What's happening on this Chart??

What's happening on this Chart??

After a long string of AHI under 1.0 and relatively flat leak lines, I get THESE two nights! Neither one woke me up, but both woke my lovely wife. (She often wakes up for apneas because the machine stops changing pitch.) I awoke both mornings feeling pretty refreshed, like I'd had a quiet night, but when I ran the charts, WHOA! The first night it pegged the APAP. I've NEVER gone over 18 before. And the first night I got an AHI = 5.8 !!!

These show the times as 2 and 3 hours into the night...I went to bed about an hour earlier the second night, so they happened at about the same clock time.

Any educated guesses what's going on?

It looks like you had a mask leak.

Well, yeah... But why at the same time...and causing a barrage of apneas? Even before I got my mask under control, I never had a 5.8 AHI. And it usually wakes me up when leaking that bad. Although I did recently switch to an Optilife...from a ComfortGel FF. Maybe leaks are not as sleep disturbing?

It looks like the leaks to me too. Could it be that something happens at about the same time each night? Like a neighbor coming home and slamming a car door, or a nearby train blowing the horn, the wife(in my case husband) getting up to use the bathroom? Anything that may not wake you completely but cause you to change position enough to cause the leaks? I found that the leaks from nasal pillows don't disturb me as much as leaks from FF masks. Have you had any symptoms of PLMD or restless leg syndrome?

Brenda

I don't know how people can sleep through mask leaks like that, but some people can, and you obviously did.

I don't often have leaks, but my M-Series seems to be able to maintain the prescribed pressure as long as the total leak is under 75 cm.

Link, Have you considered Positional Sleep Apnea? Like you sleep on your sides or stomach most of the night and when you roll onto your back, your sleep apnea is much worse and requires a much higher pressure? That's my problem and my charts looked a good bit like yours before I established a discipline of only sleeping on sides or stomach. What do you think about your case?

Regards,

Just focussing on the 1st chart, I see what looks like regular sleeping except there are 3 small bursts of leaking & the third one seems to be occurring along with a burst of hypopneas - the machine starts bumping pressure which then shows that you appear to resume normal breathing (pressure has gone from 16 to 18 cms) but then shortly after the 3rd leak burst you nose-dive

1) a hypopnea occurs, the machine bumps pressure to 18 cms.
2) Breathing goes normal for a short spell
3) You commence having apneas (AI), machine responds by going to 19 then 20 cms
4) Mask begins leaking badly (with that pressure I can see why)
5) You then have a prolonged burst of apneas combined with a fluctuating mask leak
6) The apneas become very solid & last approx 30 mins
7) Am guessing an arousal was triggered, you moved & the mask leaks stopped abruptly - the apneas ended abruptly - machine stays at 20 CMs
After approx 10 mins, the machine starts to wind down the pressure & gets back to 16 CMs

Night is good after that.

DSM

You think those are REAL? uh... wow. can't they be artifact due to the leak?

elader wrote:You think those are REAL? uh... wow. can't they be artifact due to the leak?

The issue with charted hypopneas a& apneas is that the Digital Auto Track (tm) algorithm is supposed to be able to estimate accurately
between leak & ventilation - the auto algorithm kept ramping the pressure & the machine kept logging its estimate of leak vs respiration
and the algorithm kept adjusting.

DSM

Disclaimer as to the "educated guess", but have you ever considered just running in CPAP mode? You seem to do just fine at the baseline pressure. Apneas are occurring when pressure surges higher, and the precursor seems to be a leak, rather than an apnea. Its also possible you are mouth breathing, and the exhalations are being counted as apneas due to loss of feedback. The leaks do not suggest total loss of seal, which would read in excess of 100 on the graph, but the kinds of resistance shown suggest brief or intermittent mouth breathing, or a partial leak at the mask interface.

Sleeprider wrote:Disclaimer as to the "educated guess", but have you ever considered just running in CPAP mode? You seem to do just fine at the baseline pressure. Apneas are occurring when pressure surges higher, and the precursor seems to be a leak, rather than an apnea. Its also possible you are mouth breathing, and the exhalations are being counted as apneas due to loss of feedback. The leaks do not suggest total loss of seal, which would read in excess of 100 on the graph, but the kinds of resistance shown suggest brief or intermittent mouth breathing, or a partial leak at the mask interface.

Mouth leaks after swapping from a FF mask is a very good thought.

Seems entirely plausible.

DSM

Oops, I overlooked that your are using a nasal mask. I would investigate mouthbreathing or mouthleaking and positional sleep apnea.

While I AM a mouth-breather, that's not a factor. I "Poligrip strip" AND tape. Tape is still intact in the AM.

Rooster, I start out on my back because I have been getting nasal pillow leaks on my side. Since CPAP I've not been getting OAs even on my back. However, turning on my side could very well initiate the leak/OA/pressure-rise cycle.

After reading all your responses, I took some time to readjust my Optilife. I believe I had the pillows cinched up too tight. I found with a bit of loosening I can move my head a lot more without leakage. I'm anxious to see if that reduces/eliminates these episodes.

Your dialog/brainstorming has given me some avenues to explore. Thanks! (I hope to have good news from Encore in the morning.)

Sleep well,
LinkC

I'd have to dig through a lot of stuff to find the Optilife mask I have. Too lazy to do that now. Wondering if an homemade strap to cradle the nasal pillows a little steadier might help. The extra strap doesn't have to be tight at all. Just having something "there" across the front (if you can arrange it so as not to block the vent) often helps with any kind of nasal pillows mask. Works much like the way just placing ones fingers lightly against the front of a mask can stop leaks.

Link, with the Optilife as you know has that chin strap built in. (yes we all no its not a REAL chin strap, used just to help hold mask in place.) What I have had happen to me, (as a person wearing it) and have seen in the lab, is that when you drop your mouth open, the bottom of your chin pulls on that strap causing a leak. Even though you tape your mouth shut, you chin can still drop down. So even though you aren't losing pressure from mouth breathing, your chin is pulling down on the mask causing the pillows to lose their seal. I actually just talked to the Respironics guy about this, and he said thats one of the biggest problems with this mask. He said that they are in the process to correct this with a new version, but has no idea when it will come out. I have to agree with everyone else, I strongly doubt those events are real judging from your printout. Good luck.