Newly back to CPAP, somewhat massive leak issues - help?

General Discussion on any topic relating to CPAP and/or Sleep Apnea.
JCraig
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Newly back to CPAP, somewhat massive leak issues - help?

Post by JCraig » Thu Oct 16, 2014 6:53 am

So, I'd been off CPAP for a few years (long story), but recently came back to it. Got a brand new machine and mask (profile info is correct, and I also have the hose that interfaces with this machine and enables auto-climate-control). I've been using it since Saturday night (Oct. 11). I knew I was a mouth-opener; I ended up having to tape when I was on CPAP before. But now I have full facial hair and so taping isn't an option. Ordered the adjustable Ruby-style and got it in yesterday and used it the first time last night.

It didn't go well. I woke up "several times" during the first 2 hours of sleep. I don't know how many; it's hard to keep a close tally on anything when you're in that hazy sleep/awake state. And I don't know why, either. After a little over 2 hours I decided to stop the machine and see what was up. (That's when I knew it was a little over 2 hours, the machine displays usage time when you shut it off.) It also displays AHI for the period, and I was shocked to see 9.5. What the...? Since going back on CPAP I've ranged from 1.89 - 3.4 or so; totally fine, really.

Figuring better treatment/sleep was more important than the chin strap experiment, I removed it and had better sleep the rest of the night. At the end (I sleep for ~8 hours religiously), the combined AHI was 4.1 - much better, given it was 9.5 for the first 2 hours. I haven't looked at the detail data in SH yet; I don't have time in the morning. But, does anyone have any ideas as to what could be going on?

Is it just a "getting used to the chin strap" thing? Was it too tight? Am I maybe one of the people that the vendor warns "the strap pushes the chin back, making apnea worse?" Any other ideas? I don't want to have to shave and tape.

(Adding for future readers, in case my equipment profile changes - at the time of this posting I was using a ResMed AirSense 10 Auto machine w/ build-in humidifier and the matching auto-climate-control hose. AirFit P10 pillow system mask.)

_________________
Machine: ResMed AirSense™ 10 AutoSet™ CPAP Machine with HumidAir™ Heated Humidifier
Mask: AirFit™ P10 Nasal Pillow CPAP Mask with Headgear
Additional Comments: 

Using built-in humidifier + auto-climate-control hose
8-13 CM
Unreated AHI: 111
Last edited by JCraig on Mon Oct 20, 2014 4:33 am, edited 2 times in total.

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Pugsy
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Re: Newly back to CPAP, and a new chin strap user - help?

Post by Pugsy » Thu Oct 16, 2014 7:18 am

If you had a restless fitful sleep that first 2 hours with the chin strap that elevated AHI could simply be awake/semi awake centrals getting flagged by mistake. Before worrying too much about the AHI...take a look at the software reports when you have time to make sure what is there is worth worrying about.

Finding the right chin strap is just about as difficult as finding the right mask and there's less to choose from.
Let's face it..for them to do their job sometimes it isn't exactly natural feeling or comfortable and when we aren't comfortable our general sleep suffers.

Just how bad are the mouth breathing leaks you want to fix? You know I mouth breathe sometimes too and I wear nothing but nasal pillow masks but I don't mouth breathe all that often or for prolonged periods of time and my actual time spent in large leak territory really isn't the end of the world...and since a chin strap or tape disturbed my sleep more than 10 minutes of big leak territory did...I opted to go with better sleep all night and not panic when I see a big leak that is short lived every now and then.
Now if you are spending half the night with leaks in the 30 L/min or above range...yeah gotta do something but if you are like me and maybe large leaks are short lived and not horribly far into large leak territory...maybe a compromise might work as long as you are sleeping well and leaks aren't waking you up (any leak that wakes us up is unwanted even a tiny leak but because it is disturbing our sleep)

So..how much mouth breathing leak are you seeing? And how bad?

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JCraig
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Location: Lafayette, IN

Re: Newly back to CPAP, and a new chin strap user - help?

