New to CPAP Treatment - a bit lost

[OkyDoky]

Yes you need this therapy and you might be able to make this machine work but your pressures are high enough that a bilevel might be more comfortable.
Right now what I would do is try a mask liner. You can cut your own from an old tee shirt or http://padacheek.com/. My husband decreased his leaks on the F10 with the liner. Your main task will be controling the leaks so your machine can do it's job.

Second you need to increase the minimum so it doesn't have that immediate jump. I would increase it to 10 but it may need to go higher. You still have a little room with your EPR setting that would make your machine more like a bilevel but if you are comfortable at the setting of 2, I wouldn't change it until the increased minimum of 10 is evaluated. You probably will end up closer to a 11 to 12 minimum and at that point, you might try increasing the EPR to 3.

[palerider]

zoomed in on the high event parts, and last picture the zero event parts

google drive links are NOT images, don't use the 'img' tag.

if something doesn't have .jpg or .png or similar at the end of the link, then it's NOT an img.

[Sleeprider]

PR, you don't see the posted image in your quote?

It's a close up of the events, flow rate, pressure, leaks and the left sidebar from sleepyhead. Pretty nasty sequence of OA with interspersed LL too.

[palerider]

PR, you don't see the posted image in your quote?

It's a close up of the events, flow rate, pressure, leaks and the left sidebar from sleepyhead. Pretty nasty sequence of OA with interspersed LL too.

I see:
image
image
image

[Weej]

Hi, so sorry I thought they do the same thing, showing the pictures.

here the repost from yesterday.






and here is the lastest one, just a short sleep with the machine.. i adjusted EPR to 3, and min pressure to 10.
from what i see, there was some good sleep for a good hour? before something triggered. Sleeprider mentioned that there might be a possibility of positional apnoea, so i used double pillow and sort of changed to another comfortable position, I think that helped to provide that 1 hour's no events period?

[Pugsy]

Are you awake or asleep during all those large leak spikes/times?

[Weej]

Hi Pugsy, I think I was awake at those times probably, given that I remembered being awaken by either the whistling sound of the cushion and the airblasts..

[Pugsy]

Those are some pretty massive leaks going on and if they are waking you up and those are awake events getting flagged then they don't count in the overall AHI evaluation.

Mask leaks are a war we never truly win...it's a battle that sometimes we come out on top and sometimes the leaks come out on top. Some masks are easier to beat than others.

If the bulk of your events occur during period of large leak where you may be awake...they don't count because they are awake events (and the machine can and will get confused by awake irregular breathing).
If you are asleep during the big leak times then it means the machine can't hold the airway open well enough to prevent the airway from collapsing.

Your biggest problem right now is the leaking. It's affecting your sleep quality by waking you up and it probably is allowing the airway to collapse somewhat.

If you like the mask in general and want to invest more time and money into it then you might look at a mask liner to see if it helps (you can make your own or buy them pre made and padacheek.com makes some really nice ones).
If you want to try another mask...then by all means try it.
Use whatever mask swapping time your DME will allow to try other masks in an effort to find one that doesn't cause so much large leak issues.

[oncomingspork]

Heyyy, look at that!
You started at an AHI of 88 in the study, and now at home you've already dropped down to 18.5!
That is no small achievement. Woo hoo!
Keep hammering away at it, you will get to the happy place before you know it.

[Weej]

Hi all,

thanks for the advice and encouragement.

I am on my own without any support from local DME. I have ordered a hybrid mask to try, hoping that it will improve my current situation.

in the meantime i will just try to get use to wearing a mask to sleep!

[Mudrock63]

I have that mask and have never had a large leak reported. I keep the headgear on pretty snug though. I wonder if it is a mask size issue, or if you just need to try a different mask? It does take a little getting used to, especially when you wear it as snugly as I do.

The bottom line is that progress is good. And you are making progress.

[Weej]

Hi Mudrock, thanks for your advice.

Last night i tried to move into my most comfortable sleeping position (side sleeping) and adjusted my mask accordingly. I think generally sleep was good, i got woke up a few times by leaks and high pressure, nonetheless, i managed to wear my mask on for more than 5 hours, longest ever since day 1. I will try padliner or something similar to improve on the leak problem. Here's the data for last night.



I hope I am making positive progress!

[Mudrock63]

I also slide the top strap towards the crown of my head to improve the seal around the nose. It does look like you are making progress. Unfortunately I am not experienced enough to make any suggestions about changing your settings.

[Pugsy]

Looks like the bulk of your elevated AHI is from the OA clusters that are a bit ugly.
Look at 3 AM and 5 AM time frame.
Leaks were not a factor during either of those ugly clusters and your pressure pretty much tried to do a good job by going up to the maximum of 20 while the OAs were happening.

So for those 2 time frames the pressure was maxed out and it wasn't able to prevent the OAs from happening.
The 2 most common causes of needing more pressure during times like this are either supine sleeping or REM stage sleep. Given where these clusters are happening...I am thinking most likely REM stage sleep related.
The wee hours of the morning is when we typically have more REM sleep.

About all you can do is increase that minimum pressure in hopes that the airway will stay held open better and not collapse like it is doing now during those time frames for whatever reason is causing the higher pressure needs.

If you can't get the airway held open well enough with more minimum pressure then you likely will need a bilevel machine (plain bilevel and not ASV type of bilevel) where the pressure can go to 25 cm if needed and I would push for auto bilevel if that should end up being where you go.

I would start with more minimum pressure though and probably at least 11 or 12 (maybe even a little more) if you want to keep EPR at 3. The OAs and hyponeas are telling us the airway is collapsing and more pressure is needed to hold it open. Sometimes we can get by without needing more than the max of 20 cm if the minimum pressure is able to do a better job holding the airway open in the first place. I have seen it where if someone uses a more optimal minimum pressure that the machine won't need to hit that 20 cm and what to go higher. I can't guarantee it but it's possible.

You are making positive progress though. Leaks are better managed and since we see these particularly ugly clusters during a time when the leak was within acceptable limits we have to trust the machine to be recording accurately at least during that time frame. During the times of really big leak...we don't know if the lack of much getting recorded was because nothing happened or the machine was clueless.
At any rate we see enough here where the leaks were within acceptable limits to know that more minimum pressure is still needed.

Alternately you could try reducing EPR which will increase the overall average pressure a bit but that might be uncomfortable for you and since you have some room to try increasing the minimum instead of reducing EPR then that is what I would try first if it were me and I found I rather liked EPR at those pressures.
Up to you though as to what you do with EPR and it depends on how you feel with or without it.

[Weej]

Thanks Pugsy for your explanations and suggestions! Now I begin to understand more about what is happening.

I will try to increase the min pressure for tonight and see if there are any improvements.

For reduction in EPR, I tried 2 for a night and that night was not so comfortable, so if after tonight there are no improvements, I will try reducing EPR to 2.