Acceptable leaks?

[tattooyu]

First, I would like to say greetings to everyone again after a long respite.

This post is to help my mom. She uses a Remstar Auto M-series A-flex. Her 95% pressure is 8.9. She uses a Swift FX for Her.

My question us regarding her leak rate. Her 7-day average is 31 L/min. Respironics include mask vent rate in that number, correct? If so, that's pretty spot on with the Resmed manual for her mask.

Her 7-day AHI is 3.9, and her 30-day average is similar. If her leaks ARE within acceptable limits, it sounds like her min pressure needs to be increased a bit.

Thoughts?

[Wulfman...]

First, I would like to say greetings to everyone again after a long respite.

This post is to help my mom. She uses a Remstar Auto M-series A-flex. Her 95% pressure is 8.9. She uses a Swift FX for Her.

My question us regarding her leak rate. Her 7-day average is 31 L/min. Respironics include mask vent rate in that number, correct? If so, that's pretty spot on with the Resmed manual for her mask.

Her 7-day AHI is 3.9, and her 30-day average is similar. If her leaks ARE within acceptable limits, it sounds like her min pressure needs to be increased a bit.

Thoughts?

Yes, Respironics machines report total leakage.

Sounds that way. Either the pressure is too low to respond or prevent or she has apneas without preceding events (snores or flow limitations).
Do you know what the makeup of her AHI is? Does she have flow limitations (to trigger pressure increases)?


Den

.

[JDS74]

With the leak rate approximating the manufacturer's design leak rate, your Mom's unintentional leak rate is nearly zero.
That said, increasing the pressure just a little will likely not impact the unintentional leak very much and might improve the overall AHI some. A long-term average AHI of less that 5 is considered well treated. A lower number may mean better therapy.

The main question at this point is whether she is getting good rest at night and feeling rested in the morning.

[tattooyu]

Yes, Respironics machines report total leakage.

Sounds that way. Either the pressure is too low to respond or prevent or she has apneas without preceding events (snores or flow limitations).
Do you know what the makeup of her AHI is? Does she have flow limitations (to trigger pressure increases)?


Den

.

I don't really know the makeup of her AHI. With that older model, I can't use Sleepy Head, and she's due for a new machine in February. We don't really want to spend the money on the special card reader.

If I'm not mistaken, the threshold of an AHI of 5.0 is fairly arbitrary. I know if my AHI was 3.9, I'd feel like utter crapola. Then again, I have severe apnea, and my mom has mild to moderate apnea.

I'm considering bumping up her minimum pressure by 0.1-0.3 cm for a week and check the 7-day average again.

JDS: she feels better than she had but still falls asleep on the couch and is more forgetful than normal. She's also diabetic, but her numbers are under control. She sleep about 6.75 hours on average.

[Julie]

If she sleeps on her back, get her somehow to sleep on her side (or even front) as back sleeping causes more apneas.

[tattooyu]

I'm pretty sure that she's sleeps exclusively on her sides.

[JDS74]

Mild memory loss does come with both diabetes as well as sleep apnea in addition to low B-12 levels.
Has your mother been tested for B-12 deficiency. It is a common problem with older people. If that is the case, it is treatable.

The sleepiness might be an indication of mild depression, something also associated with diabetes and with sleep apnea.

Your idea of increasing the pressure by 0.1 - 0.3 cm is cautious and safe although the 0.3 value might be a better starting value.

Bless you for taking this effort to help your Mom.

[tattooyu]

Actually, she has had her B12 tested, and it was fine. I don't doubt that she has some depression, but that's a whole other story.

I'm going to walk her through raising her pressure tonight!

[Tango]

Try raising her min. Pressure a couple tenths. Maybe two each night.
For me, it was the minimum pressure that needed to be raised and the max pressure to be dropped.
Good luck

[Pugsy]

That machine will only allow pressure changes in increments of 0.5 cm...can't do a smaller increase.
The machine's LCD screen is reporting 90% pressure numbers (that's what Respironics reports and not the 95% like ResMed does). And 90% means that for 90% of the night she was at OR BELOW that number.
I didn't catch what the minimum pressure setting was currently.
As the others have said...that leak number is well within acceptable limits and pretty much points to minimal or zero leak most of the night...That leak number is an overall average leak number (not a 90% number in this case).
Large leak territory for that machine and that mask at her pressures...probably at least 90 L/Min...so she is well below that area.

You know it may just be that the need for a nap is simply from not getting enough hours of sleep...If I get less than 7 to 1/2 hours of sleep I find I still want or need to nap in the afternoon.
Ask her about here quality of sleep...does she wake often during the night? Also ask her about her meds and then research them to see if any med may be a factor in that need for nap...like fatigue or drowsiness side effects.

That said....she might also be having some clustering of events....I had this myself because of REM stage sleep events. Nothing going on to speak of in non REM sleep but things got a bit ugly in REM stage sleep so I had an overall AHI of around 3 to 5 but the clusters were ugly....the time in non REM sleep where I didn't have much of anything brought my AHI average down.
It's possible this is going on with your mom...and it's not all that impossible either...in fact would be fairly common.
A little more minimum pressure should be enough to break up the clusters if there were any and wouldn't hurt anything to try. Maybe 0.5 cm to 1 cm is all that is needed. What is the current pressure minimum?

While it would be kinda nice to see the actual software reports it isn't that critical that we see them.
I do know where you maybe could borrow a DT3500 card reader if the person hasn't gotten rid of it yet.
Private message me if you want details.

[tattooyu]

Pugsy! Thanks for replying.

My mom reports that she sleeps fairly soundly through the night, but she admits to not sleeping enough.

It turned out that her minimum pressure was set to 6.0. I don't think the machine had enough time to respond to her apnea events.

We set the minimum to 8.0 to start. I had her test it for a few minutes BEFORE I went to bed, and she said it felt fine.

We are going to try that for a week or two and check the 7-day averages, but I'm also going to keep tabs on how she's feeling.

Edit: she's on a lot of meds for diabetes, thyroid, cholesterol, etc. Her thyroid, sugar levels, and cholesterol are good. She was battling a mysterious iron deficiency, but that seems to have been resolved.

[JDS74]

With an iron deficiency of unknown etiology, has she been checked for low ferritin levels. Low ferritin can be the cause of PLMD issues which can cause significant numbers of arousals (without actual awakes) and fractured sleep.
Even though the low iron issue has apparently been resolved, ferritin is different and is treated differently.

[tattooyu]

I believe both were tested and are normal now.