FFM and pressure

[Corky1121]

I was having issue with the first FFM I got last week because my AHI went up to 6.51 and it was a medium size. The nasal with chin strap keeps me at 1 and under, but it is very uncomfortable. I got a small face mask and used it last night and again my AHI up to 4.31. I also awoke at 2 am with hiccups which has never happened ever in my lifetime. I woke up with headache and tired at 6 am. My highest pressure went from 10 to 13.70 and that was right before 6 am when I awoke.

My concern is that my machine does auto up the pressure and will go from 8 to 14, last night only up to 13 for a few moments, but why is my AHI higher with the face mask and not the nasal and chin strap?

Through the night it stayed mostly at 8 to 10.

Also do i copy graphs to import here in case they need to be reviewed?

[LSAT]

I was having issue with the first FFM I got last week because my AHI went up to 6.51 and it was a medium size. The nasal with chin strap keeps me at 1 and under, but it is very uncomfortable. I got a small face mask and used it last night and again my AHI up to 4.31. I also awoke at 2 am with hiccups which has never happened ever in my lifetime. I woke up with headache and tired at 6 am. My highest pressure went from 10 to 13.70 and that was right before 6 am when I awoke.

My concern is that my machine does auto up the pressure and will go from 8 to 14, last night only up to 13 for a few moments, but why is my AHI higher with the face mask and not the nasal and chin strap?

Through the night it stayed mostly at 8 to 10.

Also do i copy graphs to import here in case they need to be reviewed?

Possibly leaks

[Corky1121]

I don't know about leaks because my total leaks on higher level AHI is sometimes much lower, than say one night total leaks 132 and AHI 1.21.My total leaks last night at AHI 4.31 was 49. Not sure about the leaks. Seems to not make sense. WHy is leaks higher with many nights at lowest AHI? Maybe the sofware is not accurate??

[Pugsy]

The software only reports what the machine writes to the SD card.

If your total leak was 132 L/min then that is way over and deep into large leak territory for probably quite some time. The AHI was lower because at over 100 L/min the machine starts having problems sensing and recording events and responding in general.
Lower AHI in the face of really high excess leaks doesn't mean much because we don't know if nothing happened or events happened but the machine simply couldn't sense them.

You might simply need a little more baseline (minimum) pressure when using a FFM...it wouldn't be all that unusual but we need to see what is happening to know for sure. It all depends on what type of events we see and when we see them and what the pressure is doing.

[Corky1121]

hmm then the machine can't always be accurate then can it? What do I need to focus on per leaks and AHI to be sure the machine is accurate? Because how do I know the FFM vs. nasal and chin strap numbers are valid?

I would prefer the FFM, but it seems AHI has been higher.

Should I continue the FFM for a few nights longer even though the AHI goes higher?

Can I adjust pressure on my machine, because Ive read some posts here on FFM and needing to increase pressure.

Another interesting issue I found was that when I have taken benedryl while I was away for three nights my AHI was the lowest and also using nasal/Chin, but when I return home and don't use benedryl, my AHI goes a bit higher, but still under 5 also on nasal/Chin. WHy would that be? I don't intend to use benedryl every night, but I'm curious about the numbers.

[ChicagoGranny]

focus on per leaks

For sure, you need to reduce the leaks before anything else will start to make sense.

To reduce unintentional mask leak -

- Make sure the mask is fitted properly. (See mask manufacturer's video.)
- Make sure the headgear is adjusted properly (See mask manufacturer's video.)
- Make sure to use good hose management - the hose should not pull on the mask.
- If you still have problems, learn from the forum what mask liners are available.
- If your mask still has excessive leak, try other masks. Many people report trying several masks before they find one that works well for them.

[ChicagoGranny]

when I return home and don't use benedryl, my AHI goes a bit higher, but still under 5 also on nasal/Chin.

Why are you taking Benadryl on trips? Why not at home?

Do you have nasal congestion?

With high leaks, it is misleading to compare AHI. Work on the leaks.

[Pugsy]

the machine can't always be accurate then can it? What do I need to focus on per leaks and AHI to be sure the machine is accurate?

It will only potentially be inaccurate during the times of prolonged excess leak. 5 minutes in large leak territory isn't going to impact the overall numbers that much...now 2 hours in large leak territory will bring into question the data (or lack of events) during that time only. This is why we say to look at the graphs and evaluate and not just the "numbers" when the machine is reporting some large leak time. Need to figure out just how much and how long and how does it maybe impact the numbers.

When it comes to AHI numbers...you have to evaluate the event categories themselves. Clear airway/central events we ignore unless present in high numbers. CPAP/APAP machines can't fix centrals with more pressure so we ignore them unless they are presenting a problem.

Because how do I know the FFM vs. nasal and chin strap numbers are valid?

If the majority of the time the leak stayed out of large leak territory....those numbers are valid.

Should I continue the FFM for a few nights longer even though the AHI goes higher?

Again...it depends on how high and what the higher AHI is made up of and what you want to do.
If you prefer to use a FFM then evaluate the therapy (once the leaks are under control) in terms of what is making the AHI higher and then decide what to do (if anything) to remedy things.

Can I adjust pressure on my machine, because Ive read some posts here on FFM and needing to increase pressure.

