New to CPAP - Quick Question regarding leak

[Recoil]

Hello everyone,

I just wrapped up my first 90 days on CPAP! It has honestly gone way better than I expected.

I did have a question however. Last night was my first night with new nasal pillows because the prior couple of nights I was registering large leaks which I now have possibly attributed it to my nasal pillows needing to be replaced. With the new pillows, the ResMed Air App indicated I had 0 ml leaks last night but had a 1.7 AHI. How does one still experience events with my fixed pressure and 0 leak? I have attached an image of last nights OSCAR data.

Gear:
Machine - Airsense 10 Autoset
Mask - Phillips Resp. Nasal Pillow + Mouth Tape
Pressure - 18.0 Fixed

[Pugsy]

How does one still experience events with my fixed pressure and 0 leak?

1....you are expecting 0 events? That's an unrealistic expectation.
2....you are using fixed pressures but we don't sleep the same each night and maybe you just needed more pressure for some reason on other (sleeping position maybe or REM maybe or combination maybe) and your machine couldn't go higher because it is set for fixed pressure.
3....not all events will respond to more pressure...centrals
4....Were you expecting the machine to do something during the apnea event? Even if it could go higher no machine will do anything DURING the event. It can't and won't even try.

[Recoil]

Oh ok. Thanks Pugsy! I am still naive with my knowledge and expectations of this therapy. I have oscar and am trying to learn my graphs but still can't determine what is normal /abnormal. I was under the assumption the machine would notice the event and then try to instantly get me out of it, but I guess the machine is suppose to do it's best at "preventing" events as much as possible. Also, "Centrals" can't be prevented correct? That bugs me as I am trying to get a perfect score lol.

I move a lot in my sleep, i'm a stomach and side sleeper by preference, but I always start off on my back. Since my entire mask frame is silicone, I am assuming some of the events may have been when I'm laying on my stomach and my head is turned collapsing one side of the silicone frame maybe causing less pressure at that position.

[Pugsy]

I was under the assumption the machine would notice the event and then try to instantly get me out of it, but I guess the machine is suppose to do it's best at "preventing" events as much as possible.

Even if it could immediately respond (which it can't) when people use fixed cpap mode....it can't respond because the fixed pressures can't/won't increase.

So yes...these machines try to PREVENT the airway from ever collapsing in the first place.

"Centrals" can't be prevented correct?

Well it depends on what is causing those centrals and were you sound asleep when it got flagged or were you awake or half awake? Sometimes (depending on the cause of the centrals and how many there are) we can indeed reduce or eliminate the centrals.

I move a lot in my sleep, i'm a stomach and side sleeper by preference, but I always start off on my back. Since my entire mask frame is silicone, I am assuming some of the events may have been when I'm laying on my stomach and my head is turned collapsing one side of the silicone frame maybe causing less pressure at that position.

No...your sleeping position won't do that to the pressures.

That bugs me as I am trying to get a perfect score lol.

Another unrealistic expectation. You would first need to learn the difference between awake and asleep flagged events because anything flagged while NOT sound asleep really isn't important when evaluating actual therapy effectiveness except to point to someone not sleeping so great (which is also important) but not related to airway issues per se.

And yes...these machines do flag stuff that is awake/arousal irregular breathing because they only measure air flow. They do not have any way to know that the irregular breathing it is sensing is normal awake irregular breathing.
Awake/arousal breathing is irregular when compared to asleep breathing and that irregular breathing could look like some sort of apnea so the machine sends out a flag.

BTW...getting a perfect score doesn't guarantee anything except maybe a sore shoulder from patting yourself on the back.
Doesn't mean someone will sleep great and feel like superwoman/superman the next day. Doesn't mean you will want to run marathons or go take advanced Calculus in college because your brain is so sharp. Doesn't mean anything.

[Recoil]

Thank you for your time and insight! It is tremendously appreciated!