Took your Advise

I'm no expert but it looks like you need to work on lowering your leak rate.

When you see the sleep doc tell him/her that you want a referal to the best pulmonologist in town. My first impression is that you have a high leak rate but your numbers still look pretty reasonable. What is your SpO2 like? Your sleep study will tell but a pulse oximeter is a good investment and will give hugely valuable clinical data for you to take with you to the sleep doc and pulmonologist. You want to maybe investigate other factors at play here. If you are desaturating during the night as you enter REM sleep you will never get squared away as your autonomic nervous system is going to try to arouse you to get you to breathe deeper and bring up your blood oxygen saturation. All is not simple. Get some sleep doc help and some referals. Even asthmatic reaction to allergens in your bedroom (simple dust?) can disrupt sleep. As can sleep hygiene, etc. And for crisssake don't go with an ENT guy's suggestion for surgery. What a quack! You need to remember what he does to make the big bucks.... surgery. I had four of them tell me to have the most drastic surgery you can imagine and one pushed me to book an open slot he had the next day! I found one that said he wouldn't recommend the surgery to his own family and to take another route which I did and successfully.

Hi, I am one who had the surgery [UPPP} back in 2007 and it only lasted 2 years! Now I am back on c-pap and trying hard to win!!!!! GOOD LUCK!!!

Deano wrote:Average Leak = 39.0
AHI = 3.2
Average CPAP pressure = 18.4 ( Auto CPAP )

The leak rate chart for his mask reads 40 for a pressure of 18...it appears to me his average leak rate would be acceptable, or am I missing something here?

Linda

Deano wrote:

Average Leak = 39.0

Responses included:

I'm no expert but it looks like you need to work on lowering your leak rate.

and

My first impression is that you have a high leak rate but your numbers still look pretty reasonable.

Deano's sig says he's using a PR Series M machine. I believe that the PR Series M's include the mask's standard (exhaust flow) leak rate in the reported overall leak rate, unlike the S9's which subtract off the mask's estimated exhaust flow from the leak rate data. [That's why it's important on the S9 to have the mask type entered into the settings correctly.]

So Deano, I think you need to read through the user (and clinical) guides for your Series M and your owner's manual for your mask. See if the Series M includes the mask flow in the exhaust flow data and see what your mask's intentional leak rate is at your current pressure. Subtract the mask's leak flow from the leak flow in the data to see what your leak flow really looks like. It might not really be all that high.

Tired Linda wrote:

Deano wrote:Average Leak = 39.0
AHI = 3.2
Average CPAP pressure = 18.4 ( Auto CPAP )

The leak rate chart for his mask reads 40 for a pressure of 18...it appears to me his average leak rate would be acceptable, or am I missing something here?

Linda

I agree the leak rate seems fine for that pressure but will say the only sure way to tell is to look at the leak line in the software. IF there are a lot of peaks & valleys then that could be a problem. The flatter & straighter the leak line in the software the better. Too many leaks can cause the machine not to sense events making the AHI reading unreliable.

To post your graph you need to first upload to the internet at a site such as Photobucket - then insert the link in your post.

HTH

Hi Deano,
Don't let the differences between machines confuse you. To understand leak reports on a Respironics machine, you simply compare your result to the mask's chart -- no subtraction to be done.

You leak results look you perfect, your AHI looks good too.

What are you troubled by? What is your struggle?

The sleep doctor can do a full night's titration study, in which they will try to find the pressure / machine type that will help you achieve REM and keep your oxygenation levels when they should be. Your non-cpap results are almost an irrelevance now that you're using CPAP; I wouldn't let them freak me out.

Your doctor may also give you a bi-level trial - that's a machine type that gives you much lower pressure when you exhale -- it may make sleep easier for you. It 's a more expensive type of machine, so some insurance companies insist the cheaper type of machine is tried (and failed) first -- but at your pressure, a bi-level is certainly a valid option. Bring it up if the doctor does not.

Good luck!

That leak rate for that pressure seems fine to me, too.

I'd want a bi-level machine if I were prescribed such a high pressure. Might be a lot more comfortable to use.

Three reasons I can think of for your tiredness:
If the machine is in auto mode -- the pressure changes cause aousals in some people
There' s more harm that you think in those 2 maskless sleep hours.
Breathing agains 18 may be tiring, even though you feel OK with it.

The second half of the night you're hitting the machine's maximum pressure rather often. Does that happen frequently?

Bi-level machines can supply inhale pressures of up to 25. APAP stop at 20.

O.

Your data shows that you are getting good therapy and the leak rate is good too.

I, like others, think that you are hitting the maximum pressure a lot and that maximum pressure is high.

With a high titrated pressure like yours, I think you would do even better with a Bipap.