Analyzing Therapy Data - Mouth Leak & Hypopneas

Here is the results from my first night with the IntelliPap SmartCard Module:



Note that I was only asleep from 2:30 AM until 9:00 AM, so the earlier data from 11:30 PM to 2:30 AM is throwing the overall results off a bit.

My setup:
IntelliPap APAP, Range 10 - 11 cmH20
Swift FX Nasal Pillows
Mouth taped shut
No chinstrap (I just switched from a chinstrap to taping because if I tighten the chinstrap enough to keep my mouth closed, I wake up with sore front teeth and I don't want to screw up the alignment of my teeth.)

What I notice is that each hypopnea is associated a big jump in the Max Leak, though not every jump in Max Leak is associated with a hypopnea. Perhaps at times the supplied pressure is inadequate to maintain an open airway, leading to collapse and reduction of breathing (i.e. a hypopnea), and my physiologic response is an attempt to mouth breath, which entails breaking the seal the tongue and other structures make at the back of the throat during regular nasal breathing. This then allows air to rush into my mouth and some to escape through the tape, hence the spike in max leak rate. The thing is, I find it hard to believe that so much air could get through the tape - when I woke up this morning, the tape was still securely on and my lips were still sealed together. The tape is somewhat porous so apparently some air is getting through directly, as opposed to out of a tear or flap or whatever.

Another possibility is that I am first attempting to mouth breath, which then lets air rush into my mouth, possibly out through the tape, thus dropping the therapeutic pressure which allows airway collapse causing a hypopnea.

Not sure. Thoughts? I will use the same setup tonight and we'll have more data for tomorrow.

Also, I tried using the Hybrid mask the last two nights. I don't know how you folks use this thing! On Wednesday night, in order to stop leaks, I had to tighten the straps until it was uncomfortable. I woke up after a few hours with leaks and just took it off. I spent a several hours yesterday early evening playing with the Hybrid, trying different size pillows, cleaning the mask and my face to remove all oils, etc. nothing worked to stop leaks other than extreme tightening of the straps. I even cut the chin flap off which helped a little (by letting the mask sit higher up on my face) but still not enough. Tried falling asleep for two hours and then gave up, went to the bathroom and shaved off my beard, taped my mouth completely shut, and put on my comfortable Swift FX nasal mask. Much better. I really wish I could get a FFM or Hybrid-style mask to work, as then I wouldn't need a chinstrap or taped mouth, but I just don't see it happening. Since I've shaved my beard, perhaps I can get a better seal with the Hybrid but I did do this before a few months ago (Hybrid + shaved face) and no luck.

Bob,
Before you start analysing the data gathered by your DeVilBiss, please read their default definitions of apnea and hypopnea very carefully.

By default, the DeVelibiss machine uses a highly non-standard definition of events. The only events considered apneas on a DeVilbiss (by default) are those in which you have between 90% and 95%. As a result of that, many events that would be reported as apnea by other machines, and in sleep labs, turn up hypopneas on DeVilbiss machines.

I suggest you set the defaults at more standard percentages of breath reduction, and start your analysis / self titration from there.

Here's a chart created by Velbor, comparing some other companies' definitions.
[/quote]

The American Academy of Sleep Medicine mentions a number of definitions here: http://www.ncbi.nlm.nih.gov/pmc/article ... .2.150.pdf

Of the many alternative definitions mentioned, nobody but DeVilbiss limits apneas to the narrow range of 90%-95% reduction in air flow.


O.

Thanks O. Good thing I can tweak the settings on my machine. This probably won't change my AHI, as I think the IntelliPap is classifying apneas as hypopneas and not actually missing events, but it's good to know.

Here is last night:




I had a nice stretch in there from 2:30 AM - 4:30 AM!

I wonder what happened between ~1:40 AM and ~2:25 AM. Maybe I rolled onto my back? Perhaps tonight I'll sleep on the couch which basically forces me to sleep on my side.

That two hour stretch last night without any events suggests to me that as long as sufficient pressure is delivered to my airway, I can breathe through the nasal mask without troubles, but once the pressure is insufficient - for instance, if I roll onto my back (I usually sleep on my side) - then the airway collapses and unfortunately, even a pressure of 14 cmH20 is not enough to maintain the airway and I have a series of events until I roll back onto my side. If that's the case, I need to either raise the upper limit of my aPAP range or eliminate back sleeping altogether. I've had problems with aerophagia when the pressure is above something like 13 cmH20, so I don't think opening up the aPAP range is a good solution, but I am not ruling it out, either. It's also possible that some of the events are just related to the position of my jaw or the tongue or other pharyngeal structures. I really wish I could record my sleep position (supine, prone, right lateral decubitus) and see how well it is associated with events. During both my diagnostic sleep study and my titration study, I had 33.3% more events when lying on my back than on my side.

