Abnormally High Pressure on APAP with no LL

[lazer]

Comments?

[Xney]

I'm no expert, but I think you had enough leaking going on that your machine wasn't detecting things very well. One way it deals with more leaks is more pressure, and it doesn't detect events as well.

By the time you hit "large leak" territory, you've already put the machine in a non-optimal position, IMO.

[lazer]

And since I didn't remember awaking nor did anything seem out of position in the morning (Used the SleepWeaver Elan), I would guess the leaks were "Mouth breathing"....

What to do? Chinstraps = no workie for me

Taping = Haven't been brave enough to try yet due to my mustache. (maybe it's time to shave...)

[Pugsy]

While not technically hitting large leak territory you sure were skirting awfully close.
Have you ever had the machine want to use the higher pressures and NOT have a leak line that is skirting Large Leak territory?

[lazer]

While not technically hitting large leak territory you sure were skirting awfully close.
Have you ever had the machine want to use the higher pressures and NOT have a leak line that is skirting Large Leak territory?

I really can't say for certain at this point but via Encore report which I purposely used to establish the no LL and regarding the rate of the pressure as we oft discuss "Intentional Leak Rate", I just assumed that the higher the pressure, the higher the reported Leak Rate due to the mask venting and such. I'm getting confused as to when we actually apply the LL figures or not now. I mean, if Encore says absolutely no LL for the night but obviously the pressure was high and I'm assuming due to my snoring? = Then where do we assume the skirting on the LL territory?

[Xney]

Is there some reason you have it open all the way to a max of 20? Maybe lock it down to like a max of 15.

It's true that the machines are "supposed" to only give us "what we need" but if you have some leak issues, they could get a lot worse by going higher and higher. 8-15 is a very reasonable auto range. If you really need >= 15, you probably want a higher minimum, too - and possibly bipap.

[robysue]

Lazur,

Once again it's SNORES that drive the initial increase in pressure to stratopheric heights; flow limitations and a few events that keep it there; and the leaks start AFTER the pressure has spiked. Here is a marked up copy of your data:

Notice the following things:

1) The cluster of snores at the beginning of the rectangle drive the pressure increase.

2) The pressure is AT or ABOVE 15 cm for the entire rectangle, which includes the worst of the leaks.

3) The black line in the leak graph is at 40 L/min; the red line is at 60 L/min. According to information on the Sleepweaver web site, the expected leak rate for the Elan at 15cm is 37 L/min and the expected leak rate at 20cm is 45 L/min. So any leaks below that black line I've drawn are in the range of the expected leak rate of the mask at the pressure you are using during this time frame. And the leaks that are above the black line and below the red line are on the largish side, but they are not humongous leaks---leaks of the sort that Encore is willing to flag as official large leaks. At worst, you're leaking about 15-20 L/min above the expected leak rate for your mask most of the two hour period when your pressure is sky high. (In other words, If you were using a Resmed S9, these leaks would fall below the infamous RedLine.)

4) My take is that the SNORES cause the pressure increase; and when the pressure gets up near 17cm, the leaks start to become noticeable. In other words, the snore-induced pressure increase causes the leaks; the leaks do NOT cause the pressure increase.

And so I'll say it again: Since your leaks seen to get really bad when your pressure is above 15cm and since it's snoring (and not events) that trigger the sky high pressure increases, I think you'd be better off limiting your max pressure to something like 13-15cm. If I were you, I'd lower the max pressure and see what happens to the snoring numbers (and the event numbers) for a week or so. If there's no real increase in the snoring or the events, then I'd conclude that the extra high pressures are not really needed.

[lazer]

Thanks for the replies. Still locked down with the DME's "Loaner" machine so hesitant to get into the clinical menus to adjust data without their doing as this was already pointed out to me as a "No No". Once the insurance kicks in (Today's correspondence) indicates it will likely, then I will get a little more brave on investigating the settings.

All suggestions appreciated though.

[kutastha]

Thanks for the replies. Still locked down with the DME's "Loaner" machine so hesitant to get into the clinical menus to adjust data without their doing as this was already pointed out to me as a "No No". Once the insurance kicks in (Today's correspondence) indicates it will likely, then I will get a little more brave on investigating the settings.

All suggestions appreciated though.

What time do you take the Klonopin and what time is zero on your CPAP graph?

[lazer]

Thanks for the replies. Still locked down with the DME's "Loaner" machine so hesitant to get into the clinical menus to adjust data without their doing as this was already pointed out to me as a "No No". Once the insurance kicks in (Today's correspondence) indicates it will likely, then I will get a little more brave on investigating the settings.

All suggestions appreciated though.

What time do you take the Klonopin and what time is zero on your CPAP graph?

I believe the 0 on the graph would have been about 11:10 PM - just verified with SleepyHead data for that night.

I usually take my Clonazepam like 15 minutes before bedtime.

[jen4700]

I don't have all the details, but I heard someone recommend using denture strips to hold your lips closed, therefore no tape on your mustache.

[Todzo]

Comments?

Hi lazer!

I would love to see the flow waveform for the night. Vertically expanded if possible.

Thanks!

Todzo

[lazer]

Comments?

Hi lazer!

I would love to see the flow waveform for the night. Vertically expanded if possible.

Thanks!

Todzo

Hi Todzo,

I'm not sure if this is helpful or what you were asking for? I couldn't find one with the "paperclip" in Encore any longer as it seems it only stores back a couple of days worth so here is the Flow Rate for that same date via SleepHead:



To Jen,

Yea, I've thought about the denture strips/paste routine although using that during the day for my "uppers", I dunno, I'm just a little reluctant to put more on my lips at night. Maybe that is part of my problem that I'm missing several of my front top teeth?

[Todzo]

Comments?

Hi lazer!

I would love to see the flow waveform for the night. Vertically expanded if possible.

Thanks!

Todzo

Hi Todzo,

I'm not sure if this is helpful or what you were asking for? I couldn't find one with the "paperclip" in Encore any longer as it seems it only stores back a couple of days worth so here is the Flow Rate for that same date via SleepHead:
?

Hi lazer!

Thank you. Very helpful.

Did you have another titration or at least a pressure reduction since your weight loss?

Thanks!

Todzo

[lazer]

Hi lazer!

Thank you. Very helpful.

Did you have another titration or at least a pressure reduction since your weight loss?

Thanks!

Todzo

I never really had an official titration at all due to my sleep studies (only 1 being in-lab) never recording beyond stage #2 thus I guess I never reached any "Events" criteria is the guess SO once my Dr. and finally a cooperative DME got with me, I was loaned the APAP which I am still currently on and given a range of pressure to work with which with the help of this board and several trips back n forth to the DME, we've tweaked the low end pressure higher over time.

My next goal (once this machine is deemed covered by insurance which seems to be just about to occur) is to lower my top pressure down to around 13 or 15 and maybe raise my lower .5cm to a range of 9-13or15.

Currently I'm running at 8.5 - 20 APAP.