total sense.