Need help/advise

[Barbee]

You do have an ugly leak graph. And you’re probably going to have to address that at some point.

Attached is two pic from last night, is 24.86% large leak (I've set threshhold to be 20) really that bad ??
Again, no leak at all while I am awake ... what can one really do while they are sleep to control the leak other than to make sure the mask is nicely/tightly fit when they go to bed !! ??

You have stated that your sleep is fragmented and you wake up a lot during the night. Its possible the leaks are waking you up. Thats all I mean by addressing it. How is that fixed? Hopefully someone way better qualified than I can give you an answer.

[babydinosnoreless]

Hi,

I was diagnosed with OSA back in 2009 and been on CPAP ever since. Never really had a good night sleep and always tired with mild headache (foggy head) all the time.
Have also seen 2-3 different sleep doctor & had a few sleep study done as a result. All studies have shown episodes of CA (Central Apnea).
Attached is a typical one-night graph from SleepyHead. No matter how far I raise the max pressure setting I never get more than 3 hours of sleep at a time and in the
morning always tired with headache. I am certain that some of the CAs flagged by SleepyHead is while I was awake.

Also, leak is always very very low when I go to bed & every time I am awake. But for some reason large leak % hovers around 30% when I am sleep.
My wife tells me that I move a lot while I am sleep ... I am not sure if there is anything I can do about the way I sleep!!
(Note: I have set the large leak threshhold to be 20 rather than the standard of 24)

My current machine is "ResMed S9" which obviously does not treat CA.
I am planning on getting a "ResMed AirCurve 10 ASV" pretty soon. Would the new machine make any difference (I know this is rather a hypothetical question!!)

About me : 63-year old caucasian male, 5'7'', 150 lb, in good shape & no other medical issues whatsoever, mouth breather and haven been taping my mouth with no issues.
Pressure settings : APAP, Min 13, Max 14.8, Initial 6, ramp in 10 minutes, EPR is off ... been using nasal pillow mask with no issues.

Regardless of how low the AHI is on any given night, I sleep max of 3 hours & suddenly I am up (not gasping for air or anything else & feel fine) ... then would fall sleep in a few minutes.

I would very much appreciate if anyone can comment on my situation (are CA episodes the underlying factor that I never sleep more than 3 hours and always feel tired?)
I can upload more graphs of needed.

Thanks for all your help/comments/suggestions.

SleepyHead_March_12_2019.JPG

A general purpose question : for those of you who have central apnea and are using machines that have algorithm that treat central apnea, have these machines
made a difference? Are these machines truly capable of detecting and treating CA ??

Thx.

This was from my tritation study

2B084D75-427B-4874-A022-741935DCDB6F.jpeg

Last night I had an AHI of 0.63. With zero CA's. That being said I think it depends on what is causing your centrals and how well you respond with treatment. I am on an Aircurve vauto bilevel machine. Once my settings were optimized, with the help of the wonderful people here, my ca's all but dissapeared. I was really worried about those centrals but thanks to everyone I learned it wasn't the centrals but the other stuff that I needed to fix.

[kteague]

Did your sleep study make any mention of limb movements? Thought it was worth asking since you mentioned moving around a lot in your sleep.

Yes, there was a very very minor episodes of RLS (Resless Leg Syndrome). But I don't believe that would be the underlying factor(s) contributing to my situation.

Can you be more specific and quote the actual reported info on any limb movements, with comparison between the diagnostic and titration? If (and that's a big "if" because we don't have any specifics) you happen to have had minor issues with limb movements during the study, it is not unusual to have them worsen once CPAP treatment is effective. There is an explanation for that, but I'll wait and see if you want to pursue that line of thinking. A video of your legs while sleeping could also rule in/out if you have a limb movement issue. It may be your moving around a lot is breathing related, but just throwing out another possibility to rule out.

[unknown12345]

Hi,

I am using one of my old post as a ref & also to ask a couple of questions ... hopefully someone can answer/comment:

Attached are two JPG of my SleepyHead chart from 2/9/2020 ... question:

In below graph why is there a high "Flow Limitation" corresponding to the "Leak Rate" section area highlighted by red (very low ... like 1.5)?
Also, why is the pressure spiking up for that period (which is when I went to bed & I know for sure that I was still up) even though leak is very low?

