I don't understand last night's data

BigEd · Post by **BigEd** » Fri Jul 18, 2008 4:45 pm

For the last month or so I've been mouth breathing - a lot. (Averaging over 90 minutes a night in Large Leaks.) I've been toying with changing from the Swift Nasal Pillows to a FF. But before taking that step, I've been working through the various techniques to try to stop my mouth breathing. I've tried mouthguard, chin strap, Poli-Grip, cheek puffing mouth band, etc. I had avoided taping because I have a moustache.

Well after all those methods failed, I decided to go the taping route (moustache and all). It actually worked really well. The tape seal never broke. 0 minutes of Large Leak and a relatively flat leak line - with the exception of hours 2, 3 and 4. Looks like I was leaking, but where?

I don't believe the nasal pillows are the problem (replaced them about 2 months ago). I've never had a problem with the seal on the nasal pillows in the past.

I've included a copy of last night's data. Any thoughts on what might have happened in hours 2-4? I would really love to get rid of that jump in the middle of the night, but I don't understand what would be causing it and therefore what I should do to correct it.

Thanks for the help

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CPAPopedia Keywords Contained In This Post (Click For Definition): swift, seal, Nasal Pillows

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CPAPopedia Keywords Contained In This Post (Click For Definition): swift, seal, Nasal Pillows

feeling_better · Post by **feeling_better** » Fri Jul 18, 2008 7:18 pm

BigEd,

Your avg pressure goes from around 9 in the first couple of hours to about 19 in those two middle hours. So your intended leak (the constant outflow from the exhaust port) would correspondingly increase. I do not have any first hand knowledge about your specific machine, but since it is a Respironics, I am pretty sure that the leak reported includes the intended leak. I do not know the leak curve for your mask, but assuming it is around 35 or so at pressure 9, it would be around 60 at 19 (just estimating). So a good chunk of what you see is the actual intended normal leak variation.

Of course there are lot of variations in specifications of masks and the accuracy with which the machine measures the flow and the leak. You can determine your actual intended leak as measured by your equipment at two of those settings using my method here:
viewtopic.php?t=32896&highlight=

I would be interested in the numbers you get from such a measurement.

I also noticed that there are small leaks around many of the swivel or rotating type joints, these leaks can be a good chunk (10% or more) of the intended leak. Sometimes the leaks are distributed around the circumference of the swivel and is not felt as strong enough if you simply hold your hand there to detect it.

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CPAPopedia Keywords Contained In This Post (Click For Definition): respironics

GumbyCT · Post by **GumbyCT** » Fri Jul 18, 2008 9:07 pm

BigEd,
If you are like me & toss n turn in your sleep, you likely dislodged a nare to make a leak. Are you a pretty sound sleeper too?

So first you have to get your leaks down. If it were me, I would also consider moving the Epap to 3 less than your 90% (15.3) so 12-13. I think that will catch more apneas for you then you should feel the diff pretty quickly. But you will have to keep the leaks down. Do you use anything to help seal the nares? Some use Ayr gel or Ky, or something else w/lanolin. I use Lasinoh - it really does help.

Good Luck,
GumbyCT

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edit: fix tpyoes
CPAPopedia Keywords Contained In This Post (Click For Definition): seal

jules · Post by **jules** » Fri Jul 18, 2008 9:22 pm

you might want to look at how people dealt with swift leak and anchoring issues - lots of ideas in that UFO13 thread listed below -

Swift

Moby
pantyhose tights replacing headgear
Dec 30, 2007 subject: Swift 2 Pantyhose headgear to Di for modification and pictures -- using pantyhose tights to replace straps on the Swift II.
viewtopic.php?t=27187

svh
safety pin/sewing fix for Swift's backstrap
Nov 09, 2006 subject: Swift headgear modification for stability to svh3 for modification and pictures -- using safety pins (or sewing) to shorten and slightly change angle of back strap.
viewtopic.php?t=14991

ufo13
velcro fix for Swift's backstrap
Dec 03, 2005 subject: Tips for SWIFT users!! to ufo13 for modification using velcro strap to keep Swift's back strap from slipping upward.
viewtopic.php?t=5965

Tridens
Routing Swift's hose in front:
Aug 22 2005 subject: Solution for Swift side sleepers to Tridens for modification to place Swift's hose at front/center and Lori's pictures of the fix.
viewtopic.php?t=4290

===================================================

for other masks look at
viewtopic.php?t=15104

BigEd · Post by **BigEd** » Fri Jul 18, 2008 9:32 pm

Feeling_better: I like your idea. I'll test that out tomorrow. Thanks.

GumbyCT wrote:BigEd,
If you are like me & toss n turn in your sleep, you likely dislodged a nare to make a leak. Are you a pretty sound sleeper too?

I sleep on my back and really don't toss and turn much at all - if any.

