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

[Pugsy]

I wonder if there's a bug with SleepyHead and the new AirSense data?...need to see what you are seeing.

Are you using a Mac? If so can't use ResScan but if you are using a Windows computer we can get you ResScan if SleepyHead isn't showing the leak graphs properly.

I will get you a couple more leak line graphs as example in a little bit.

[JCraig]

Are you using a Mac?

Not on your life. (Sorry to Mac fans...)

if SleepyHead isn't showing the leak graphs properly.

Oh the leak GRAPH shows fine, I just can't see any red line on it like I've seen in some screenshots. Maybe my resolution is just too high to see it.

[Pugsy]

Ahh..the missing red line..that does make a difference. Mine was there and then disappeared...part of having Beta software. No wonder you are having a hard time evaluating the leak.
Resizing the leak graph itself...makes it a lot easier...hover mouse on the bottom of the graph line till you see a little short double line...then click and drag to resize.

Missing red line is easily fixed.....open up your graphs...expand and resize a little so you can see things better like this one below.
Take your mouse cursor and put it on the y axis leak line (vertical line)...right click your mouse and from the menu that pops up go down to "dotted" lines choice...then see the "leak rate upper threshold" line....put a check mark in that line like I have mine...then you will get a red dotted line to help see. Now this may or may not stick..I had to do this twice and so far it has stuck...but if the red line disappears..you can go back and repeat this step and you should get it again.

[JCraig]

Cool - got the red line issue fixed. Anyway, here's 2 nights of leak rate graphs.

Last night:



Night before:



Last night seems pretty terrible (and it was pretty terrible for AHI/other data too).

In fact, here's the whole thing for last night:

[Pugsy]

Let's do another little tweak to that leak graph so seeing time over red line is even easier.
Go back to that y axis line and put your mouse cursor on it and double click the line...that changes the y axis from the fixed 120 L/min scale so that it auto adjusts to whatever the max leak happens to be. Makes evaluating how much over 24 L/min you go ..a little easier.

Have you thought about tightening up that apap range just a little? Might help with the wide pressure fluctuations and help with mask seal and overall help with sleep quality in case the pressure changes are impacting sleep.
Your minimum is 8 cm right now but you spend a good bit time close maximum...maybe try 10cm minimum and see what happens.
I think it will also help prevent those clusters of OAs from happening so often...looks like maybe REM stage sleep from the pattern of the clusters...you need more pressure at that time and the machine can't quite get there fast enough. It's likely either REM or sleeping on your back as those are the 2 most common culprits for clusters like that and the pressure can't get there quickly enough...set the minimum up to get a better head start so that the airway is held open better in the first place and then the machine is preventing and not trying fix so much. Wouldn't be surprised to see that maximum come down if the minimum was more optimal. Or at least have less frequent pressure swings.

Yes..last night was pretty ugly but the clusters didn't happen during the large leak periods so we can't blame the clusters on the leaks. Your night before last graph isn't as ugly as last nights...if that is what you normally see I don't know that I would worry about those 2 brief excursions over the red line unless they are waking you up.
Up to you but I wouldn't be worrying about them if it were me.

Last night...yeah it's ugly but unless I see ugly most of the time (and I do see ugly on occasion) I wouldn't be spending a whole lot of effort worrying about it and trying various chin straps or even consider full face mask for that small amount of time in large leak.

Besides...there's a good chance that with a more optimal minimum pressure maybe everything will settle down a bit.
Worth a try anyway....and if it is determined that the pressures auto adjusting are a problem with sleep quality...you can always really tighten up the range or go to cpap mode.

[JCraig]

Oddly, yeah, when I was on treatment before, I ended up disabling auto and just running straight 11CM for a long, long time. And then bumped it to 13 CM for some reason I can't recall.

I thought maybe auto would work, but maybe it just won't in the end. I'll try tightening the range though.

(And I'll change the graph display as suggested, sounds like that will make it a lot easier to read.)

[JCraig]

Ugh, last night leak rate:



16.3% :/

But, AHI much better, 3.1. Dunno, it can only be mouth opening. I'll try a few more nights but then may have to try the strap again. Or, ugh, shave-n-tape.

