Thinking of switching to Auto Set

[cj7jeep81]

First post, so I'll put most of my background here. Have had issues for the last several years of very low levels of energy, depression, etc. Finally went to a doctor last September, and was diagnosed with low testosterone (32 years old). Doc had asked how my sleeping was, and thought it was Ok (snored, but wife never noticed major issues). Started taking shots, and no improvement (got worse). Told Doc that sleeping seemed to be getting worse (more snoring, starting to worry wife at times), and had a sleep test performed in January.

Found out I had mild-severe sleep apnea (can't recall the numbers off the top of my head). Sleep study said I needed a setting of 7, and got all my stuff set up. Didn't really help, still snoring very loudly, so talked to C-PAP provider people and they talked to my Doc, and bumped it up to an 8. Still no improvement, and they bumped to a 10. This helped some, but never got the "Wow, this is worth it" feeling, and still tired (but not fully exhausted by 2 or 3 in the afternoon). So things are better, but still no what I think they should be. Energy levels are still low, and physical activity wears me out pretty quick.

I've played around with the settings some, and think now I'm close to an 11, but not feeling any different than 10. I've gone higher, but had issues with leaks around the mask, and found that whatever I'm at (10.6 or 10. was the highest I could get without leaks.

Since then, I think I've gotten it adjusted better, so I might be able to crank it up higher. But trying to decide if I should go higher, or play around with the auto-set features. Right now, once I get to sleep, I generally sleep with it for 6-8 hours. However, if I have even small leaks, I absolutely can not fall asleep as it bugs the hell out of me (which is also why I wear ear plugs now, so I can't hear the air rushing out the vents).

[Pugsy]

Welcome to the forum.

Are you using the software that is available to monitor your therapy in correlation with your increases in pressure? Or are you just increasing the pressure?
If you are thinking "what software" please take time to read the links provided in my signature.

You are in luck..I have injured both my hands so I can't type much to give you my usual novel but let's start by evaluating our current therapy to see what, if anything, needs work.
Get SleepyHead and post a typical night so we can see what might be going on. See this thread to know what I mean about posting a copy of the report.
viewtopic.php?f=1&t=81072&p=737779#p737779

Couple of questions also.
You say you get 6 to 8 hours of sleep each night...which is the most common number? Are those hours fragmented with wake ups for any reason? If so, approx how many times, why and do you get right back to sleep.
Do you take any meds (even OTC) for any reason? If so, what is name, does and time of dose?

Before worrying about changing the pressure and leaks that go along with higher pressure let's make sure that you even need higher pressure...at least on paper.
Evaluate the reports first and then work from there.

[cj7jeep81]

I think I have sleep head software installed at home, but haven't used it in several months. I'll try to do that tonight.

I generally go to sleep around 10, and some nights I'll sleep all the way through till 6 with the mask on, but some nights I'll wake up around 4 and take the mask off and go back to sleep (could wake up due to 4 year old, sometimes just wake up). I'd say 75% of the time its closer to 8 hours.

As for meds, I take a fish oil pill and a vitamin d pill every morning. Another fish oil after dinner, and 1 inhalation of Symbicort before bed (mild asthma). Other than that, occasional ibuprofen, but nothing regular.

[Pugsy]

When you get home and get the software up and import your data...just post a typical night detailed report and also could you go to the overview section and get a snapshot of the Usage graph?

[cj7jeep81]

When you get home and get the software up and import your data...just post a typical night detailed report and also could you go to the overview section and get a snapshot of the Usage graph?

I should be able to handle that. Thanks!

[cj7jeep81]

Ok, don't know how to do the report, but hopefully this is what you are asking for. Here is the data for last night (fairly typical night), and the overview graph.

Edit: Should also note it looks like the time is off by a couple of hours, so disregard that. I think I went to bed around 10pm last night, not 8 like it says.









And the overview

[Pugsy]

First thing that needs a lot of work...Leaks. They are massive and prolonged.

Your leak number you don't want to go above is 24 L/min. Last night it doesn't look like you spent any time below 24 L/min except for momentary downward spikes.
You have the dubious honor of having probably one of the worst leak lines I have ever seen. I don't know what is going on with that mask but something is not right somewhere and is very, very wrong.

