Just started CPAP

[btown]

I have just completed my second night of cpap. So far so good, i do feel more rested. Having some trouble with my Resmed full face mask. To keep leaks from happening I have to strap it down so hard that it gives me a headache. My real question though is that when browsing the menu on the cpap, it says my 7 day average AHI is 17.5. I was wondering if this is accurate? Or could the testing that the respiratory specialist did on the unit have artificially bumped the number? My doctor said I was down to an AHI of 3 during my titration. Also would taking your mask off and leaving the air on while you go to the bathroom register as an apnea event?

[pap4life]

Hi btown... welcome to the land of CPAP. Straping down do hard to stop leaks is the wrong thing to do. It shouldn't be necessary to strap down so hard. It may take several trials with different mask to find a more comfortable one that doesn't leak. Leaking masks are probably the nr.1 problem child with CPAP useage.
I'd be patient with the AHI numbers that you are getting from the 7 day average. Remember the 7 day readout is only for your past two days. Give it a week (7days) to see exchatly what your AHI (7day) average is before making a deal out of it.

[LSAT]

If you would fill out your profile we would see what mask and CPAP you are using. I'ts hard to diagnose without that info.
The 7 day average probably reflects only 2 nights.

[ameriken]

I have just completed my second night of cpap. So far so good, i do feel more rested. Having some trouble with my Resmed full face mask. To keep leaks from happening I have to strap it down so hard that it gives me a headache. My real question though is that when browsing the menu on the cpap, it says my 7 day average AHI is 17.5. I was wondering if this is accurate? Or could the testing that the respiratory specialist did on the unit have artificially bumped the number? My doctor said I was down to an AHI of 3 during my titration. Also would taking your mask off and leaving the air on while you go to the bathroom register as an apnea event?

The 7 day average is probably just a normal thing and you'll see that until you actually do have 7 nights in. It's probably just averaging the nights (night) you have so far. Just keep going and don't quit. As for the mask, yes, you don't want to crank it down so much that it hurts, that defeats the whole purpose of trying to get you to sleep. Somewhere you'll find a happy medium and it may take a few nights to get it tuned in. Give it some time. You might want to consider a maskliner from www padacheek com. They're pretty good for making a comfortable fit and stopping leaks.

[btown]

If you would fill out your profile we would see what mask and CPAP you are using. I'ts hard to diagnose without that info.
The 7 day average probably reflects only 2 nights.

Done.

[archangle]

Get SleepyHead and you can look at the results in detail, including when apneas happened.

Taking the mask off won't record as apneas, but it does screw up some of your statistics like leak numbers. It's better to turn it off and on.

Some of the full face masks are tricky to get to seal right. There are some hints around here, but a big one is that sometimes looser is better because the seal has to inflate to seal well.

[Pugsy]

Regarding the 7 day average on the LCD screen when there are only 2 or 3 nights....it is still an average of however many days the machine is used. AHI average of 17 points to something not working effectively.
It won't magically go to AHI of 3 on the 7 th night unless the AHI is markedly improved on subsequent nights.

Get SleepyHead (look in my signature line for link for download and the User Guide) then you can see each night's daily details and see for sure what is going on. I suspect that major leaks are impacting therapy negatively. Taking the mask off to go to the bathroom will NOT cause any apnea events to be scored. It will impact the overall leak numbers but it is easily seen on the leak line graph using the software.

What pressure are you using? You may need to add a mask liner to help with leaks and comfort. These masks should not be tightened to the point of pain. It actually makes the leak worse.

Also at what pressure are you fitting the mask initially before going to sleep? Are you using ramp and the lower ramp pressure to adjust the fit?

[retrodave15]

As a fellow Mirage Quattro user - it is a mask that takes some finesse to get seated properly on your face:

Check out "Taming the Quattro", which I have found really helps

http://maskarrayed.wordpress.com/taming ... -quattro//

Tighter which you think would make this mask seal is the wrong way to go. This mask has an air cushion so "just tight enough" is the operative phrase.

[btown]

I am using a pressure of 20. My mask is rated to have a leak rate of 50 at that pressure and sleepyhead says that the 95th percentile is 53. So unless im way off the mark I think leak rate is in check.

My AHI for last night breaks down thusly...

Total: 15.90
Hypopnea: 3.77
Obstructive: 1.69
Clear airway: 10.48

Thanks for all the good advice.

[Pugsy]

Your leak is fine. Your clear airway events are not fine. THey are way too high if you have this number every night if you can say that during the time the clear airway events are flagged at you were awake or possibly awake.

