Frustrated

In general, is a 10% leak or less acceptable for calling it a decent sleep? The leak in the graph below 10% but the "events" are low (less than a minute in apnea.) This is only part of the night (because I'd gone back to sleep after being up for a couple of hours). I do not FEEL like I slept well. Maybe there are other factors involved but I'd like to rule out the sleep issue (leaks) being part of it. The first link below should work, the second link should show the same graph.


https://ibb.co/bJgK55

https://image.ibb.co/dqHsQ5/6_18_17_questionable.jpg

<a href="https://ibb.co/bJgK55"><img src="https://preview.ibb.co/dUsgJQ/6_18_17_questionable.jpg" alt="6_18_17_questionable" border="0"></a>

DeeCPAP wrote:In general, is a 10% leak or less acceptable for calling it a decent sleep?

First to clarify what you mean for others:

On the night in question, your leak rate was officially flagged as a Large Leak by your S9 machine for approximately 10% of the time the machine was used for that night.

The Large Leaks were confined to a 75 minute period of usage. One of the large leaks lasts approximately 30 minutes, the other lasts about 25 minutes, and they are separated by 20 minutes no excess leaking.

In general, if you had said you were doing a lot of tossing and turning during that time and you were aware you were leaking and you were fighting leaks the whole time, I'd say the fact that you're feeling bad was due to the tossing and turning at the end of the night and that you might have felt better if you'd just got up rather than fighting the leaks for a significant fraction of the last 90 minutes of your time in bed.

However, you write:

The leak in the graph below 10% but the "events" are low (less than a minute in apnea.) This is only part of the night (because I'd gone back to sleep after being up for a couple of hours). I do not FEEL like I slept well. Maybe there are other factors involved but I'd like to rule out the sleep issue (leaks) being part of it. The first link below should work, the second link should show the same graph.

So the questions become:

1) How did you feel when you got up before you went back to bed?

2) Do you remember fighting any leaks during this time? Do you remember any restlessness at all? Or based on your memory, would you say you were sound asleep when these large leaks occurred?

3) The sleep time for this bad period is from 11:30AM to 2:00PM. So it's more like a "early nap" rather than "last part of a night of sleep". That raises the question: Do you usually feel better, worse, or about the same after a two-hour nap?

In other words, it is possible that the leaks were disturbing your sleep. Given that the unintentional leaks pretty much stay below 35 L/min, I'm not sure that the leaks are so hideously out of control as to make it impossible for your machine to track your breathing. However, without scrolling through the flow rate data zoomed in to the point where it's possible to see the individual breaths, it's impossible to say whether your machine clearly missed scoring some events.

I'll add: If this were my data, I'd not lose any sleep over it---unless I saw bad large leaks on most of the naps I took while using CPAP OR unless every large leak I saw lasted 20-30 minutes or more.

robysue wrote:

DeeCPAP wrote:In general, is a 10% leak or less acceptable for calling it a decent sleep?

First to clarify what you mean for others:

On the night in question, your leak rate was officially flagged as a Large Leak by your S9 machine for approximately 10% of the time the machine was used for that night.

The Large Leaks were confined to a 75 minute period of usage. One of the large leaks lasts approximately 30 minutes, the other lasts about 25 minutes, and they are separated by 20 minutes no excess leaking.

In general, if you had said you were doing a lot of tossing and turning during that time and you were aware you were leaking and you were fighting leaks the whole time you're feeling bad was due to the tossing and turning at the end of the night and that you might have felt better if you'd just got up rather than fighting the leaks for a significant fraction of the last 90 minutes of your time in bed.

However, you write:

The leak in the graph below 10% but the "events" are low (less than a minute in apnea.) This is only part of the night (because I'd gone back to sleep after being up for a couple of hours). I do not FEEL like I slept well. Maybe there are other factors involved but I'd like to rule out the sleep issue (leaks) being part of it. The first link below should work, the second link should show the same graph.

So the questions become:

1) How did you feel when you got up before you went back to bed?

2) Do you remember fighting any leaks during this time? Do you remember any restlessness at all? Or based on your memory, would you say you were sound asleep when these large leaks occurred?

