How to get my leak rate down?

General Discussion on any topic relating to CPAP and/or Sleep Apnea.
jwuzy
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Joined: Thu Sep 25, 2014 10:09 am

How to get my leak rate down?

Post by jwuzy » Mon Sep 29, 2014 4:21 pm

Hi everyone,

Right now it seems like I'm leaking quite a bit - screenshot from last night's Sleepyhead: http://imgur.com/Ojpv8pf

It's pretty consistent on a night in and night out basis. Right now, I'm rocking the Respironics SystemOne (with no humidier) and using a Resmed Swift FX Nasal Pillow. I think the leaks are waking me up. There's no holes in the mask but I do tend to open my mouth when I sleep. I bought a chinstrap but it's just uncomfortable.

Any other tips to keep the leak rates down?

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Pugsy
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Re: How to get my leak rate down?

Post by Pugsy » Mon Sep 29, 2014 4:37 pm

Your leak line graph....is just fine where it's at. There's no need to worry about doing anything in terms of losing therapy effectiveness.
That red line at 24 L/min....that's for a ResMed S9 machine. You need to put your red line up around 80 to 90 L/min. That's where your large leak territory begins. Did you know you can change where the red line is supposed to go.
I wish Mark would take that default install out of SleepyHead...it's confusing to newbies with Respironics or other equipment.
ResMed is the only machine that only reports excess leak only and uses the 24 L/min mark...all the others are much higher because of how the leak is reported.

That top line on the leak graph is total leak which includes the intentional vent/leak rate plus any excess leak.
Your leaks are minimal...that one little blip at the 00:00 mark...no where near large leak territory.

If your mouth is dropping open...it isn't causing a massive exodus of the air out your mouth...if you are mouth breathing it's minimal. It would show up on the leak graphs if you were doing that...believe me...I do it and have seen it.

If you had any large leaks they would also be flagged up in the Events graph....LL is what it's called. You didn't have any at all.

Now little leaks can wake us up so if little leaks are waking you up then they need to be fixed but because they are waking us up and not because therapy itself is in the toilet.

I would kill to have a leak line as pretty as yours. I wouldn't be messing with a chin strap either...I don't now and my leak lines rarely look as pretty as yours.

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jwuzy
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Re: How to get my leak rate down?

Post by jwuzy » Mon Sep 29, 2014 4:52 pm

Thanks for the quick reply! If it's not the leaks, then would could it be? You'll see I woke up around 4 times last night and that's been pretty much on point.

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Pugsy
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Re: How to get my leak rate down?

Post by Pugsy » Mon Sep 29, 2014 5:10 pm

Well....when you wake up...is the mask leaking? or is it maybe something else causing the wake ups?
Comfort? Nasal pillows pinching...anything that might be a problem?
Tiny leaks can disturb a person's sleep but still not be bad enough to do anything about them in terms of chin straps or stuff like that.

I sometimes wake up with a tiny leak and sometimes sleep through some massive mouth opening for sure leaks.

Not all wake ups are from cpap stuff though. Wish it were that simple.
Do you have any pain issues?
Take any meds that might mess with sleep?

Your AHI is great...you have a handful of Flow Limitations and RERAs even less. It wouldn't be impossible for those to be a disturbing factor in terms of sleep but I doubt they are playing a huge part. You might try just a little 0.5 cm increase in that minimum pressure to see if it helps. Your pressure is very low right now and a tiny change in the minimum shouldn't be a problem and might help.

If you for sure are waking up because of a small leak at the mask then maybe a different mask might be more stable for you but the Swift FX nasal pillow mask is pretty darn stable... Maybe try a different size nasal pillow???

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jwuzy
Posts: 26
Joined: Thu Sep 25, 2014 10:09 am

Re: How to get my leak rate down?

Post by jwuzy » Tue Sep 30, 2014 11:00 am

Thanks, will do... My AHI is low because I don't believe I have sleep apnea. The doctor diagnosed me with UARS... Still waking up a lot. Woke up about 5 times last night. Maybe I'll look into investing for a mouth guard.

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Pugsy
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Re: How to get my leak rate down?

Post by Pugsy » Tue Sep 30, 2014 11:13 am

Ahhh...the UARS thing. So we can't rely on AHI but have to rely on sleep quality which is much harder to isolate problems and fix problems because we often don't know what the problem is.

Using the typical guidelines when trying to isolate potential problems isn't going to work for you.

