Seems that centrals have started,...

[Pugsy]

That little spike above 24 L/min barely makes it a large leak.
The main thing about large leaks (assuming they aren't waking someone up) is that if the leak is too big then the data might not be accurate mainly people are concerned if a nice low AHI is because nothing happened or in the face of a large leak that the machine might have totally missed an event. Until we hit up around 35 L/min the machine will usually flag something.
Between 24 and 30 L/min...the machine is really quite reliable. Between 30 and 35 it might flag some unknown apneas meaning something happened but it didn't know what to call it. Over 35 L/min and the machine could miss stuff.

Even if someone does spend 10 minutes over 35 L/min...it's only the data during the 10 minutes that might be questionable.

I don't know where you heard to avoid the CMS pulse oximeters but that's what most of the forum members who monitor their own oxygen levels will be using. Cheap and actually fairly reliable. Many have taken their units to the doctors office and compared the results from the doctor's office units to what their CMS unit tells them.

What you might do is ask your DME to get the doctor to order an overnight pulse ox and check it that way first.

[Madalot]

I used a CMS50F (wrist model) for years, bypassing my DME for my annual overnight test. To ensure the accuracy of it, I did a side-by-side overnight using both monitors (mine & the DMEs - that was a rough night since I used both hands!) - the results were comparable on both monitors. My doctor loved that I did it myself.

One of the nice things is that if you get a lot of artifact (mine comes from my finger slipping out sometimes) - you can just do another test the next night (not easy when the DME gives you ONE night)! I always give myself a couple nights before my appointment to make sure I get a good test.

I'm now using a CMS60F (NOT wrist model) and I like it, but the sensor is more problematic to keep on. I end up securing it with a small rubber band.

[Mark55]

Glad to see your original post got put back.

With that low AHI I would look for other causes of not feeling well.

It does take a while to get used to that mask and air blowing at you.

Like pugsy noted show a more detailed flow rate near some events it flagged.
And it would be nice to see what happens to your heart rate and spo2 during the centrals that got flagged.

I agree, and will most likely order a recording oximeter now that a couple of people have said they have no issues with Contec. Actually it was the sleep tech that said to stay away from that brand.

I also agree with Pugsy in the fact my centrals, or what looks like centrals, are too short to cause a desat event I would think. My spo2 is typically between 98 and 99% when I have checked it under normal circumstances with my Nonin. The same readings appear at my doctor visits as well, so I seem to not have any issues while awake anyway.

I'm mainly confused as to why these central events suddenly started appearing as all of my reading to date says it takes higher therapy pressures to initiate these events. Something I must keep my eye on for sure.

[Mark55]

Here is the large one that maxes out at 37.2 I believe. It goes on for almost eight minutes, and was just before I woke up and took it off for the night. Weird!

Last one, as I don't want to drive you folks nuts.

[Jay Aitchsee]

I have a crazy question,....is it possible for an open mouth event to look like a central on the SH chart? I know I'm having issues with my mouth dropping open enough to bypass a lot of air. The sore, dry throat is proof of that.

Yes, an open mouth event can look like an apnea (either central or obstructive).

Here's how it works: If one is using a nasal mask, which it appears you are, the machine can only detect flow through the nose, the body part to which the hose is attached. If a breath is taken in through the mouth, the machine will not detect that flow. If mouth inspiration continues long enough, 10 seconds or about 3 breaths, an apnea will be scored. If one exhales through the mouth but inhales through the nose, the machine will detect a leak because the outflow and inflow will not be equal, but an apnea will not be scored. If one both exhales and inhales through the mouth while wearing a nasal mask, no flow will be detected and the graphic representation will be a flat line usually ending with an apnea being scored as nose inhalation resumes. The latter, in my opinion, is the most common cause of apneas which appear to last a very long time.

These anomalies are not seen when wearing a FFM mask as the machine is able to detect both nasal and oral flows.

[Mark55]

I have a crazy question,....is it possible for an open mouth event to look like a central on the SH chart? I know I'm having issues with my mouth dropping open enough to bypass a lot of air. The sore, dry throat is proof of that.

Yes, an open mouth event can look like an apnea (either central or obstructive).

Here's how it works: If one is using a nasal mask, which it appears you are, the machine can only detect flow through the nose, the body part to which the hose is attached. If a breath is taken in through the mouth, the machine will not detect that flow. If mouth inspiration continues long enough, 10 seconds or about 3 breaths, an apnea will be scored. If one exhales through the mouth but inhales through the nose, the machine will detect a leak because the outflow and inflow will not be equal, but an apnea will not be scored. If one both exhales and inhales through the mouth while wearing a nasal mask, no flow will be detected and the graphic representation will be a flat line usually ending with an apnea being scored as nose inhalation resumes. The latter, in my opinion, is the most common cause of apneas which appear to last a very long time.

These anomalies are not seen when wearing a FFM mask as the machine is able to detect both nasal and oral flows.

