Completely confused newbie...

[thasatelliteguy]

I realize I may be jumping the gun on the complex apnea too. It'd be nice if I am found to be wrong. It's not been proven one way or the other, just the observations of people that have known me all my life. I have no insurance, so this is really my only option anyway, so I may as well make all I can of it.

[thasatelliteguy]

My mask is Fisher&Paykel 431

[oak]

Ok, sorry I have been gone all day, but here are some answers to some of your questions...

1. I have a full face mask already. When my buddy gave me the original CPAP, he gave me nose pillow mask with it, but I am definitely a mouth breather, so I immediately found a medical supplier here in Houston that would sell me a mask cash.

4. Mask... I have no idea what model it is. It may be the source of the leak in and of itself. It is the CPAP mask that I originally got for the old machine. Unlike the hospital's mask, it doesn't have one hole, it has a whole patch of holes. Is this the wrong mask for this application?

I am not sure I understand about your mask. You say you bought a full face mask but you don't know the name of it? Does it have any writing on it? Can you look at full face masks on CPAP.com and see if you can find the same mask? The people here can help you not only with your pressure, but your mask, idiosyncracies of your machine, and many many other things. Come back here when you can and give more information to the "veterans, okay?" Try to be as descriptive and specific as possible, and you will get more help.

Hope the changes you made help tonight. Sweet dreams.

[Julie]

Hi - in case no one's told you, the 'patch' of holes is the CO2 vent. A very necessary feature and one that absolutely must never be covered by bedding or anything else because you end up rebreathing the CO2 and that produces some very unpleasant consequences.

[Pugsy]

Vent rate for the F & P 431 at 19 cm pressure is 46 L/min.
http://www.fphcare.com/CMSPages/GetFile ... ae8ba88198
Total leak per Respironics is the vent rate plus any excess leak... so the leak line hovering around 90 L/min...twice the expected vent rate...the times over 90 L/min up around 120 L/min...big large leak.

The mask is leaking a lot more than "a little" or there's some other big leak somewhere.
I sent you a PM with some information on getting Encore Software so we can see if Encore thinks you past the line into large leak territory.

[thasatelliteguy]

OK! I DL Encore... Here are the results...

Sunday night was the night I was at 74. It was also the night that the leak was the most. Avg of 57. Still, Encore never puts me into LL territory. Well it does, but like .4% of the night and such. (And I think that's mostly me allowing the machine to shut off cuz Mon was 1 min in LL exactly at the end of the night)

Monday night was a vast improvement. AHI 34.4. The leak meter is a nice smooth flat pretty line @ 43. However, I distinctly recall lynching the mask down tighter last night. So... it would appear that it helped, and I need to pay more attention to my mask leaking. I suppose I'll try the vaseline trick tonight on the lower section that contacts my beard.

So, Monday night's numbers, with no leak were:
21/11
CA 7.1
OA 26.1
H 1.2
VS .2
AHI 34.4

I'm thinking that the CA being down lower is a good thing toward the thought of NOT having central or complex?? And do you think I should tweak the pressure back down and possibly raise the EPAP a lil?

[robysue]

I have the mask extremely tight. I do have a goatee, and it tends to seep a lil right at my chin, but I mean a LIL. I don't think this is accounting for the large leak. Especially since I had the same goatee in the hospital, and their machine wasn't screaming at me about a leak. (And it griped at me for EVERYTHING! lol)

Overtightening a mask can increase leaks. You might be better off loosening the headgear a bit. You need to figure out if the mask cushion is an air-filled cushion or a gel-filled cushion or something else.

That said, I don't think a too-tight mask can be responsible for the incredibly steady Large Leaks that you are dealing with.

4. Mask... I have no idea what model it is. It may be the source of the leak in and of itself. It is the CPAP mask that I originally got for the old machine. Unlike the hospital's mask, it doesn't have one hole, it has a whole patch of holes. Is this the wrong mask for this application?

The "whole patch of holes" are the vents that prevent you from rebreathing CO2 when using the mask. They are where the intentional leakage comes from.

But a good question to ask might be: How old is this mask? If it's more than a year old, maybe something on the mask is worn out or aged to the point of being worn out even if the mask hasn't been used. (The silicon can deteriorate just by being left out in the open too long.) Perhaps there's a seal or a junction somewhere on the mask that is not properly seated and properly sealed. I take it you don't have the owner's manual for the mask. So I wonder if it's possible that the mask was disassembled at some point in the past and then improperly put back together. That could be the source of the leak. Of course, you'd think that if the leak were anywhere close you your head you'd notice either the jet stream of air being blown out at 90+ L/min or you'd notice the sound of the air hissing as it comes out of the leak.

5. I have the heated tube on the old cpap, but on the new one, no. It is a brand new machine, new hose, and yes it has the humidifier, and I am using it... I think. The System One option is ON in the menu.

Check the hose for leaks even if it's a new one. Check carefully around the couplings of the hose. And make sure the humidifier is properly attached to the blower unit and that the humidifier tank is securely placed inside the unit and that the cover is fully closed. Make sure that the hose is firmly attached to the coupling coming out of the humidifier unit too. And make sure that the hose setting is correct. Are you using a skinny hose or a regular hose?

OK! I DL Encore... Here are the results...

Sunday night was the night I was at 74. It was also the night that the leak was the most. Avg of 57. Still, Encore never puts me into LL territory. Well it does, but like .4% of the night and such. (And I think that's mostly me allowing the machine to shut off cuz Mon was 1 min in LL exactly at the end of the night)

Can you post the Encore reports? I really want to reconcile those SleepyHead leak graphs with what you are seeing in Encore.