3) The sleep time for this bad period is from 11:30AM to 2:00PM. So it's more like a "early nap" rather than "last part of a night of sleep". That raises the question: Do you usually feel better, worse, or about the same after a two-hour nap?

In other words, it is possible that the leaks were disturbing your sleep. Given that the unintentional leaks pretty much stay below 35 L/min, I'm not sure that the leaks are so hideously out of control as to make it impossible for your machine to track your breathing. However, without scrolling through the flow rate data zoomed in to the point where it's possible to see the individual breaths, it's impossible to say whether your machine clearly missed scoring some events.

I'll add: If this were my data, I'd not lose any sleep over it---unless I saw bad large leaks on most of the naps I took while using CPAP OR unless every large leak I saw lasted 20-30 minutes or more.

Thanks, RobySue. After the "nap", I woke up in pain (arthritis or fibromyalgia or both -- docs can't tell me). Before the nap I was in pain, but not as agitated. After waking up, the pain *and* agitation was quite a bit worse. If people sleep well, I'm told the pain is less -- theoretically. I'm trying to nail down the variables so whatever the problem can be fixed. As the song goes, "To Dream the Impossible Dream"...

Naps (and sleeping) can be variable so I can wake up feeling refreshed. The naps are "dangerous" because I wake up feeling horrible. e. The weather's been horrible, gray, hot, humid. Sometimes when I open the window slightly, the humidity enters and causes pain. There are just too many variables to determine what's causing what. This kind of thing has been going on for years and I'm extremely tired of dealing with it.

The leaks have been a problem for a long time. Worse using a FF mask - last time I tried one I had 40 obstructive apneas lasting a total of 23 minutes. Does that mean I didn't *breathe* while the apneas were taking place?

The DME's are horrible where I live according to the secretary who does the ordering for my doc. I called a local medical stor today to see about getting a new Dreamware and they have ONE. I asked what the size was and he said there's no size on the package. It's adjustable. He added, "small medium and large". I assume he meant the cushions inside but he had no idea of what I was talking about.

I'm going to cut this message short because I'm in pain. Sleep is supposed to help. Sometimes I feel doomed because I don't know what's an acceptable for leaks. Or how much over red line counts as too much. If it were a new problem, I wouldn't feel so bad, but it's not. I only wore two small pieces of tape on my mouth last night, so the air coming out of my mouth may be the problem -- tonight I'm going to tape my mouth shut. (the other details are so long I'm sure it'd be confusing). Thanks for your help.

DeeCAP,

I think you've identified the real source of why you didn't sleep well last night and during the nap: PAIN.

You write:

DeeCPAP wrote: Thanks, RobySue. After the "nap", I woke up in pain (arthritis or fibromyalgia or both -- docs can't tell me). Before the nap I was in pain, but not as agitated. After waking up, the pain *and* agitation was quite a bit worse. If people sleep well, I'm told the pain is less -- theoretically. I'm trying to nail down the variables so whatever the problem can be fixed. As the song goes, "To Dream the Impossible Dream"...

Naps (and sleeping) can be variable so I can wake up feeling refreshed. The naps are "dangerous" because I wake up feeling horrible. e. The weather's been horrible, gray, hot, humid. Sometimes when I open the window slightly, the humidity enters and causes pain. There are just too many variables to determine what's causing what. This kind of thing has been going on for years and I'm extremely tired of dealing with it.

My guess is that your pain (arthritis or fibroyalgia) adversely affects your sleep and bad sleep adversely affects your pain. It's a tough trap between a rock and a hard place. And it sounds like the weather has been adding significantly to your woes.

It may be the best thing you can do right now is to focus on what minimizes the pain during the daytime and hope nothing makes the pain worse when you are sleeping.

The leaks have been a problem for a long time. Worse using a FF mask - last time I tried one I had 40 obstructive apneas lasting a total of 23 minutes. Does that mean I didn't *breathe* while the apneas were taking place?

Well the definition of an apnea is there is no air moving in or out of your lungs for at least 10 seconds. With an obstructive apnea, you're trying to breathe but no air can get through the collapsed airway.

