AHI 131 !! - Help me understand my SleepStudy & CPAP results

[Kenwood]

What the hell happened to me the other night?!!!

I have never seen so many events? 200 pressure pulse events. 65 Hypopnea & 42 Obstructive Apnea's. 105 snores. My AHI shot up to 65.

Look at that first hour block of time when I went to bed. It actually woke me up. It was strange as I thought it was around 5:30am and my alarm would be going off, but I was only asleep for less than an hour. I got up and went downstairs for a bit before going back to bed.

[Pugsy]

Your EPAP pressure is insufficient to keep the airway open.
The later part of the night where the events seem to die down...your leak is excessive and that messes with the accuracy of the data. Remember you need to stay below 85 to 90 L/min to stay our of large leak territory.
But even when the leak wasn't in large leak territory...the pressure is/was insufficient to prevent the collapse of the airway.

What happened to the auto bilevel or at least increasing the EPAP?

[Kenwood]

Your EPAP pressure is insufficient to keep the airway open.......What happened to the auto bilevel or at least increasing the EPAP?

I'm still waiting to get the Auto BiLevel machine. Waiting on the Insurance company as the DME company hasn't received anything. Since I learned today (thanks a that thread) how to get into the secret setting menu on my machine, I bumped the IPAP to 20 and EPAP to 14.5.

[Pugsy]

Okay...try really hard to deal with the leaks.
More EPAP should help...how much? We just have to wait and see.
Good luck tonight.

[Kenwood]

Okay...try really hard to deal with the leaks.

Well yesterday I got the Regenesis buckethull pillow in the mail. And today I got the Pad-a-check "Anti leak strap". Fingers crossed

[Kenwood]

Here is last nights chart.....using high settings of: IPAP to 20 and EPAP to 14.5. Also using Pad-a-check "Anti leak strap". But I have ben sleeping on my back all week, as I have had terrible back pain since being on CPAP (switch from stomach to side sleeping). So my Chiro has asked me to sleep on my back to help.

Looks like the leaks averaged around 93 L/min. The "anti leak strap" helped the lower areas, but I ca't seem to do anything to stop the nose leak into my eye. I'm gonna make some calls today on the Auto BiLevel machine as the RX was written on 3/11 and the RX for the Mirage Quattro was written on 3/18.

[Pugsy]

I can't tell if the better report is because the pressure is better or the leaks are just causing the machine not to pick up the snores and events. Given the snores at the beginning and end of the report and where the leak line is closer to 75 L/min for part of the time...I am leaning toward the leak being large enough so that the machine simply can't sense the snores and events so the blank space may be the machine not being able to record things properly.

Do you have Encore software that would actually flag large leak times?
I know for sure 90 L/min is in the beginning of large leak territory...we aren't ever told exactly where it starts but some people would get large leak flags at 80 L/min...

Your leaks are still at the point that they are making it difficult to evaluate the effectiveness of the pressure.

Look here at the vent rates for your mask...even at 20 cm straight pressure...you never come anywhere near what the vent rate is. Have you checked all your hose connections and the hose itself to make sure that there are no leaks elsewhere in the system? Something is not right here...you should at least be able to have a short time around 60 L/min or a little lower even.
http://www.resmed.com/us/assets/documen ... sa_eng.pdf

[Kenwood]

Look here at the vent rates for your mask...even at 20 cm straight pressure...you never come anywhere near what the vent rate is. Have you checked all your hose connections and the hose itself to make sure that there are no leaks elsewhere in the system? Something is not right here...you should at least be able to have a short time around 60 L/min or a little lower even.
http://www.resmed.com/us/assets/documen ... sa_eng.pdf

I'm still using the ComfortGel Blue mask.....haven't received the Quattro yet. I'll check my hose tonight. I don't have the Encore software (I'm a Mac user).

[Kenwood]

Here's my overall charts since I started on CPAP.....

[Pugsy]

Sorry, forgot about the Mac.
I was mainly wanting the Large leak color thing that Basic offers that SleepyHead can't give us just so we would have a better idea where your large leak territory begins.

[Kenwood]

I had a long 20 min conversation with a rep at my DME company on the phone yesterday. This guy was a tech at sleep study labs for 20 years, so he had some knowledge. I explained everything thats been going on with my treatment and my concerns. I learned a lot.

