Nasal Pillows: Mouth leak vs Equipment leak?

[lazer]

Thanks Pugsy. Still confusing yet also makes a little sense. I thought I had one of those "breakthrough" moments in thinking I had another tool to use for titration instead of the 90% or 95% subtract -2 theory, ect...

Since I never had the opportunity via a "sleep study" to get titrated NOR with the help of a sleep doc as you know, this is still of ongoing interest to me even being 3 months in. Finding that "sweet spot".

Side note: My PCP kindly called me back yesterday and discussed the problem with getting another sleep study covered in the same year by my insurance since we did that "in home" one the beginning of the year. He's looking into a different type of "in home" one that is much cheaper and that I could either pay for out of my own pocket OR he's going to run it by the insurance. Otherwise, it will soon be time to turn in my equipment (loaner) to the DME and proceed on my own which he also fully supports since I've found benefit on xPAP.

[Pugsy]

You know if you really are one of those people who have more events in REM (and there are a lot of us..me included) you may never be able to find a perfect "sweet spot" that works perfect every night. Sometimes those REM events need more pressure...sometimes they don't. Maybe related to sleep position ..maybe not. Maybe the aliens dropped by and gave some of the REM events a dose of steroids so they are super resistant to the pressures.

I have over 3 years with using some sort of auto adjusting pressure machine...first the APAP and now the bilevel and I have a whole bunch of reports that show that sometimes "crap" happens and we just need more pressure and sometimes the night is totally calm and the machine barely raises the pressure beyond the little test probes (saw tooth things). I have see the higher pressures when leaks are minimal to none so I know the machine wasn't chasing leaks.
When those "super duper events on steroids" occur the 90/95% pressures are going to get elevated markedly. For that night it points to the sweet spot being much higher but for the nights that the pressures never need to go up...the sweet spot is much, much lower. That is why you will see me tell people that the 90/95% numbers aren't always the holy grail of where the sweet spot might be. It can be but it can also easily not be.

Here are examples of what I am talking about. These are Encore Pro reports with leak set to report only excess leak and my baseline at my pressure happens to be zero. March 27 and March 30 (2011 on my APAP)...close together. March 30 has a little bit of leak but not nearly enough for the machine to be chasing it. I see this often..sometimes to 18 and 19 max and I have had 90% as high as 18 cm. Sometimes the machine barely increases the pressure. There simply is no way to find a "sweet spot" for me that would work for all nights. This is why I use a wide range. The pressure changes don't bug me. Leaks aren't an issue at the higher pressures. I have chosen the wide range so that the machine can do its job the best it can. If leaks at those pressures were really messing with my sleep then I would compromise. If pressure variations seemed to disturb my sleep then I would compromise.
I am documented worse in REM sleep (53 AHI in REM and 12 in non Rem). Look when the machine wants to increase pressure...right about the time that REM normally starts. I have seen the 2 hour witching mark so often I just ignore it.
I don't think it is positional. In my sleep studies I didn't have any change with supine vs side sleeping and my early experiments with forcing myself to stay on my side did not eliminate the 2 hour witching mark. I am certain that it is REM sleep events.
Why sometimes need higher pressures and sometimes not? I have no idea. Aliens dishing out steroids is as good of a reason as any. It doesn't really matter though...they have to be addressed no matter what the cause.
You may be like me...some nights your sweet spot would be much lower than on other nights. If you have issues with leaks and pressures disturbing your sleep then you may need to compromise...if not then just find a minimum pressure that seems to let the machine do its job. 10 cm happened to be mine on the APAP...if I dropped it to even 9.5 I had some clustering...when I experimented up to 13 cm...no change in AHI or how I felt. The machine did just as good of a job at 10 as it did with 13.

[lazer]

Possibly I've found another way to get an idea on this. Per last night's data with SleepyHead & Zeo:



Notice the alignment of the leaks corresponding to REM. Thinking mouth leaks. I don't remember waking up at all to reposition the mask.

Hrmmm ... Maybe some proof?

[Pugsy]

Maybe you do like me...likely roll over on to your back right before REM starts and the mouth falls open just a little for some of the time, maybe intermittent mouth opening and not always wide open. I am pretty sure that is what I am seeing with the blocks of larger leaks that I see. Almost always in a time frame where REM would be. I am 99.999% certain that my nasal pillows never move much. Certainly not enough to give me what I am seeing.

[lazer]

Maybe you do like me...likely roll over on to your back right before REM starts and the mouth falls open just a little for some of the time, maybe intermittent mouth opening and not always wide open. I am pretty sure that is what I am seeing with the blocks of larger leaks that I see. Almost always in a time frame where REM would be. I am 99.999% certain that my nasal pillows never move much. Certainly not enough to give me what I am seeing.

I'm guessing that is the case, spot on

I am also throwing out those initial Hypopnea's (3 total) at the beginning of the night because I know I was awake screwing around on my tablet... - bad, bad, sleep hygiene - I know

Overall, I feel pretty rested and alert today which would also correlate to the Zeo report of fairly extensive periods of REM and also point to the (mouth) leaks that did occur not having a great impact on therapy although if this is what my trend is, I feel for optimal therapy I am still going to have to address the mouth leaks in general. Maybe I will throw my PapCap in the damn washer on hot cycle instead of hand cleaning it and see if I can get it to shrink. I think I can tolerate it if I can get it to not slide down my damn face overnight and wake up blind like I pulled a damn snooky cap down over my eyes Otherwise the PapCap was much more comfortable than the Respironics "Premium" ChinStrap... - that thing just tears up my chin and face and feels like shit.