Average Leaks & still tired question!

[sleepyruss]

Lincare reviewed my sleep statistics from the machine at my request.

I have still been feeling VERY tired after a month of consistent use. My AHI appears to be in a decent range of 2 - 3.

The Lincare rep showed the stat that said my average leak was 20. I assume this is per hour, but I am not sure. She said this was high and recommended I use a chin strap.

Do you guys feels this is sound advice? Is that number high? Is it indicative of a mouth breather?

I should also point out that the leak graph is plenty flat at around 18-20....no spikes. I am using a ComfortGel nasal mask.

Any help is GREATLY appreciated.

Russ

[RogerSC]

If you could post some data including leak graphs, it would be easier to make a useful comment. However, it can take a while to catch up on your sleep, and start feeling better. But posting your sleep data would help us help you.

Thanks.

[Pugsy]

The Lincare rep showed the stat that said my average leak was 20. I assume this is per hour, but I am not sure. She said this was high and recommended I use a chin strap.

Do you guys feels this is sound advice? Is that number high? Is it indicative of a mouth breather?

No, No and No...not sound advice, not high and not indicative of mouth breather especially when you say no spikes and pretty much a flat line.
You are showing Respironics equipment in your profile. Respironics machines all report total leak which is the mask's expected vent rate plus any excess leak.
Now if you were using a ResMed machine..yeah..it reports only excess leaks and that 20 would be pushing close to large leak limits for a S9 machine.

You might want to read up on how your machine reports stuff and what it means and leak numbers.
viewtopic/t88983/Pugsys-PointersSleepyH ... nding.html
then come back if you need additional clarification of something.

Your fatigue after a month of use..may or may not be related to your OSA or therapy and of course bears further investigation but a chin strap is unlikely to work any miracles. Flat line leaks of 20 L/min (liters per minute) on a Respironics machine isn't a problem.
How many hours of sleep are you averaging? Are those hours of sleep fragmented for any reason..wake up often? If so, why?
Do you take any meds of any kind even OTC?

[SleepWellCPAP]

For what it's worth, I'll add a plus one to Pugsy and RogerSC's post for sure. By now you should be feeling some benefit.

Though leaks can cause a person to feel unrested, which would indicate a mask change/refit or chinstrap. Your persistent fatigue could certainly be something entirely unrelated to pap therapy.

Posting more data would be helpful as already stated, but so are other details. When you say consistent usage, is that 6 hrs or more starting at about the same time everyday? What is your physical activity level? Lots of good things to consider.

Good luck.

[sleepyruss]

Thanks again for the responses.

Attached are scans of the some of the docs she provided me...sorry they aren't easier to read.

As you can see from the graph, my average usage is almost 6 hours on a 30 day basis. I don't seem to have problems with waking up at night (that I know of).

The only med I take is Prilosec for Acid Reflux. 20mg daily. I do not have any reflux issues that keep me awake at night.


Night Usage by Russell Denney, on Flickr


Usage by Russell Denney, on Flickr

[Pugsy]

Would you like to be able to get your own copies of those reports easily? Send me a private message and tell me what operating system in on your computer.....if you want the software that the DME is using.
You can use SleepyHead right now...information on it is in my signature line.

Are you okay with that starting pressure of 4 cm? For many people that pressure is rather stifling.
I see many nights with breaks in therapy lines..so you were awake to turn the machine off and back on. I see a lot of short nights too.

Not a lot of consistent night by night same number of hours with no breaks in therapy. The last week things are a bit more solid in terms of sleep hours so some improvement just this past week or so.

I don't see any need for a chin strap on this report though. Your leak line shows only very tiny minor movement and most of that is associate with pressure movement because we would expect the vent rate to increase along with the pressure increases so we expect the leak like to move up a little because of vent rate increasing a little.

[sleepyruss]

Pugsy,

When you say a pressure of 4 is stifling, what do you mean exactly? Sometimes when I first place the machine on and it starts out at the minimum pressure, I feel like I am not getting enough air - like I am trying to breath through a straw! This sounds like what you may be referring to. Could this lack of enough draw contribute to my ongoing fatigue? I spend a lot of the night (28%) in the 4 range.

Many of the breaks in therapy are bathroom breaks (no more than one a night). Other breaks in therapy were caused by me turning the machine off and removing the mask. I would then (sometimes) put the mask back on and start again.

[Pugsy]

Yes, for many people that 4 cm starting point feels like there just isn't enough air movement.
I describe it as trying to breathe through a straw with cheesecloth over the end.
For many people the feeling is hugely pronounced to the point that they feel like they are suffocating. Is it affecting how you sleep and thus maybe some of your symptoms...it's possible but mainly because of comfort more than anything else. While it can feel stifling or suffocating...we won't actually suffocate and their is sufficient air movement to provide adequate ventilation but it just doesn't feel like it for a lot of people. I think the feeling might be made worse by use of a full face mask where the air movement feeling is less than it would feel like when using a nasal type of mask.