Post by JCraig » Thu Oct 16, 2014 7:22 am

Pugsy wrote:So..how much mouth breathing leak are you seeing? And how bad?
I can't recall in minutes, but we're talking 1-3%, I believe. I'll confirm via SH when I get home, but I'm recalling 1-3% (I think 3% is the maximum that I've seen). And of course the machine is totally happy with leaks (green "mask ok" happy face at the end of the night), but I'm assuming the machine's ok and "really ok" are vastly different.

_________________
Machine: ResMed AirSense™ 10 AutoSet™ CPAP Machine with HumidAir™ Heated Humidifier
Mask: AirFit™ P10 Nasal Pillow CPAP Mask with Headgear
Additional Comments: 

Using built-in humidifier + auto-climate-control hose
8-13 CM
Unreated AHI: 111

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Pugsy
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Re: Newly back to CPAP, and a new chin strap user - help?

Post by Pugsy » Thu Oct 16, 2014 8:20 am

Yes...the machine's Mr Smiley face leak requirements are vastly different from mine and most people.
Mr Smiley doesn't become Mr Frowny until large leaks are present for 30% or more of the night...that's why when people tell me they are seeing Mr Frowny the next morning...I don't even have to see the reports to know leaks were really bad.

3 % of the night...6 hours let's say...that's 360 minutes...and 3% of that is roughly 11 minutes in large leak territory and I slept well...I am not going to go messing around with a chin strap or tape or going to a full face mask for 11 minutes out of 6 hours when doing any of those things causes me to sleep poorly...it's just not going to happen. Good sleep is my primary goal and not a perfect flat 0.0 excess leak line.
Plus..remember there are leaks and then there are BIG leaks...25 L/min gets counted as large leak territory and 25 L/min isn't horribly horrible if it is brief and we already know it's brief because the grand total was 11 minutes.
So not only how long you might be above 24 L/min but how far you go is also a factor. The machine doesn't become totally useless at 25 L/min terms of sensing events ...now when you get above 30 L/min it gets iffy...above 35 L/min and all bets are off but 3 minutes at 40 l/min isn't the end of the world.

Your call..but if the worst you ever see is 3 %...I wouldn't worry about it. If you are sleeping well and feeling decent and AHI is good.
And for anyone wondering what I would start worrying about...10% consistently maybe..depends on how far it goes into large leak territory. Has to be consistent though...random really ugly nights I laugh about and move on. We all have them from time to time...I do especially when trying a new mask because I don't get the fit just right.

Oh...any newbie Respironics PR System One users reading this and thinking ""OMG I am way over 24 L/min all the time"...don't get into a panic.. Your machine reports leaks differently than the S9 does and your large leak territory isn't at 24 L/min. It way higher than that and depends on which mask you use and what your pressure is.
So large leak territory varies with the PR S1 machine...up around 70 L/min for people using low pressures in the 4 to 8 range with nasal pillows...up around 90 L/min for people with pressures in the mid teens..higher for people using pressures in upper teens and the 20s with full face masks..
And any number in between 70 and 90 for those with moderate pressures.
Use SleepyHead's latest version ...if you went to large leak territory ...your machine will flag it and SleepHead shows LL for large leak. You can get an idea where large leak territory there.

Same thing though...if you don't spend much time in large leak territory...I wouldn't panic.

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Machine: AirCurve™ 10 VAuto BiLevel Machine with HumidAir™ Heated Humidifier
Additional Comments: Mask Bleep Eclipse https://bleepsleep.com/the-eclipse/
I may have to RISE but I refuse to SHINE.

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JCraig
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Re: Newly back to CPAP, and a new chin strap user - help?

Post by JCraig » Thu Oct 16, 2014 8:32 am

Thank you for your replies!

Yeah, I didn't think 1-3% seemed bad, but then again, we all try to optimize, so... (And I sleep 8 hours, so it's 14.4 minutes, but still... Ok.)

I'll get the more detailed info once I'm home though.

(And yeah, in the end, feeling good is what's important, and I DO feel better!)