23 minutes in apnea with 40 apneas means that on average the apneas lasted about 34.5 seconds. That's not unheard of, but it is on the long side.

The DME's are horrible where I live according to the secretary who does the ordering for my doc. I called a local medical stor today to see about getting a new Dreamware and they have ONE. I asked what the size was and he said there's no size on the package. It's adjustable. He added, "small medium and large". I assume he meant the cushions inside but he had no idea of what I was talking about.

Yet another example of a genuinely clueless DME person.

I'm going to cut this message short because I'm in pain. Sleep is supposed to help. Sometimes I feel doomed because I don't know what's an acceptable for leaks. Or how much over red line counts as too much. If it were a new problem, I wouldn't feel so bad, but it's not. I only wore two small pieces of tape on my mouth last night, so the air coming out of my mouth may be the problem -- tonight I'm going to tape my mouth shut. (the other details are so long I'm sure it'd be confusing). Thanks for your help.

Some comments about Large Leaks:

1) Resmed engineers are happy enough if the percentage of time over the Red Line is less than 30% of the night---that's the criteria for having Mr. Red Frowny Face show up instead of Mr. Green Smiley Face. So you could use the Resmed engineers definition of when to start worrying about leaks. In other words, not every Large Leak has to be fixed.

2) I repeat: Not every Large Leak has to be fixed. My own view is that if most of the Large Leaks are relatively short (5-10 minutes) AND there's no evidence that they're disturbing your sleep AND the total time in Large Leak territory is reasonably acceptable (say no more than 15-20% of the night most nights), then it's worth considering whether the extra work (and potential discomfort) needed to "fix" the Large Leaks may not be worth it. In other words, if "fixing" the Large Leaks requires measures that make it more difficult to sleep, then fixing the Large Leaks may not be worth it if they're not horrible.

3) Your Large Leaks may be long enough where they are disturbing your sleep, even though the total time in Large Leaks is not long enough for a visit from Mr. Red Frowny Face. And anything that disturbs your sleep is probably going to add to the pain issues you living with. If you are comfortable with taping your mouth, that may help the Large Leak problem. But if taping adds to your discomfort, then it's probably not worth doing.

4) There's a lot of anecdotal evidence that Resmed machines can track the breathing (and hence respond) to apnea events even in the presence of large leaks as long as those leaks are not horribly, horribly large. Judging from the charts I've seen posted here, I'd say that most of the time the flow rate data seems reasonably accurate as long as the leaks are less than about 40 L/min. The flow rate data can definitely look really ratty once the leak rate is above 50 L/min 5-10 minutes or more.

As for where to go from here, I'd suggest keeping a pain/sleep journal for two to three weeks to try to tease out whether your pain aggravates the subjective quality of your sleep (in terms of how unrested you feel when you get up---not in terms of AHI) or whether bad sleep (in terms of how unrested you feel when you get up) aggravates the daytime pain. I'd suggest keeping it simple.

On the sleep side of things, you ought to keep track of the following things:

• Standard objective sleep data: Bedtime, wake-up time, guessitmate of how much actual sleep you got during the night.
• A small set of data coming from the CPAP: Percentage time in Large Leak and length of the longest large leak. Maybe AHI, but my guess is that apnea events are not what is causing your current problems---the CPAP is controlling the apnea quite nicely.
• A simple rating of how rested/refreshed you feel when you get up in the morning. Keep it simple: 0 means totally unrefreshed/unrested--as in still exhausted. 5 (or 10) means completely refreshed. (Try to evaluate this separately from how much pain you are in when you wake up.)
• Use the same scale to measure how refreshed you feel after each nap you take during the day.

On the pain side of things, keep track of the following:

• A simple rating of the pain you are experiencing when you go to bed each night. Keep it simple: 0 means no pain and 5 (or 10 if you prefer) means really, really severe pain.
• Use the same pain rating to keep track of how much pain you are in when you wake up for the day.
• Use the same pain rating for the maximum pain level during the day. And maybe a very rough estimate of how long the pain was at the maximum level. (All day, several hours, an hour or so, less than an hour, or something similar.)
• Some notes about what seems to make the pain worse during the day. (Bad weather. Lots of stress. Overdoing on things. etc.) Maybe add a note or two about when the pain was at its worst if the pain was highly variable during the day.

