New to CPAP, Trying to understand Sleepyhead

[Ranuki]

So, I'm new to CPAP. Started yesterday actually. Decided to pull my SD card and upload it into sleepyhead just to see how things are.

I'm curious about my leak rates. I'm using the Dreamwear mask, and I'm not sure if I'm really keeping my mouth closed when sleeping. My mouth doesn't feel dried out in the morning, or anything.

I looked up information on the Dreamwear mask, and for my typical pressure of 9-11, Dreamwear has an intentional leak of 26.6. http://www.apneaboard.com/Intentional-l ... -masks.pdf

I'm not sure what else to make of this. Thank you for any help.

[Julie]

I'd be more concerned about your pressure settings - the low one at 4 is not helping and I'd raise it to 6 or 7 at least... 4 does not allow the machine enough time to address events at higher levels in time to be effective.

[LSAT]

I'd be more concerned about your pressure settings - the low one at 4 is not helping and I'd raise it to 6 or 7 at least... 4 does not allow the machine enough time to address events at higher levels in time to be effective.

Julie...Her Sleepyhead charts show that the minimum is already at 6...

[Ranuki]

The 4 is the starting ramp pressure. Sorry, guess I should've said that as well. Ramp starts at 4, lasts 10 minutes to minimum pressure of 6.

Also, I work nights, so, most of my data will be during daytime hours.

[Pugsy]

Your leak rate is fine. Well within what the machine can compensate for.
Respironics machines report total leak (that's the top line on that leak graph) and total leak will vary as the pressure varies.
Your pressure moves around a lot so it is to be expected that the total leak will move around a lot.
More pressure means more vent rate and total leak includes vent rate. This is the way with all masks...there is an intentional leak/vent rate with all masks and the pressure pressure that gets used the more that vent rate will increase...so it isn't fixed unless you are using a fixed pressure.

Your machine will flag a large leak if you get one (and mouth breathing would be reflected in the leak rate) see the LL on the events graph?
That's large leak.
If you are doing any mouth breathing it sure isn't very much and for sure not enough to impact therapy pressures.

Your minimum pressure of 6 probably could stand to be a little bit higher and you would probably see less snore flagging but given this is your first night on cpap I wouldn't worry about it too much right now. Probably something more along the 8 cm area would do a better job preventing those snores (which are signs the airway is trying to collapse). A few snores isn't that big of a deal but you are having more than "a few" but give yourself a few nights to see how things settle out.

But as far as the leaks go..it's not a real pretty leak line but it's well within the machine's ability to compensate for excess leak.
If you don't see a LL flag...leaks are within acceptable limits.

[palerider]

I'm curious about my leak rates.

with your machine, if it's not complaining about large leaks, and the leaks aren't bothering you, they're fine. it's different for other brands ofmachine.

[Ranuki]

Thank you very much. I'm typically a mouth breather by day, but I have jaw sensitivity issues, so it was best to try a nasal mask first. I wasn't sure if I would keep my mouth shut.

[Guest]

Thank you very much. I'm typically a mouth breather by day, but I have jaw sensitivity issues, so it was best to try a nasal mask first. I wasn't sure if I would keep my mouth shut.

Even tho your cpap can handle it IMO you would feel better if your leak line didn't have all those peaks and valleys. I think one should always always strive to have a flat leak line within the specs of the mfg.

You want the pressure to increase only when an event is detected not because a leak is detected.

The vicious circle is when the cpap detects a leak it increases the pressure which results in a larger leak, and so on, and so on.

About the jaw pain - is it possible you grind your teeth (bruxism) while sleeping? Or are you having some other kind of jaw pain? I think bruxism is more common than we realize. If you think that is it you can try using a sports type mouth guard which can also help you keep your mouth closed believe it or not. You will keep your lips together to keep the mouth guard in place.

[Ranuki]

Even tho your cpap can handle it IMO you would feel better if your leak line didn't have all those peaks and valleys. I think one should always always strive to have a flat leak line within the specs of the mfg.

You want the pressure to increase only when an event is detected not because a leak is detected.

The vicious circle is when the cpap detects a leak it increases the pressure which results in a larger leak, and so on, and so on.

About the jaw pain - is it possible you grind your teeth (bruxism) while sleeping? Or are you having some other kind of jaw pain? I think bruxism is more common than we realize. If you think that is it you can try using a sports type mouth guard which can also help you keep your mouth closed believe it or not. You will keep your lips together to keep the mouth guard in place.