_________________
Machine: ResMed AirSense™ 10 AutoSet™ CPAP Machine with HumidAir™ Heated Humidifier
Mask: AirFit™ P10 Nasal Pillow CPAP Mask with Headgear
Additional Comments: 

Using built-in humidifier + auto-climate-control hose
8-13 CM
Unreated AHI: 111

JCraig
Posts: 206
Joined: Thu Jul 27, 2006 4:49 am
Location: Lafayette, IN

Re: Newly back to CPAP, and a new chin strap user - help?

Post by JCraig » Thu Oct 16, 2014 12:46 pm

Well, bleah, was a little off on %'s. (These are "Time over leak redline"):

Sat - 1.088%, Sun - 3.249%, Mon (tried an ancient-design single-strap chin strap for part of night) - 5.574%, Tues - 6.932%, Wed - 2.887% (and all of it was after I removed the new chin strap).

_________________
Machine: ResMed AirSense™ 10 AutoSet™ CPAP Machine with HumidAir™ Heated Humidifier
Mask: AirFit™ P10 Nasal Pillow CPAP Mask with Headgear
Additional Comments: 

Using built-in humidifier + auto-climate-control hose
8-13 CM
Unreated AHI: 111

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Pugsy
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Re: Newly back to CPAP, and a new chin strap user - help?

Post by Pugsy » Thu Oct 16, 2014 1:43 pm

Okay...a little higher than you though but still not horrible and how far over the red line?

Was it 26 or 29 or was it 35 or 40?

Up to you how "perfect" you want things but remember...sometimes the cure is worse than the disease.

Do you want maybe 2 hours of restless sleep and a perfect leak line with it...or do you want 7 hours of maybe not quite so perfect but good quality sleep.

And...with time the mouth breathing may lessen. Some of it is likely habit from whatever length of time you had the sleep apnea untreated and you were gasping for any air you could get during the night. That's what my mouth breathing was.
Might not ever totally go away as some habits are hard to break but may lessen where you have nights with no large leak and the nights you do have some will decrease and the amount of time you spend there lessens.

Up to you though. You can always get a full face mask but those little puppies have their leak issues also. Pros and cons to everything.

_________________
Machine: AirCurve™ 10 VAuto BiLevel Machine with HumidAir™ Heated Humidifier
Additional Comments: Mask Bleep Eclipse https://bleepsleep.com/the-eclipse/
I may have to RISE but I refuse to SHINE.

If you want to try the Eclipse mask and want a special promo code to get a little off the price...send me a private message.

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Re: Newly back to CPAP, and a new chin strap user - help?

Post by JCraig » Thu Oct 16, 2014 2:01 pm

An FFM won't work for me due to the facial hair (which I'm trying to avoid having to shave, heh).

Not sure how far over the redline, as for some reason, SH doesn't display the actual line for me like I've seen in some screenshots.

_________________
Machine: ResMed AirSense™ 10 AutoSet™ CPAP Machine with HumidAir™ Heated Humidifier
Mask: AirFit™ P10 Nasal Pillow CPAP Mask with Headgear
Additional Comments: 

Using built-in humidifier + auto-climate-control hose
8-13 CM
Unreated AHI: 111

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Re: Newly back to CPAP, and a new chin strap user - help?

Post by palerider » Thu Oct 16, 2014 2:42 pm

JCraig wrote:An FFM won't work for me due to the facial hair (which I'm trying to avoid having to shave, heh).
.
something special about your face fuzz?

lots of people with beards/moustaches report decent results (including a friend of mine who frequently looks like the wildman from the mountains) with a ffm.

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JCraig
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Re: Newly back to CPAP, and a new chin strap user - help?

Post by JCraig » Thu Oct 16, 2014 3:22 pm

palerider wrote: lots of people with beards/moustaches report decent results (including a friend of mine who frequently looks like the wildman from the mountains) with a ffm.
Odd. I wasn't able to get a FFM to seal when I was clean-shaven back in '06 when I was first DX'ed. Way too much surface area that has to seal.

_________________
Machine: ResMed AirSense™ 10 AutoSet™ CPAP Machine with HumidAir™ Heated Humidifier
Mask: AirFit™ P10 Nasal Pillow CPAP Mask with Headgear
Additional Comments: 

Using built-in humidifier + auto-climate-control hose
8-13 CM
Unreated AHI: 111

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palerider
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Re: Newly back to CPAP, and a new chin strap user - help?

