More exhausted than before cpap Need HELP (interpret numbers

[Guest]

I feel soooo much worse than before I started cpap, I really don't know what to do. The data is not very easy to understand and even if I did understand the data, I would not know what to change. Remstar Auto w/ c-flex 8/17. Can someone help please.....

here is 1 nights data:

90% AutoCPAP 8
Avg AutoCPAP 8
NR 0.0
FL 0.0
OA 11.9
H 0.0
S 10.5
AVG AHI 11.9
Large Leak 55.0 Min
13.9% of Night
Average Leak 103.83

I am using an Activa Nasal mask.

[Banshee]

Sorry, the above post was me. I forgot to sign in

[GoofyUT]

Well, it says that about every 5 minutes while you're asleep, you stop breathing because your airway collapses, not because your brain stops sending signals to breathe(centrals or NR apneas). You're also snoring about once every five minutes. And, it looks like you might be mouth breathing with your Activa, so you may not be getting the full benefits of your treatment, though your pressure is staying pretty low at 8. Have you discussed mouth breathing and its solutions with your sleep doc? There are lots of folks here who experience the same thing and can help you, so don't fret!

Chuck

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CPAPopedia Keywords Contained In This Post (Click For Definition): activa

[Wulfman]

Hi Christina.

Looks to me like you've got a little (?) leakage problem.....for one thing.

It says you're staying at a pressure of 8.
Non-responsive events (NR) (which might imply central apneas) are 0.0 (that's good)
Flow Limitations (FL) are 0.0 (that's good)
Obstructive Apneas (OA) are 11.9 (kind of high....best to be less than 5.0)
Hypopneas (H) are 0.0 (that's good)
Snores (S) are 10.5 (not that bad and I wouldn't worry about it at this point)
Average Apnea/Hypopnea Index (AVG AHI) is the sum of the Apneas and Hypopneas.
Large Leak was 55.0 minutes in this case (either you took the mask off or it slipped during the night) and that accounted for the 13.9% of the night.
Your average leak was 103.83. Again, it sounds like the mask was off or not positioned properly for quite a bit of the night.

I would suggest that you try bumping up the lower pressure a point or two to see if it will clear those apneas and see if you can fix whatever the situation was with the mask and the leakage from that situation.

Hope that helps.

Den

[Wulfman]

OOPS......forgot about the mouth-leakage. (thanks, Chuck)

Try mouth-taping or using the Polident adhesive strips to keep your lips together.

And, you might try that before you bump up your pressure.

Den

[rested gal]

Hi Banshee,

This is probably the main problem you're having with your treatment:

Large Leak 55.0 Min
13.9% of Night
Average Leak 103.83

Almost an hour's worth of "Large Leaks" means the machine was not able to do its job properly during the "Large Leak" times. When the REMstar Auto notes a Large Leak, it drops the pressure down to the minimum you have set. It will not detect, record, or respond with more pressure to any events during the "Large Leak" times.

An average leak of any number over 40 with a Respironics machine is....pretty leaky, imho. Personally, I want to see my average leak rate stay under 40, no matter what mask or what pressure I'm using. Each mask's normal built-in "leak" (the exhaust vents) and the pressure being used will make the acceptable leak number vary, but an average leak of over 100 means there's way too much leaking going on. Mouth air leaks or mouth breathing would be what I'd suspect. You really need to make ferreting out the cause of such massive leaks your major concern right now.

For the data to register both the 90th % pressure as 8 , AND the average pressure as 8 , sounds like an odd outcome, but math and statistics have a way of throwing me for a loop...a lot!

What was the prescribed single pressure from your sleep study?

Do you think the massive air leaks are air gushing out your mouth? Or from your mask (unlikely with the usually very leakproof Activa)? Are you taking the mask off during the night? I'd bet on mouth air leaks/mouth breathing.

Do you have the machine's operating mode set for AFLE or APAP? Either of those operating modes is fine for running it as an autopap.

If you are using either AFLE or APAP mode, do you have "ramp" time set at 00:00? It's extremely important that "ramp" be set for all zeros when using a Respironics autopap in either of those auto modes.

So....most of all...gotta get those big leaks under control. Can't get effective treatment until that's done. Treatment air escaping out into the bedroom instead of down the airway can't keep the throat open.

You'll get there -- you'll just have to be a good detective to track down all the pieces of the treatment puzzle. It can be frustrating, but you'll get it all in place.

[Banshee]

My dr prescribed a pressure of 17 at the beginning with remstar pro. But had to drop it to 12 due to aerophagia. I have a new chin strap, so I guess I had better use it huh. LOL!! Its the really wide one all white. I'll have to go look to make sure but I beleive it is the deluxe from respironics. I don't think that it is the mask either, although I do wear it quite loose. It seems that alot of air comes out of the mask vents during exhale. I guess maybe since I am not used to a mask that is loud, thats probably why I think that too much air comes out of the vents? So, how do ya figure out how long an apnea lasts? I am still trying to understand this stuff but I am really having a hard time of it. I beleive the machine is set to apap. They did not set a ramp up for me. I am still trying to figure out why the DR prescribed a pressure of 17 at the beginning, now that I have the Auto, the very highest it got up to was 15 and that was for like 1 min. Seems like they just start ya at the highest.

[rested gal]

I have a new chin strap, so I guess I had better use it huh. LOL!! Its the really wide one all white. I'll have to go look to make sure but I beleive it is the deluxe from respironics.

If you still have large leaks show up in your data after you try the chin strap, you may be like many of us...no chin strap can stop mouth air leaks for some of us. Some of us will puff air in and out of the mouth anyway, no matter how firmly the jaw is held up. What matters is whether the tongue can maintain an airtight seal INSIDE the mouth during the total relaxation of sleep. Click the link below and read everything you can about controlling mouth air leaks because that pesky, very common problem can be a real treatment breaker:
Links to: Mouth leaks - Air Leaks - Tape - DIY Guard

I don't think that it is the mask either, although I do wear it quite loose. It seems that alot of air comes out of the mask vents during exhale. I guess maybe since I am not used to a mask that is loud, thats probably why I think that too much air comes out of the vents?

You're doing right to wear the Activa very loose. That's the way it needs to be (straps quite loose) for its unique cushion design to seal well.

Couple of things you might want to check about your mask:

1. Look at the bottom front of the plastic frame...the frame itself, not the elbow. There should be a silicone strip along the bottom of the frame. The silicone strip has two little plugs - one on each end - to cover two round holes (O2 ports) on the Activa. If you are not using supplemental O2, those two ports (holes) at the bottom of the Activa should always be plugged closed with the silicone strip.

2. Be sure your Activa's cushion is firmly seated into the hard plastic frame...that the blue clips have been "clicked" into place in the frame.

[Banshee]

Thank you guys and gal very much for the help. I think there are more people on this board willing to help than at any other place. I trust you all more than I trust my DR. Thanks to Wulfman, GoofyUT and Rested Gal. May you sleep well tonight and every night!!!