Over a month on CPAP, AHI 20.53

[Pugsy]

Hopefully with the bilevel pressures you will be able to maybe get better therapy without having to be so high for so long.
Hopefully with the bilevel pressures you won't have the aerophagia issues so badly.

Yes, IPAP will go up but it won't stay up for prolonged periods of time without a drop in pressure during exhale.
Actually everyone I talked to about going to bilevel at the higher pressures said leaks were easier to manage even with the higher pressures.

Also another remote possibility....it's possible that with your continued high AHI because your pressures are sub optimal that once your OSA is better under control that maybe you won't be moving around quite so much (if you are now because of the OA stuff maybe causing arousals and tossing and turning) and this will also lessen mask movement chances. It's a remote possibility but not an impossibility.

You definitely need bilevel anyway to have any hope of getting your OSA under better control.

[Uff Da]

I haven't heard from the sleep center yet to schedule another sleep study for a possible bi-level machine. I'm glad to hear, Pugsy, that you think that move may well be worthwhile.

In the meantime I'm trying to do the best I can. I'm now on my fifth mask, fourth one FFM. It isn't perfect, but so far seems to be giving me a lower amount of leaks than the others without having to resort to a chin strap, which caused me jaw pain. However, I do pretty much have to sleep on my back, as I seem to get leaks as soon as I try side sleeping. This mask, the Amara View, also seems to give me less aerophagia for the same level of pressure. I may try bumping the maximum up one point tonight, to 15, and see if that is tolerable with regard to both leaks and aerophagia. Have to try to find a reasonable compromise, as I'd like a better AHI.

At any rate I hope some of you knowledgeable people will give me input on viewing this morning nap's results. First I'm showing the whole night, so you can see the morning nap in context. You can see that my mask leakage wasn't too bad earlier in the night. It really got bad during that morning nap, when I suspect I rolled over on my side. The big gap in the middle is because I couldn't get back to sleep with the mask and cervical collar on after about 2:00, so I threw them off and slept about three hours without them. I know that isn't good since my AHI without CPAP was 88, but hey, I wanted some sleep! Then I got up, had breakfast and went back to bed, with the mask and c. collar this time.

The second set of charts shows part of the morning nap only. You can see that there was bad mask leakage. So how likely is it that all these UAa during that time are for real? Part of the time it looks like maybe the mask didn't leak so much when I was gasping for air between apneas, but that didn't happen all the time either. Or do some of you have a different interpretation of what I'm seeing here. Anyway, that one UA was 120 seconds, preceded by one 75 seconds and followed by two 69 and 70 seconds. Just a little concerning - if they are real. Opinions, please.

[palerider]

The second set of charts shows part of the morning nap only. You can see that there was bad mask leakage. So how likely is it that all these UAa during that time are for real? Part of the time it looks like maybe the mask didn't leak so much when I was gasping for air between apneas, but that didn't happen all the time either. Or do some of you have a different interpretation of what I'm seeing here. Anyway, that one UA was 120 seconds, preceded by one 75 seconds and followed by two 69 and 70 seconds. Just a little concerning - if they are real. Opinions, please.

With leaks that high, it's likely that the machine would have trouble sensing breathing... It's odd that the only time there's breathing shown is when the leaks aren't so bad.

[Uff Da]

With leaks that high, it's likely that the machine would have trouble sensing breathing... It's odd that the only time there's breathing shown is when the leaks aren't so bad.

So do you think the UAs shown are likely not UAs at all, but that the more or less straight line is just from the leak? I guess what made me think they might be real is that the big jagged lines following the UAs don't look all that much different to me on the last four (where there was a big leak) as they do on the earlier ones where there was no major leak. Aren't those big jagged lines "sensing breathing?" Just trying to figure out what factors you experts use to make informed guesses as to what's real and not real.

[Pugsy]

With leaks that high it's pretty much impossible to even guess what the machine was thinking.
Things get iffy at 50 to 60 L/min and yours are pretty much double that.

[palerider]

Aren't those big jagged lines "sensing breathing?" Just trying to figure out what factors you experts use to make informed guesses as to what's real and not real.