Post by palerider » Thu Oct 16, 2014 4:10 pm

JCraig wrote:
palerider wrote: lots of people with beards/moustaches report decent results (including a friend of mine who frequently looks like the wildman from the mountains) with a ffm.
Odd. I wasn't able to get a FFM to seal when I was clean-shaven back in '06 when I was first DX'ed. Way too much surface area that has to seal.
different masks fit different faces better or worse than others.

my furry faced friend is wearing the resmed quattro air, and his leak numbers are good most of the time, even with the high pressure swings of his ASV.

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Re: Newly back to CPAP, and a new chin strap user - help?

Post by chunkyfrog » Thu Oct 16, 2014 4:14 pm

You never heard of mask liners? ---Yes you can . . . grow your own.

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Re: Newly back to CPAP, and a new chin strap user - help?

Post by grayghost4 » Thu Oct 16, 2014 5:06 pm

I have a full face of hair and use a full face mask ... the airfit F10 and have good success with it . Also the Froma is a good one for me, and because it goes under the chin it helps to keep the mouth closed.
If you're not part of the solution you're just scumming up the bottom of the beaker!

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Pugsy
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Re: Newly back to CPAP, and a new chin strap user - help?

Post by Pugsy » Thu Oct 16, 2014 8:26 pm

How come you can't see the leak line in SleepyHead? Which version are you using? Was the SD card in the S9 all night?
Can you get me a screen shot of what you do get?
Would it help you if I showed you some examples of what I see in terms of leaks and when they aren't so good and when they are okay and when maybe really good so you could get a feel what I mean about how far and how long the leaks are before I start worrying?
I have a good one that shows 95% leak number as 24 L/min which scares the devil out of people but when you look at the actual graph it's easy to see that most of the night was below that number and remember the definition of a 95% number...at OR BELOW and people forget the "or below" part.

This one. It's not real pretty but out of 8 1/2 hours of sleep I spent 1.65% of the night above 24 L/min which was about 8 minutes. I am not going to do anything about this type of night. It's fairly common for me. I sleep well..slept right through it. I don't know what happened maybe a little mouth breathing where you see the plateau effect but the spikes were probably mask movement or strap movement letting the pillow move a bit. I am just not going to get in a panic over 8 minutes out of 8 1/2 hours and I don't care if the leak went to 100 L/min for those 8 minutes.

Image

I have worse on occasion but more often than worse is I have nights where I don't even reach 24 L/min.

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Additional Comments: Mask Bleep Eclipse https://bleepsleep.com/the-eclipse/
I may have to RISE but I refuse to SHINE.

If you want to try the Eclipse mask and want a special promo code to get a little off the price...send me a private message.

JCraig
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Re: Newly back to CPAP, and a new chin strap user - help?

Post by JCraig » Fri Oct 17, 2014 4:30 am

Pugsy wrote:How come you can't see the leak line in SleepyHead? Which version are you using?
Whatever testing version was the latest as of Saturday when I downloaded it. I'll have to check for exact sure when I get home.
Was the SD card in the S9 all night?
I don't have an S9, I have the newer AS10. And yes, I don't take it out except to download data, which I wouldn't do in the middle of the night hehe.
Can you get me a screen shot of what you do get?
Yeah I can, I'll grab a bunch when I get home.
Would it help you if I showed you some examples of what I see in terms of leaks and when they aren't so good and when they are okay and when maybe really good so you could get a feel what I mean about how far and how long the leaks are before I start worrying?
Probably would help, yeah!

Last night was odd, summary screen shows 5.4 AHI O_o. Will have to look at data when I can.

_________________
Machine: ResMed AirSense™ 10 AutoSet™ CPAP Machine with HumidAir™ Heated Humidifier
Mask: AirFit™ P10 Nasal Pillow CPAP Mask with Headgear
Additional Comments: 

Using built-in humidifier + auto-climate-control hose
8-13 CM
Unreated AHI: 111