Leaks might be disturbing your sleep. There is no way to tell if they are or aren't from the data available here. These machines and their data are designed for OSA stuff and not UARS stuff.
With UARS those Flow limitations might be a lot more important to your sleep quality than a typical OSA patient's sleep quality.

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jwuzy
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Re: How to get my leak rate down?

Post by jwuzy » Tue Sep 30, 2014 11:32 am

Gotcha. Here's last nights data. http://imgur.com/PnFmQwV You can see I woke up quite a few times and this time, there were some large leaks. I might look into getting a mouthguard or taping my mouth down.

Looks like I have a good amount of flow limitations. Is that bad?

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Pugsy
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Re: How to get my leak rate down?

Post by Pugsy » Tue Sep 30, 2014 12:36 pm

Your leaks still aren't much...part of the increase you see in the leak line is the vent rate increase when the pressure increases...more pressure means more vent rate so the leak line will go up no matter what.

The flow limitations aren't really bad in number. Far from bad but when someone has the UARS diagnosis we can't just the numbers shown in the same light as we do when someone has plain OSA.
UARS often means a lot of low level flow limitations or reductions that might not even be flagged by this type of machine.
You don't seem to be having the RERAs that we might expect with UARS though...

Sometimes people with UARS are thought to be especially sensitive flow rate changes. If you happen to be one of those super sensitive people even the changing pressures could be a factor in causing your wake ups. So sometimes people should maybe use a non auto adjusting pressure (cpap mode) on the chance that the changing pressures are contributing to the wake ups.
Something to think about.
Though I will warn you about using cpap mode on your machine...don't do it because it won't flag the FLs which might be important in your situation. Instead if you want to use a single non auto adjusting pressure set it in apap mode but set the minimum to equal the maximum and the pressure will be fixed but you won't lose FL flagging. Like maybe use 8 minimum and 8 maximum.

And you know....it's entirely possible those unwanted wake ups are from something else unrelated to any sleep disordered breathing issues.

UARS makes it so we can't use the usual landmarks to evaluate therapy. Complicates things. We do have a few forum members here with that diagnosis and have had success with cpap therapy but it took a while to get there. Often they seem to need more pressure so they sleep better than what the reports are showing on paper.

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jwuzy
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Re: How to get my leak rate down?

Post by jwuzy » Tue Sep 30, 2014 2:09 pm

Thanks again Pugsy. You're amazing. I'm sure everyone else appreciates your contributions just as much as I do

I'll bump up my APAP pressure some more. I did 5.5 last night (was 4.0 before that). Maybe I'll try 8 as you said. Do you have any experience with taping your mouth? I'm not sure my insurance will cover a full face mask...

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Pugsy
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Re: How to get my leak rate down?

Post by Pugsy » Tue Sep 30, 2014 2:22 pm

Yeah, lots of experience taping my mouth. I did it for about 2 months when I first started therapy. Mouth was dropping open out of habit and not a need to mouth breathe. Chin straps were a PITA and didn't really help so I elected to tape (full face mask for me just ain't gonna happen) and I did it for a couple of months then started "forgetting" and found out that for the bulk of the night my mouth stayed shut and I was sleeping through any minor mouth leaking so I elected to forgo the tape.
I use the blue painters tape...cheap and I already had it handy. Plus it's fairly easy to break the seal should the need come up...a big yawn will do that easily. I didn't want to cement my lips closed in case of power outage or something like that.
All I wanted was a gentle reminder for the lips to stay closed.

It is a bit annoying though and you may find that the presence of tape also causes wake ups like the chin strap did for me. That thing was really a PITA and why I decided to try tape instead. We all have little things that bug us and the chin strap was a big one for me.
Others do great with a chin strap and can't stand tape. Each to their own.

Whatever you do....if you make a change in your routine with something don't make any other changes because then you won't know which change made things better or worse.
Keep your variables to a minimum.

About the 8 cm...that was just a number I threw out there. I don't think you particularly need that much from what I see on your reports....probably 6 to 7 ish...pressure would be where I would start if doing the minimum to equal maximum thing.
See how you do with a smaller increase first.
Though 8 cm is far from high and you might actually find it comforting to have the extra air support and movement.
Those pressures below 6 cm can be rather stifling for a lot of people.
Just because you may not "need" so and so pressure on paper doesn't mean you can't use that pressure if it makes you feel better and sleep better. It's all about sleep and feeling better and anything is fair game to try. For this reason I don't dwell on pressures used or the AHI or leaks in any great detail. I use what let's me feel the best. I keep one eye on those numbers but don't dwell on them. We don't get extra points for a perfect math score anyway.

