Check my leak data please

[cinephile]

Hello all,

I've been on CPAP therapy for a couple years now and most days I'm either good or good enough (once in a while quite good). But this week I've been wrecked. I have a suspicion it's due to my mask leaking excessively. My employer switched insurance companies back in April and this company only pays for new cushions and headgear every 6 months. I think I've simply worn out the silicone in the mask and I'm overdue for a new one, which may explain the leaking.

Anyway, here are graphs of my leaks from the last 5 nights. I've made sure to set the leak threshold to 80L/m in Sleepyhead as I'm using a Respironics machine. Does this look like excessive leakage?

Thanks!

8/26/16:
http://imgur.com/QZtqXbf
8/27/16:
http://imgur.com/r1ukEXZ
8/28/16:
http://imgur.com/qXpVvSn
8/29/16:
http://imgur.com/0PeOeZP
8/30/16:
http://imgur.com/f7vQdHK

[Julie]

Have you clicked on it? Doesn't grow at all... miniature graph.

[cinephile]

Just went back and fixed it. The links should be full-sized graphs

[Pugsy]

Look on the Events graph top right...see the LL on the left side...see all the marks in the LL line? Those are marks flagging times in large leak.
You can also see the large leak shaded in the leak graph.

Friday is pretty ugly in terms of large leak.
Saturday isn't so bad
Sunday isn't so bad
Monday isn't so bad
Tuesday isn't bad either.

What I see are lots of apnea events and snores and the machine increasing the pressure like crazy to fix them.
Your minimum pressure is too low. Looks like the settings are 4 minimum and probably 20 maximum.
When the pressure varies wildly like it is doing it makes for a difficult time getting and keeping a good seal. What works great when you go to bed at 4 cm starting point isn't going to work so great when the pressure is up around 12 or 15.

I think a better minimum pressure might be something around that median of 8ish...see how it does then.
You are having enough events and snores and FLs to impact how you feel and while the leaks are sometimes pretty ugly...most of these nights shown weren't all that bad except for Friday.

So your mask is maybe a small part of the problem but I suspect the bigger part is the minimum pressure.

How did you come to be using these settings which are pretty much the default from the factory settings?
Have you been doing this for the 2 years?
Have you changed sleeping position recently...like maybe spending more time on your back than you used to?

[cinephile]

Thanks for the fast and insightful reply Pugsy! I will refer my sleep doc to this conversation and show her the graphs. Perhaps bumping the minimum pressure to 8-10 would be a good place to start.

A question: What makes you say Friday was the worst for leaks? Are you just eyeballing the number of LL in the events graph? Do you have a ballpark number of LL that are undesirable for a typical night, or is it too hard to pin something down like this?

Now to answer your questions:

How did you come to be using these settings which are pretty much the default from the factory settings?

I actually started CPAP on a constant 10 cmH20. This was set during my initial sleep study. However, after about 18 months I realized I didn't feel as good as I thought I should (still sleepy during the day and needing naps). So I applied for another sleep study but it was denied by my insurance. So my sleep doctor suggested using the auto-pap mode (I believe the range is 4 cmH20-16 cmH20). She suggested this because she could then look at the data my machine was providing and see if any adjustments were necessary and if those adjustments didn't help, then we could use that evidence as grounds for an appeal to the insurance company for a second in-lab sleep study. Unfortunately the remote access to the CPAP machine wasn't working properly so the doctor couldn't read the data it was sending. I didn't pursue it though because I was actually feeling pretty good. However, I've felt quite awful this last week and intermittently for all of August, so I'm thinking of following up with her about my apap therapy.

Have you been doing this for the 2 years?

No, I've only been on apap therapy for about seven months.

Have you changed sleeping position recently...like maybe spending more time on your back than you used to?

Not that I'm aware of.

[Pugsy]

Okay...some sort of therapy for 2 years and last 7 months on apap but most likely with minimum to low.
The machine needs a better head start to get to where it needs to be to be to hold the airway open and prevent the collapse.
4 cm would work okay if you needed maybe 7 cm but you need more than that and the machine just can't get there soon enough.

I eyeball the large leak flags and look at how large the block of color representing the large leak is.
Just years of looking at graphs.
My own personal line in the sand in terms of large leak is 10 % of the night in large leak.
ResMed uses a 30% of the time as their line in the sand.
Respironics never gives us a line in the sand %.
A few minutes here and there in large leak (assuming it doesn't wake you up) probably isn't going to impact the overall therapy all that much...so 5 or 10 minutes here and there I kinda shrug my shoulders and say it isn't horrible. Now a 50 minute solid block of time in large leak is a different story.

The really ugly night that you had you had several rather large blocks of time in large leak.
I don't remember if I looked at the SleepyHead statistic for how much it figured up but it's real hard for that to be 100% accurate when using the 80 L/min number and auto adjusting pressures because large leak territory line will move up when more pressure is used and down when the pressure reduces.
We don't have any way to allow for that movement in the time over red line leak statistic. So with the Respironics machines and when auto adjusting pressures are used I take that particular SH statistic with a grain of salt. Eyeballing the flagged Large Leaks gets me close enough.

Edit...the pie chart is preventing the time over red line statistic from showing up but eyeballing that Friday night...it's pretty bad and I bet over 30% of the night was in large leak.
But your other nights weren't all that bad and well within what I would let slide if they were my reports.
I don't expect perfection.

I think that your leaks will improve when you do your mask fitting to something more in line with where the mask is spending most of the night...
So if you fit it to say 8 cm...it likely will be less leaky.

You might need a little more minimum than 8 cm...but I don't know for sure and going to 8 from 4 is a pretty big jump...and you might get lucky and with a better minimum pressure the machine may not need to go so high so often.
It works best when it is preventing the apneas instead of trying to fix or clean them up after they happen.
And to do a better job preventing it needs to start out higher.
I get a similar report to yours when I use APAP with 7 cm minimum but it cleans up real nice with a 10 cm minimum.

Until you can get the mask cushion replaced...perhaps use 8 cm for fitting purposes only until you get your doctor to make a permanent change to a more optimal minimum.
I think it would help you.

Your machine has a mask fit feature where I think if you use it that it will blow a higher pressure for fitting purposes. I don't remember exactly which pressure number it uses.
It's all explained in the provider manual..not sure if it is in the patient manual.
Did you know about this feature? It might be called mask check...I can't remember exact wording.