GumbyCT wrote: If it were me, I would also consider moving the Epap to more more than 3 less than you 90% (15.3) so 12-13. I think that will catch more apneas for you then you should feel the diff pretty quickly. But you will have to keep the leaks down. Do you use anything to help seal the nares? Some use Ayr gel or Ky, or something else w/lanolin. I use Lasinoh - it really does help.

I'll try moving the EPAP setting up as suggested. BTW: I use the Ayr gel and really do not have any leaks at the nares/pillows.

Thanks for the advice GumbyCT. I'll post my results tomorrow.

Jules - thanks for the additional links. I think I've read through most of those, but I'll double check just in case.

jules · Post by **jules** » Fri Jul 18, 2008 9:35 pm

you need to do something to try to figure out the leaks - I did the elastic around base of head to the triangles in the swift barrel ends myself - worked to hold the mask in place

you had a leak/pressure raise combo that went sky high

ww · Post by ww » Fri Jul 18, 2008 9:46 pm

Everything above about 40 l/min happened because of leaks at the nares, although you don't feel that is the case. If your mouth is sealed then it has to leak at the nares! Jules offers some very good advise on this problem.

Snoredog · Post by **Snoredog** » Fri Jul 18, 2008 10:38 pm

Changing your pressure is NOT going to help with that report. Leak is what caused that train wreck, the machine increased pressure due to the FL and VS but leak developed so it lost control of the events.

Anytime leak gets above 50 L/m the machine cannot maintain pressure to treat effectively. The Bipap for the most part is able to manage that better, but the problem is leak shown in the same chart.

You cannot go by that report due to the leak seen.

EPAP was pushing IPAP up as it went, so the event that triggered that upward trend is shown on the bottom of the report on the left, NOTICE IPAP handles certain events and EPAP handles certain events. The events that cause EPAP to move and push up IPAP are Apnea and Vibratory Snore.

Flow Limitation and Hypopnea are treated with IPAP pressure just as your report legend shows.

There is absolutely nothing wrong with your machine setting other than you had some leak.

I'd make a potato launcher out of that Swift.

BigEd · Post by **BigEd** » Sat Jul 19, 2008 9:27 am

Ugh! I won't bother posting last night's results because they were all over the place with severe leaks. I did increase my EPAP pressure from 8 to 12.5 as suggested and also changed the tape I was using to the 2" blue delicate release painter's tape. (The tape didn't hold as well as the night before - large leak of 74 minutes.)

The pressure increase helped me discover that I am leaking at the nares. I never noticed before, because they didn't leak at 8 (while I was awake). Once the pressure went up, the leaks began. So now I'll add mask leaks to my list of issues.

I'll take Snoredog's advice and return the EPAP pressure to 8. I'm not ready yet for the potato launcher - but getting closer. I have a new Swift II that I can try tonight. I wish this discovery process wasn't limited to once a day. Looks like it may be time to explore FF masks. Thanks for all the help, advice and analysis.

DreamStalker · Post by **DreamStalker** » Sat Jul 19, 2008 9:43 am

You are at a rather high pressure with that nasal pillow interface.

You are most likely mouth leaking. Are you taping or doing anything to control those leaks?

Yes, the FF masks are something you may need to look into.

GumbyCT · Post by **GumbyCT** » Sat Jul 19, 2008 4:11 pm

How old are your nose pieces? Glad you have new ones to replace them. Maybe you need something better than the Ayr Gel to help your seal.

For high pressure - I am at 18/15 with a Headrest. The very first thing I do when I put my Headrest on is to feel, with my hand, for leaks. Any air at all is a leak. The Lasinoh really does help. I have Ayr gel but haven't tried it.

BigEd, maybe you need to be more sensitive, ha!

jules · Post by **jules** » Sat Jul 19, 2008 4:33 pm

My understanding is that Swift 2 has the same crappy headgear as Swift original. That headgear is a BIG problem and you need to find a fix that works for you.

As I said last night, the elastic band around the base of my head worked for me. I was able to totally dislodge the headgear and the nasal pillows stayed in place and so no big leaks. YMMV.

Read the fixes and start working on one to try and try another if that doesn't work. Elastic, Velcro, knee high nylons, safety pins all should be on your shopping list if you don't already have them.

Also start looking for another mask to try.

BigEd · Post by **BigEd** » Sat Jul 19, 2008 5:46 pm

GumbyCT wrote:How old are your nose pieces? ... BigEd, maybe you need to be more sensitive, ha!

It's about 2 months old - and I always considered myself to be sensitive (yet still in a manly way - haha! )

jules wrote:Read the fixes and start working on one to try and try another if that doesn't work. Elastic, Velcro, knee high nylons, safety pins all should be on your shopping list if you don't already have them.

Also start looking for another mask to try.

Thanks Jules - will do. BTW, you left off Superglue.