AHI & Leaks

[SuperGeeky]

qjosea, you have the same Machine as me. Personally, I would switch to Auto until the Doctor and Techs get it straightened out. Matter of fact, that's what the Doctor did for me. We weren't communicating well because of my fatigue, he just had the DME send me a Card programmed for Auto.

As leaks go, it's the wide boxes/arches that are troublesome. When you have vertical lines, sometimes thick, it's OK.

PS If you don't know how to switch to Auto, PM me.

Hope you feel better,

SG

[jules]

isolated spikes no problem - agree

but these spikes are numerous and most coincide with events

need to get a better leak graph and then see what the pressure needs to be - leaks might be just movement of the nasal pillows on the mask or might be opening mouth and closing it every breathe --- not wide open mouth for extended period of time

I don't disagree with gumby's wild ass guess that the pressure needs to be raised but first lets get control on the leaks

[SuperGeeky]

Jules, something I only realized recently. If you have a Apnea, where does the CPAP air go? I'm mean really?? If a leak doesn't form to let out the air, your head will explode

I always feel a good Apnea pops the tape around my mouth. It's the ole blowfish effect. So, which came first, the chicken or the egg. Leak causing the Apnea or Apnea causing the leak? Someone please correct my understanding of air dynamics!!

Again, I would set it to Auto...

later,

SG

[jules]

the machines use PRESSURE not FLOW


it is my understanding that every x seconds (I don't know and I think it varies) the firmware for the machine decides what is going on - ie leak and apnea are two of the options. in cases such as Jose''s above, with the resolution we have in the encore software graphs, we are seeing an alternation between the these two events (although I am sure there are other possibilities and Muffy could give us insight as I have seen them take apart the actual database information). When these events alternate like this (and I have seen other cases) imo what is best is to eliminate one of the options. In this case eliminating the leaks via a FFM would be the first thing I would try. Once the leaks are eliminated, then we can look for an optimal pressure for Jose. I would not suggest Auto or pressure change until the leaks are under control.

Now some can argue his leak average is fine. I will respond with my 14.x flow rate I got on my LT at a range of 8.5 - 10 when I first got the mask. I don't have faith in the accuracy of the LT flow chart. I want to see an actual leak graph (although I realize there can be missing information in the graphs Encore provides).

[SuperGeeky]

Jules, interestingly my Doctor would not script a FF Mask. And, I've always been fascinated why.

I think it's a matter of the greater surface area in contact with skin, greater potential for leaks. That's why I don't understand why a FF Mask will solve a leak problem? Though, I've never used one.

One could argue either way on setting to auto. I don't know the programming behind it at all, but on Auto if it's losing the battle on an Apnea it's going to jack up the pressure automatically. Question is, does it overcome the leakage and win?

Well, on Auto he has one hell of a better chance than his current static settings.

For me, solving leakage problems can involve much time and experimentation. At 33 AHI, how much time do you have and at what physical and mental damage??

Really, the only correct answer to all of this, listen and work with the Doctor. And, if that Doctor doesn't get it done, time to find a new one!!

P.S. I'm using the Respironics ComfortFusion with this BiPap Machine. Hardly any leakage and I know I've got it right when it's snug and very comfortable. Embarrassingly, took quite a while to get there....

[jules]

SG, you seen his sleep study to know he doesn't have pressure induced centrals? He doesn't seem to have been able to get them and post them

Jose needs to get this leak/apnea cycle that firmware is finding under control ASAP so he can find out where he really is in treatment - rather than play around with a lot of nasal masks or mask with tape or polident strips, my suggestion is for a FFM - he of course has to find one that works for him - once that cycle is figured out perhaps he can go back and use a nasal mask or nasal pillows but until then my suggestion is for a FFM

as with any post on the forum he can take it or trash it as he sees fit

[birdshell]

I do not fully understand the ins and outs of bipaps or the fine details of the Respironics graphs but I do know this...

If your car tire is leaking considerably, can you expect to keep it inflated? How can you take the pressure accurately of the tire if it is losing air?

That is a rough approximation in comparison to a sleep-disordered breathing, but seriously--how can you keep your airway open if your pressure is being lost to leaks?

FWIW: This is a great ResMed video: Sleep Disordered Breathing that may help to visualize what happens when we are sleeping.

IMHO, jules is quite right--none better at reading graphs. You cannot really trust any other information until you get the leaks sealed. My guess is that you first need a really good mask fitting, if you can find anyone to do so. Remember that all of the major mask companies give you 30 days to return a mask as a newbie. Take advantage of that, if you can. It made all the difference for me.

Most of us would agree that the ONE MOST IMPORTANT FACTOR in therapy is a mask that works. It is the biggest factor in success during the first year, I believe. And, the second biggest cause of leaks is...a poorly fitted mask.

The biggest cause of leaks is an open mouth. Sometimes that is caused by improper pressures; but others really need the full faced mask. May I just encourage you to keep at it until you find a mask that you can use; you really need that therapy.

