need some thoughts about cpap pressures

[mgrunk]

I have an intellipap w/ the smart flex. I've been using this since June and have yet to more than a couple of nights of where I sleep more than 4 hours at one stretch. I'm to the point I feel like a zombie.

Anyway, I can't seem to get a tolerable range set that helps me to feel better. The smart flex makes this bearable but when I get up around 10.5 - I'm ripping the mask off repeatedly.

I am use a quattro full face mask. I'm hoping now that the weather is cooling down, that it won't make me so itchy. But, I continue to wake up to scratch my nose and under the forehead piece. My face is sore all the time.

But, I've tried a nasal mask (comfort gel?) and hated the feeling if my mouth came open and I can't tolerate a chin strap or taping - I just panic. I tried Swift Lt for her and I can't tolerate that much air being blown directly up my nose. Same w/ the liberty hybrid.

I am self pay so I can't just buy another mask. I've got more than a half dozen kids (just a joke when people ask - I have to judge if they really want to know because it's a lot) - but if I could buy one, I would look for FF w/ no forehead piece.

I posted reports of some of the dates in September - the problem is that it doesn't (at the bottom of the report) report the pressure range correctly. It reports what it is currently set to - so in the report, the mean, median and 90th and 95th are correct - but you can't exactly tell what my pressure range was because the graph doesn't have that much detail. I am having non responsive events and hypopneas, not many obstructive. Also, there's almost always a break when I move from sleeping in a recliner to the bed. I end up feeling too stressed to go to sleep in bed w/ my husband since I'm so fidgety.

http://chswebmaster.com/cpap/906-75-12.pdf Sept 6 - range of 7.5 - 12
http://chswebmaster.com/cpap/907-75.pdf Sept 7 - range of 7.5
http://chswebmaster.com/cpap/917-85-12.pdf Sept 17 - range of 8.5 - 12
http://chswebmaster.com/cpap/925-65-95.pdf Sept 25 - range of 6.5 - 9.5
http://chswebmaster.com/cpap/927-65-95.pdf Sept 27 - range of 6.5 - 9.5

I think I'm going to end up needing to put this into some kind of spreadsheet so I can see everything together. Because I don't know how to make it all make sense. Or what else I should try.

I also don't understand the concept of the 90th and 95th pressure percentiles.

[Julie]

Hi, I'm not going to advise about your pressure problems because other people will do it better, but as far as your mask goes, Google Padacheek and look at the different 'fixes' you can use under the mask very inexpensively. Many people here use them and they're supposed to be terrific. If you're more comfortable when sleeping, you're less likely to wake up too soon.

[DeVilbiss Marketing]

It's clear you are experiencing some significant leaks (most masks expiratory port leak rates are between 30-40 LPM. The IntelliPAP AutoAdjust
considers leak rates greater than 95 LPM to be excessive). Since leak rates greater than 95 LPM cause irregular flow signals, the AutoAdjust algorithm can no longer properly detect breathing events, so event response is disabled; however, following procedures similar to those used in sleep labs, the algorithm decreases pressure every 6 minutes until you change body or mask position to resolve the leak or stops mouth breathing.

90th/95th Percentile pressure indicates that therapy pressure was at or below this pressure for 90- or 95-percent of its usage time. It would be helpful to look at a summary report as opposed to the single night reports as you would be able to see your Average Pressure plateau time which is the percentage of time therapy was at the upper prescription limit. If the time is 10% or higher, the pressure has been railing at the upper pressure and this may be an indication the prescription setting should be increased to allow the therapy to move to a higher pressure than is currently allowed.

Also, I noticed that your Event Detection Settings were changed from the factory default settings. Was this something that your clinician adjusted? The
Hypopnea % (percent which the respiratory flow must fall from its normal value to be considered as a hypopnea) is 40% and the factory default setting is 50%
By reducing your Hypopnea %, you are setting the IntelliPAP Auto to respond more aggressively to Hypopnea events.

I hope this information helps

[elena88]

do you know if youre apnea is positional?

I am learning that I only need a high pressure on my back, around ten, and I find that also very disturbing to me..

I think I only need four on my stomach..

so I am doing experiments..

My leaks went way down when I used some pads on the side of my mask..

strapsofties.com

and I also learned to use my outside arm hand to push indentations into pillows to keep the mask from moving.. when side sleeping..
you can use a flat hand or a fist, or pretend you are holding an icecream cone and place your hand under and the the inside of your chin..

I have found back sleeping causes high pressures which keep me from sleeping soundly..