[Pugsy]

EWWW...that one is indeed ugly. Too much time too far past 30 L/min IMHO. If shorter time blocks and not past 30 L/min wouldn't be quite so bad. Did you sleep through all those? I know I have slept right through some pretty big leaks but they were really short lived and rare.

Are you maybe also sleeping on your back during those time? 99% of my mouth breathing is when I am on my back..I wake up with mouth open and almost always I am on my back. I don't normally like to sleep on my back because it causes back pain and it's the pain that wakes me up.

[JCraig]

Did you sleep through all those?

I have no way of knowing if I did or not. I don't recall waking up much last night, which is nice.

Are you maybe also sleeping on your back during those time? 99% of my mouth breathing is when I am on my back..I wake up with mouth open and almost always I am on my back. I don't normally like to sleep on my back because it causes back pain and it's the pain that wakes me up.

I don't know that either. I nearly always wake up in the exact same position I went to sleep in (on my side), but I realize I could have moved 1000000 times during the sleep.

I try to avoid the back as well, since it's basically a guarantee you'll have apnea events. (Even in undiagnosed people...)

[Pugsy]

My OSA isn't particularly worse supine but I kick ass in REM sleep no matter what sleeping position.
Like in REM my OSA is 5 times worse when compared to non REM.
Part of the reason I don't go to extraordinary measures to stay off my back...it doesn't really change things.

You know you might go back to the chin strap (and maybe try a different chin strap that isn't quite so annoying) to see if maybe with some time your mouth will learn to stay closed a little better.
When I first started therapy I opted to do the tape thing as the chin straps were more annoying to me than tape was and after a couple of months I started forgetting to tape until lights outs didn't want to get up....and that's when I discovered that the really bad prolonged mouth breathing wasn't happening nearly as often. I didn't totally break the mouth breathing habit but reduced it to the point that it was minimal.

Is your reluctance to tape because you don't want to shave or just the idea of taping?
If it's just the reluctance to shave you could maybe try taping without shaving and see how effective it is in keeping the mouth closed. The tape doesn't have to be cemented on and doesn't have to be a hair removal agent.

[JCraig]

Is your reluctance to tape because you don't want to shave or just the idea of taping?

Taping doesn't bother me in the least! I had to tape when I was on treatment before, and did it for about 2 years; it's no big deal at all!

But now I have full facial hair so taping just isn't an option.

If it's just the reluctance to shave you could maybe try taping without shaving and see how effective it is in keeping the mouth closed. The tape doesn't have to be cemented on and doesn't have to be a hair removal agent.

Tried it. Can't get the tape to do anything at all with the facial hair. It just doesn't adhere enough to do a darn thing.

[Pugsy]

Ahhh...Okay...too much facial hair I guess. It was thought..a not so great one..
My husband has a goatee...sometimes short haired and sometimes long. Right now it is longer and I can see where tape wouldn't stick so well. Wonder if I could get him to let me experiment with just taping lips only.
I doubt it...it's a good thing he doesn't have OSA...biggest weenie in the world about the whole process.
"I could NEVER wear a mask"... but sure as hell quick to tell me I need mine.

Did you ever try the poligrip/polident strips?
I did try it and wasn't horrible but they sort of tasted nasty. It was fairly effective though.
Maybe they could sort of glue the lips together enough and it doesn't have to touch the hair.

[JCraig]

Did you ever try the poligrip/polident strips?
I did try it and wasn't horrible but they sort of tasted nasty. It was fairly effective though.
Maybe they could sort of glue the lips together enough and it doesn't have to touch the hair.

Huh, never heard of anyone using anything like that for CPAP enhancement. Hmmm.

[Pugsy]

Never heard of the polygrip trick..Been around a long time
Take a look here and scroll down till you see a couple of links that have polygrip discussions.
viewtopic.php?t=8011

It's cheap and easy to try. It doesn't act like cement but it sticks well enough to deter some mouth opening... and might be enough to get your mouth to stay shut better.

[JCraig]

Hmm, guess I do remember some talk about that, but taping always worked for me. I did fool around with the tape a couple hours ago and did find a procedure that has it adhering somewhat well so I'll try that tonight.