Help please with large mask leaks and runaway pressure

[johnrrr]

A small update.

I went back to one pillow instead of two. I didn't change anything else on this night.

My AHI went down to 3.17 but my large leak rate was 40.74%! (up from 17.37% and 23.04% the previous two nights).

The pressure still went up to 20 though and never went down, despite periods of no events.

The next two nights I used a different nasal mask - a Respireo Primo P (http://www.airliquidemedicalsystems.com ... nomic.html). The mask is nice, but it leaves marks on my face which the P10 doesn't (although the strap and ability to put the tube over my head is better).

I kept the pressure at max 20 for this first night and my AHI was 3.86. Again the pressure only ever went up (maxing and staying at 20). The large leak rate was 14.62%.

Last night I reduced the max pressure to 15. My pressure did go up throughout the night, and never came down, but it only went up to 14, not to 15 - and medium pressure was 12.5. My AHI was down to 2.32. Most interestingly the large leak rate was only 0.6%

Ultimately, I've only really gone back to where I started in my last thread (Will I ever get less than 2.2?). Obviously 2.32 and a leak rate of 0.6% is much better than 5.87 and leak rates of 40% etc - but I wish there was a way to get it down further.

I know the question asked is - how do I feel? rather than focusing on the number. I feel better than when I wasn't using xPAP and getting an AHI of 30. But it just feels like I should be getting a lower AHI.

I've written to F&P and they've asked me for the serial number etc and they are going to try to find out why the pressure is only going up.

The did answer one question for me already which could be useful for other ICON AUTO users. The manual mentions the firmware is upgradable using the USB stick. I asked but they've never realised a new firmware.

[palerider]

Ultimately, I've only really gone back to where I started in my last thread (Will I ever get less than 2.2?). Obviously 2.32 and a leak rate of 0.6% is much better than 5.87 and leak rates of 40% etc - but I wish there was a way to get it down further.

2.3 isn't bad, actually. it could be better, but it's in the area of 'acceptable' for the most part

maybe once they figure out why your pressure isn't going back down, you can experiment with a higher max, and let the pressure go up when needed, and back down when not needed, and maybe get a lower AHI.

[johnrrr]

Ultimately, I've only really gone back to where I started in my last thread (Will I ever get less than 2.2?). Obviously 2.32 and a leak rate of 0.6% is much better than 5.87 and leak rates of 40% etc - but I wish there was a way to get it down further.

2.3 isn't bad, actually. it could be better, but it's in the area of 'acceptable' for the most part

maybe once they figure out why your pressure isn't going back down, you can experiment with a higher max, and let the pressure go up when needed, and back down when not needed, and maybe get a lower AHI.

Yes, I'm happy with anything around 2 or 3, I'd just be happier with it lower

I spoke to F&P before about the pressure problem. They didn't have any obvious thoughts about what it could be.

But I bought the machine second hand and it is out of warranty so they can't really help further, which I understand. It's showing an error code 13 in the menu, which they said means a problem with the power and would normally be sent in for repair inside the warranty period.

I bought it second hand because it was cheap and at that stage I hadn't being diagnosed so didn't want to spend too much (I was 99% certain I had apnea though). Now I do know, maybe I'll just buy a new machine.

My other machine is the one given by the hospital but it's very basic fixed CPAP machine with no way to access data, so I don't care to use that.

Thanks

(ps Palerider - not forgotten about the other thing, combination of busy week and my sd-card slot breaking on my laptop but I'll sort it out later).

[robysue]

Last night I reduced the max pressure to 15. My pressure did go up throughout the night, and never came down, but it only went up to 14, not to 15 - and medium pressure was 12.5. My AHI was down to 2.32. Most interestingly the large leak rate was only 0.6%

Ultimately, I've only really gone back to where I started in my last thread (Will I ever get less than 2.2?). Obviously 2.32 and a leak rate of 0.6% is much better than 5.87 and leak rates of 40% etc - but I wish there was a way to get it down further.

...

I know the question asked is - how do I feel? rather than focusing on the number. I feel better than when I wasn't using xPAP and getting an AHI of 30. But it just feels like I should be getting a lower AHI.

Why are you chasing a lower AHI?

I'll ask a question that Muffy/Not Muffy once asked me: What do you think getting a super-low AHI will achieve?

It's important to understand several things about machine recorded AHI numbers. The first is that they while they are good for trending data and giving a good idea about whether therapy is effective, but statistically speaking, there's not much difference between a machine AHI of 1.5 and a machine AHI of 2.5. If you typically spend some time awake while using machine, your wake breathing patterns can be mis-scored as sleep disordered breathing events and artificially increase the machine scored AHI.

Once the AHI is regularly below 3 or 4, you really should start focusing much more on How do I feel? rather than How low is the overnight AHI?

By the time the AHI is that low, if you are still having problems with fatigue or other daytime symptoms, you need to be looking at the whole, big picture rather than focusing just on the AHI. By the big picture, I mean everything connected to your sleep and your sleep environment, as well as other possible causes of the remaining problems.

As far as the other questions/concerns that are part of this thread:

Why doesn't the machine ever reduce the pressure after increasing it? I don't know, but then I'm just not that familiar with the Icon's auto algorithm, so I don't have an answer to that. You might want to ask the people at the DME if they have any idea why your Icon is so reluctant to lower the pressure.

High max pressure, high leaks, and higher AHI vs Lower max pressure, lower leaks, and lower AHI. This has an obvious answer: Masks are easier to seal at lower pressures than higher pressures. Masks are also easier to seal if the total pressure swing is not as large. Lowering the max pressure then helps make it easier to keep the mask sealed. Given that the AHI is very acceptable with the lower max pressure, there is no good reason to just increase the max pressure to chase after a 0.0 AHI. And in your case, the higher max pressure setting seems to be increasing problems with leaking, which can increase the AHI in two different ways:

• More restlessness while fighting the mask leaks leads to more "fake" events scored during periods of restlessness and wakefulness
• More real events occur because the therapeutic pressure is (partially) lost because of the large leaks

So in my opinion, you're much better off limiting the max pressure to a level where the leaks are under control and the AHI is consistently below 5 and usually below 3.5ish.