Well, they're air flow, and if you notice, at the end of each huge leak, there's a very large negative airflow being registered, so unless you were holding a *HUUUUUGE* breath, and then suddenly let it out, all of those are artifacts of the huge leak stopping.

Look at how the flow variations and huge leaks line up.

[Uff Da]

With leaks that high it's pretty much impossible to even guess what the machine was thinking.
Things get iffy at 50 to 60 L/min and yours are pretty much double that.

Okay, that's a good guideline to keep in mind.

Aren't those big jagged lines "sensing breathing?" Just trying to figure out what factors you experts use to make informed guesses as to what's real and not real.

Well, they're air flow, and if you notice, at the end of each huge leak, there's a very large negative airflow being registered, so unless you were holding a *HUUUUUGE* breath, and then suddenly let it out, all of those are artifacts of the huge leak stopping.

Ah, makes sense. I hadn't thought about it that way. Not too likely to hold a huge breath for two minutes, that's for sure.

You guys are a fountain of knowledge.

[palerider]

Aren't those big jagged lines "sensing breathing?" Just trying to figure out what factors you experts use to make informed guesses as to what's real and not real.

Well, they're air flow, and if you notice, at the end of each huge leak, there's a very large negative airflow being registered, so unless you were holding a *HUUUUUGE* breath, and then suddenly let it out, all of those are artifacts of the huge leak stopping.

Ah, makes sense. I hadn't thought about it that way. Not too likely to hold a huge breath for two minutes, that's for sure.

Also, if you note, the negative peaks on those are well over 100lpm. and sustained. like the one just before 9:22:00, peaked at well over 100lpm, and lasted at least 12 seconds. Are you a blue whale in disguise? It's just the machine recovering from being totally confused by the huge leak.. (unless, that is, you're coming to us from the pacific ocean.)

[Pugsy]

I have a thought and I might be all wet but I have read your various mask struggles and your facial feature issues.

I am wondering just how bad your mouth leaks would be if you just used a nasal mask and said to hell with covering the mouth?
At this point considering the size of your leaks...mouth breathing leaks would be the lesser of two evils here.

Your therapy while trying a full face mask (which forces you to stay on your back which makes you need more pressure and causes more leaks) is in the toilet as it is now. Maybe using a nasal mask would mean less leaks overall and better therapy and less pressure needs because you could maybe sleep on your side without the mask moving and leaking.
Might have some times with mouth breathing large leaks but it's not like you are leak free now anyway.

Just a thought......

[Uff Da]

I am wondering just how bad your mouth leaks would be if you just used a nasal mask and said to hell with covering the mouth?

Tried that, too. One of the five masks I've tried was the Wisp Nasal mask. I got some great AHIs during that period, most of the time under 5, occasionally under 1. Unfortunately, the leaks tended to be in the 35-65% of time over redline if I wore a cervical collar but not in addition, a chin strap. And to get leaks down to where the AHI would be meaningful, I had to wear the chin strap so tight it distorted my face and pressed red marks into my cheeks. In addition, the chin strap caused jaw pain problems to the point that eating became difficult. I lost more weight and got down to 103 pounds. I concluded that a chin strap just wasn't going to work for me, so a nasal mask would probably be out unless I could find some other combination that would work.

Because of pain from my other condition, I have to spend most of my time on my back these nights anyway. But because of pain, I also need to get off my back periodically. It is all that moving around that gives me the most trouble. Masks just don't seem to fit my face well enough to handle it.

Last night my Sleepyhead shows an AHI of 4.55 with 10.86% of time over leak redline with 4 hours 50 minutes with mask on. And most of the events were during times I know I was awake. But I had a really crappy broken up night. Ended up sleeping several hours without the mask again because I got so tired of trying to fix the leaks. I did bump the maximum pressure up to 15 and the pressure chart shows it wanted to go higher. But 15 is, I think, the maximum I can take with this mask for aerophagia, plus it might already be more than I can take for the leaks. Will try it again tonight and see.