For future reference we don't need all those extra graphs.
The main graphs we like to see
the AHI graph on the left side which you have omitted.
The Events graph
The Flow rate graph
Pressure graph
Leak graph
You can turn off the AHI graph and mask pressure graph in Preferences/graphs tab...remove the check mark

Figure out what to do about the mask...check your connections...also take the long hose off and run some water through it to look for leaks in the hose.
When was the last time you changed the cushion? Got a new mask? Different mask?

We can't evaluate anything right now due to leak being so large and so prolonged that everything else is unreliable.
Your job right now find the leaks and fix them.

[cj7jeep81]

Here's the AHI. I'll check my tube tonight. It has been a while since I replaced my cushion. I have always gone by leaks that I can feel around the outside of the mask (where it seals against my face), and don't really feel any. If there are, they are minor. Since it felt like it had been sealing well, I haven't replaced it lately.

I have also attached the leak overview. I have replaced the cushion several times since I started (used to be about once a month to every 6 weeks). Judging by the graph, doesn't seem like it's ever been working right.

First thing that needs a lot of work...Leaks. They are massive and prolonged.

Your leak number you don't want to go above is 24 L/min. Last night it doesn't look like you spent any time below 24 L/min except for momentary downward spikes.
You have the dubious honor of having probably one of the worst leak lines I have ever seen. I don't know what is going on with that mask but something is not right somewhere and is very, very wrong.

For future reference we don't need all those extra graphs.
The main graphs we like to see
the AHI graph on the left side which you have omitted.
The Events graph
The Flow rate graph
Pressure graph
Leak graph
You can turn off the AHI graph and mask pressure graph in Preferences/graphs tab...remove the check mark

Figure out what to do about the mask...check your connections...also take the long hose off and run some water through it to look for leaks in the hose.
When was the last time you changed the cushion? Got a new mask? Different mask?

We can't evaluate anything right now due to leak being so large and so prolonged that everything else is unreliable.
Your job right now find the leaks and fix them.

[hueyville]

I just switched from bibap to bipapASV a few weeks ago. Massive centrals came down and my AHI dropped from average of low 30's to around 10. My mask was a bit of issue for a time until found the correct one for me. I also take testosterone and mine is mixed at a compounding pharmacy and administered via weekly injection. Two weeks ago doctor worked out over perkod of a month and two blood draws my adrenal glands and thyroid glands were shot so added synthroid and corteff to my meds. The synthroid and my body were not getting along so tried armorthyroid. The new meds causing me issues that extended into sleep. Last night I took a sleep aid I have not used in a while and my AHI went from solid 10 to 14 up to 30. So tbat culpret is nailed. Looked back on some old med journals and sleep info to confirm.

Your leaks are terrible. No way I could sleep like that. I average 0.0 on leaks. Only have one on occasion if missadjust headgear but solve it with straps in a few seconds. My pressure goes up to 25 when the centrals go haywire and the mask doesnt leak. Wheather 8 or 25 I have to yank a stap loose to get a leak. Have you tried other masks? I have six incorrect fits in a box. Cost a few bucks to solve that way but was worth the money to get the function and fit that is comfortable too.

[RandyJ]

The Quattro can be a real leak monster. I got the leaks under control with a mask liner and anti leak strap from Padacheek.

http://www.padacheek.com

Some people can wear it loose, but I really had to tighten it up to get the leaks under control.

[Pugsy]

I figured that you were going on "feel" for the leaks around the face and if what we see on the reports were typical leaks they should be hugely evident when you feel around the mask..
That's why I suggested check all your connections and the hose...also make sure the anti asphyxia valve isn't stuck open.
Something is very wrong here.
Also..try just watching TV with the mask and machine on for about 30 to 45 minutes so you are awake and you know for sure there are no leaks.
Then check the leak line graph. It will or should give you a nice 0.0 leak line showing and if it doesn't while you are awake...there's a big hole somewhere.

While awake the leak line should be right at 0.0...
See one of my better nights here with my S9...it's a bilvel machine so that's why the 2 pressure lines. And below it is one of my not so great leak lines where I was trialing a new mask and it was too loose.

[penuel]

Your S9 wants to raise the pressure b/c of your flow limitations but the set up does not allow it (CPAP mode). If you switch to APAP it might deal with by raising the pressure. But then the leak would increase. I tried this mask in the past and also had too much leaks with it. I think that this that this mask require a close fit with the contour of your face. Have you tried any of Resmed or Respironics traditional nasal masks preferably with a chinstrap?

