One year -- whazzup with these numbers?

[OSAHell]

The night my husband heard me stop breathing was Friday, the 26th. AHI of 12.38.

Here is a zoom shot of that night at 2:40 a.m.:

Yes, it is! Since the min pressure is higher than before, the APAP might be a bit louder and that may be the reason why your husband notice it. Now for the graph, not exactly what I was expecting for your breathing pattern but the cause might be similar. Let the speculation begin... You "might" be to sensitive to pressure changed and the pressure jump that we see in that zoom-in exacerbate/change your breathing pattern to the point of causing a bad hypopneas and apneas cycle. That reminded me of a question I ask before, have you ever been on fixed pressure of 13 (or lower) for at least a week or so in the past?

Your sleep doc competences might be questionable but the sleep tech that did your titration might actually have done a good job!

And as for palerider note on leak, I'm no expert of Respironics leak, but my understanding of Pugsy's comment on your leak was that you where ok for that brand.

If you've never been on fixe pressure before, personally I would try a fixed pressure of 10 for at least 4-5 days. Your AHI isn't that good anyway and the goal would be to try to go to the 13 of your titration. If you start to see higher AHI than usual. i.e if your higher AHI you've seen is near 20s and you're starting to see AHI in the 30s or more for 2-3 days in a row, back off to you current setting until someone can look at your graph. If your AHI start to drop, post the result and we’ll see what’ the best move.

[palerider]

And as for palender note on leak, I'm no expert of Respironics leak, but my understanding of Pugsy's comment on your leak was that you where ok for that brand.

here's the deal with leaks... and respironics machines. the machine shows total leak in the upper line, sleepyhead attempts to make a guess at excessive leak, (the bottom line) however, there are holes in the baselining part of the algorithm that I was discussing with jedimark and may be addressed in future versions, to wit, if you never get a good seal on the mask, then SH will end up with a falsely elevated baseline for calculating excess leak.

pugsy is completely correct that the machine isn't complaining much about large leaks, and it can keep pressure up against the leaks that are occurring, since most aren't in large leak territory.

HOWEVER, when there is excessive problems with breathing, OR excessive leaks, the machine won't go into auto mode, and it will sit there the whole night sometimes at base pressure, never raising the pressure to deal with hypos and apneas, which is what is happening right here.

the vent rate (intentional leak) for her mask at 9cm pressure is about 33lpm. she's having excess leaks approaching twice the vent rate. I believe this is the reason that the machine is not attempting to treat the hypos and obstructives.... something that you noted earlier.

[Pugsy]

In terms of large leaks and Respironics machines...I have never seen an auto machine not be able to respond in auto mode until total leaks were in the 110 L/min and above mark.
They start flagging the leaks long before the machine throws up its little hands and says "I quit".
I don't think that the leak is the cause of the machine not increasing the pressure for those events. It's not that big.
But it won't hurt to try to manage the leaks better to see if it helps or not.

The machine is the one flagging the large leaks if they happen...We can use Encore software and any large leaks flagged showing in SH will also be flagged with Encore.

[OSAHell]

...
something that you noted earlier.

Thanks for the explanations palerider. As for your comment that I noticed the machine not attempting to treat hypopneas and obstructives apneas earlier, your right I noted it but I wasn't thinking about leak since my understanding, at that point, was that leak where well under control. But if that's not the case, it might worth investigate and fixing of course.

However, my suggestion might still be a good idea for her or at least give it a try.

[palerider]

In terms of large leaks and Respironics machines...I have never seen an auto machine not be able to respond in auto mode until total leaks were in the 110 L/min and above mark.
They start flagging the leaks long before the machine throws up its little hands and says "I quit".
I don't think that the leak is the cause of the machine not increasing the pressure for those events. It's not that big.
But it won't hurt to try to manage the leaks better to see if it helps or not.

The machine is the one flagging the large leaks if they happen...We can use Encore software and any large leaks flagged showing in SH will also be flagged with Encore.

you may be right, it's just my best guess at the moment....

[RubySnooze]

Thank you all for the huge amount of information!

OSAHell, no I've never been on fixed pressure.

Regarding leaks: the months I was using a FFM I was absolutely tortured by small leaks. Mainly under my cheek bones. They would wake me up, keep me awake, I was always struggling to get an adequate seal. Adding a Padacheek mask liner helped some.

Since switching to the nasal pillow (AirFit P10) I don't notice leaks during the night. Sounds like I'm still having them but they're not waking me up. OTOH, the whole system seems to fall apart early every morning. I'll wake up at 6 or 7 and be unable to stop the leaks. After trying for awhile, I give up and figure I'm done sleeping. Although I'm really wishing for more!

Hubby says the machine is making weird noises. He's going to record it so I can hear it. Although I'm not sure what good that will do. He says it gets really loud, like it's moving a ton of air, then suddenly goes completely quiet. He won't hear the machine and he won't hear me breathing. Then it starts with the really loud thing again. When I start the machine at night, I hear my breathing through the nasal pillow, but I don't really hear the machine. Maybe faintly, but I've always thought it's a very quiet machine. Maybe this is how the machine is supposed to sound, but according to hubs, it never did this prior to nasal pillow.

Now that I'm typing this, I'm remembering an early morning a couple days ago when I was somewhat aware of the machine jacking the pressure way up, me turning the machine off and on, and the machine jacking the pressure way up. Did that for several cycles then gave up and got out of bed.