Do you know if you had any history of centrals on either one of your sleep studies?
Do you have copies of your sleep studies? If not you should get them.

Could you post a screen copy of one of your reports?

If you don't know how this is how I do it.


Open the image to full size so it is easily read.
I use Vista snipping tool to create a screen shot and crop the image at the same time.
Prt/scr key will also take a screen shot if using XP. If laptop is used sometimes the Fn key has to be pushed at the same time as the prt/scr key
I think windows 7 Home Premium has the snipping tool, Basic may not.
Once the screen shot is created save it in jpg format.

Upload the image to a host site. I use Photobucket it is free, there are others.
Once the image is uploaded then copy the ENTIRE IMG address. Be sure to include the opening and closing IMG in brackets. Paste that copied address into a post here.
Use the preview button. If you can't see the image try again because if you can't see it we can't.

[btown]

I dont have any copies and wont be able to get any for a few days because of the holiday weekend. But I think I may know what the cause is here. While reading about the Clear Airway apneas I found a paper by philips that discussed their algorythm. They said that when you stop breathing they ramp the pressure up by 2cm and fire bursts into the airway. If there is flow then it is a clear airway, if not it is obstructed. So keep that in mind. Now to my personal experience. While trying out the cpap I noticed that at a cflex 20-3 = 17 that i had to push hard to empty my lungs. (It required conscious thought.) I noticed that my lungs would not vacate air completely and that occasionaly I got to the point where I should be inhaling, but my lungs were still full. Now remember that the algorythm calls for upping the pressure by 2cm for it's test pulses. This could force just enough air into my lungs to trigger the clear airway apnea flag.

TLDR: I think the problem is that I can't breath out against the pressure while asleep. Thus leaving the airway open, but me apneatic.

[Julie]

Then you need a machine with something called either a-flex or c-flex (and I think you have one) which does exactly what you want... makes exhaling easier. Did you get any kind of a manual with your machine? It should tell you how to turn the feature on and off...

[Pugsy]

The Flex settings on the Respironics machines (either CFlex or AFlex) do NOT reduce the pressure during exhale on a cm per setting like the ResMed machines do with their EPR settings. Instead the reduction in pressure is flow based in response to you own individual breath. The more forceful your breath the greater the reduction. CFlex of 3 doesn't give you exhale pressure of 17.
You can read about it here.
http://cflexplus.respironics.com/

Given your cpap pressure of 20cm (yikes..a hurricane) on the PR S1 Pro cpap and the abundance of clear airway events....I don't know why they didn't give you at least a BiPap machine to make it easier to exhale and perhaps deal with the clear airway events (centrals if you had them on your sleep study)

I would suggest talking to someone about
1. the clear airway events which are too high
2. the fact that 20 cm of pressure is difficult to exhale against and bipap would make it easier. CFlex won't give near the exhale relief you could get on a BiLevel machine and if you had zero centrals in any of your sleep studies...that 20 cm pressure may be actually causing those Clear airway events.
All this points to things not going well and it is so far off that I don't think "giving it time" is going to make any huge difference.
I wouldn't be waiting for long if it were me.

While trying out the cpap I noticed that at a cflex 20-3 = 17

[Kilgore Trout]

To keep leaks from happening I have to strap it down so hard that it gives me a headache.

I know the middle of the night Quattro anger well. Suddenly the air channels Harry Houdini and finds an escape in every direction, or makes that farting sound (which I know my wife wonders was really the mask).

If you're a man with facial hair, the Quattro is a challenge to get a good seal with. With smooth clean skip, usually looser is better, though I practically had to hot glue the thing to my face to make it through the night. I ended up switching to nose pillows and a chin strap, and it's much better for me.

[btown]

I would suggest talking to someone about
1. the clear airway events which are too high
2. the fact that 20 cm of pressure is difficult to exhale against and bipap would make it easier. CFlex won't give near the exhale relief you could get on a BiLevel machine and if you had zero centrals in any of your sleep studies...that 20 cm pressure may be actually causing those Clear airway events.
All this points to things not going well and it is so far off that I don't think "giving it time" is going to make any huge difference.
I wouldn't be waiting for long if it were me.

While trying out the cpap I noticed that at a cflex 20-3 = 17

Have some new numbers from last night...

Total AHI:10.40
Hypopnea: 3.24
Obstructive: 1.23
Clear Airway: 5.93

My next meeting with the Sleep Doctor is coming up in ~30 days. So I guess I wont tinker with my settings and see if the AHI stabilizes at some point.