First night at home with cpap - fast breathing periods?

[jwwill0]

I had my first night at home with the new machine after recently being diagnosed. Equip in sig, but RemStar Pro, HH, w/ Mirage Quattro full face mask (nasal congestion and mouth breathing issues).

During the titration study, I went to sleep fairly quickly and slept on my back the entire night. At home last night, I tried to sleep on my side more. I don't think I have the mask adjusted right yet, but was eventually able to get a good seal that lasted most of the night. Initially I couldn't get comfortable with the pressure, then kept having leak issues as I would shift slightly or my face would relax or tense. After the first hour and a half or so of not sleeping and adjusting mask laying down, I finally just got up and stretched, and relaxed for about 10 minutes. I went back to bed and it still took a while (not sure how long) but finally went to sleep. I think I slept for about an hour. Woke up with a leak, but not too bad and was able to adjust laying down and went back to sleep. Slept for about 4 hours that time. Also, I don't remember seeing where the mask type was entered into the machine, so the leak would be Total Leak, correct? If so, the average leak was listed at 9.5 l/m, but I don't know the typical leak of this mask at 11 cm H2O. ResMed mask with Respironics machine.

Data:
Pressure: 11
CA: 0.5
OA: 0.3
H: 0.8
FL: 0.0
VS: 4.1
RE: 0.6
AHI: 1.6
Average Leak: 9.5 l/min (After the first three hours of higher leaks, the actual was probably somewhat less than 9.5)

I can't upload screenshots of the trends directly here I don't think, so I need to find a site to upload and link. I notice that I had a couple of periods where my breathing became very short and fast, but was consistent. One time that I know I woke up was right after one of these and I had turned onto my back and my mouth was open and a little dry. Again, full face mask with HH and it wasn't really leaking. Just curious if you all think the change in breathing is related more to turning onto my back or if that is a specific sleep cycle (REM??), or both.

I feel pretty decent this morning so far. I don't necessarily feel super sharp, but do feel sort of refreshed. After the titration study, I felt this way for about an hour the next morning before getting tired again. So far today it has been about 3 hours.

[Pugsy]

Aren't you using Encore Pro 2.4xx? If so it defaults to report unintentional leak which is what that 9.5 sounds like.
If it was total leak we would expect to see something in the 30's to 40's with full face mask.
There is no place to input mask type to alter what the machine uses as a baseline. Instead it seems to pick up an average (like when you first start up and having no leaks). It is a close estimate so don't try to match it number for number. If you look at the detailed report it will say Unintentional Leak or Total Leak at the right side by the overall nightly average. This can be changed to Total Leak if you wish.
So your 9.5 L/min average is likely Unintentional or excess leak but it is quite acceptable. I wouldn't worry about it at all. I look more at the line itself than the number. If fairly straight at whatever number..it is good.

I use Photobucket for my report screenshots. It is free. There are others available. If you use the IMG address and not the url address we don't have to click on a link to see your reports.

[jwwill0]

Thanks Pugsy! I am using the software and you are right. It says Unintentional Leak. After the initial couple of hours where I was adjusting the mask constantly, the leak leveled out to almost a straight line the rest of the night around 7-8 l/min. Should I be targeting something better than that or is that a good fit for the mask?

Also, I'll get an account to upload the trends of the breathing pattern changes. Thanks!

[Breathe Jimbo]

Faster breathing is common during REM sleep. Don't worry about it.

[Pugsy]

After the initial couple of hours where I was adjusting the mask constantly, the leak leveled out to almost a straight line the rest of the night around 7-8 l/min. Should I be targeting something better than that or is that a good fit for the mask?

That is a good fit. Especially for a full face mask. I wouldn't be messing with things trying to fix what isn't broken. Due to the way the software establishes the baseline you may not be able to ever have a 0.0 anyway. Your baseline could very well be that 7 L/min line. It is hard to describe but not everyone will have a zero baseline to run start out with.
Since the machine has no way of knowing exactly which mask you are using it doesn't come up with an exact baseline.
The baseline will vary depending on mask an pressure.

Example. I use the Swift FX and at my average pressure the intentional vent rate is around 35 L/min.
Now when I toggle the software to show Total leak in the reports I see around 28 L/min most of the time.
Well common sense tells us that isn't right. I can't have a total leak that much less than my vent rate but that is what the report shows.
If I toggle back to Unintentional Leak it will report often less than 1.0 L/min and the leak line sits on the zero line.
I could drive myself nuts trying to figuring out how Respironics comes up with the baseline.... or I can simply look at the line itself and give it a quick glance. If only minor little blips I am doing fine and I don't have a headache from worrying about why the numbers aren't perfectly correlated. I am lazy. I just glance at the leak line and move on.
Short term blips and upward spikes will happen from time to time. Just make a mental note to self that mask was leaky and work on fixing it and be done with it.

[jwwill0]

[Pugsy]

That report looks awesome. Your leak baseline is going to always be right about where you see it leveled out. It might change if you switch to a different mask type.

Your numbers are great. I wouldn't try to do anything different. I don't see anything that needs fixing.
Well done.

[jwwill0]

Great! Thanks! So those quick breaths that lead up to that CA event were REM sleep? I'm not worried about it just curious on how to interpret the trends and distinguish different patterns.

[Pugsy]

Great! Thanks! So those quick breaths that lead up to that CA event were REM sleep? I'm not worried about it just curious on how to interpret the trends and distinguish different patterns.

It is possible. We don't have any way to know with certainty given the data we have on hand. It is common to breathe a little more rapid while in REM sleep and the timing of those events loosely correlates to the cycles of sleep where we might see REM. Towards the wee hours of the morning we normally will have more REM cycles and they will last a little longer.
You can see "normal" stage in the Hypnogram here.
http://en.wikipedia.org/wiki/Sleep
It could even have been a little mini arousal. The only way to know for sure would be with an EEG and PSG.

Either way nothing to be alarmed about. I suspect some nights you will have some and other nights you won't.
My OSA is documented really worse in REM sleep. I use APAP and sometimes it never raises the pressure any and sometime it will nearly max out. When it does max out it is always in those wee hours of the morning when we normally have more REM stage sleep.

[DaveLP]

I like the detail of the graphs, especially where it displays codes on top of events in the flow graph.

My Intellipap Smartlink software doesn't generate flow graphs. It's my only sticking point with the software. Other than that, the data it presents is good.