Leaks are high...AHI acceptable

Im not understanding something.....Why are my AHI's fairly good with the leaks so high (this graph is fairly representative of the lash 6 days). Still not feeling all that rested.

While your leak line is ugly you don't spend a horrible amount of time above 24 L/min so the machine is able to compensate for the leaks for the bulk of the time. Above 30 L/min and the machine could perhaps be missing some events but you don't spend but maybe a couple of 30 minute time frames with leaks in that neighborhood so even if it missed a few events it's doubtful that the AHI would have been all that different just from 60 minutes of maybe missed events.

If you will click on the leak graph where the left side vertical and horizontal leaks meet at 0.0 the graph will auto adjust so that you can see the leak graph zoomed in and get a better idea how far above 24 L/min you go. When it auto adjust to the scale of the max leak instead of the 120 L/min mark it makes evaluating the leak line easier.

Looks like mouth breathing a little...those increases with the sort of flat plateaus.
Are you waking often during the night?
Leaks waking you up?
Dry mouth waking you up?
I see one break in therapy where you turned the machine off and then back on. Were there other wake ups? If so, any idea why and how many were there?

Pugsy wrote:While your leak line is ugly you don't spend a horrible amount of time above 24 L/min so the machine is able to compensate for the leaks for the bulk of the time. Above 30 L/min and the machine could perhaps be missing some events but you don't spend but maybe a couple of 30 minute time frames with leaks in that neighborhood so even if it missed a few events it's doubtful that the AHI would have been all that different just from 60 minutes of maybe missed events.

If you will click on the leak graph where the left side vertical and horizontal leaks meet at 0.0 the graph will auto adjust so that you can see the leak graph zoomed in and get a better idea how far above 24 L/min you go. When it auto adjust to the scale of the max leak instead of the 120 L/min mark it makes evaluating the leak line easier.

Looks like mouth breathing a little...those increases with the sort of flat plateaus.
Are you waking often during the night?
Leaks waking you up?
Dry mouth waking you up?
I see one break in therapy where you turned the machine off and then back on. Were there other wake ups? If so, any idea why and how many were there?

1. I could be mouth breathing a little (dry mouth sometimes not that often) That's why I have a FFM on it's way.
2. Im recording my sleep with a web cam set up to capture motion detection. On average their are around 55 recordings (detections) per night it appears to be leg motion mainly, but rarely going from side to my back, and arm motion around face rarely. I don't wake up at least I don't remember waking during those arousals.
3. No dry mouth wakes.
4. Other than how I answered in #2 above I did wake once for a potty break.

NEED HELP!

So long time cpap user.
Not feeling the low AHI numbers I take it. Main complaint daytime fatigue? Or drowsiness? Or both?
Do you take any meds of any kind? If so, what? This includes OTC meds.
Any other health issues going on?
Pain?
Bed comfort?

Pugsy wrote:So long time cpap user.
Not feeling the low AHI numbers I take it. Main complaint daytime fatigue? Or drowsiness? Or both?
Do you take any meds of any kind? If so, what? This includes OTC meds.
Any other health issues going on?
Pain?
Bed comfort?

1. You'd think after nearly 20 years on CPAP I 'd be a PRO.
2. Daytime fatigue.....drowsiness sometimes......when it's bed time I out within minutes.
3. Sotalol, Eliquis, Quinapril, Xanax as needed, OTC sinus med as needed.
4. AF
5. No pain
6. 2 Year old mattress very comfy

Average 7 hours of sleep like above?

Research your meds for potential side effects that might impact sleep quality and/or maybe cause your unwanted daytime symptoms.

At this point the only thing I see on the report that maybe (and that's just a maybe) be much of a factor is if the leak/mouth breathing (if that is what is going on here) is impacting sleep quality itself. I just don't see 60 minutes of maybe allowing a few events to happen and not get flagged being the primary culprit.
The 7 hours of sleep could be a factor. I know I need closer to 8 hours of sleep or my butt is dragging the next day and I almost always will want/need a nap.
But then I have other issues that affect my overall quality of sleep and maybe I could get by on less if I didn't have those other issues.

Of course excessive limb movements during the night can also wear us out.

When you get the full face mask dialed in it will be interesting to see if that changes anything in terms of how you feel.

And of course not everything that is wrong with us is caused by sleep apnea and can't be fixed with the cpap machine.

