Cpap leaks - Mouth leaks?

[vangmay231]

Hello
Since my last sleep study, I've been told that the pressure I need is 15cm/H20. I tried a Bipap at that pressure and that worsened things, and since then I've gone back to my dreamstation Cpap and have started from 10 at Auto to increase slowly as I get comfortable with it. I've got to 12.5 now. Overall, absolutely no relief.
Now I've been having constant leaks above 30-40L/min, there were some days with a lower pressure earlier but with the higher pressure now, every day I have high leaks.
I use a dreamwear nasal mask, and for a couple of days have been experiencing dry mouth on waking up, so it could possibly be mouth breathing. I sleep alone so no actual information on it.
Please look into it. It's been 1.5 months and there's absolutely no relief, with the efforts of trying to get this right already taking a toll on me.

[Pugsy]

Do you know what the leak numbers reported by the Respironics machines in SleepyHead mean?
Top leak line is total leak.
Bottom leak line is an approximation of excess leak only.

Where did you get the idea you were having high leaks? You aren't.

Now you might be mouth breathing but if you are it isn't showing up as a large leak.
It only takes a very short period of time of mouth breathing to dry out the mouth though.

[vangmay231]

Okay, it's just I saw that numbers over 24 or 30L/Min were more than usual and might need to be corrected, as I've read here or online in general.
According to the leaks should I do something about the mouth breathing? I guess not.
Thought this was adding to not getting relief but maybe not. What do I do then

[Pugsy]

The 24 L/min number is a ResMed line in the sand number. ResMed machines report excess leak only...would be comparable to the bottom leak line number on your graphs.
Look on the events graph...see the LL...that's large leak and if you were to hit large leak territory with your machine there would be a flag up there for when you did and how long.
You aren't having large leaks.

Total leak is excess leak plus the mask's intentional vent/leak rate. Vent rate will vary as the pressure varies and the more pressure that is used the higher the vent rate.

Unless the leaks are disturbing your sleep they aren't an issue with your therapy.

Maybe more information from you would be in order.
Exactly what are your symptoms that you haven't had any relief from?
How is your sleep quality....are you waking often during the night? If so, how many times and any idea why?
Do you take any medications? If so, what?

[palerider]

Okay, it's just I saw that numbers over 24 or 30L/Min were more than usual and might need to be corrected, as I've read here or online in general.
According to the leaks should I do something about the mouth breathing? I guess not.
Thought this was adding to not getting relief but maybe not. What do I do then

I'd just turn off that 24lpm redline, and watch for LL flags, that's how Respironics handles it.

Your leaks are actually pretty good.

[vangmay231]

Oh, I didn't know that my leaks were actually good. Cool, cause I was going to try new things for that
Pugsy, my symptoms have been - excessive daytime sleepiness, tiredness throughout the day, the general sleep deprivation symptoms(lack of concentration, on some days it's an effort to keep my eyes in focus, heavy head, fogginess etc) and unrefreshing sleep.
I wake up once without fail every day, twice once in every few days. Mostly I just wake up, visit the washroom and sleep again. Ahi is higher towards the waking up part but I've been told that's just due to awake breathing possibly. Haven't felt refreshed sleep for about 2 years at least now.
No medications at all.

[Pugsy]

How many hours of actual sleep are you averaging a night?
The above reports shows less than 6 hours or just barely over 6 hours.

Can you get me a screen shot of the overview graph showing usage hours?

[vangmay231]

Oh no, the past few days were like that, but generally I sleep a lot, at least 7 hours I'd say, some days over 8. The 3-4 days with very low usage is when my mask came off early into the night.

[Pugsy]

The session times are highly fragmented. Meaning lots of wake ups often.
Some sessions are relatively brief also.
So multiple sessions often and while they might add up to 7 or so hours....not solid sleep.
Might be a factor in not feeling so great. Your sleep architecture is sometimes not so great.

[vangmay231]

Yeah, there are wake ups for sure. What could I do though? I thought that the apneas are cusing this, but they're going down now. I've tried to change basic sleep habits - getting to sleep early, no electronic devices etc. But I wake up without fail every day.

[Pugsy]

Sleep maintenance insomnia...look it up.
The list of causes is extremely long and apnea is but one item on the list.
Fragmented sleep totally trashes sleep architecture so you don't get the nice normal progression into each sleep stage and you don't get the needed amount of time in each stage either.

[vangmay231]

Do note that the sessions on certain days includes a one-two hour nap in the afternoons. I generally do sleep from 10 to say 4 or 5 and then I go back to sleep. So I do get about 5-6 hours of sleep before I wake up on most days

[Pugsy]

I said it might be a factor in how you feel. It's certainly a factor in how I feel. I have first hand experience with highly fragmented sleep and near perfect OSA therapy and not feeling so great during the day.

Or maybe 1.5 months of therapy simply isn't enough time for you to feel any benefits.

Leaks aren't a factor unless they are disturbing your sleep though.

[vangmay231]

Yeah, for sure it could be a factor. If you went through the same, what made you feel better? Just with time or you changed things?
Thank you so much btw in all of this

[Pugsy]

I am still going through it...
You have to identify the cause of the poor sleep quality first. Sometimes that's easy to do...sometimes not so easy.
Then you have to try to fix the cause if you can.
My main cause...pain and fixing that is still a work in progress.
Secondary cause is an elderly dog with bladder issues...fixing that is also a work in progress.
Neither of the fixes has anything to do with cpap settings though. Wish it did because cpap is the easy part.

There is still some truth to the give it time thing for beginners to cpap...let's face it sleeping with all this stuff isn't natural but it can become natural with time.
It took me over 3 months just to quit waking up to feel the mask on my face...another 6 months to experience any improvement in energy levels.
Now I did have 2 sleep apnea symptoms that went away immediately once I had my therapy optimized....nocturia and morning killer headaches so I had some indication that the therapy was working. The other stuff like better sleep and sleeping longer and increased energy took months to actually see some difference.
It's been 9 years on cpap now. Unfortunately while the sleep apnea issues are well controlled...the stuff causing me pain has worsened over the years and that's why I am fighting that battle now. Just one of extra joys we get when we get older and have broken bodies.

Try to improve your sleep quality if at all possible. Nothing but good can come of it. Do it while "giving it time"...might as well huh?
Won't hurt to try but it will take a hard look at your sleep hygiene and anything else in your life that could be impacting sleep quality.

The rare nights that I get close to 8 hours of sleep with maybe just 3 or 4 very brief wake ups that I don't really remember...I feel like superwoman the next day. We all wake up during the night..the key is number of wake ups and if we remember a lot of wake sups then it is a safe bet we have even more that we don't remember.

Did you ever read this....while it talks about the effects of alcohol on sleep architecture...it doesn't have to be alcohol that is messing with things. It can be anything that disturbs sleep and thus affects how we feel during the day.
https://www.thesleepdoctor.com/2017/11/ ... hol-sleep/
For me it's hours of sleep and minimal fragmentation that is the key to feeling better.