Sure...adjusting the pressure is easy to do but I don't recommend that people do it until they understand what they see on the reports and know that what they are trying to fix is fixable with a little more pressure.

I have no idea why Benadryl impacts your numbers because I don't know which part of the AHI has increased.
It has zero impact on my AHI and I have to take a pretty good dose of it on occasion due to itches that annoy me.

You seem to be fixated on the "numbers" but to get concrete answers you have to understand what makes up the "numbers" and understand if the "numbers" are really a problem and is it something that you can even fix.

AHI going from 1.0 to 4.0 ....depends on what that AHI is made up of...depends on was the 1.0 AHI even accurate in the first place if there is a history of large leak that is prolonged.....Depends on how you feel you slept and how you feel in general....depends on a lot of things as to whether that "high" AHI is even worth worrying about.

Numbers all by themselves don't really mean much. AHI of 0.0 doesn't guarantee the "miracle" that so many expect. AHI of 4.5 doesn't mean the therapy is in the toilet either...it could be higher because of clusters of events that are related to maybe sleep position or sleep stage....or it could just be Sleep/Wake/Junk messing with the averages.

AHI is just an hourly average. If you sleep for 5 hours and have a total of 10 (of some type of event) the AHI will be 2.....now it could be that all those 10 events happened in the first 30 minutes of the 5 hours of sleep because they were SWJ getting flagged by mistake (the machine has no way to know if you are asleep or not) and the AHI would still be 2.0 just like it would be if you had 1 event every 30 minutes for those 5 hours.

[Corky1121]

LOL Boy this can get complicated. I'm not sure how to read these graphs. I was having some problems with the software and graphs since I downloaded it, but now as of this moment I seem to be able to see the graphs without data disappearing and such.

As for the leaks, I do see on the day I had a 132 leakage, the graph shows steady up and down, but then at 2:30 it goes up to 132, then it goes back to up and down type line. I assume I may have woke up and took the mask off without turning off the machine and went to the bathroom? That might explain such a large jump in a short time.

Last night when I woke up with hiccups (weird) I took the mask off and I turned off the machine and went to the bathroom. The graph shoes the line going down to stop, then back up I when I returned to therapy.

Interesting the night of my highest AHI, first night on the medium size F&P mask, the leak charge is one steady line across at about 27.

I'm learning slowly about all this, so thank you all.

Another question, why are there two lines for Leaks graph?

[Pugsy]

The top line on the leak graph is the total leak line...remember that total leak is the mask's expected vent/intentional leak rate plus any excess leak so it will always be up somewhere on the graph and it will vary if the pressure varies.

The bottom leak line is a close approximation to excess leak only. It's hard to evaluate because we don't know how much is too much excess leak and again it varies as pressure varies which makes it difficult to compute...so that's why it is a close approximation. I don't even bother with it myself.

[Corky1121]

Thank you. I just now found the sleephead software link on the main menu of this site. I will read through all that info too. Much appreciated. I will also get a mask liner and try that.

[Pugsy]

Having a maximum leak number of 132 L/min could mean nothing other than a brief mask refitting while the machine is on...so if you are freaking out over the maximum leak number...don't.
Look more at the 90/95% leak number which means you were at OR below that number for 90/95% of the time...or look at the median number.
If your 90/95% leak number is below 80 L/min then I doubt that leaks are seriously impacting the data and unless they are waking you up or disturbing your sleep I wouldn't worry about them.

[ChicagoGranny]

90/95% leak number which means you were at OR below that number for 90/95% of the time

As I learned this week:

90/95% leak number which means you were at OR below that number for at least 90/95% of the time

[Pugsy]

As I learned this week:

90/95% leak number which means you were at OR below that number for at least 90/95% of the time

I take my definition from the provider manual and in the Respironics manuals there is no "at least" wording stated though I suppose one can infer those words if they want to. Just more words to confuse people who don't grasp that it doesn't mean that's where a person was at for 90/95 % of the time.
I haven't looked at ResMed definition lately to see how it is worded.

What we don't know is how low the "number" went and how much time was spent there.
We do know that for 5/10 % of the time we were above that number but we don't know how far above we might have been.

So there's a lot we don't know when it comes to 90/95% numbers and what we don't know may or may not be all that important....and that's why I don't use 90/95% numbers as some sort of miracle number for anything other than long term trending. It's too easily skewed.
In general though if the 90/95% numbers are within an acceptable expected range...as in below large leak territory numbers then we can infer that for at least the bulk of the night leaks weren't an issue.
I don't worry about 5% of the night being in large leak territory (if it goes there) as long as I sleep well and feel decent.

[ChicagoGranny]

As you, Pugsy, have said many times before, when the types of issues involved in this thread are present, it's best to look at the timeline trace of the pressure. The percentile number, regardless of what definition you accept, can be misleading.

My therapy is stable, so I rarely download the card and only look at the summary statistics on the machine display upon arising. If I see a big jump in events, pressure or AHI, I might download the card to look at the night's events. Fortunately this rarely happens to me.

On the other hand, Corky's therapy is not yet optimized and the Sleepyhead reports could help him in this process.

BTW, here is a simple example of "at least 95%" pressure.

12 12 12 12 12 12 12 12 12 12 12 12

The at least 95% pressure is 12, the at least 90% pressure is 12, and the 100% pressure is 12.

And Den would be proud.