I've also thought that the water chamber is much hotter when I pull it out in the morning, since starting the nasal pillows.

Is there a mask setting I should be changing for the nasal pillows?

Feeling sadly cpap-remedial...

Ruby

[OSAHell]

...
Is there a mask setting I should be changing for the nasal pillows?
...Ruby

Actually there is! It's called "System One resistance" in Respironics machine but I don't know if they all have it. Look a that thread, start at the 3rd page (might save you some time), my post should be at the top:

viewtopic.php?f=1&t=106224&st=0&sk=t&sd=a&start=30

In this case it was more a comfort problem but it might help. Since your mask is not a Respironics you might need to do some digging or trying to find the right setting for your mask.

Good luck

[palerider]

Hubby says the machine is making weird noises. He's going to record it so I can hear it. Although I'm not sure what good that will do. He says it gets really loud, like it's moving a ton of air, then suddenly goes completely quiet. He won't hear the machine and he won't hear me breathing. Then it starts with the really loud thing again. When I start the machine at night, I hear my breathing through the nasal pillow, but I don't really hear the machine. Maybe faintly, but I've always thought it's a very quiet machine. Maybe this is how the machine is supposed to sound, but according to hubs, it never did this prior to nasal pillow.

that sounds like you're having a bad leak, when it happens again, ask him if he can try gently adjusting your mask on your face to see if the nose stops...

[RubySnooze]

Thank you, Palerider! I will work on those leak numbers. Don't see any downside to fewer leaks.

Will also pass along your suggestion to my husband. This will be interesting...

[RubySnooze]

Hi OSAHell,

I remember reading about System One Resistance a few weeks ago. Seemed like there was confusion because of the Respironics / Resmed thing. Some were saying with a non-Respironics mask leave the resistance at zero. Others were saying find the specs for a Respironics mask similar to your non-Respironics mask and use that number. Possibly 2X for medium AirFit P10?

My lil brain got overwhelmed and I just left my machine set where it was (zero).

So if I play around with the resistance setting, what am I looking for?

[OSAHell]

I also saw this (leave the resistance at zero) for non Respironics mask but I'm not sure it's an exact science! Didn't work for me anyway.

In the other thread I mentioned, for the OP and me the main problem was a comfort one when trying to fall asleep. In my case (using a P10) there was really just one setting that was comfortable (I think it was X2 but really don't remember). Since the problem was while awake, I simply tried each setting during the day for a few minutes each and set the machine to the more comfortable one.

In your case it might not be so simple since you doesn't seem to have problem while awake. In any case, you can write down your current setting and tried the others to see if your more comfortable but the difference is quite subtile. You might end up with different setting for each of your mask. I have only one mask so, not to much of a problem for me!

You might try palerider trick for a few night and see if you can lower your leaks if you don't feel trying it right now. Either way, leaks are always important to look at when having problem.

[RubySnooze]

Played around with the resistance setting and it does seem more user-friendly at 2X. Rather than zero. I've had it at 2X the last two nights.

Here are stats on the last three nights, including pressure settings:

June 27
9 / 14


June 28
10 / 10


June 29
10 / 10


That last one is interesting because I laid in bed for about 40 minutes unable to sleep. No leaks. But as soon as I'm asleep, the leaks go nuts. I use tape, and have played around with a headband chinstrap the last two nights. Using the chinstrap makes my jaw joints seriously sore, so gonna have to ease into strapping.

[OSAHell]

Hi RobySnooze,

I don't have much time but I'll try to make a quick answer... Your AHI is not good I know, but it's not unexpected if your optimal pressure is 13. I would stick to that for 2-3 days to get data and then 11.5 for 4-5 days and see (goal still 13! ). One thing for sure is that personally I would stick to fixe pressure while trying to find the best pressure since your AHI tend to vary a bit... I had higher swing and switching to fixe pressure and trying different setting for a week or more on each help in trying to figured out my problem. It might also be easier to manage leak on fixed pressure. I noticed in your previous graph is that when your AHI is lower your med pressure is around 8 but leak seem lower also so it's hard to tell. It could also be that when your AHI is low it's because you have less time in supine during sleep (if your AHI is higher while supine which is often the case with OSA). If your AHI stabilize with fixe pressure (even if high) I think it would be a good sign and probably easier to find the best pressure. It take time but sometime it's the easiest way...

In the mean time I would try to get a copy of your previous Full PGS report AND titration report and try to set a meet with an other sleep doc to get a second opinion. The first thing it would probably suggest is to try a fixed pressure of 13 for a few weeks if he see your titration report and think it's been correctly done. He'll probably also want you to do a other sleep study and titration. Even if you don't go to an other sleep doc, there's a lot of infos in those reports that might come handy to help figuring out your problem. (AHI on your side vs supine, etc.)

[BIGELI]

A 13 fixed rate is to high. You need to find a real sleep specialist. These newer machines that can supposedly adjust themselves may not work. On my old M series machine my settings started at 15/11 and after I lost weight I went down to 13/9. A constant 13 is to high. Plus make sure you have a conform able level on your humidifier.

[palerider]

A 13 fixed rate is to high. You need to find a real sleep specialist. These newer machines that can supposedly adjust themselves may not work. On my old M series machine my settings started at 15/11 and after I lost weight I went down to 13/9. A constant 13 is to high. Plus make sure you have a conform able level on your humidifier.

please don't post bad advice. it's clear you know nothing about the situation, and are just confusing the issue.