AHI & CA Climbing, Mask Fit Declining, Feeling Awful

[palerider]

The next thing I need to figure out is the large leak events. Any idea why when I run the mask fit it shows the red frown on inhale but not exhale?

More air's flowing through when you inhale, hence more leak.

What doesn't make sense is that if the mask is fitting poorly, I would imagine there would be a bigger leak on the exhale.

Why?

Is there any way to tell from SH data whether the leaks are open mouth or a mask fit problem?

Not reliably, though you can sometimes get an idea based on the breath shapes.

Or could the nasal congestion be interfering with the mask seal in some capacity?

I can't see how, unless you've got a very snotty situation.

[eyeheartny]

More air's flowing through when you inhale, hence more leak.

Makes sense. My thinking was that there's more outward pressure from my breathing on the exhale, which would then be enough to dislodge the pillows.

It's not moist snot-- more dry/obstructed breathing higher up in the sinuses. If I close my left nostril right now I can't really get a clean inhale on the right. Feels like I'm breathing through a tiny cocktail straw/about 20% of the flow on the left. Left is unobstructed at the moment.

Other than trying it without EPR and without humidification, any ideas on how to improve results in terms of tweaking settings, the mask, etc? Or is this really about getting my back pain, sinuses, etc in better shape and then seeing how things go on the apnea side?

[palerider]

More air's flowing through when you inhale, hence more leak.

Makes sense. My thinking was that there's more outward pressure from my breathing on the exhale, which would then be enough to dislodge the pillows.

There's no more pressure on exhale, in fact, if you've got EPR on, then there's *LESS* pressure during exhale.

Without EPR, the pressure remains the same, because the machine slows down the blower, reducing airflow so that the added pressure from your exhalation and the reduced pressure from the cpap cancel each other out and you get a stable, desired pressure. Opposite happens on inhale, the machine speeds up, so that pressure doesn't drop during inhale.

[eyeheartny]

More air's flowing through when you inhale, hence more leak.

Makes sense. My thinking was that there's more outward pressure from my breathing on the exhale, which would then be enough to dislodge the pillows.

There's no more pressure on exhale, in fact, if you've got EPR on, then there's *LESS* pressure during exhale.

Without EPR, the pressure remains the same, because the machine slows down the blower, reducing airflow so that the added pressure from your exhalation and the reduced pressure from the cpap cancel each other out and you get a stable, desired pressure. Opposite happens on inhale, the machine speeds up, so that pressure doesn't drop during inhale.

Got it, thanks. Well, I guess I'll learn tonight whether there are pressure-related mask issues. Wish me luck, haven't tried sleeping without EPR since I started on therapy.

[palerider]

Other than trying it without EPR and without humidification, any ideas on how to improve results in terms of tweaking settings, the mask, etc? Or is this really about getting my back pain, sinuses, etc in better shape and then seeing how things go on the apnea side?

Your first screenshot had no EPR, your second series did.

EPR can, in some people, exacerbate centrals, however, it's not going to affect post arousal centals.

Work on your pain, sinuses... try different humidification levels to see if any of them make the sinus situation better... some people's noses like a lot of humidity, some just a little, or no added...

[palerider]

More air's flowing through when you inhale, hence more leak.

Makes sense. My thinking was that there's more outward pressure from my breathing on the exhale, which would then be enough to dislodge the pillows.

There's no more pressure on exhale, in fact, if you've got EPR on, then there's *LESS* pressure during exhale.

Without EPR, the pressure remains the same, because the machine slows down the blower, reducing airflow so that the added pressure from your exhalation and the reduced pressure from the cpap cancel each other out and you get a stable, desired pressure. Opposite happens on inhale, the machine speeds up, so that pressure doesn't drop during inhale.

Got it, thanks. Well, I guess I'll learn tonight whether there are pressure-related mask issues. Wish me luck, haven't tried sleeping without EPR since I started on therapy.

you had no EPR on the screenshot of the 20th.. (well, a few minutes during ramp.)

[eyeheartny]

you had no EPR on the screenshot of the 20th.. (well, a few minutes during ramp.)

I see that, but it is a weird error in the data or mysterious machine behavior. I've never turned EPR off, and the machine settings for that night indicate that it was on...