Also track whether the pain is better or worse after each nap.

After a couple of weeks some patterns in your handwritten notes may emerge to help you figure out whether the biggest problem is bad sleep makes the pain worse or whether pain is what makes the sleep bad. That may help identify where to start trying to cut the Gordian knot of your current bad sleep/lots of pain problems.

No leak at all doesn't necessarily mean the sleep quality is good and guarantee that you are going to feel those good numbers. It just means that the therapy itself wasn't impacted. We can still feel like crap from poor sleep from any number of reasons.

Sleepy quality itself can be affected by so many things and not just "numbers".
How we feel each day can be affected by so many things and not just "numbers".
My biggest factors are number of wake ups and hours of sleep. If I have less than 7 hours of sleep my butt is going to be dragging. If I have a large number of wake ups my butt will be dragging no matter how good the leak control might be and no matter how many hours of sleep I get. All the factors are intertwined...mess up a bit with one of them and you don't feel so great no matter how good the other part is.

In looking at the report above...your 95% leak number was about 31 L/min...so for 95 % of the time you were at or below that number.
To me that's an acceptable number because these ResMed machines can compensate fairly well for that amount of leak and they can still respond appropriately and still record fairly accurately. Meaning we can trust the AHI to be fairly accurate and not inaccurate due to a large number of apnea events being totally missing.
The 5% above 31 L/min I really don't bother with because the time between 24 L/min and 31 L/min plus whatever time was spent above 31 only totals 10% of the night and the bulk of that 10% wasn't above 31 L/min.

My thoughts about leak management.
First and foremost the leaks can't be waking me up no matter how big or small they are because anything that wakes me up is unwanted.
Now assuming the leaks don't wake me up my own personal line in the sand before I even look at the leak data more closely is 10 % of the time in large leak. If I decide to look for some reason I look to see how high it went and how much time I was deep into large leak territory Like with your report above I would look and see that the 95% was just 31 L/min and the data is still accurate and I would shrug my shoulders and not give it any more thought.

ResMed's leak management Mr Smiley or Mr Frowny....Mr Frowny won't show up until you spend 30% or more of the night above 24 L/min.
It take a lot of large leak to earn Mr Frown...I haven't seen him often but again if I did I would look to see how far into large leak territory I went and again if it was less than 35 L/min for the most part I wouldn't do anything except keep one eye on things to see if I did it again, and again, and again. One bad night can be simply a bad night and I never worry or do anything about random bad nights of anything.

So if my report looked like your report last night I would shrug my shoulders and not give it a second thought ....assuming the leaks didn't wake me up.
Now if I didn't feel so great and the leaks didn't wake me up then I might look at other potential causes for not sleeping so great or feeling so great.
Example...been doing a lot of yard work lately and my back has been just killing me and my pain meds barely touch it so I have been having more wake ups than usual from the back/pelvis pain. Hurts to lay in one position too long...hurts to turn over...hurts to do anything.
So despite my getting about 8 hours of sleep and the AHI being less than 1.0 and the leaks not even being worth looking at...I still feel a bit crappy during the day...get tired sooner...might have an urge to nap...have to struggle to get the energy to do much..that sort of thing.

Sometimes the answer to why we feel like crap isn't anywhere in the software report "numbers"...sometimes it's factors totally unrelated to sleep apnea.
Remember cpap/apap machines can only fix bad sleep that is caused by sleep apnea. It can't fix bad sleep caused by factors outside sleep apnea no matter how much we wish it could or would.
Same for sleep quality itself...bad sleep or insomnia...if it's caused by sleep apnea alone then cpap stands a good chance of improving on things but if it's caused by anything else (and we know the list of potential culprits is miles long) the best cpap therapy on paper in the world isn't going to guarantee fixing bad sleep quality.

Ooops, I see Robysue posted while I was composing this but I will post anyway. A lot of what I said mirrors here thoughts.

