Thanks: "Almost perfect" Leak Line finally achieve

[ww]

Thanks to all the wonderful members in this forum that helped me so much over the past 4 months!!!

For anyone new to CPAP wondering what a good leak line looks like on Respironics software in straight CPAP mode, this is the first all night "almost perfect" leak line achieved in over 100 nights of slow and steady progress!!

This data was using the Nasal Aire NAII MP pillows with Slumbergear Headgear.

Does anyone know what causes the downward blips in the leak line? Something woke me up many times during the night and I wonder if that was what caused the blips?



Previously (for the chart below) I had been told that I needed to fix the leaks, but I was not sure what a good or bad leak line looked like (but now I do).

For reference, this was one of my first leak lines that Snoredog called a "train wreck" It was using the Respironics Optilife Nasal Pillow Mask Med pillows and straight CPAP mode.

Without software and this forum, I would never have realized the extent of the leak problem, much less have been able to correct it! Thanks again for the help from everyone!

[Babette]

Why is it that I post similar stats and 6ptStar chastises me to do better?

Congratulations WW! So happy for you!!!

Huggers,
Babs

[OutaSync]

I've wondered about the down blips, too. Maybe that happens when we pass gas.

[DreamDiver]

WW

Thanks for posting this. I've been wishing for a perfect example of good vs. bad leak graphs. This is an excellent one

Congratulations!

[DreamStalker]

I think the down blips are do to a resolution issue of the software. The leak chart only plots in increments of 5 L/m ... so if your leak rate is less than about 27.5 it will plot as 25 and if it is greater it will plot at 30.

So you must have a leak rate of just over 27.5 but every once in a while it dips below and shows up as a downward blip.

[6PtStar]

Why is it that I post similar stats and 6ptStar chastises me to do better?

Babs

When your OA gets to 0.3 I will quit bugging you. Let me know when it happens so I can quit!!!!!!!!!!!!!! Of course i expect your leak line to look like that also!!

Jerry

[Babette]

SHADUPPPPPPPPPPPP!

Thank you for looking out for me, buddy!

Hugs,
B.

[Babette]

I can't figure out how to post my charts to my Photobucket. 6ptStar, I'll PM to you for proof.

Last night - my Average overall AHI was .7 - lowest score yet!

Straight Zeros at 11 and 12, and 1.4 AHI at 10. OA was 1.0 at 10, and Zero at 11 & 12.

I think this 10-12 Auto thing is working for me.

Cheers,
B.

[Babette]

Hmmmm.... EP Analyzer says my OAI for last night was under .5. HI under .2. FLI just over 1.4. SI at 9.

Snores are holding steady. Everything else is down.

Time in Apnea under 50 seconds.
Average Apnea Duration about the same - Just over 10 seconds/apnea
Variable Breathing - 25 - about the same

Large leaks nonexistent.

Leak rate still varies. I roll alot, okay?

Total Events way down. About 1/4 of the night before. Looks like 6.

Apneas right at 5.

Hypopneas at 2.

Eeck! Flow limitations up - 15. What the heck IS that, anyway?

Snores 95 - same as the night before.

Okay, that's all I know.

LOL,
Babs

[6PtStar]

Keep up the good work Babs. Flow limitations can best be described as hypotneas that did not quite make it, just almost. Sent you an e-mail as to how I post data so you won't have to type it.

Congratulations to WW also on working out the leaks. Looks great.

Jerry

[Babette]

Got it! Thanks Jerry!!!
B.

[feeling_better]

This data was using the Nasal Aire NAII MP pillows with Slumbergear Headgear.

Does anyone know what causes the downward blips in the leak line? Something woke me up many times during the night and I wonder if that was what caused the blips?

In another recent thread, you had referred to this earlier thread. This line caught my attention. I know exactly what the cause of the downward blips. First read this detailed posting on leak reporting:
viewtopic.php?t=33829&highlight=

When you do not have much changes in leaks, as in your above night, if the average leak value happened to be between two of the discreet reporting numbers, say 28.5, then the report will randomly, but uniformly, jump between 25 and 32, because of the 7 lpm step in reporting. In your case the average is a bit lower than 32, so it jumps downwards ones in a while.

But there is another distinct factor in play if you are using clfex or aflex. You would be able to demonstrate it yourself by noting the time when you are awake and intentionally breathing at lower rates (longer breaths.) Both cflex and aflex lowers the pressure during the exhale. For me at a constant pressure setting of 5.5 with cflex, during the exhale the pressure drops to about 4.0. The leak as measured by the respironics machine and sw is the total out put flow from the machine. During the exhale period this would reduce, following the leak curve of your mask. Now whenever the machine's sampling or measurement point falling during this the 'measured leak' would be also low. That is exactly what causes those downward blips in your graph, since it is fairly regular.

The import point is that the ratio of the duration of inhale to exhale changes overnight, and because of that the average pressure may change!

Of course, if the average leak was a little bit higher, closer to 32, and if the clfex induced changes was small, then you might have got a flat line assuming (no other leak events).

The following is a real data of mine for one night.

At that break in the graph about 6:40 hrs, I got up and after that I was awake and I was doing deep breathing, and then my relative exhale period tends to be longer. You see the average pressure during that period really going down!

[mellabella]

Wow, ww, how did you manage that small, flat leak line with the Nasal Aire II? How do you wear your headgear?

Edit: scratch that....just caught the reference to "Slumbergear headgear"

[ww]

feelingbetter: That was at a cflex=2. Interesting that the leak line for 25 can be so stable and for 33 will dip down on many of the cflex exhales.

mellabella: I cut all the mask straps off of the Slumbergear headgear and only using it for a chin strap. Kinda expensive chinstrap, but with the NA2 it seems to work pretty well. Unfortunately, I have never quite got used to the NA2 so I can wear it every night, but I will keep trying as it would be so nice if it didn't make my nose sore.

[feeling_better]

feelingbetter: That was at a cflex=2. Interesting that the leak line for 25 can be so stable and for 33 will dip down on many of the cflex exhales.

ww, It seems my description was not clear enough The conclusion you came to is what exactly I am trying to avoid people from making The difference between the 25, and 33 are not because they are 25 and 33. In this particular case we are comparing apples and oranges, since we are comparing one night of my data with one night of your data for different masks, different breathing, etc.

But let us assume, for this discussion, that those two graphs were your data for two nights under say two different pressures. The fact that one was so steady and the other was not was just a accidental. Because, for the steady one the average was sitting at a point very close to one of the reportable values 25, so most of the time when they are measured (remember these leaks are being measured by the machine at some regular interval, say every 10 seconds) it will come up as 25. But for the other where it was dipping down often, the average might have been at say 30, which means more often it will get reported as 25 when there are changes with respect to the average.

If you change your pressure up say 0.5 cm or perhaps 1.0cm, and had an identical situation as that night, you would have got a very steady cleaner line. Similarly, if I change my pressure down by such smaller amounts, I might see a lot more squiggly line, though the leak changes might be similar to those nights.

So what we think as very clean, and smaller squiggles are not that different type of leak changes, than a flat line. They are essentially the same. One need to watch out for the bigger changes, like the one you started out with at the beginning (the 'train wreck' one).

Hope that was a bit clearer.