Leaks and Events Coinciding

[questor1]

Hi Folks,

I'm new to the CPAP world and have had my CPAP for just over two months. I'm very pleased to have found this forum! This is my first post and I assume the equipment information I provided in my profile will display when I post this message, but just in case I'm using a ResMed S9 with a full mask and Sleephead Software.

I have a load of questions, but I'll start with some observations and just one question. As I look over the charts I see an absolute correlation between recorded events and reported leaks. Every time I see a cluster of events, I also see a pattern of reported leaks. (I've attached a 16 minute slice from last night as an illustration of what I mean.) I have an occasional isolated event, but every time there is a cluster, there is also leak data. The question is whether the events are artifacts of the leaks, visa versa, or what?

[Pugsy]

Due to the scale of the leak line graph we can't really see how much leak is going on.
Could you show and image of the night without zooming in on a section of time and also include the numbers under the AHI bar graph on the left? You have some massive leaks going on for the scale to be what it is.

If you are having a lot of central events get flagged during a time of large leak it may be that the leak is causing an awakening of sorts and thus possibly some awake/semi awake centrals.

Depending on just how much past 24 L/min (where your large leak territory begins) when the machine can't sense events effectively the first sign is unknown events being flagged. In other words the machine knows something is going on but can't tell you exactly what is going on.

If you are seeing events of some sort get flagged...they are happening. Now they might be awake events getting flagged since the machine can't tell if you are awake or not but something is being flagged. Events don't show up as artifacts during large leak.
If large leak is bad enough you might have a period of time where nothing gets flagged due to machine's inability to function properly but if you are seeing something getting flagged...they aren't artifacts from a large leak.
Instead the leaks are either allowing events to happen then you would likely see unknown events or nothing or increased obstructive apneas or hyponeas. For centrals to increase during a period of large leak we might wonder if the leaks caused an awakening and thus awake breathing irregularity might be flagged.

[CJay]

Hey guys, maybe someone can help me. On my ResMed S9 auto set after I downloaded the data on my card onto my laptop I saw on my graph that I had hypopnea episodes. Should I increased pressure?

[Pugsy]

Hey guys, maybe someone can help me. On my ResMed S9 auto set after I downloaded the data on my card onto my laptop I saw on my graph that I had hypopnea episodes. Should I increased pressure?

Depends....on several things and especially depends on how many you had and how many of the other event categories you had.

[questor1]

Thanks for that quick reply! Here's the full chart of last night with the info on the left. The AHI of 10 is not a typical night as my 76 day average is 4.39, but I figure for this question it might actually be good to post. I can always post a more typical night if that's what's called for. Here's some additional information from the Statistics screen. The Pressure is 11, Average Leaks 2.9 and 95% leaks 22.80. In order to see the scale better, I included a chart with just the Leaks and Flow Rate. Thanks!

[Pugsy]

There's a definite correlation with leaks and events. Seems to be primarily centrals events which makes me wonder if the leaks woke you up at some level even if you don't remember. Of course it's impossible to know for sure unless you remember being awake fairly often during the time frame in question.

So either the leaks are maybe waking you up (that would be my first suspect) or the leaks are allowing a few events to sneak past the defenses. Sneaking past the defenses is probably what you see with the obstructive apneas.
The centrals though I imagine are more related to maybe waking up and having some sleep wake junk centrals pop up.
It's fairly common for the machine to flag some centrals when we are awake or semi awake or during sleep stage transition.

Since it is not a common occurrence I wouldn't spend a lot of time worrying about it.
Your 95% leak number is 22 so that means for 95% of the night you were at or below that 22 L/min mark. It's pretty obvious when that bulk of the leak occurred and you likely skirted that 24 L/min line a good bit of the time where you see the leaks increase.
It's still hard to see exactly where 24 L/min would be.
If you used ResScan you would have a red line at 24 L/min that would show up despite the scale and you could have a better idea what events happened when the leak exceeded 24.
That one big leak spike at the beginning of the night is throwing the scale way off making it hard to see actual leak numbers on the graph up close during the time where it is obvious the leak increased significantly.

