A big ol' thumbs up for Lansinoh! Still some leaks though

[JoeP]

One night of use and "ouchy" nose is gone.

Still not real happy with the leak line in sleepyhead though. I am thinking of taking the drastic step of shaving my mustache this weekend. My upper lip and chin have not been bald since 1995 so it will take a bit more thought to commit to it although i have been considering shaving just the mustache for a couple months and keeping the goatee.

[Pugsy]

How bad is the leak line in SleepyHead? Sometimes SH makes mountains out of mole hills when it comes to that line because of the scale that is shown. The closer the scale the worse it looks when it really isn't all that bad. Hate to see a guy go naked on the upper lip area unless he just has to if he doesn't want to.

What is the maximum leak and do the leaks wake you up?

[Slartybartfast]

Nose hairs can also cause annoying little channels for air leaks; keep them well-trimmed, too. Congrats on the decision to lose the 'stache.

[JoeP]

I'll post a few charts tonight.

I have been woken up by the leaks on a few occasions, mostly due to the leak/pressure cycle, i end up not being able to get a good seal with the high pressure and have to hit the ramp button to drop the pressure back down.

I am getting better at not obsessing over potential leaks and fussing around with my mask when i should be falling asleep.

[Pugsy]

If the leaks are feeding the pressure increases that can disturb sleep...so obviously we want to limit them if that is happening.

They may not be bad enough to really impact therapy but they might impact sleep quality.

As long as I stay below large leak territory (90 L/min for Respironics machines) and they don't wake me up often...I don't care what the leak line looks like.

So it all depends on how much leak and how often it might be waking you up...

[NateS]

One night of use and "ouchy" nose is gone.

Still not real happy with the leak line in sleepyhead though. I am thinking of taking the drastic step of shaving my mustache this weekend. My upper lip and chin have not been bald since 1995 so it will take a bit more thought to commit to it although i have been considering shaving just the mustache for a couple months and keeping the goatee.

I have not given up my mustache and I am not going to.

There is no need to radically change one's daytime appearance in order to achieve low-leakness.

I agree with Pugsy that SleepyHead tends to exaggerate the appearance of leaks in its graph. I use both and I always switch back to the leak chart in ResScan to make me feel better and more satisfied with myself.

It is enough to have to radically change it with a mask and hose while asleep - even my dog was frightened and puzzled for awhile.

Nate

[JoeP]

It is enough to have to radically change it with a mask and hose while asleep - even my dog was frightened and puzzled for awhile.

Nate

Yeah, our poor dog, he was scared of me the first night, then i took the hose of the mask and blew some air at him which i though the would like based on past car trips, but he buried his head in the covers. He is getting a bit better with my appearance.

[Janknitz]

When you have an auto machine and you fit your nasal pillows at the starting pressure, the seal may not hold in the middle of the night when the pressure maxes up. S9 Autos have a "mask fit" feature which increases the pressure to the max setting so that you can fit your mask at that pressure, then the pressure returns to the "regularly scheduled program". That makes so much sense. Stupid PR for not including this feature on the S1's!!!!

On the PR machines, you have to go into the clinician's menu, reset the pressure for a FIXED pressure at your highest limit with NO ramp. Now fit your mask (be sure to do it lying down in your normal sleeping position). Once it is fit, then go back into the clinician's menu and restore the normal settings (what a PITA!!!! ).

I would try that before shaving off your "stash".

I think it was alreay suggested, but have you tried a larger nasal pillow? Sometimes that will do the trick.

[JoeP]

Here are some graphs from sleepyhead.

The first two are with min pressure set at 5.0 and no A-flex, the last 3 are the most recent and have min pressure at 5.0 with A-flex enabled.











I dont know if they are acceptable or if i need to be changing things, any input is appreciated.

Thanks
Joe

[Pugsy]

SleepyHead scale is making mountains out of mole hills.
Plus your are using APAP and when your pressure increases we also expect your normal vent rate to increase (that is part of that leak line). Notice the increase in pressure also correlates with an increase in the leak line.
Respironics machines report total leak. Total leak is mask vent rate/intentional leak plus any excess leak.

The vent rate at 6 cm pressure is quite a bit lower than the vent rate at say 12 cm pressure. That line will go up because of the vent rate even with no leaks.

The scale that we are seeing things is zoomed in so close that the changes look like mountain size leaks but they aren't.

The worst you had was a spike to 65 L/min..this was/is a very short lived spike...it doesn't last all that long in the grand scheme of things. The other times the scale is down around 35 to 40 as the highest leak and this is going to be real close to the vent rate for around 12 cm.

Respironics say they can adequately compensate for leaks up to large leak territory and after using Respironics machines for nearly 3 years and I have seen some large leak flags...they don't occur until you get near that 90 L/min mark when reporting total leak.

So in regards to therapy your leak line is really quite acceptable and the bulk of the varying that you see is related to pressure going up and down. Most of it is the vent rate. Do you have the paperwork showing normal vent rates? If not, I can try to find it.

So your leak line is well within acceptable limits...very well within and likely very minimal when compared to the pressure (and that pressure's vent rate) used when the leak line has increased.