[mgrunk]

Yes, she did have me change to 40% since that's what the sleep study used for measurement.

In regards to the leak rate - I think the graphs are very difficult to understand, but if I look in the box, it seems like the median leak rate is in the 30's with the max being in the 40's. So, I don't know how to read the graph.

My pressure is higher when I'm in the recliner - who'd imagine. And, the leak rate is very flakey while I'm sleeping there. I'm generally a side sleeper in bed. I just can't sleep there until I'm relaxed enough (i.e. I can't go to sleep in bed).

I'll look to see what padding options there are.

I did bump up the range to 8 and 11 - things look better as in fewer hypopnia's and unresponsive events.

http://chswebmaster.com/cpap/SummaryReport.pdfSummary report

http://chswebmaster.com/cpap/SummaryReport.pdfMonthly report

Sorry, I used html tag markers for the url.

[DeVilbiss Marketing]

Yes - your Pressure Plateau is above 10% which may be indication that you do indeed require a higher pressure.

If you look at your Leak Statistics, you'll see that your Maximum Leak was actually 132 L/Min. Your Average Leak in around 33 L/Min, but you'll notice that your 95th Percentile leak indicates that you leak rate was at or below 52 L/min. Looks as though the leak rate is going down.

Please let me know if I can be of any assistance.

[mgrunk]

I didn't see the Pressure Plateau percentage at first. So, I'll be sure to watch that figure. I did bump everything up last and all the charts where smoother.

I do have a question about the charts - specifically the ahi - I don't understand what the vertical axis indicates - the range is 0 to 15 but I don't know what the measurement is.

I do wish all the charts could be laid on top of each other because it would be seriously easy then to compare leak to pressure to AHI - but what I'm seeing if both the leak, and ahi seem to correspond most nights. But, maybe it's a hypopnea that I'm responding to and bumping the mask - or - maybe it's the other way around.

According to some charts I found here referencing the quattro mask, it looks like the leak rate is around what is reported - I did have the one outrageous night of leaking - can't remember what the deal was - oh, another mask, nasal, that I did some serious mouth breathing I think.

viewtopic/t40039/Need-leak-rates-for-Mi ... -mask.html

At pressure of 4 its 22 LPM
at 8 its 32
at 12 its 41
at 16 its 48
at 20 its 54

That doesn't really deal either though w/ my serious discomfort w/ the mask.

I know I keep saying it but the SmartFlex has made this all so much more bearable. I was nearly ready to quit - I tried for three months to tolerate breathing out against the pressure and just felt miserable. I'm so grateful for the firmware update.

[jdm2857]

DeVilbiss Marketing:

I have seen people post that their AHI is xxx per hour, and have been wondering where that terminology was coming from. Now that I see that wording in the DeVilbiss reports, my question is answered.

The indexes (AHI, HI, etc.) are all defined as events per hour. So reporting an AHI of X per hour (instead of just 6.5) is both redundant and confusing. People post that they are having X AHIs per hour, which, of course, is nonsense.

I suggest that you remove the "per hour" wording from the reporting of the indexes.

[Calist]

Get a nasal mask.

[Leonrandall]

A few things I've learned in 12 years of compliance with CPAP therapy. First, the right mask is priceless. I have found that an air cushion mask, for me, is by far the best. The ResMed Activa fits loosly and still seals when I lay over on my side. Second, I have found that by putting my tongue on the roof of my mouth, the air movement will actually create a vacuum seal and you will find it easy to breath only through your nose. This works best if ramp is off and the unit starts at operating pressure. Finally, I make strap covers from a light fleece material. These are sewn in tubes through which the face strap is strung. This makes the straps far more comfortable, and I never have strap or mask marks. Hope it helps

[DeVilbiss Marketing]

The verticle axis is the number of Apnea/Hypopnea events.

Since SmartFlex seems to be working for you, you might want to explore the Flow Rounding options of SmartFlex - there are two adjustments: iFlx and eFlx. By increasing the setting number you will soften the pressure transition. For instance, a setting of 5 on iFlx will slowly transition from your lower pressure to your higher pressure. Likewise, a setting of 5 on eFlx will slowly transition your higher pressure to your lower pressure. This is a patented technology that we have had in our Bilevel devices for almost a decade and it has been well received.

JDM2857 - point noted, let me bring this up to our software engineers and understand the reasoning for including "per hour".

[charliegreer]

I use a Quattro and have to scratch my nose when my humidifier is set a little too high. Maybe you can try dropping the humidifier down a notch, or even shutting it off for a night, and see if that helps.