Need Help

[wacyone]

My wife just started her cpap therapy in July 2013. She is using a System One Bipap Bi-Flex. Her Max IPAP is 15,her Min EPAP is 10. She is doing fairly well using her machine but at night sometimes she gets noisy. She does show some leaks on her readout but it is not like air noise. It is more like a small gas engine running. I was awake for about an hour last night monitoring her sleep. This seems to happen when she is on her back. Her Vibratory Snore is very active. If anybody would have some ideas or suggestions I would appreciate them.

Wes

[Pugsy]

If you are seeing snores on the reports...which software are you using?
Can you post an image of the detailed graphs showing snores? Don't know how...this thread explains how.
viewtopic.php?f=1&t=81072&p=737779#p737779

Normally too many snores usually means that EPAP is not quite optimal....what about the other items on the reports?

[Julie]

It would be a great idea for you to find her a back wedge - a triangular, body length foam piece (you can buy them online I think) that would keep her from turning onto her back at night - the worst position for provoking more apneas (and snores!). If using her mask is difficult on her side you can find a Pap Pillow (it's got cutouts for the mask) as well. I think they will make a big difference.

[wacyone]

http://s811.photobucket.com/user/wacyone/story/31333#

[JDS74]

The chart shows a sudden onset of 'snoring' interspersed with some hypopneas.
The pressure increase is insufficient to treat this and may indicate a need for an increase in pressure.
Making sure she never sleeps on her back will likely help.

[Pugsy]

Do you ever hear her snore?
That snore line looks awful but we had another person her with a similar snore line and spouse said zero snoring ...of course can't sit up all night and watch.

There is that one cluster of hyponeas..
Is this machine a fixed pressure bilevel machine (that's the mode it is showing now) or does it have auto adjusting mode available.

What is the model number?
The humidifier you have chosen in the equipment profile was discontinued in 2007 and won't work with a System One machine.
If you will tell me model number I can point you to the exact equipment choice in the equipment drop down menu
Model number is a 3 digit number on the bottom of the blower unit....may have DS or REF in front of it.

[wacyone]

First thanks for the help. I have never heard her snore. That is why it is confusing seeing some of the results. She did have cancer in 94,has lupus so she could not have chemo just radiation and that caused her lungs to be burnt bad. She only has 50% lung capacity now. Her machine is a Bi PAP Auto(System One 60 Series)Model 760P. Why she sleeps on her back a lot is she has had most of her clavicle removed so it gets sore sleeping on the side for long periods of time. I may have not put the right humidifier on the specs.

Wes

[jweeks]

Why she sleeps on her back a lot is she has had most of her clavicle removed so it gets sore sleeping on the side for long periods of time. I may have not put the right humidifier on the specs.

Wes,

Is one side better than the other, or does it get equally sore on both sides? In the first few years that I used CPAP, I could not sleep on my side, yet I would get very sore in my hips. I found two things that helped. First, Advil PM and Acetaminophen PM knocked out the pain that I had. If I didn't do that, I'd toss and turn from the soreness, which messed up my sleep almost as bad as apnea. The second item was getting a memory foam mattress topper. I started with a 4 inch topper, and later added a 2nd layer. It serves three purposes. Since I sink in a bit, it holds me in place. It spreads out the pressure to help avoid getting sore in areas that had the most weight such as my hip area. Finally, it is so comfortable that I don't unconsciously change positions as often when sleeping.

-john-

[Pugsy]

In the equipment drop down menu this is the machine choice
PR System One 60 series BiPap Auto
and the humidifier is
PR System One 60 Series Heated tube humidifier with heated tube (even if you don't have the heated hose at the moment).
I have the same machine and humidifier.

It wouldn't be impossible for the machine to pick up some sort of external noise or vibration and mistake it for snores.
Leaks can cause either mask noise or therapy effectiveness drop and allowing real snores to materialize because the airway is collapsing.
First thing I would work on would be the leaks.
I can only see a portion of the leak graph on that one screen shot but I see the lighter shade of green in multiple segments and I see max leak up to 120 L/min. Just see the tips of the leak line and 159 minutes in large leak on the right side...that's really bad to see that much time in large leak. Nearly 3 hours.
Snores seem to correlate with the leak except for the last group of snores.

Can you give us a better picture of that leak graph?
It looks like the leaks are bad enough that they could be impacting therapy and allowing the snores to materialize or it might be mask noise getting picked up by the machine and reported as snores.

Also what software are you using? The times look weird. If Encore Pro did you set the time zone to match your time zone?

[robysue]

The thing that jumps out at me is the 159.0 minutes in Large Leak time. That's a lot of Large Leak time. And the time frame when the hypopnea cluster is at its worst seem to occur during the light Large Leak bars over the leak graph. And the snoring seems strongly correlated to the Large Leaks as well.

Like pugsy says: It could be that mask leak noises are being picked up as snores and that the leaks are large enough that the machine is having trouble maintaining enough pressure to prevent the hypopneas from occurring.

She does show some leaks on her readout but it is not like air noise. It is more like a small gas engine running. I was awake for about an hour last night monitoring her sleep.

Wes,

Can you identify the noise a bit more precisely. Was it "put-put-put" noises coming from the mask itself (face-farts)? Was the noise coming from your wife's mouth (lip flutters)? Was it coming from the blower unit rather than the mask or your wife?

Your profile shows a full face mask. Is that the mask that your wife is using? If she's using a FFM, then my guess is that the mask seal sprang a leak, perhaps when her face fully relaxed as she hit her first REM cycle. (The timing of the first large leak is about 1.5 to 2 hours after the beginning of the session; hence it's reasonable to assume that she may have been in REM when the leak first started.)