I don't worry about oddball nights other laugh and blame them on alien abduction. We all have them from time to time. Even long time cpap veterans. We don't always have a black and white explanation as to what happened. Not long ago I had 17 centrals in 17 minutes about 2 hours prior to waking up and I didn't remember anything that would explain it. So I just blamed it on the aliens. Another night I had a truckload of events both central and obstructive during an hour one night where I know for sure I was awake because I was fighting the urge to go vomit for an hour. I was most definitely awake but breathing weird trying to fight the nausea and keep from getting up to go throw up.

Were you wondering if the events were real? They are indeed real in the sense that the machine sensed some sort of reduction in flow rate but the machine doesn't know if you are awake or asleep and it can and will flag awake stuff which can make for some real ugly looking reports but they don't really count if you are awake.
To me it looks like your leaks likely disturbed your overall sleep quality and you woke up somewhat or a lot and the machine likely flagged some awake breathing irregularities. The machine has its limitations and just calls them like it sees them.
You have to determine just how important it is when you see this type of stuff. If there is a good chance you were awake then they aren't important.

[questor1]

Thanks for that detailed explanation. I suspect you are correct about me waking up at some level. In retrospect, when I wake up after about 4 hours and have to take the mask off, I usually notice a leak. I suspect the small leaks before that have disturbed my sleep enough that it tips the scale and I am fully awake. I know when I had the sleep study, they told me I woke up 127 times and I only remembered waking up twice. I'm going to crank down on the harness tonight and see what happens.

[questor1]

Last night I cranked down on the harness and the results were positive. I did get 4.5 hours before I woke up. I did notice a small leak, but shifted the mask and tried to go back to sleep. When I went to check my stats, I realized I had left the SD card in the computer yesterday. As a result all, I was able to get was the first screen data. However it was good with a 5.09 AHI and a 95% Leak of 2.4 The other positive thing is that sitting here at 4 AM, after going to bed at 10:45, I feel pretty good and not groggy. Going to hit this gym an about an hour or so.

[Pugsy]

Don't you just hate it when you realize you have left the SD card out? I have done the same thing.
It would have been nice to see how many of those events got scored around the time you woke up.

When you have time it would help if you add your equipment to your profile so we can see at a glance what you are using.
While not a critical issue it helps us help you better with any questions we might have related to your equipment. You don't have to keep typing it and we don't have to keep asking.

[questor1]

Actually, I did put in my equipment when I first signed up, but I guess I didn't click the submit button. I just did it again. If it doesn't show up then I have to do some more checking. BTW - I'm using SleepHead software. Is there somewhere I can get the ResMed software? If I go to the ResMed site, it looks like I either have to be a Dr. or a dealer.

[Pugsy]

The register required link is for an older version 3.16 and it really doesn't matter what information you put in the boxes...they don't check it. When I did it Mickey Mouse at Disneyland got the download.
Anyway, I sent you a private message with a link for the very latest version and you won't need to call upon Mickey Mouse to get the download.
This version is a little bit faster during the download of SD card data and that is about the extent of the changes that pertain to patients. The rest of the version changes are geared towards DME side of things.
It's still slower than a turtle with 3 legs.

[StuUnderPressure]

This version is a little bit faster during the download of SD card data and that is about the extent of the changes that pertain to patients. The rest of the version changes are geared towards DME side of things.
It's still slower than a turtle with 3 legs.

Do you have access to a Summary of the changes in ResScan 4.2 from ResMed OR are these just the changes you noticed?

[Pugsy]

Do you have access to a Summary of the changes in ResScan 4.2 from ResMed OR are these just the changes you noticed?

I have never seen the summary of the new version changes.
Can't find it anywhere in the new install. It might be there and I just don't know what I am looking at. I can open the main folder and find the usual ResScan Clinical Manual for the software but didn't see anything that looked like new release notes.
It isn't mentioned in the software manual that I could find.