First thing I learned was the DME had NOT received the RX for Auto BiLevel from the Sleep Dr. from two weeks ago. I called them afterwards and had them re-fax the RX and they will call DME on Monday to confirm its been received. The DME tech said that my Insurance company (Aetna) might not approve the RX as the Ins Co will only pay for the minimum for treatment based upon ONLY my sleep study results. The Ins Co won't look at the data from my machine to base their decision for the added costs of a Auto BiLevel. The Ins Co only uses the machine SD card data for compliance usage to continue payment. So the tech asked me to send me my SD card as he wants to look over my current data since he knows how to read them. Wants to see whats going on with me. So I'll drop my card in the mail today. He will call me after he reviews my data and discuss what's going on with my treatment and come up with options.

Then we discussed my major mask leak issues since they are over 100 L/min. He didn't seem to like that I've been using a Pad-a-cheek mask liner. Got the talk about the seal and how (if face and mask are clean) its supposed to seal better with my face. I explained the problems I've been having with my ComfortBlue Gel FF mask. Creases that have developed (both sides) on the clear part that goes over the blue gel piece. Since I'm already at a month, he was going to mail me replacements for that part. I still don't think that's gonna help my nose leak into my eyes problem. Told him when I was at my Mask refit at the Sleep Study place, they confirmed that I had my mask properly adjusted and that I had a high leak on their machine at my 20 IPAP pressure. But when they put me on a Mirage Quattro, the leak went to almost nothing and they wrote an RX for that exact mask. The problem is my DME doesn't carry ResMed products. He basically said without solving the major mask leak issues everything else (like getting an Auto BiLevel) is pointless. So that problem I guess I'll have to bring up with the Sleep Doctor and send it to a different DME? I do have a follow-up appt already scheduled on April 8th with my Sleep Doctor.

Here's Friday night's data/charts:

[Pugsy]

Your time in large leak was much less last night.
Don't worry so much about the Auto Bilevel right now...it's possible to get the straight bilevel to work if you can
1....get the leaks managed which you have to do no matter which machine
2....find a suitable pressure on EPAP that gets the job done and you are comfortable with it.
The Auto part is nice but it's not like you can't get effective therapy with the fixed bilevel machine...you just will have to use a little more pressure all the time instead of some of the time.

Time spent in large leak last night....significantly reduced. Reduced to the point that we can actually evaluate the pressures for the bulk of the night.
EPAP of 14.50 is still not quite enough to reduce the snores but it does a good job on the full blown events.
Snores are indications of minor flow reductions.
I think a little more EPAP and you will be in good shape...maybe another 0.5 to 1.0 cm.

Last night is a good report. You can see the time above 90 L/min isn't huge.
AHI is nice and low...this is a huge improvement over your first reports. I would be doing the happy feet dance for this one even though it isn't perfect. It's a huge improvement.

I still think the PB is likely related to arousals. Clean up the clutter a little more and the PB should reduce more...if it doesn't then talk to your doctor about it. The PR S1 tends to "over" report PB meaning that if you look at the actual flow itself it might not be nearly as scarey looking as we might originally think especially since your CAs are essentially gone.
Not all PB is an indication of something really bad going on.

I am actually quite pleased with this most recent report of yours.

[Kenwood]

Pugsy - Question for you (look at last nights chart):

Maybe this is just a perception issue as a result of getting used to the pressure feeling during the night......but when I woke up this morning.....it felt like the pressure was almost nothing in my mask - unlike the feeling of the 14 EPAP/20 IPAP when I start my therapy going to bed at night. I couldn't really feel as difference between the EPAP/IPAP pressures.....just felt super low (like ramp). My first thought was if there was something wrong with my machine. Have anyone else experienced this feeling?

[Kenwood]

Your time in large leak was much less last night.

Time spent in large leak last night....significantly reduced. Reduced to the point that we can actually evaluate the pressures for the bulk of the night.

Last night is a good report. You can see the time above 90 L/min isn't huge.
AHI is nice and low...this is a huge improvement over your first reports. I would be doing the happy feet dance for this one even though it isn't perfect. It's a huge improvement.

Forgot to mention...that I took off the Pad-a-cheek mask liner last night, but still used the Pad-a-cheek "anti-leak strap".

[Pugsy]

but when I woke up this morning.....it felt like the pressure was almost nothing in my mask - unlike the feeling of the 14 EPAP/20 IPAP when I start my therapy going to bed at night. I couldn't really fell as difference between the EPAP/IPAP pressures.....just felt super low (like ramp). My first thought was if there was something wrong with my machine. Have anyone else experienced this feeling?

Yep, this is common. What feels like a hurricane at night is nothing more than a gentle breeze when we wake up.
Your body is adjusting to the pressure during the night. And yes, sometimes we wonder if the machine is blowing the right amount of pressure. Entirely normal..and nothing at all to worry about.

Looks like the padacheek liner was creating more leak issues...it can happen that way for some people.
Bummer because the comfort is nice and not everyone has that happen but you drew the short straw in that regard.