About switching to APAP mode you need to be certain that you don't suffer from Central Sleep Apnea syndrome, COPD, or hypoventilation due to weak lungs, b/c then it would be contra indicated by Sleep Board of Medicine. I myself did switch to APAP about 3 years ago on my S9 Autoset. My pressures are 9/12.6 and my flow limitations are half the height of yours. During my first year I had AHIs as hi as your but since the beg of 2013 they have been below two. It's going great.

See my one year ResScan Stats:

[cj7jeep81]

Messed around some last night, and got a bit better results. First, I tried my normal/old mask. Just going by the smiley face on the machine, I could not get it to be happy, even when I had it on like I normally do. Swapped out for a new cushion, and it was a lot worse. Couldn't get it to seal for anything (tight, loose, etc). Got a whole new mask/cushion/headgear out (they ship them every month, so I hoard), and same results. Finally, decided to trim my beard really short as it was getting fairly long (3/4" or so). Now that it is roughly 1/8", I could get the guy to smile. I downloaded my data this morning, and the leaks were still there. Looks a little better than it was, but not much (still averaging around 30). Running late for work this morning, so I couldn't upload anything.

I really don't want to shave off my beard, so I'm guessing I need to call back to my equipment provider and start trying other masks. When I did my sleep study, they first had me try some nasal pillows. Felt like I was suffocating, and could not get used to them. Also, I tend to be a mouth breather (have trouble sometimes breathing through my nose), so not sure how well those would work even if I could get used to them.

[Pugsy]

The suffocation feeling with nasal pillows is because they were starting you out at the lowest pressure and/or the size was too small. Start out with 6 cm more of pressure and that suffocation feeling goes away.

At this point...a little mouth breathing leak would be an improvement over what you have been having.
Didn't realize you had a beard. That does complicate things. Let's try to save your beard.

You might be surprised but often nasal congestion reduces with the humidified air from the nasal pillows...worth giving it a try for sure.
Just make sure that they give you all 3 sizes with whatever nasal pillow mask you choose (the package comes with 3 sizes).
Don't know what they will have in stock..but the Swift FX nasal pillow..the Aloha nasal pillow..the Respironics Nuance nasal pillow are all quite nice and would be a good place to start with one of those. The Nuance is relatively new so may not have them in stock.

I use a nasal pillow mask and yes, sometimes I do a bit of mouth breathing but sometimes the mouth breathing is very minor and not all that therapy air gets totally lost out of my mouth. Besides 15 minutes of even big mouth breathing would be better than what you are seeing all night with your current mask.

[cj7jeep81]

You'd think the sleep clinic person would have told me that. But then she also put me on 7cm as the amount I needed, which did nothing for me (but maybe the leaks were a problem). I will give the nasal pillows a shot. I do noticed that I can breathe through my nose better when the pressure is higher on my mask than without the mask, so that makes sense. I'll see when they can get out and go from there. They have been pretty good to deal with, so I'm sure they'll help. They might get a bit upset that I've been monkeying around with my pressure, but oh well

Definitely want to save the beard, although I'm sure my wife is thrilled that I had to trim it short last night to get a better seal. She wasn't too happy with the long beard

The suffocation feeling with nasal pillows is because they were starting you out at the lowest pressure and/or the size was too small. Start out with 6 cm more of pressure and that suffocation feeling goes away.

At this point...a little mouth breathing leak would be an improvement over what you have been having.
Didn't realize you had a beard. That does complicate things. Let's try to save your beard.

You might be surprised but often nasal congestion reduces with the humidified air from the nasal pillows...worth giving it a try for sure.
Just make sure that they give you all 3 sizes with whatever nasal pillow mask you choose (the package comes with 3 sizes).
Don't know what they will have in stock..but the Swift FX nasal pillow..the Aloha nasal pillow..the Respironics Nuance nasal pillow are all quite nice and would be a good place to start with one of those. The Nuance is relatively new so may not have them in stock.

I use a nasal pillow mask and yes, sometimes I do a bit of mouth breathing but sometimes the mouth breathing is very minor and not all that therapy air gets totally lost out of my mouth. Besides 15 minutes of even big mouth breathing would be better than what you are seeing all night with your current mask.