I have a lot of nerve pain in my lower left jaw, when I had my wisdom teeth taken out about 10 years ago, the doctor ripped the nerve in the jaw that affects the lower front of my jaw. The specific nerve is the inferior alveolar nerve. The lingual nerve, thankfully is just fine. The ripped nerve healed back odd though, and now it's numb, but pressure on the area hurts.

[Pugsy]

These newer machines today don't respond to a leak with an increase in pressure. If anything they will reduce the pressure a bit in an effort to lessen excess leaks.
Now a long time ago..yeah, maybe the machine would go trying to fix a leak with more pressure but not in the last few years....I think maybe 7 years or so for the Respironics machines.
They just won't respond to a leak with more pressure. If you see a leak and a pressure increase at roughly the same time it's just a coincidence that the leak happened at about the same time as some sort of apnea event or warning sign that the airway is trying to collapse.

The machine will NOT try to fix a leak with more pressure.

[linuxman]

If you want the unintentional leak rate line (lower line) to be a bit more accurate you can set the mask intentional leak curve in SleepyHead to match your mask's curve. Go to Preferences>CPAP Tab. You'll see "Calculate Unintentional Leaks When not Present" selected (it's on by default for this machine). Below that you'll see two sliders where you can set the leak rate for 4cmH20 and 20cmH20. See your manual for those values. It will likely be set to something else right now, which probably does not match the Dreamwear leak curve.

All in all, not too bad on leaking. You are leaking some but it's not enough to worry about unless it wakes you. If it does, then you do want to try to address it.

[palerider]

The vicious circle is when the cpap detects a leak it increases the pressure which results in a larger leak, and so on, and so on.

this is demonstrably false. no machine made in at least the 7 years, certainly not any that sleepyhead supports, *EVER* increases pressure due to a leak, in fact, if the leak is bad, they DECREASE pressure in an attempt to get the mask to seal.

[Ranuki]

If you want the unintentional leak rate line (lower line) to be a bit more accurate you can set the mask intentional leak curve in SleepyHead to match your mask's curve. Go to Preferences>CPAP Tab. You'll see "Calculate Unintentional Leaks When not Present" selected (it's on by default for this machine). Below that you'll see two sliders where you can set the leak rate for 4cmH20 and 20cmH20. See your manual for those values. It will likely be set to something else right now, which probably does not match the Dreamwear leak curve.

All in all, not too bad on leaking. You are leaking some but it's not enough to worry about unless it wakes you. If it does, then you do want to try to address it.

Thank you. I've adjusted the preferences to fit the mask curve. We'll see if I get better readings when I sleep again. I do notice I feel a slight leak around the bottom flare of my nose when I lay on my side. (Tried when I was awake first) but it wasn't bothersome. Nor did it blow in my eyes. Yay!

[Guest]

I've adjusted the preferences to fit the mask curve. We'll see if I get better readings when I sleep again. I do notice I feel a slight leak around the bottom flare of my nose when I lay on my side. (Tried when I was awake first) but it wasn't bothersome. Nor did it blow in my eyes. Yay!

Take some time before bed to adjust your mask at your highest pressure. Lay down in your sleeping position with cpap on at your highest pressure and adjust the straps to eliminate any leaks. See if that doesn't help. The leaks shown in your above graph could very well be disturbing your sleep stages without waking you. See if that helps.

You may have to do this a few times before bed before you get the hang of it.

You see with an auto as the pressure increases it increases the force on the straps which can lead to leaks which can disturb sleep stages without you ever knowing it.

When you get up to use the bathroom try to remove the mask w/o changing the adjustment any.

[linuxman]

Thank you. I've adjusted the preferences to fit the mask curve. We'll see if I get better readings when I sleep again. I do notice I feel a slight leak around the bottom flare of my nose when I lay on my side. (Tried when I was awake first) but it wasn't bothersome. Nor did it blow in my eyes. Yay!

You don't have to wait for new data to see the results of the updated mask curve. When you leave preferences and change that curve it recalculates all of the current stored leak curves (the unintentional curve only of course). If you happen to have different masks in use over time, it's a good idea to keep a log of what masks were used each day so that you can adjust the mask curve in case you ever go back and look at old data. It won't make a huge difference, but more so between radically different mask types (FF vs Nasal, etc).