Oh, one other thing. Have you always used auto adjusting pressures? If so maybe the variations in the pressure during the night is impacting your sleep quality at some level (even if you don't wake up) and it might be worth trying cpap mode or a very, very tight apap mode just to see if that helps or not...if you have not tried cpap mode.
Some people can sleep through wild changes and some people find that just a little change in pressure can disturb sleep.

Pugsy wrote:Average 7 hours of sleep like above?

Research your meds for potential side effects that might impact sleep quality and/or maybe cause your unwanted daytime symptoms.

At this point the only thing I see on the report that maybe (and that's just a maybe) be much of a factor is if the leak/mouth breathing (if that is what is going on here) is impacting sleep quality itself. I just don't see 60 minutes of maybe allowing a few events to happen and not get flagged being the primary culprit.
The 7 hours of sleep could be a factor. I know I need closer to 8 hours of sleep or my butt is dragging the next day and I almost always will want/need a nap.
But then I have other issues that affect my overall quality of sleep and maybe I could get by on less if I didn't have those other issues.

Of course excessive limb movements during the night can also wear us out.

When you get the full face mask dialed in it will be interesting to see if that changes anything in terms of how you feel.

And of course not everything that is wrong with us is caused by sleep apnea and can't be fixed with the cpap machine.

Oh, one other thing. Have you always used auto adjusting pressures? If so maybe the variations in the pressure during the night is impacting your sleep quality at some level (even if you don't wake up) and it might be worth trying cpap mode or a very, very tight apap mode just to see if that helps or not...if you have not tried cpap mode.
Some people can sleep through wild changes and some people find that just a little change in pressure can disturb sleep.

1. Some of the meds do effect tiredness, however Im aware of the difference in med and sleep tired feeling.

2. No, I've only been on APAP since the 26th of last month. The last study I had (7 yrs ago) I was put on CPAP pressure 13.0 and prior to that back in 1995 I was put on CPAP pressure 11.0.
So this APAP is new to me.
The reason I got the new machine (S9 AutoSet) was to be able to see what was happening ...Since 13.0 on straight CPAP wasn't working all that great, and I was feeling tired most of the time.
That's why I've been so aggressive looking for answers to minimums and maximums for the new S9.

JUST A THOUGHT......I've set EPR setting at 2 for no particular reason........How do I really know what setting it should be at? Is it all about comfort?

I hope this all makes sense (I am on my own....my insurance pays for NOTHING)

EPR is all about comfort. Whatever feels good to you and let's you sleep the best.
For some people that use EPR and want to use it but their AHI is a bit high we sometimes have to adjust the inhale pressure a bit to compensate for the drop during EPR on exhale but I don't see the need for that in your report.

Oh...what does your flow limitation graph look like? Sometimes if it shows lot of activity that could maybe be a factor.

Pugsy wrote:EPR is all about comfort. Whatever feels good to you and let's you sleep the best.
For some people that use EPR and want to use it but their AHI is a bit high we sometimes have to adjust the inhale pressure a bit to compensate for the drop during EPR on exhale but I don't see the need for that in your report.

Oh...what does your flow limitation graph look like? Sometimes if it shows lot of activity that could maybe be a factor.

Hopefully you can see something.....I have NO idea how to read this graph.

You've got the FL graph so big it's going to make mountains out of mole hills.

Can you make it so that is more along the size and shape of the Events graph you posted?

I don't think it is going to look horrible though. The highest peaks barely reach 0.30

Check the report image in this thread and look at his Flow limitation graph. His are ugly but I have seen worse. I don't think yours are going to look nearly as ugly once we look at it in normal viewing size.
viewtopic.php?f=1&t=100655&view=unread#unread

Pugsy wrote:You've got the FL graph so big it's going to make mountains out of mole hills.

Can you make it so that is more along the size and shape of the Events graph you posted?

I don't think it is going to look horrible though. The highest peaks barely reach 0.30

Check the report image in this thread and look at his Flow limitation graph. His are ugly but I have seen worse. I don't think yours are going to look nearly as ugly once we look at it in normal viewing size.
viewtopic.php?f=1&t=100655&view=unread#unread

Have a look

That's not a bad looking FL graph. Others have FL graphs that look a lot uglier. We are never really given any sort of documented guideline as to what really is good or bad when it comes to FL graphs. We have just had to sort of learn as we go with this data point. We know that the more of them that go closer to 1.0 the worse it gets. Clinical correlation is sort of out there too.

Mine you have to really look to see any blip at all on the FL graph. This one is probably one of my worst. Pretty boring.