Leaks with APAP vs CPAP

[CocoPazzo]

I have been using a Res Med Elite S9 with Swift Nasal Pillows for about four years (with an earlier Res Med CPAP before that for perhaps four more years).

Pressure at 7.

Over the summer, my numbers were terrific, some times with no events at all during the night and an AHI average of .87 for the last six months, Obstructive Index .27, Hyponea Index .02, Clear Airway .58. 90% Avg Leak .55 Leak Rate 0.0. Since May I have also been using a 6.25 mg Ambien Controlled Release tablet. No naps during the day.

For the past six weeks or so, I have been waking up 6 -8 times a night, never sleeping more than three hours in a row, often less than an hour. Most of the time I have been able to return to sleep fairly quickly, although occasionally I have had the hour or more of insomnia. AHI for past month: 2.71, Obs .65, Hypo .07, CA 1.97. 90% Leak Rate 0.0

It is driving me crazy. So I went to the Sleep Clinic and the doctor suggested I try an APAP for a month to see if there is any improvement. (IT is the the Res Med 9 version as well set to 5 -15).
Okay, it has only been two nights, but here are the numbers: Night 1- AHI 7.31, CA 5.38, Obstructive .67, Hypo 1.25. Night 2: AHI 4.79, CA 3.31, Obstructive .8, Unclassified .23, Hypo .46.

And of course I am still waking up about eight times per night.

However, the numbers that really jump out at me are Large Leaks: Night 1, 9.68%, Night 2 13.04%.
Avg Leak Rate 7.38; 90% Leak 27.6 % of time above Leak Threshold: 13.04%
Leaks were virtually non-existent with the CPAP.

Does the APAP register LEAKS more, due to the fluctuation in pressure? Since I sleep on my back, left side, and right side, does my shifting during the night alter the position of the nasal pillows and cause a large leak that didn't register with CPAP? And most importantly, could these leaks be the reason I am waking up so much?

As I said, I'm supposed to use the APAP for a month then return for an evaluation. At this rate, it is going to be a long month.

Ideas? Thanks.

[Wulfman...]

If you're using Sleepyhead (as your profile states), you should be able to see what's happening, when and why.

Most likely with that wide range of pressures, your pressure is increasing beyond where your mask was adjusted with straight pressure. Consequently, you're going to see more leakage. It's not that the APAP registers more leaks or detects them differently, it's probably the higher pressures.
Basically, only Flow Limitations and Snores will increase pressures with an APAP in a range of pressures. It won't try to jack up pressures unless either of those events are present. It won't try to stop an Apnea in progress since it takes at least 10 seconds to define an apnea (for one thing) and without the preceding events it won't increase pressures.

So, look at your reports and see what you can find using those criteria.

Another possibility may be that the pressure changes are disturbing your sleep and you're tossing and turning more than you did with straight pressure.......and thereby dislodging your mask and creating more leaks.


Den

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[CocoPazzo]

Hope this works. If not, please advise how to get the image onto the site. Thanks.

[LSAT]

Personally ...If you are going to stay with auto,I would increase your minimum pressure from 5 to 8. You don't show leak data so can't tell if there is any problem. The large amount of CAs are probably from all the wake ups. The wake ups may be caused by all the changes in pressure. You could try going to a fixed pressure of 10 and see if the wake ups stop. By the looks of your data, fixed pressure of 7 is too low.

[Wulfman...]

Personally ...If you are going to stay with auto,I would increase your minimum pressure from 5 to 8. You don't show leak data so can't tell if there is any problem. The large amount of CAs are probably from all the wake ups. The wake ups may be caused by all the changes in pressure. You could try going to a fixed pressure of 10 and see if the wake ups stop. By the looks of your data, fixed pressure of 7 is too low.

I agree.


Den

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[ChicagoGranny]

Ideas?

Here are some instructions on organizing your SH charts - https://sleep.tnet.com/resources/sleepyhead/shorganize

The chart you posted is missing the leak graph. Also, you can eliminate the mask pressure graph because the data is not meaningful, and the pressure graph is what you should be looking at.

You can see from the pressure graph that very little time is spent under 8 cm pressure. That is why raising the min pressure to 8 is a good next move. At a pressure of 8, the machine will more quickly reach the higher pressures when needed.