Now...if those pressure increases are disturbing your sleep causing little leaks that awake you and annoy you. Then you might want to consider limiting the pressure ranges so that there is not so much variation and lessen the chance for the variations disturbing your sleep quality.

If you were to use Encore software to view these leak lines...the scale is fixed and zoomed way out and most of these mountains would look almost entirely flat lined with maybe the exception of that 65 L/min spike because the scale goes to 120 (I think somewhere in that neighborhood) and a 40 l/min leak at that scale barely moves.

[JoeP]

Thanks Pugsy, To my untrained eye the lines looked horrendous so it is good to know that they are reasonable.

My first follow-up is in 2 weeks, I want to know what i am talking about when i go back and ask what adjustments can be made.

According to sleepyhead for the past 2 weeks I have had zero OSAs on several nights with only 1or 2 the other nights, Most of my events are hypopneas 5-10, flow limitations 10-20, RERAs 5ish, VSnore#2 30-50 and VSnore 15-25. One thing that i did notice is that the snore #s have roughly doubled after bumping base pressure to 6 and enabling A-Flex.

My AHI was not high to start with so based on what i am seeing in Sleepyhead i think that my fragmented sleep and hence sleep apnea symptoms were caused by the flow limits and snoring. Is that a logical conclusion from the data?

[Pugsy]

My AHI was not high to start with so based on what i am seeing in Sleepyhead i think that my fragmented sleep and hence sleep apnea symptoms were caused by the flow limits and snoring. Is that a logical conclusion from the data?

It's possible. Obviously kind of hard to know for sure.

The APAP should respond to the snores and flow limitations if they are accompanied by normal obstructive event precursors. I didn't look at that part of it real close but it is possible that the minimum of 6 is just a wee bit low and the machine can't quite get to where it needs to be to effectively minimize the flow limitations. This area is harder to judge than AHI. What I might sleep through (in terms of flow limitations and snores) you may very well find disturbing to your sleep. Overall the snores and flow limitations aren't horrible numbers by any means but they might be enough to disturb your own sleep.
It is also possible that the pressure variations might be some what disturbing in general also. Some people find pressure changes disturbing and others do not. I routinely used to see 18 cm with my 10 cm minimum and 20 maximum and I never knew it until I looked at the reports.
It isn't all about the "numbers"...wish it were that easy...but instead it is about the quality of our sleep too and people tend to zero in on "numbers" and forget that other part of the equation. We have to look at the whole picture.

Also play around with your Flex choices. You may find that one setting lets you rest better than another setting. I always used AFlex. I just liked it better than CFlex. One time I decided to turn AFlex off to see what happened. Bad mistake, horrible night. I have it documented here and I think you can easily see it was a disaster.
viewtopic.php?f=1&t=67883&p=631376&hili ... mb#p631376
You might like it off...you might like a different setting...this part is another of those "individualized results" thing that goes along with cpap therapy. Don't do something based on what someone else has good luck with...do something based on your own response. Using CFlex or AFlex with these machines doesn't alter the therapy pressure like EPR does in the ResMed machines. If you breathe easier and smoother and rest better...it doesn't matter what the setting is.

[JoeP]

It isn't all about the "numbers"...wish it were that easy...but instead it is about the quality of our sleep too and people tend to zero in on "numbers" and forget that other part of the equation. We have to look at the whole picture.

haha, well i am an engineer, so I gravitate towards the numbers as validation that i am doing things "right"

thanks again for all your input and knowledge.

[Pugsy]

haha, well i am an engineer, so I gravitate towards the numbers as validation that i am doing things "right"

Well you certainly are not alone. Most of us look to the "numbers" first for validation because that is what we have been given to look at.
Seems like that is what we are taught with all this medical stuff for sure....glucose numbers, thyroid numbers, etc.
While they definitely are important we just have to remember that for sleep apnea "great numbers" doesn't guarantee great results simply because of the other things that can mess with our sleep that are more subjective than quantitative.
By the same token not so great numbers doesn't always mean everything has gone to hell in a hand basket.

But at least good numbers rules out one potential problem when we evaluate subjectively how we feel. It's not perfect but it's the best we have to work with right now.

I have a bad back and bad neck...lots of pain..all day and all night each turn over in the bed would wake me up because of the pain and because I am in pain I tend to toss and turn a lot trying to relieve that pain so nasty little circle develops.
So my sleep is horribly fragmented due to multiple wake ups from pain. My AHI is/was great but I felt like I had been hit by a bus. Waking up (and remembering) 20 plus awakenings totally screws up any chance of normal sleep cycles no matter whether I had OSA or not. So I take some meds to help with the pain and also help me sleep a little deeper so that the pain doesn't fragment my sleep so much. If I hadn't looked at the whole picture back when I started cpap and I got the great numbers but felt bad due to something totally unrelated to sleep apnea then I likely would have put all the blame on the machine not doing its job and shoved it way back in the closet.

So it is good to look at the numbers but don't have tunnel vision and limit oneself to not being able to see the whole picture. Sometimes that big picture has some pretty interesting stuff.