Tonight, I will sleep on the couch and place a few pillows behind my back so that I have no choice but to sleep on my side.

I have data from last night. I slept in two spurts, once for an hour from 8:30 PM - 9:30 PM, during which I slept on my side and used the Hybrid mask, and again from 1:30 am - 7:00 AM, during which time I used the Swift FX mask with my mouth taped shut.



The first period of sleep on my side with the Hybrid looks great - no events, no leak (accept at the beginning and end when adjusting the mask), and no pressure spikes. The second period with the Swift FX and mouth tape is not so good. I had events throughout the period from 1:30 AM - 5:00 AM, including leaks and a slight rise in pressure. I had a two hour window without any events or pressure spikes, but a few leak spikes. I am still not certain what is happening, but my best guess I am rolling onto my back which triggers the event clusters, though without video recording myself I cannot be sure.

Tonight I will try sleeping on the couch, which should force me to sleep on my side. I tried this two nights ago but it was a disaster - it was extremely hot and humid and I was sweating lightly, which caused leaks. I also had bad insomnia and couldn't fall or stay asleep. Tonight should be cooler and I will try again.

I am hoping that either forcing myself to sleep throughout the night on my side or sleeping with the Hybrid will resolve my ongoing OSA problems. If the back sleeping is causing the events, side sleeping might resolve this. If mouth leaks are causing the events, the Hybrid might resolve this. If it's a combination problem, then the Hybrid with side sleeping should resolve everything.

Does anyone have a recommendation for a cheap video recorder I could use to record my sleeping?

Your leak looks too high. Once you get that under control, your AHI should be significantly lower. Try adjusting your mask or maybe even try a different mask. Good Luck!

sleepmba wrote:Your leak looks too high. Once you get that under control, your AHI should be significantly lower. Try adjusting your mask or maybe even try a different mask. Good Luck!

Thanks for your input. I am trying to find the source and cause of the leaks. I have extensive experience fighting leaks with my previous masks (several months of hell, really) and I have almost never experienced a leak with the Swift FX while I am awake. I often take an hour to fall asleep, and I can roll around, move my head up and down, read in bed, etc. without leaking. Because of that, my best guess as to the cause of the leaks is that I am having mouth blowouts that cause air to leak through the mouth tape or somehow escape my mouth when I am using a chinstrap. It's disappointing because the Swift FX is so comfortable compared to any other mask that I've used. However, after last night, I think I may need to commit myself to the Hybrid.

Last night's data:



I slept on the couch on my side with some pillows stuffed behind me to prevent back sleeping. Not sure it worked, I woke up a few times to switch positions a bit, and I am not certain I slept on my side all night. Fortunately, the webcam I ordered will be here tomorrow so my plan is to record myself sleeping (actually, I'll be taking pictures at one minute intervals) so I can figure out what position I was in at what time and hopefully figure out how this relates to OSA events and leaks. The big spike in leak rate just before 3:00 AM was from me adjusting the mask manually.

Tonight I will try and sleep with the Hybrid. It's so much more intrusive than a nasal pillow mask, but I don't think I have a choice. After shaving my beard, I can get a decent seal so I just need to get use to the discomfort of the thing.

How does the software calculate the math for those two leak lines?

Here are some tips on adjusting the Hybrid wiki/index.php/Hybrid_Mask_Modifications

My Hybrid is adjusted lightly. Tightening it down is unlikely to work for you in the long run. Probably more leaks and definitely less sleep.

The ladies tights fix allows me to adjust the nasal pillows lightly and provides them stability if I toss and turn.

Glad to see you are analyzing positional sleep apnea. On my back the sleep lab could not get me to breathe until the pressure was raised to 19 cm. I confirmed that at home.

In the meantime I wear a backpack and sleep mainly on my tummy with a little bit of time on my sides - always avoiding the back. A pressure of 7.5 cm is very effective on my tummy or sides.

Please keep us informed.

Thanks Rooster. Your wiki article is where I got the idea to cut off the chin lift, and that has helped quite a bit. The first time I tried the Hybrid (a few months ago) I also used your "ladies panthose" trick, also effective. I will try playing with the straps more tonight. Shaving my beard has helped immensely to stop leaks. Now maybe I can loosen the straps enough to be comfortable enough to sleep. I am hopeful that once I learn to sleep with the Hybrid, I will finally get some good rest.

That didn't work.



Last night I slept in bed with the Hybrid mask. I wen to bed sleeping on my side with no noticeable leaks, and the first hour of the evening I showed minimal leaks and no events. I am guessing that the waves of hypopneas later in the evening began after I rolled onto my back while asleep. Tonight I should have my video recorder setup to confirm this. A possible solution is to sleep with a backpack on as Rooster suggested, sew tennis balls into my shirt, etc. My sleep process is becoming more and more complex. C'est la vie.