Another frustrated newbie

[MushCreek]

Ooookay. It reverted back to Thursday. Let me see if I can attach Wednesday, too.

screenshot-20210226-144817.png (128.47 KiB) Viewed 1378 times

[Pugsy]

What is really weird is your leak rate is never at 0.0 or anywhere close to zero and it should be.
Your baseline leak rate is close to 20 L/min.

What is your mask setting for on your machine...pillows, nasal or full face?

We need to get the baseline leak lower because right now the slightest leak puts you over the 24 L/min mark and something isn't right here. Check to make sure the water chamber is fully and completely inserted. Make sure there are no holes in the hose anywhere and no tears. Easiest way...fill up the hose with water and look for drips or wet areas.

[MushCreek]

Last night was a lot better as far as leakage is concerned, although I have no idea why. It seems to me that the AHI is rather high considering a better night. Also, it runs out of water. I fill it to the max, and at 7 hours it is empty, and my mouth is dry. Does leakage cause it to use water faster?

[resmed10guy]

Some background- 69 years old, very bad shape for my age, exercise rarely, so so diet, cancer survivor, stay very lazy in my recliner.

First of all, I admire your good health and keeping fit.
Second, I have a very short beard and score 90-100% nightly.
Third, I did not sleep my first couple nights due to having that mask on my face. Sad to say, gone are the days of laying my head on a pillow and dozing off. The mask changes everything. Despite hearing miraculous stories of how CPAP completely changed lives, I have noticed little help with snoozing during the day. But, I am breathing correctly through the night.
Fourth, don't give up. At least when my spouse or dogs fart during the night, I never smell anything but fresh air
Fifth: Make sure you have the right size mask. Sounded like your CPAP handlers weren't the sharpest.
Good Luck

[MushCreek]

The further I get into this, the more confusing it gets. Last night, my leakage was less than 3%. Yay, right? Wrong. My AHI went UP to over 12. Let me get this straight- my mask is working better, and my apnea got worse?!? A most of last night's trouble was Cheyne-Stokes respiration, the first time that has showed up on my read-out. At any rate, I have an appointment with the equipment provider tomorrow morning, and I'm not going to leave until I'm satisfied.

[zonker]

The further I get into this, the more confusing it gets. Last night, my leakage was less than 3%. Yay, right? Wrong. My AHI went UP to over 12. Let me get this straight- my mask is working better, and my apnea got worse?!? A most of last night's trouble was Cheyne-Stokes respiration, the first time that has showed up on my read-out. At any rate, I have an appointment with the equipment provider tomorrow morning, and I'm not going to leave until I'm satisfied.

without seeing the chart, we can't tell WHY your ahi was up over 12.

there's more to ahi than leakage.

plus, we don't necessarily sleep the same way every night.

[Miss Emerita]

Please do post the chart from last night, as Zonker suggests. The chart from the previous night is suggestive of some changes to your settings that might be helpful, but it'd be important to see what was going on last night.

About the high base-line leak: Did you check the hose, as Pugsy suggested? And check how the water chamber is seating? (Look inside the machine to see whether the tub seals are twisted or torn.) Does the tub leak? Is the plastic part of the tub well sealed to the metal plate at the bottom? Does the lid click fully shut? Is the coupling of the long hose to the short hose secure? Are you inserting the tub firmly enough? (I give it a little spank when it's almost all the way in.)

Given the fact that you run out of water in 7 hours, my suspicion is that you have a problem with the water tank.

[MushCreek]

Here's last night's screen shot.As you will see, leakage is way down, as was water usage. I've checked everything I could for sealing. I think it's the face mask, as I can hear and feel when it is leaking. I think I've learned to stay still at night, keeping a better seal (or I just got lucky). What scared me about last night is the appearance of the CSR. From what I read, CSR is not good, although the CPAP machines don't always accurately identify it. According to my PCP and cardiologist, my heart is fine. I had tests done recently, as I had a stent put in 3 years ago. I've already noticed that a lot of my apnea, hypopnea, and CSR are around an hour after I go to sleep.