SleepyHead_Feb_10_2020_Pic1.JPG (334.29 KiB) Viewed 2162 times

Below graph is the expanded version of the above-mentioned graph

SleepyHead_Feb_10_2020_Pic2.JPG (316.68 KiB) Viewed 2162 times

I am up (always with headache) after three hours when I initially go to sleep & then would usually fall sleep about 5-10 minutes & again another 2-3 hours of sleep and up again.
I see that SleepyHead reports Hypopnea (ResScan reports ALL of them as Apnea) every night.

Question : Could "Flow Limitation" indicate that I need to raise the Min EPAP (currently 8.2) ?
If so, I am thinking of raising Min EPAP by "0.2" every few days and see how I feel (hopefully sleeping longer and not seeing any Apnea/Hypopnea)
It seems that realistically Min EPAP should be set to "Median" (about 10) ... will that be a correct assumption?

I've been trying to control the leak for a LONG time & still working on it!!
I have no other medical issues.

Thanks for all your help!!

[Pugsy]

Your large leaks are so bad that I wouldn't trust the flow limitation graph (or the other data) to be accurate during the flagged large leak times when you are so deep in large leak territory (over 35 L/min is deep IMHO).
Besides...ResMed ASV machines always have some really ugly looking FL graphs even without large leaks being present.

The machine responds only to air flow....it has no way to know if you are asleep or not. If it responds and does something while you are awake then it is because your awake breathing irregularities made the machine think something was going on with your air flow that it needed to fix.

[unknown12345]

Your large leaks are so bad that I wouldn't trust the flow limitation graph (or the other data) to be accurate during the flagged large leak times when you are so deep in large leak territory (over 35 L/min is deep IMHO).
Besides...ResMed ASV machines always have some really ugly looking FL graphs even without large leaks being present.

The machine responds only to air flow....it has no way to know if you are asleep or not. If it responds and does something while you are awake then it is because your awake breathing irregularities made the machine think something was going on with your air flow that it needed to fix.

Thx for the reply ...
question : so Hypopnea(s) are solely as a result of all the leaks? If so, increasing Min EPAP would be wasteful as long as leak(s) are no taken care of?

[Pugsy]

Increasing the pressure isn't going to do anything until you get the leaks under better control.

What settings are you using now? Get the actual settings off the machine's setup menu because it is obvious that SleepyHead hasn't got a clue.
Or install OSCAR and see if it plays nicer with your machine....and it might.
OSCAR https://www.sleepfiles.com/OSCAR/
http://www.apneaboard.com/wiki/index.ph ... stallation
http://www.apneaboard.com/wiki/index.ph ... rpretation

Here's a novel idea....maybe if leaks weren't so massive whatever pressure you are using now might just pretty much eliminate the hyponeas.

First order of business....get the leaks under better control and THEN see what might be left that needs to be worked on.

[unknown12345]

Increasing the pressure isn't going to do anything until you get the leaks under better control.

What settings are you using now? Get the actual settings off the machine's setup menu because it is obvious that SleepyHead hasn't got a clue.
Or install OSCAR and see if it plays nicer with your machine....and it might.
OSCAR https://www.sleepfiles.com/OSCAR/
http://www.apneaboard.com/wiki/index.ph ... stallation
http://www.apneaboard.com/wiki/index.ph ... rpretation

Here's a novel idea....maybe if leaks weren't so massive whatever pressure you are using now might just pretty much eliminate the hyponeas.

First order of business....get the leaks under better control and THEN see what might be left that needs to be worked on.

My current settings are in my signature (comment section) as follows :

Mode: ASVAuto, (Min EPAP: 8.2), (Max EPAP: 15.0), (Min PS: 0.0), (Max PS: 8.0)

As I mentioned previously been trying to control the leak for a long long time to no avail!!
Before I go to bed I set the pressure to 20, check the leak & absolutely No leak ... set the pressure back to its proper min, got to bed, wake up & then bingo : there has been leak !!
So, I must be moving (wife has confirmed that too!!) a lot in my sleep such that mask becomes loose!! .... grand project!! ... working on it!!

[Dog Slobber]

As I mentioned previously been trying to control the leak for a long long time to no avail!!

Then it's probably time for a change in mask/mask type.

[Pugsy]

Are you still using the Swift FX Nano mask that is showing in your profile?
If you are....what have you done to try to figure out if the mask is moving causing the leaks or if the leaks are from mouth opening?