Leaks and OA's?

[remstarcpap]

Here is last nights readout at fixed 9.0cm cflex pressure.



It looks to me like all my OA's are associated with small leaks. Not the Hypopnia's so much.

Does this mean that they are "real" or are they an artifact of the leak?

If real, what can I do to lower the leaks? I use an Optilife mask, and have it probably as tight as I want it to be for comfort. Or should I just not worry about it? I'd like to get my numbers down lower, as I still don't always feel so well rested on awaking. Of course, that could have nothing to do with apnea.

Aside from how I feel, what is the right AHI number to shoot for? Should it be zero, or is under 3.0 good enough? What's a realistic and optimum number?

Thanks.

[LinkC]

Can't answer the "artifact" question, but clearly most of your OAs occur with the larger leaks.

My doc told me anything below 5 AHI is considered "effective therapy". Most who track data shoot for < 1.0. I think it's about looking for trends and keeping the numbers as low as reasonably achievable.

But anything I can get is better than the 96 AHI I had before CPAP...

BTW, although your leak line looks very good, I found the Optilife may leak less if you back off the straps a bit. The pillows need a bit of flex and play to maintain a seal in all positions. If you crank down until they are fully compressed you may actually induce leaks when there's pressure on the frame.

[dsm]

Remstarcpap,

Unfortunately the data reported can be quite misleading. Many of those so called OAs do look like CAs or leak related.

The machine really doesn't know for certain if an OA is central or obstructive. If the OA was obstructive, it will usually be preceeded by FLs or Hypops & often Snores. If none of them show, it may well be CAs that have been scored as OA.

If you wake or turn over etc: then there is a high possibility a OA will be scored because the machine has no category for scoring a natural CA.

DSM

[Gerald]

To answer your questions.......here's how it works.

The CPAP machine uses pressure to push your airway open....so that you don't suffocate. If you have a leak, that means the pressure goes down....and your airway closes. When your airway closes, you have an apnea...or maybe a hypopnea.

If your leak line is nice and straight......and your pressure is set high enough....you'll have few apneas or hypopneas....and your AHI will drop.

My honey and I have found that an AHI of 2.5 or above does not continually allow 93% O2 blood saturation. That's why you still don't feel quite right.

If you get the AHI down around 1.0....and test yourself with an Oximeter....you'll see that your O2 is where it should be (while sleeping).

Elemination of leaks is the "game"....get rid of 'em.

Gerald

[remstarcpap]

dumb question, what is a CA? central apnea? Also, what's the best way to lower leaks? I can check my O2 with my oximeter and see what it's at. Is the 93% threshold a good one?

[dsm]

dumb question, what is a CA? central apnea? Also, what's the best way to lower leaks? I can check my O2 with my oximeter and see what it's at. Is the 93% threshold a good one?

Gerald made an excellent point re how leaks allow the pressure to drop & airway to perhaps close.

Most machines have leak detection algorithms (i.e. Respironics call their AUTO-TRAK) but they still don't always get the numbers right when high leaks occur.

CA is Central Apnea. As for SpO2 desats - below 88% will usually cause your doctor concern, 92% is not a bad figure - a tad low but still ok. You can expect to see your SpO2 drop to 90% on occasions.

Scored Apneas are when the machine detects no flow of air (or a 75% / 80% depending on brand) for 10 secs or more. It is a Central if this happens when your airway is open (an open airway with no flow means you have stopped breathing for other than obstructive reasons). It happens normally duing the period we start to go to sleep & sometimes when we turn over etc:.

DSM

[DoriC]

If the manual states 41 as the Leak Rate for the UM at 12cms, what would be considered acceptable above that? Hubby's LR is usually 45-48 with AHI=0.6-1.7. It seems the higher LR correlates with snores but not OAs.

[ozij]

There is absolutely no inidication in the graph that the apneas reported are central origin.
The fact there are no flow limitations on this report does not indicate anything about the apneas recorded.

As for the relationship of apneas to leaks - those leaks are within the machine's compensation capacity, so I rather doubt they indicate pressure loss which causes apneas. Rather, they may actually indicate resltless movement in response to the apnea, and the movement will cause these small leaks.


O.

[Guest]

T. If you have a leak, that means the pressure goes down....and your airway closes.

Thus is actually quite incorrect. Leaks on the order shown above do not cause a decrease in pressure. The machine will respond with an increase in flow to maintain the desired pressure.

[Gerald]

OK, Guest......

If I'm "quite incorrect", then please explain why the spikes in the leak line....seem to line up perfectly with the apneas on the AI line.

Surely you have a "scientific" explanation for these "coincidences"........

Gerald

[Wulfman]

I agree with the points made by "ozij" and "guest". Your leak line isn't all that bad. In my estimation, your pressure needs to be raised a bit to squash some more of those apneas. Also, make sure you're not mouth-leaking.......I notice you're using a nasal mask. (those leak spikes could be mouth-leaking, too)

Den

[Guest]

OK, Guest......

If I'm "quite incorrect", then please explain why the spikes in the leak line....seem to line up perfectly with the apneas on the AI line.

Surely you have a "scientific" explanation for these "coincidences"........

I didn't say anything about the perceived coincidence of the leaks and the apneas. I was pointing out that you were incorrect about leaks (on the order of those shown) resulting in a loss of pressure.

[Hawthorne]

I agree with Ozij, Wulfman and guest on this one!

Actually, I agree with Ozij and Wulfman quite often!

I don't know who "guest" so don't know if I agree with him/her often or not!

[Gerald]

So if he has apneas when he has leaks....and the machine is supposed to be compensating for the leaks....what's causing the apneas?

Gerald

[Guest]

So if he has apneas when he has leaks....and the machine is supposed to be compensating for the leaks....what's causing the apneas?

The coincidence of events may simply be that, a coincidence. If the leaks cause apneas (which I can't recall ever reading here before) as you assume, then why don't all of the leaks result in apneas? There are leaks seen around the 1 hour mark, the 3 hour mark and the 6 hour mark that are not associated with apneas.