I have let my mouth pop open on purpose just to see what happens, and of course 90% of the flow just blows right out of my mouth. Since I breathe quite shallow, I thought that to the machine it might look like an open airway with no breathing taking place,....which is pretty much a central right? I guess the PR chin strap I ordered will tell me if that has anything to do with it or not.

I don't even remember the first two masks they tried on me during my titration study. The first was a nasal mask, and there was no way that was going to work. The second was a FFM that they could not get the leaks stopped on regardless of how tight they pulled the straps. They then used a Mirage Quattro and finally got it adjusted without leaks. I slept for about 4 hours iirc, and woke up with a sore forehead, and nose bridge. My forehead, and nose were also blood red where the contact points were, and my nose felt like I had bumped it for two days afterwards.

I then got an Amara View FFHybrid which is very sensitive to leaking. It takes me five minutes to get it leak free, and just takes a small move to start it leaking.

Finally I tried the Brevida nasal pillow mask, and it fit perfect with the M/L pillow with very light strap tension. Some of my first nights at home after switching came in at an AHI of 1 or less. Since then I am moving up slowly, going as high as 5.7 one night. I can never find this mask leaking, so I'm convinced my mouth is popping open when I reach deep sleep, especially considering I sleep largely on my back, and propped up as well. (mild GERD)

I'm considering turning off the autoset function because my mind tells me I might be going through a loop of starting and stopping due to it thinking I have disconnected a hose when my mouth pops open. If that's true, then I would go into the autoramp mode again, and be running at 4cm/h2o over and over. Just a thought, that hopefully the strap will settle.

[Jay Aitchsee]

A chin strap might help, but it might not, since even though it could keep the jaw closed, it wont necessarily prevent leaks through the teeth and out the lips. Try to exhale through your mouth with your teeth together and your lips open. No problem, right? Same with a chin strap. Most mouth leaks are caused by a failure of the seal at the back of the throat. Try exhaling while making the beginning of a K sound - that seal. Some people have some success "learning" to make this seal by holding their tongues in position during the day and while falling asleep until it becomes second nature. Others, not so much. Many resort to tape to keep the lips closed to prevent air escaping. Some have had some success using a soft cervical collar, some go to a FFM. I use a hairband over my mouth which slows the leaks enough that therapy is not affected and the leaks are not disturbing. A Scunci.

[Pugsy]

I use a hairband over my mouth which slows the leaks enough that therapy is not affected and the leaks are not disturbing. A Scunci.

Hey Jay, since the Photobucket blackmail...have you moved your Scunci picture to imgur? I wanted to show a couple of people how you do it but can't find a new picture.

[Mark55]

I use a hairband over my mouth which slows the leaks enough that therapy is not affected and the leaks are not disturbing. A Scunci.

Hey Jay, since the Photobucket blackmail...have you moved your Scunci picture to imgur? I wanted to show a couple of people how you do it but can't find a new picture.

Yes,...that would be interesting to see.

[RestlessinWoolley]

Mark, I also suffer from major Centrals due to long term chronic pain medicine and opiate use to control the pain I live in. Did they do an ASV study on you or see centrals during the study? I did my first and second night on a standard machine and it took my ahi from 50-70 down to below 10. That cleared all the riff Raff up, I don't snore much either. At my follow up I did a third night totally dedicated to ASV, and after 8 months on Bipap ASV my average is 1.0 AHI. I still have the centrals but the machine will take over when my breathing gets too shallow or I stop breathing. I was stopping breathing 20-30 times a night. It's almost been a year total on one machine or the other and I am still slow reaping the benefits. It's going to take time. I use my machine 7-9 hours a night. Medium setting on Humidity and have the hose fairy warm. So don't give up have your sleep doctor download the data from your machine. They might want to make adjustments or bring you back for an asv study.

[Jay Aitchsee]

I use a hairband over my mouth which slows the leaks enough that therapy is not affected and the leaks are not disturbing. A Scunci.

Hey Jay, since the Photobucket blackmail...have you moved your Scunci picture to imgur? I wanted to show a couple of people how you do it but can't find a new picture.

Yes,...that would be interesting to see.

Here you go:
viewtopic.php?f=1&t=112758#p1086296

[Pugsy]

Here you go:

Thanks so much.

[zonker]

I use a hairband over my mouth which slows the leaks enough that therapy is not affected and the leaks are not disturbing. A Scunci.

Hey Jay, since the Photobucket blackmail...have you moved your Scunci picture to imgur? I wanted to show a couple of people how you do it but can't find a new picture.

Yes,...that would be interesting to see.

Here you go:
viewtopic.php?f=1&t=112758#p1086296

hi, jay! good to see you back. and thanks for posting the pick.

to anyone reading, i fully endorse this method. it's dirt cheap. i use it along with a soft cervical collar and a few modifications. and it works a treat!