You are fortunate in that your APAP mode machine doesn't seem to need to go all that much higher than 4 cm to effectively prevent the airway collapse. I think that a little more minimum pressure starting point would offer you more general comfort...will it help you feel better (feel the good numbers you are seeing on the reports) ? I don't know but it might and sure worth a try. There are some people who find that the varying pressures of APAP mode actually disturb their sleep. Some people are a bit unsettled with just the least changes in pressure and some people can sleep through hurricane force wind changes. I am one of those...I have seen 20 cm from my 10 cm starting point and never know it till I saw the report. Other people find that as little as a 3 or 4 cm change in pressure through the night can disturb sleep.
Anything that disturbs sleep is unwanted because we need good sleep with minimal fragmentation for the body to utilize the restorative powers of sleep. When we have multiple awakenings then we have multiple sleep stage changes back to sleep onset and that limits the amount of deep sleep or REM sleep that happens to be where the restorative powers of sleep work their best magic.
Sleep cycles normally progress in stages with so and so percent in each stage...we need the normal progression to have the greatest chance to feel the good numbers.

I think if you were to increase that minimum pressure setting to 5 or 6 cm...leave everything else alone...that you will feel more comfortable for sure...this would also limit the pressure changes during the night and if you happen to be sensitive to pressure changes then that would also reduce the number and amount of changes. I suspect that more minimum will also reduce the maximum as a by product because the machine will be doing a more preventative job than a fix it after the fact job of preventing the collapse of the airway in the first place.
Technically your current 4 cm minimum is getting the job done but sometimes there's more to it than the technical aspects of OSA therapy. Comfort and sleep quality are hugely important and just because someone has a really good AHI and no leaks doesn't guarantee that comfort and sleep quality are optimal.

Also a little more minimum will likely prevent the bulk of the snores and those RERAs that you are seeing reported. While they aren't present in huge numbers...they could also impact sleep quality and cause little arousals that you may or may not remember and are worth reducing to see if it helps how you feel. I am thinking minimum pressure change to 5.5 cm or 6 cm...depends on what feels good to you...then see how things go.

[khauser]

Leaks are definitely NOT the issue. Even the machine says so:
Min in Large Leak
0.0 mins.

% of Night in Large Leak
0 % of Night

The machine says something else that's interesting ... you're still showing some snoring (those are the VS items). Although you're not having obstructions, the snoring and partial obstructions could be keeping you from getting deep sleep.

If it were me, I would SLOWLY raise the minimum pressure (and the max if you start topping out).

As Pugsy said, a lot of people find an initial pressure of 4 difficult ... it makes us feel like we're suffocating. If you find that to be the case, feel free (in my opinion) to bump the min to 6 and wait there for a few days. Then, depending on your results (data AND MORE IMPORTANTLY feeling) you could bump it another point or so until the VS number comes down.

That's what I would do...

[sleepyruss]

One more important note,

I did try increasing the pressure to 6 (non-auto mode) for a week (couple of months ago) and my AHI dropped to the 1-2 range instead of the 2-3 range. This was before I understood and had access to all the statistics from my machine.

I set it back after a week as I knew they were pulling a compliance report for insurance and I did not want them to know I had changed the settings.

Thanks to all of you for your responses. I appreciate your lengthy input and thoughts on the matter for sure.

[sleepyruss]

Also, one additional question:

My AHI for the in-hospital sleep study was in the 10-12 range. I know this is considered mild. Is this really high enough to cause someone to feel fatigued?

[Pugsy]

My AHI for the in-hospital sleep study was in the 10-12 range. I know this is considered mild. Is this really high enough to cause someone to feel fatigued?

Yes, it's enough to cause symptoms. Not only is the number of events a factor...the duration of the events is a factor.
They have to be 10 seconds long to meet criteria...there's a big difference between 10 per hour at 10 seconds or 10 per hour at 45 seconds...and that doesn't even count the maybe close events that lasted only 9 seconds.
Have enough of them back to back and sleep is disrupted and oxygen levels can drop.

I am one of those people whose AHI is much worse in REM stage sleep...53 per hour compared to 12 per hour in non REM sleep BUT
I was having some massive long events in non REM sleep and my oxygen level dropped to 73% in Non REM sleep...so number wise they were real exciting but what they did was.

So as you will find out with OSA and therapy...it isn't all about a single number...it's a combination of factors that become important and that's also why an AHI of 0.0 with the machine doesn't guarantee the "miracle" that we read about. I didn't have the miracle myself. I saw some definite improvement but not the miracle....at least not consistently. I have felt the miracle on occasion but it is elusive for me. I have other issues unrelated to OSA that mess with my sleep quality...I can't expect the machine to fix issues unrelated to OSA. I think that is one of the problems of a lot of newbies...they expect the machine to fix everything all at once and get impatient because they read about others who got the miracle straight away when in fact those miracle seeing people are really in the minority.

Google your Prilosec side effects and be sure to go to the various hits you will get....even relatively benign meds can impact how a person feels the next day.....might be rare but it isn't so rare if you are one of those people.
Now it isn't known for being horrible in terms of how it makes a person feel during the day but some meds are known to cause fatigue or drowsiness or insomnia and people taking them blame the cpap therapy for not being effective when in fact a lot of the time there's a good chance that meds are a factor.