Large Leak _ Central Apnea question

[braddw25]

Hello all,

I am very glad to have found this support site. There seems to be a ton of really good information and support for cpap users. I started CPAP therapy back in January of this year. It has been going fantastic for the most part. In conjunction with starting therapy, I have also been doing other things to try to be more healthy. I have lost nearly 50lbs from eating better and walking 3-6 daily. While this has been beneficial, I am thinking that the weight loss may have rendered my Resmed air touch mask less effective. I can notice a very visible difference in my face between now and when I started and it just dawned on me this morning that this very well could be the cause of the leaking that I have been experiencing for the past week. This mask has worked nearly perfectly since day one of usage and now all of sudden it has started to leak. I have a new mask on order because this one is due for replacement anyway so that also might be part of the problem I am having with leaks.

My real question though is can a machine sometimes misread leaks as central apneas? I have never had any problem with central apneas until the last three nights. Last night my data shows a 100% mask fit (which I find dubious to begin with because the previous night's it had been showing lots of large leaks and I have not changed anything yet) but now it's showing 98 clear airway apneas for the 8.3 hrs I slept. Is it possible that the leaks are fooling my Phillips machine into recording central apneas? My wife said she noticed that I slept very restfully last night as best she could tell and she has been very good at noticing and reporting any problems she observes because my sleep problems often wake her up. I feel REALLY good this morning as well so I am wondering exactly what is going on here. Thanks for any insights anyone might be able to provide.

Bradd

[Pugsy]

If a mask is leaking really badly it can affect the reporting ability of the machine because it can affect the sensing of the air flow.
But if you are seeing 100% mask fit...that means no time in large leak and for the sensors to be screwed up from leaking...it takes a lot of big leaks.

Now what might be happening is minor leaks are causing arousals (which you may or may not remember) and the machine might be flagging arousal pauses in your breathing as some sort of central apnea. So leaking enough to annoy you and wake you up but not so much that the machine can't compensate for it because it never makes it into large leak territory.

And you might have had a large number of pauses in breathing while awake maybe fiddling with the mask...those can get flagged as centrals or clear airway events.

Would really need to see the detailed reports to know get a more educated guess as to what might be happening.

If this is a one off bad night....don't know I would worry about it since you report feeling good but if this is something that happens often I would suggest digging deeper.
Do you know about available software to see more details than what you get off the machine?
If not...
OSCAR https://www.sleepfiles.com/OSCAR/
http://www.apneaboard.com/wiki/index.ph ... stallation
http://www.apneaboard.com/wiki/index.ph ... rpretation

If you do already have OSCAR...post the questionable detailed report and lets see when those CAs/centrals got flagged.
viewtopic/t158560/How-to-post-images-for-review.html

[braddw25]

Thank you for the reply, Pugsy. I do have OSCAR so here is a screen shot of the data from last night. If this is not what you were asking, let me know and I will get whatever you need posted. Thanks again for your help.

[Pugsy]

Oh man, that's ugly.

Any new medications or changes in meds?
On any meds? If so what?

How long has this been going on? Can you get me a screen shot of a "good" night for you?
Is this a rarity one off bad night....or do you see ugly nights a lot?

Hide the calendar and make sure the leak rate graph can be seen...you can resize the other graphs a little so the leak graph will come into view.
and by hiding the calendar the statistics will show up.

[braddw25]

No new meds or any meds at all.

This is the first night I have ever seen anything like this.

I will take a screen shot of a typical night for comparison.

[braddw25]

Here is data that is far more typical for me. I chose data from the night exactly one week before the ugly night (last night).

[Pugsy]

That one report from last week.....massive large prolonged leak and bad enough it could have been missing a lot of crap.

See all those big gray blocks.....that's large leak into large leak territory. And at time very deep and definitely could affect the sensors.

Do you have a good AHI night that doesn't have large leak blocks of gray all over the place?

[Pugsy]

Last night....you didn't have any large leaks. The sensors should have been fine.
Now the big question is....which report is the more accurate report????

You are using the AirTouch mask...that memory foam mask?

[braddw25]

Yes. I am using the memory foam mask and it is due to be replaced. I had one ordered, but apparently supplies are low because of COVID. I will look for a good AHI night with no leaks to post.

[braddw25]

Here is data from Aug 5. This was the last night in a long string (over 2 months) of zero leaks. The next night is when I stared having a small amount of leaks that has been getting progressively worse. Not sure if it's because of losing weight and not having as much fat in my cheeks, the mask starting to wear out, or a combination of both. It is probably worth adding that normally a bad night for me is an AHI between 5 and 10 and most of the time when that has happened (rarely) I noticed a difference as soon as I get up in the morning. Not feeling refreshed like I do when things go well overnight. I felt great this morning and was expecting the data to look much better than it did so I was kind of shocked when that nighmarish data appeared.

[Pugsy]

We've got a lot of variables in the mix which makes it hard to isolate and fix a potential problem.
Then add in the metabolism changes that go along with a lot of weight loss besides the physical changes.
And one thing we didn't talk about...potential machine sensor issues themselves...while rare they aren't impossible to have happen.

Since you are reporting that you felt you slept good and feel good how about we see what happens tonight?
I hesitate to panic and start screwing with things based off of one night of really bad data that is a rarity and we have multiple variables in play.

How much weight have you lost?

[braddw25]

Thanks so much for the help and advice. I appreciate you taking the time to do that. I don't really think it's anything to get worked up about at this point either. I just thought it was very weird to see that data on a morning when I felt as good as I feel today.

I have lost 50lbs since January. I looked at a photo of myself at the beginning and compared it to today. My face is noticeable MUCH slimmer especially in and around my cheeks near my nose which is precisely where my mask contacts my face and where many of the leak are coming from. This causes air to blow up into my eyes and drives me completely nuts. I am nearly certain that mask fit is an issue at this point so that is step one in trying to eliminate variables. I have a new mask on rush order that should be here by Monday at the latest.

Thanks again for taking the time to help out.

[Pugsy]

Pressure needs can change with that much weight loss....sometimes more...sometimes less and we never know which way until it happens. Obviously mask fit will change with facial changes.

Let's see what happens the next few nights and after you get the new mask.

If the centrals persist to the high side...we can try a little adjustment to see if it helps. It wouldn't be totally impossible that with the weight loss there is also a change in your own metabolism affecting gas exchange but for now lets just adopt a wait and see thing.

[braddw25]

I had a much better night last night. Still had 20 CA events, but at least that is far better than the night before. I also noticed something else. I woke up briefly a couple times during the night and rolled over, changed my hose position and my pillow position. I happened to note after one of those incidents that for whatever reason I was holding my breath while doing that. I noted the time and sure enough I had a central apnea flagged at about that time. In looking at the data this morning, I had some CA's right at the beginning of the night before falling asleep and there were also some clustered around the time I woke up. I know this is true because I hit the ramp button on my machine while I was awake at 3AM and alot of the CA events took place during that ramp up time so I am thinking that I was actually awake for some if not all of the CAs that registered. Overall AHI was 3.8 which is also much better than the 13+ from the previous night. I'm still not completely sure what is going on, but am even less concerned than I was before. Am I correct in stating that if these Central apneas are actually taking place when I am awake because I'm holding my breath while messing with my mask, rolling over, fluffing my pillow or whatever else then it is not as much a concern as if they were happening when I was sleeping? Thanks again.

[Pugsy]

You have to be asleep for anything flagged to matter.
Awake flagged stuff simply doesn't count.

It's sleep apnea...not awake apnea and you must be asleep for it to count. Anything flagged during known awake times we have mentally toss it out the window and ignore it.