[zonker]

Here's last night's screen shot.

here's one of the things about sleep apnea and trying to beat it into submission; sometimes, you put out one fire only to have to put out yet ANOTHER fire.

now that leaks are under control and the machine can start to do it's job, we find that your ahi is still high. why is this? well, i'll take a stab at explaining and then someone will come in and tell me i'm full of prune juice. or not. i'm willing to risk it.


can you see what this chart is telling us? see that green line in the pressure section? that's the very slight air pressure that is trying to open up your airways. the higher that pressure goes, the more open your airway.

but it can't get past the maximum that is set at 10. it keeps crashing into it. for 95% of your time on the machine, it was at the 10 (or below). so i would suggest that you set the maximum pressure at 20. this will allow the machine to do it's job.

good luck!

[MushCreek]

Yeah, my machine is set up right now to go from 7.0 to 10.0. I was thinking 10 was pretty low compared to what I see. I found out how to re-program it, and I may try that, but in baby steps. Tomorrow, I go try to find a better mask. I think I need to settle in with the right mask so I can get consistent results. Then I'll start tinkering.

[zonker]

Yeah, my machine is set up right now to go from 7.0 to 10.0. I was thinking 10 was pretty low compared to what I see. I found out how to re-program it, and I may try that, but in baby steps. Tomorrow, I go try to find a better mask. I think I need to settle in with the right mask so I can get consistent results. Then I'll start tinkering.

as you wish....

[MushCreek]

Another mask; another fail. I went to the equipment provider, and spent a while trying different masks. I went with one that covers the nose, A ResMed AirTouch F20. It's very comfortable, and worked well in the office. I put it on last night, and all was good for a short while. Then, it started leaking. I kept adjusting, and it would work a while, then start leaking. Apparently, the memory foam is anything but. By morning, the only thing that worked was to put my hand over it, and push down HARD. 33% large leak, AHI 13.4.

I've tried all of the masks (two) that this place offers. They have a nose-only one, but I tend to breathe through my mouth from time to time, so there's no point in trying that one. Now what? TBH, I'd like to try another DME dealer, if there is one. I'm very disappointed with this place so far. The masks are leaking around my nose, not my beard. I can feel the air blasting upwards towards my eyes. I used to scuba dive, and finding the right mask is crucial. The test is that you place the mask on your face and suck in. It should stick on without leaking. With the CPAP mask, it's just the opposite. You have pressure trying to push the mask off of your face. I'm assuming that there are other manufacturers for this stuff? I have a very normal nose and face; nothing unusual or damaged.

Should I call the pulmonologist and ask her what to do? Maybe they can refer me to a different dealer, that carries different equipment? So far, I've experienced poor sleep, pain, a numb nose, annoying leaks, and my AHI has gone up pretty much every night. Thanks for any advice!

[yule6565]

Hang in there...I am newly diagnosed and just started on 1/21 with a Phillips Dreamstation. ( 55 yr old ) I have good nights and bad nights. Still trying different nasal cushions. It still wakes me up frequently when the cushion moves or I feel the hose tugging on my head. They gave me 3 cushions to try. Even with all that, I can tell when I am sleeping, my sleep quality is much better. No more waking up with my heart pounding like I just ran a 100yard dash. Like my resp therapist said, it may not be the most comfortable thing but it beats having a heart attack!

[Miss Emerita]

MushCreek, I hope you'll do as zonker suggests and raise your maximum. I also think it's worth trying to introduce some EPR (expiratory pressure relief). This reduces your pressure when you exhale -- and therefore it increases your pressure when you inhale, which may help you some with the hypopneas and flow limitations.

If you're game to try that, I'd suggest setting EPR to 1 and raising your maximum to at least 12. This will mean an increase of only 1 to your maximum exhale pressure. I'll be curious to see the results if you try this.

[MushCreek]

Until I can find a mask that fits, I don't think much else will help. I came closer with the F30i, but it is too painful to consider for use every night. The nasal pillow feels more like a nasal anvil. I wake up in pain after a few hours of use. The full mask one I tried simply will not maintain a seal. I'm going to try to get the air cushion to replace the memory foam, and see if that helps. I've read numerous articles about mask fit, and haven't come close to a candidate so far. Since my DME provider has so few options, I'm going to call the pulmonologist and see if she can recommend a competent supplier.