New: Help! Too many ahi's

[Stejoel3]

Hi everyone,

I've been unable to have a good night's sleep in years. I wake up over and over gasping for air all night long and snore terribly. I've always thought I had sleep apnea. The problem was that I've a had a terrible phobia of medical procedures and tests since I was young. I finally couldn't take it anymore and persuaded my Psychiatrist to prescribe an apap. I got an intellipap auto with all the software last week. From what I can figure out I've been having around 15-22 ahi's per hour and the pressure has gone from about 11-14 for the past few nights. The pressure is set for 10-16. I'm trying to figure out how to get the ahi's under 5. Any suggestions would be appreciated.

[mdbarthe]

Hi, Stejoel3,

Welcome to the forum. It helps if you register and fill out your profile which displays your machine equipment, model, mask, software, etc. Do I understand that you did not have a sleep study done?

It takes some time to adjust to the equipment and your body to get used to breathing at night again, and everyone is different as to how much time that takes. Is your software measuring any mask leaks you might be having at night? If your mask is leaking, you most likely are not getting good treatment and that would effect your results.

How are you sleeping and feeling in the morning? Do you sleep better with the therapy and do you feel more rested in the mornings?

[stejoel]

I did not have a sleep study.
Here is some info from the report. Is the leak bad?




Events Summary (AutoAdjust Mode)
Time: 5 Hours Mask Leak Time: 0.8 % of total
AHI: 19.6 Per Hour EPI: 0.2 Per Hour
AI: 0 Per Hour Average Pressure: 14.4 cmH2O
HI: 19.6 Per Hour Average Leak: 66.1 L/min
NRI: 0 Per Hour Avg. Est. Tidal Vol.: 761 mL
Snores: 1 Events Avg. Breath Rate: 21.3 bpm

[stejoel]

here is more from the report

http://www.flickr.com/photos/35677752@N02/3304306984/[

[SharkBait]

I did not have a sleep study.
Here is some info from the report. Is the leak bad?




Events Summary (AutoAdjust Mode)
Time: 5 Hours Mask Leak Time: 0.8 % of total
AHI: 19.6 Per Hour EPI: 0.2 Per Hour
AI: 0 Per Hour Average Pressure: 14.4 cmH2O
HI: 19.6 Per Hour Average Leak: 66.1 L/min
NRI: 0 Per Hour Avg. Est. Tidal Vol.: 761 mL
Snores: 1 Events Avg. Breath Rate: 21.3 bpm

At first glance that leak rate does look bad. Your mask should have some documentation that shows the vent rate (kind of a designed "leak" to flush out exhaled CO2). Your AI of course is awesome, and I bet once you get that leak rate down closer to the vent rate the machine can maintain the pressure necessary to knock that HI down as well...

Keep wearing that mask. I personally will read all night before I take the mask off and sleep without it...

[SharkBait]

At 14.4 cmH20, your mask should vent around 41-42 lpm.

You need to seal that puppy up some...

[SharkBait]

Here's the user manual for your mask, it has a chart showing the vent rates...
http://www.resmed.com/en-us/products/se ... smulti.pdf

[stejoel]

I haven't noticed any air coming from where the mask meets my face. Could I be breathing through my mouth when I'm sleeping?

[SharkBait]

I haven't noticed any air coming from where the mask meets my face. Could I be breathing through my mouth when I'm sleeping?

Absolutely. If you're not detecting a bunch of mask leaks, and I'd think you would be able to hear and feel them, then out the mouth is the next logical place. Pretty common as you'll find lots of folks trying different things (chin straps, tape, denture strips) in an effort to seal up those lips. Of course, a full face mask will solve the problem as well as it covers the mouth thus eliminating that leak.

Have you been experiencing any "dry mouth"?

[stejoel]

Yes I have had a dry mouth. I think I'll try taping my mouth first and see if that does anything. Thanks for your help by the way.

[SharkBait]

Yes I have had a dry mouth. I think I'll try taping my mouth first and see if that does anything. Thanks for your help by the way.

My pleasure.

Yeah, look at your avg leak on your chart...



You start out okay, but you start drifting up, presumably as you fall asleep and your mouth opens. Could also be that you turn over on your side and are knocking your mask loose. But based on where you start out it looks like your mask starts out doing fine...

[SharkBait]

Yes I have had a dry mouth. I think I'll try taping my mouth first and see if that does anything. Thanks for your help by the way.

Remember, when you're leaking out like crazy, your machine really has no idea what you're getting as far as AHI... And your chart also shows as the leaks go up, the machine starts sending your pressure up as well and stays maxed out. It's great you've got the software to show you these kinds of things. Get the mouth sealed and you'll most likely be doing great.

[stejoel]

Well, I taped my mouth shut and here are the numbers and a graph.


Events Summary (AutoAdjust Mode)
Time: 3.3 Hours Mask Leak Time: 0.2 % of total
AHI: 20.6 Per Hour EPI: 0.9 Per Hour
AI: 0 Per Hour Average Pressure: 12.6 cmH2O
HI: 20.6 Per Hour Average Leak: 56.7 L/min
NRI: 0 Per Hour Avg. Est. Tidal Vol.: 782.5 mL
Snores: 1 Events Avg. Breath Rate: 20.1 bpm

http://www.flickr.com/photos/35677752@N02/3306487056/

[kebsa]

I know that sealing for leaks is important and i know that many people here have come up with a variety of methods to keep the mouth shut. I know that i have skin that reacts to many tapes and basically if i use any tape on a regualr basis it will gradually cause problems and this is not all that unusual- so i just thought i would mention that there are a variety of chin straps that can be useful- i had to try a couple before i found one that worked well and i eventually found one made of neoprene called the Ruby that works well for me. The interesting thing is that after being a mouth breather for years even a few weeks worth of using this seems to be re training me to sleep with my mouth closed- i just thought it was worth mentioning!

[rested gal]

i just thought i would mention that there are a variety of chin straps that can be useful- i had to try a couple before i found one that worked well and i eventually found one made of neoprene called the Ruby that works well for me. The interesting thing is that after being a mouth breather for years even a few weeks worth of using this seems to be re training me to sleep with my mouth closed- i just thought it was worth mentioning!

It's always a good idea to try a chin strap (several types) in case that's all it takes to prevent mouth-breathing and let a person wear whatever mask they like. The Tiara Ruby chinstrap seems to suit quite a few people.

For people whose tongues maintain a leakproof seal inside the mouth, if only the jaw doesn't drop too much, a chin strap can be just the ticket.

For others, it doesn't matter how closed the mouth is or how the jaw is held up, even to the point of clenched teeth. Some people's mouth geometry just isn't going to allow the tongue to hold an airtight seal, and they'll have cpap air detouring into the mouth and out, as lip puffs or lip flutters. It's a short step from there to breathing in through the mouth, too, during sleep.

But yes, that's a good suggestion, kebsa, to try various chin straps. Especially the Ruby.