Pugsy wrote:No leak at all doesn't necessarily mean the sleep quality is good and guarantee that you are going to feel those good numbers. It just means that the therapy itself wasn't impacted. We can still feel like crap from poor sleep from any number of reasons.
<snip>

My biggest factors are number of wake ups and hours of sleep. If I have less than 7 hours of sleep my butt is going to be dragging. If I have a large number of wake ups my butt will be dragging no matter how good the leak control might be and no matter how many hours of sleep I get. All the factors are intertwined...mess up a bit with one of them and you don't feel so great no matter how good the other part is.

In looking at the report above...your 95% leak number was about 31 L/min...so for 95 % of the time you were at or below that number.
To me that's an acceptable number because these ResMed machines can compensate fairly well for that amount of leak and they can still respond appropriately and still record fairly accurately. Meaning we can trust the AHI to be fairly accurate and not inaccurate due to a large number of apnea events being totally missing.
The 5% above 31 L/min I really don't bother with because the time between 24 L/min and 31 L/min plus whatever time was spent above 31 only totals 10% of the night and the bulk of that 10% wasn't above 31 L/min.

My thoughts about leak management.
First and foremost the leaks can't be waking me up no matter how big or small they are because anything that wakes me up is unwanted.
Now assuming the leaks don't wake me up my own personal line in the sand before I even look at the leak data more closely is 10 % of the time in large leak. If I decide to look for some reason I look to see how high it went and how much time I was deep into large leak territory Like with your report above I would look and see that the 95% was just 31 L/min and the data is still accurate and I would shrug my shoulders and not give it any more thought.

ResMed's leak management Mr Smiley or Mr Frowny....Mr Frowny won't show up until you spend 30% or more of the night above 24 L/min.
It take a lot of large leak to earn Mr Frown...I haven't seen him often but again if I did I would look to see how far into large leak territory I went and again if it was less than 35 L/min for the most part I wouldn't do anything except keep one eye on things to see if I did it again, and again, and again. One bad night can be simply a bad night and I never worry or do anything about random bad nights of anything.

So if my report looked like your report last night I would shrug my shoulders and not give it a second thought ....assuming the leaks didn't wake me up.
Now if I didn't feel so great and the leaks didn't wake me up then I might look at other potential causes for not sleeping so great or feeling so great.
Example...been doing a lot of yard work lately and my back has been just killing me and my pain meds barely touch it so I have been having more wake ups than usual from the back/pelvis pain. Hurts to lay in one position too long...hurts to turn over...hurts to do anything.
So despite my getting about 8 hours of sleep and the AHI being less than 1.0 and the leaks not even being worth looking at...I still feel a bit crappy during the day...get tired sooner...might have an urge to nap...have to struggle to get the energy to do much..that sort of thing.

Sometimes the answer to why we feel like crap isn't anywhere in the software report "numbers"...sometimes it's factors totally unrelated to sleep apnea.
Remember cpap/apap machines can only fix bad sleep that is caused by sleep apnea. It can't fix bad sleep caused by factors outside sleep apnea no matter how much we wish it could or would.
Same for sleep quality itself...bad sleep or insomnia...if it's caused by sleep apnea alone then cpap stands a good chance of improving on things but if it's caused by anything else (and we know the list of potential culprits is miles long) the best cpap therapy on paper in the world isn't going to guarantee fixing bad sleep quality.

Ooops, I see Robysue posted while I was composing this but I will post anyway. A lot of what I said mirrors here thoughts.

Thanks, Pugsy. I just remembered the sleep doc saying I had alpha intrusions, but that may be a part of the problem -- pain in sleep. Problem is it's erratic. I was okay today when I woke up at 10-ish, but I'd only slept 6 hours so though I'd try to get another hour in. Took some Sleep Time tea and it put me to sleep (probably because I needed it) then woke up and the little pain I had got MUCH worse. There's where the confusion comes in --- is it a weather front, a difficult conversation I had with a relative, whatever it iwas- seems I can't do much about it so *maybe* it's worth getting some pain killers rather than just use Tylenol. Now I realize believing good sleep will knock out a lots of health issues may be a bit delusional, but most of all, at least I know now my afternoon nap today wasn't the culprit. I'm going to copy your reply and Robysue's so I'll have it when my mind is a bit clearer. Again, thanks, Pugsy!