Monday night was a vast improvement. AHI 34.4. The leak meter is a nice smooth flat pretty line @ 43. However, I distinctly recall lynching the mask down tighter last night. So... it would appear that it helped, and I need to pay more attention to my mask leaking. I suppose I'll try the vaseline trick tonight on the lower section that contacts my beard.

Leak line at 43 L/min is right where you want it to be. Does SH show the same leak line that Encore shows?

Vaseline is a no-no, however. As a petroleum product, it can harm the plastic and silicone in the mask cushion. You'd be better off with Lansinoh lanolin cream. (It's in the baby aisle at your local drug store or grocery store---it's sold to nursing mothers to soothe sore, dry, cracked nipples.)

So, Monday night's numbers, with no leak were:
21/11
CA 7.1
OA 26.1
H 1.2
VS .2
AHI 34.4

This CAI is much less alarming than the CAI on the night you posted SH data for. The OAs are way to high. Nonetheless, I'd be reluctant to do anything with the pressure until I was sure I had the leaks sorted out.

Concerning the possibility of Complex Apnea: I think you need to be a bit cautious with increasing the EPAP pressure, but not panicked about it. If you can get the leaks under control and the CAs go way down in number as you get the leaks under control, that may indicate that the CAI was so high on the SH night simply because you may have spent more time awake or drifting in and out of sleep than you remember. (And the machine can score a lot of false CAs when you're not sleeping or when you're drifting between wake and stage I or stage II sleep.)

Finally you write:

That said, she (mom) spent 5 days with me in the hospital, and she was astounded by how smooth my breathing was on bipap @ 20/10. She indicated I seemed to be breathing nearly normal. Smooth, even, long breaths, no choppy, short or broken, uneven breathing, no snoring, no struggling, nothing.

So---why not try using 20/10 for several days and see what the data looks like on that setting since you apparently did seem to do well on it?

[Pugsy]

So---why not try using 20/10 for several days and see what the data looks like on that setting since you apparently did seem to do well on it?

That's what was used on the SleepyHead report first shown and he says he slept well. Since he said he slept well that was the reason I didn't go into the awake breathing thing too much.

21/11
CA 7.1
OA 26.1
H 1.2
VS .2
AHI 34.4

I'm thinking that the CA being down lower is a good thing toward the thought of NOT having central or complex?? And do you think I should tweak the pressure back down and possibly raise the EPAP a lil?

The 21/11 was the pressure? You still hung up on that PS of 10? Why?....Did you know that the most commonly used PS on these bilevel machines (not ASV bilevel machines) is 4 to 6? Why not use what commonly works for most people first?

Try EPAP 12 or 13 and IPAP 16 or 17 tonight. So yes...increase the EPAP and reduce the IPAP.
If your CAs are arousal related centrals due to the OAs if we can get the OAs better managed then there's a good chance that if the OAs reduce the CAs will reduce.

[thasatelliteguy]

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[Pugsy]

Leak line much improved.
OAs reduced somewhat.
CAs reduced again.
How about another 1.0 cm EPAP?..don't change IPAP though..don't increase it.

[thasatelliteguy]

OK... 19/13 tonight

BTW, Somehow SH is graphing the leakage wrong. Encore shows a totally different story. There was no leak @90+. The highest the avg has been since I got the machine was 57. SH also doesn't show the graphs right on my computer no matter how I set the fonts and graphs. Either it doesn't like my display, or I'm missing some setting somewhere. I'll figure it out eventually.

Too late on the PJ, but it did work like a charm. I will be getting a new mask within the next couple months so i dont really care if it dont last too long. I didn't realize it, but it IS over 4 years old. With two weeks in the hospital though, it'll take me a lil while to catch up where I can get one. I will definitely get the lanolin though, cuz I too hate sore cracked nipples.

This morning, I awoke to find my nose very red, as well as a ring of 6 small bloody sores on the very tip of my nose. The sores seemed to have pore-cheese cores. I have had what we affectionately call "blow-outs" b4, but always around the rim of the nostril. Never out on the tip. Did I cut off the circulation to my nose or something?

[Pugsy]

Here's an idea to see if we can get SleepyHead to do better with the graphs.
Go to the Preferences tab...then the Appearance tab and in the upper right side remove the check mark in the box next to "use Pixmap caching"...close SH...open again and see if the graphs straighten up.
Assuming you have the Windows SH version.

[thasatelliteguy]

[Pugsy]

Are you sleeping in any certain position predominately? Are you mainly side sleeper or back sleeper or just whatever?
How is your comfort level with the pressure?
How is the sleep quality in general? Having very many wake ups?
Another 1 cm increase in EPAP? Leave IPAP alone still.
Remember EPAP for OAs...IPAP for hyponeas...that's the general standard guidelines.
I know this is going up slowly but it's the most cautious/safest way. I suspect you are going to need EPAP 15 or 16 to get those OAs down to single digits but you might get lucky and not need that much. Besides it's an easier adjustment usually to go up slow.
Once we get close to some acceptable numbers then we give it a little more time between changes but right now there's too significant of a difference between what is happening and what we want to happen.

[ReadyforRest]

Your OA's look like they're occurring most when you're in REM sleep. I see groups or clusters at the times of night when you would naturally be in REM. There might be a positional component too. Which (I'm assuming) is why Pugsy asked you if you're a side sleeper or back sleeper. People tend to have more apneas when lying prone (on their backs) than on their sides.