[palerider]

you had no EPR on the screenshot of the 20th.. (well, a few minutes during ramp.)

I see that, but it is a weird error in the data or mysterious machine behavior. I've never turned EPR off, and the machine settings for that night indicate that it was on...

I don't see that. I see machine settings saying EPR was ramp only, and I see ramp only during the EPR part of the night, based on the pressure trace, as well as the median, 95% and max numbers in the stats.

I suppose that could be some kind of weird glitch... what's the mask pressure line for sep 20 look like?

[eyeheartny]

you had no EPR on the screenshot of the 20th.. (well, a few minutes during ramp.)

I see that, but it is a weird error in the data or mysterious machine behavior. I've never turned EPR off, and the machine settings for that night indicate that it was on...

I don't see that. I see machine settings saying EPR was ramp only, and I see ramp only during the EPR part of the night, based on the pressure trace, as well as the median, 95% and max numbers in the stats.

I suppose that could be some kind of weird glitch... what's the mask pressure line for sep 20 look like?

Just realized what the confusion is. I was thinking you were talking about the June 20th night in terms of EPR, and you were discussing the September 20th graph. About to get to sleep but will post the chart in the AM. Trying to minimize screen time at night to not interfere with sleep. Thanks again for all your help.

[palerider]

I'd bump the minimum pressure up to 7.

[eyeheartny]

I'd bump the minimum pressure up to 7.

Thanks, I'll try that tonight. Woke up with a headache that hasn't cleared yet. Here's what last night looked like. All the reported "centrals" had the zigzag pattern before them, so it looks like that's a consistent issue for me-- something is disrupting my sleep, whether it's pain or congestion. I think things felt better nasal congestion wise without the humidifier on, so I'll keep that off.

I noticed last night I was burping up a good bit of air early in the morning. Does that mean I was swallowing air? I'm wondering if I need EPR on to stop that, but with a higher minimum pressure (like you recommend, around 7ish).

Anything else that stands out from this chart from last night other than raising minimum pressure?

screenshot-20180924-141358.png (257.69 KiB) Viewed 326 times

[Julie]

Looks more likely that you are leaking somewhere... try a full face mask? Or taping? Or soft cervical collar?

[eyeheartny]

Looks more likely that you are leaking somewhere... try a full face mask? Or taping? Or soft cervical collar?

Thanks for the reply, Julie. What are you seeing that looks like a leak somewhere? I don't think a full-face mask works for me as I have a beard/mustache and I'm not willing to shave it. I tried a Dreamwear full-face and it wouldn't seal at all. I will run to the drugstore later to get tape and see if they have a cervical collar. Would you agree with trying to raise the minimum pressure as well?

[Pugsy]

Check to make sure you have accidentally turned off the large leak flags. You had some large leak but it's not flagged.

Lower left below the graphs...see where it say Flags and has a little arrow thing and see where the LL is red/black. That is the large leak flag and you turned it off. To turn it back on just click on it and change it to green/black.

Increasing the pressure isn't going to help reduce the centrals and yes..burping a lot means you got some air in your stomach.
Aerophagia...google it or do a forum search for it.

Be careful if you increase that pressure. It may make the aerophagia worse and it won't do a thing for the centrals/CAs.

[eyeheartny]

Check to make sure you have accidentally turned off the large leak flags. You had some large leak but it's not flagged.

Lower left below the graphs...see where it say Flags and has a little arrow thing and see where the LL is red/black. That is the large leak flag and you turned it off. To turn it back on just click on it and change it to green/black.

Increasing the pressure isn't going to help reduce the centrals and yes..burping a lot means you got some air in your stomach.
Aerophagia...google it or do a forum search for it.

Be careful if you increase that pressure. It may make the aerophagia worse and it won't do a thing for the centrals/CAs.

Thanks, I’ll keep that in mind. I think the “centrals” may be false positives/post-arousal events. There’s no decrease in the flow rate when I look at the zoomed in charts. I posted a few screenshots earlier in the thread.

Whatever is going on I need to figure it out. I’ve had a bad headache all day and feel exhausted, worse than before I started therapy. The only bright spot is that the congestion appears to be improving after a few steady days of Allegra.