Best wishes,

Karen,
Who has a bit of experience with flat tires

[Sleeprider]

FWIW the little data here does not suggest a leak that would by itself lead to this severity of apnea. 27 as an average and no large leaks, no sustained losses above 50. He does better than I do, but my AHI is 0.5 to 3.0. This poor guy needs professional evaluation, and pending that, the suggestion for auto bipap sounds pretty good. What he is getting now is not therapeutic.

[ozij]

My turn for wild ass guessing:

Data:

J[*]ose starts out with a top of the line automatic machine on lvery ow pressures. Very surprising.
[*]Jose does not mention any other machine was tried. [*]Jose's AHI at the titration was 57 -- that's severe. [*]He tried teh machine on those settings for 18 months (!) to no avail. [*]Stopped, and felt much worse, so he started again.
[*]He can't get hold of either his Rx or his PSG.

Fact: Apria must have a copy of the Rx at the very least - because otherwise, how did they set up the machine, and how did they charge the insurance company???

WAG no. 1: Somebody is actively hiding the Rx..

Question: Would any insurance company pay for an AUTO BIPAP at those pressure, just like that? Jose, can you try to get documentation from the insurance companye (if you have one). Can you tell Apria you demand to see the documantation they used to set up your machine (threaten them with a complaint to authorities, if necesssary)?

WAG:no. 2: What if the PSG or Rx actually said IPAP= 19, EPAP= 15 and somebody flubbed along the way?

Barring other medical problems, I think giving the machine its head in auto mode and keeping the minimums where they are now will show -- very quickly --if higher pressure lowers the AHI, or raises it. Things are terrible as they are - I wonder how much worse they can be with a night or two on auto.

That leak/event relationship could be and idication of restlessness (arousals) caused by bad breathing ---> tossing and turning ---> interpeted as hypopneas.

O.

[Muffy]

...it is my understanding that every x seconds (I don't know and I think it varies) the firmware for the machine decides what is going on - ie leak and apnea are two of the options. in cases such as Jose''s above, with the resolution we have in the encore software graphs, we are seeing an alternation between the these two events (although I am sure there are other possibilities and Muffy could give us insight as I have seen them take apart the actual database information)...

Right! Like in Paul's download:



If you ask me, looking at the leak line in the DDs is a little like fixing a fine Swiss watch with a chainsaw.

It looks at a window that is reported out at 30 second intervals.

The value reported is rounded off to be a multiple of 7 (the "25/32 Rule").

And tossing out another tidbit, even if we were to examine the leak value in real time, looking at continually-reported data points (technically, 16 times/second, which, for our purposes, is pretty much "continuous") we would realize that the leak calculation itself needs a little time to equilibrate following major swings in total system flow. The algorithm needs time to figure out what's breathing and what's leak, so even in the absence of leak that is beyond Designed Leak, there will still be a little Leak Bounce (another term from the Mufftionary. She likes to make stuff up) until breathing stabilizes. This can be seen in the following example, where a patient (Muffy) suddenly puts on a mask, is assured that there is no leaks, but it takes several breaths before the reported leak rate stabilizes:

Jules, something I only realized recently. If you have a Apnea, where does the CPAP air go?

It simply vents out the leak port. In real time and intact interface, an apnea would have a stable leak line:



Muffy

[ozij]

Machine: Dell Dimension 8100
Mask: 3M N-95 (during flu season)
Humidifier: Tea kettle on the woodburning stoveSoftware: XP Pro
Additional Comments: Fine, the "D" will just cut the field in half

Slinky found a humidifier was very important when she used a woodburning stove. You may want to search her posts for further info...

I don't know about using Dells in that enviromnent -- the smoke may clog the power supply.

Do you use 3M Micropore with that mask?

I do need help in understanding you additional comment...

Cheers.


O.

[SuperGeeky]

It simply vents out the leak port. In real time and intact interface, an apnea would have a stable leak line:

Muffy, just outstanding analysis!! Jules, tremendous insight! I'm so glad such bright folks as yourselves take time to contribute, I benefit tremendously...

Air dumps out into leak port as it should, so no blowfish Muffy, please correct me if I'm wrong... Throat flattens, air has less space too travel, pressure rises, Leak Port diameter remains static, leaks around mask would increase. Though, I would think it would slight....

If my SA was severe and struggling with leak management, changing types of Masks isn't going to solve the problem. 'Different Dog with same fleas'.

Next question, would the Leak Graph above distort the 'Auto Setting'? My opinion, no!! We all know excessive leaking makes the Encore Report distorted. I don't think that's the case with what I'm seeing? Jules & Muffy, what say you??


qjosea, I hope at this point, you've gotten the help you need!! Please post if you haven't,

Thanks everybody...

SG

[Muffy]

Additional Comments: Fine, the "D" will just cut the field in half

I do need help in understanding you additional comment...

That refers to the valiant effort of the D(efense) of my beloved Oklahoma Sooners trying to overcome the decimation of the offense by graduation and injuries.

Muffy

[ozij]

Gotcha.
Thanks.
O.

[jules]

Right! Like in Paul's download:

Muffy

Yes, like Pauls. Paul was using a nasal pillow mask and wouldn't use a FFM. He has this alternation pattern. I have seen it in a couple others.