Do you take any meds of any kind? Even OTC? If so, what?

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jwuzy
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Re: How to get my leak rate down?

Post by jwuzy » Tue Sep 30, 2014 2:45 pm

I'll try the tape later on. Tonight, I'll raise the pressure a little bit. I'll try the 6-7 guideline you suggested.

As for meds, I don't really take anything anymore. I'll take a benadryl every once in a while or pop a melatonin if I'm feeling wide awake. Though, they don't really help anymore as I'm still waking up pretty often.

I just hope to get a good night's sleep!!!

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Pugsy
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Re: How to get my leak rate down?

Post by Pugsy » Tue Sep 30, 2014 2:57 pm

Okay...it was just an idea about the meds and a question I have to ask people who are having sleep maintenance insomnia issues (that's what you are having) trouble staying asleep.
Often meds have hidden side effects that mess with sleep architecture.

I take one that comes with a "may cause drowsiness" sticker but while I can go to sleep most of the time with it in my system...I wake up in about 2 hours and I am wide awake and cleaning the house at 2 AM. Sometimes I can't even got to sleep with it in my system. So that's why I try not to take it after 6 PM.

Also take a hard look at your sleep hygiene in general and see if you do anything that could make sleep architecture worse.
We all normally do a few things that are considered a "no no".

Read up on UARS...search the forum for previous discussions...consider adding UARS to your subject line here to get the attention of our UARS members here for their input. From what I have read about UARS...I am sort of glad I have plain jane OSA because it is much easier to get good results with cpap therapy with OSA. UARS...is still sort of an unknown and hard to fix problem. Therapy for it is still in its infancy since it really hasn't had a separate label all by itself until fairly recently in medical history.

I do know that at least from what I have read that if I did think I had UARS and my CPAP reports were nice and pretty and not screaming out "Fix Me"....I would probably try more pressure (a little) just to see if the wave forms smoothed out in an effort to sleep better. I know about bad sleep but it isn't from UARS and it's a bitch to deal with no matter what the cause. Damned if you do and damned if you don't sometimes.

You may need to learn to understand your flow rate better....discussed in the past on the forum and I don't have time right now to find it for you. Don't try to do it all at once though. I have been looking at flow rate wave forms for 3 years and just now getting any sort of handle on what they mean.

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Machine: AirCurve™ 10 VAuto BiLevel Machine with HumidAir™ Heated Humidifier
Additional Comments: Mask Bleep Eclipse https://bleepsleep.com/the-eclipse/
I may have to RISE but I refuse to SHINE.

If you want to try the Eclipse mask and want a special promo code to get a little off the price...send me a private message.

jwuzy
Posts: 26
Joined: Thu Sep 25, 2014 10:09 am

Re: How to get my leak rate down?

Post by jwuzy » Wed Oct 01, 2014 10:44 am

I put my pressure at 7.5 last night and although, it didn't feel uncomfortable, I got a bloody nose. My machine doesn't have a humidifier so I might want to invest in that. I've been getting bloody noses here and there since I've started the therapy.

There's no point of me taking a screenshot of last night's data since I took the mask off around 1am... Still woke up like 2 or 3 times. I think I'm still adjusting to the machine.

Should I bring the pressure back down or wait until I can get a humidifier?

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Pugsy
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Re: How to get my leak rate down?

Post by Pugsy » Wed Oct 01, 2014 11:28 am

You don't have a humidifier? I didn't realize that or the fact you have been getting bloody nose.

While there are people who do well without using a humidifier or even using one in simple passover mode...most people do better with the addition of moisture to the air they are breathing in.

If my humidifier broke...I don't think I could even use my machine because I am so dependent on the moisture added to the air.

More pressure without the humidity is just going to dry out the nasal mucosa even more. I would reduce the pressure (there's no real urgent need at the moment to go higher anyway) until I added the humidifier.

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Machine: AirCurve™ 10 VAuto BiLevel Machine with HumidAir™ Heated Humidifier
Additional Comments: Mask Bleep Eclipse https://bleepsleep.com/the-eclipse/
I may have to RISE but I refuse to SHINE.

If you want to try the Eclipse mask and want a special promo code to get a little off the price...send me a private message.