One year -- whazzup with these numbers?

Thank you all for continuing to offer suggestions and support. I so appreciate you!

Was able to make an appointment with the other sleep doctor in town. August 1st.

I also went back and reread the part of the sleep lab report originally given to me. I've always felt that my sleep was so poor and fragmented that night, they couldn't possibly have gotten good numbers. Some highlights:

* Lowest oxygen reading was 89% [home oximeter test showed 74%].
* I spent no time in REM or Stage III sleep during the test.
* They recorded an AHI of 17 [home oximeter test showed 30 desaturations per hour].
* They show hypopneas only (?). No obstructive apneas, no central apneas.
* The recommendation at the end is to start on cpap with a pressure of 13.

Palerider, I think you're right about the leaks. Night before last I managed to be aware enough to realize air was coming out between my lips. No obvious jaw drop, just loose lips. I got more aggressive with the tape, finally taping my mouth completely shut for the last hour or so. Leaks were way better (end of June 30) with wall-to-wall taping. Last night I taped up completely but it didn't seem to help. Aargh.

I kept pressure at 10 the last two nights. Here are the charts:

June 30


July 1

Thanks for the infos on your sleep study report and the updated charts.

In your highlights, the most interesting thing for me is that 100% of your events were hypopneas and those can be a b**ch. It's because it not that simple to classified a hypopnea as central or obstructive and many Dr simply classified them as obstructive... I'm not saying that this is your problem but it might be something to investigate if you're unable to find a pressure that lower your AHI under 5 with low leaks on a regular basis after a while. If a big part of your hypopneas are centrals a simple CPAP/APAP is rarely the best option. In my case both PSG report showed about 80% hypopneas and when using APAP or CPAP my AHI was now about 80% centrals apneas... And I never could obtained a average AHI under 8 no matter what pressure I tried. And that's when I started looking into ASV machines. But your case doesn't look that "simple" and I wish your new Dr will be able to help you. If you end up doing a other sleep study ask him if there is any probe or something that can be used to help classified your hypopneas. I think a Pes probe (esophageal pressure probe) is the best for that but I've not looked into that to much since Drs don't seem to know about this here and the fact that my AHI is now well under control with my ASV now.

Is your report was for a split night study like the first part without mask (sleep study) and the other part with the mask on (titration)? I ask because in your last comment you say that the recommendation at the end is to start on CPAP with a pressure of 13... Which would indicate that they probably tried some pressure to come out with this number.

If you had a titration you should also see a page with the pressures they tried, the time sleep in those pressure and the AHI for each, do you see that?

Also, can you see in your report somewhere where you see your AHI number for supine and non-supine?

As for the leaks I really can't comment much on it since I never really had problem with that with my P10 that I've been using for nearly a year now and I can't really compare my leaks numbers with yours since I'm on a Resmed machine.

SORRY -- that one got away from me before it was finished. Try this:

* Yes, it was a split night study. Qualification / baseline followed by titration / treatment.

* The actual titration numbers are:
Pressure of 5 12 minutes 3 hypopneas AHI 15
Pressure of 6 6.5 mins 4 hypops AHI 36.9
Pressure of 7 6 mins 4 hypops AHI 40
Pressure of 8 3 mins 3 hypops AHI 60
Pressure of 9 7 mins 1 hypop AHI 8.6
Pressure of 10 20 mins 6 hypops AHI 18
Pressure of 11 13 mins 1 hypop AHI 4.6
Pressure of 12 15 mins 2 hypops AHI 8
Pressure of 13 29.5 mins 0 hypops AHI 0

* Re supine / non-supine:
During baseline study
Supine: 32 events Index 25.8
Non-Supine: 12 events Index 8.8

During titration
Supine: 24 events Index 12.9
Non-supine: zero events Index 0

During the baseline, I slept mainly on my back and twice on my right side. During the titration, looks like I was on my back the entire time.

In their written summary, they say "Pretreatment there was a total of 44 hypopneas for an AHI of 17. The majority of these were position related."

Out of curiosity, I went back and looked at my first days on APAP. Here are my SH stats for the first night:

OSAHell wrote:I also noticed your inspiration-expiration time are reverse compared to mine. And looking back at my old APAP data I was like you on APAP but not on ASV. I don't no much about I:E ratio but it might worth a look.

OSAHell, if you have a minute, would you explain this a little more? I want to understand it so I can ask my new (and improved!) doctor about it.

Thank you so much!

Thanks for your more detail respond to your sleep study. That reinforce my idea that there might be something else than obstructive going on here. I’m not so sure that a pressure of 13 would be the best pressure but the only way to know is to try it... In the actual titration numbers you write hypo and AHI, is there any apnea at all during your titration time? (doing some quick math based on time, # hypo and AHI, it doesn't appear so...)

What might have put your already "limited" sleep doc #1 on the wrong direction is that your AHI seem to be position related which is typical of an OSA patient for obvious physical reason. I had an AHI 4 time higher in supine than non supine during my sleep study with most of them being hypopneas... But there is so little study on CSA (without CHF) that it might not be unique to OSA patient. Also a CSA Dx doesn't means there's no OSA, just that event are predominantly central. In my case a simple fixed pressure of 4 or 5 get rid of basically all of my obstructive apnea event but without the ASV pressure support, the central apnea are all over the place and vary a lot from night to night.

As for the I:E ratio it's something I noticed when I started ASV while comparing my "new" data with my old CPAP/APAP data. From what I remember and my understanding at the time, a normal breathing should have a little longer expiration time but don't take my word for it. Info as been hard to find and I think I find it in a unrelated (to I:E) research. I didn't read much on that since I was now "normal" on ASV but mostly because after a few weeks on ASV, little improvement started to appear and I put my focus on using my ASV the much I can and to get better without trying to over analyze to much my data. I had very good AHI (< 1) from the start with ASV but my physical and mental improvement start only after a few weeks. Maybe your next sleep doc will have a better explanation on that, I don't think it's that important but who knows.

I've you up your pressure to 11 or 11.5 yet?

No, there were no apneas at any time during my sleep study. Just hypopneas.

As weird as that sounds, it actually fits how I sleep. Very quiet, shallow breathing. No snoring, gasping, body movement.

Did 11.5 / 11.5 pressure last night. Stats below (July 4). Also the previous two nights at 10.5 / 10.5 pressure.

I'm having more trouble with the chipmunks (air bubbles) running around inside my cheeks, but otherwise seem to be tolerating the pressure pretty well.




July 4


July 03


July 02

Hi RobySnooze,

How things have been doing since your last post? Are those "chipmunks" less disturbing? Have you work on sleeping less supine if you still go in that position during the night?

Frustration is high here at the RubySnooze house. I've been really going after those leaks. Have had myself completely taped up for several nights now. I thought I had last night in good shape...ha!

Here are the last two nights:

July 5
At 11.5/11.5 pressure


July 6
At 12/12 pressure


OSAHell, thanks for checkin' on me. The chipmunks are about the same; not too bad. The pressure doesn't seem to bother me. I put myself on my side every time I go to sleep, or go back to sleep, but sometimes I wake up on my back.

Not sure what else to try. Guess I'll keep pushin' toward 13/13...

I assume you are taping your mouth.....if so, when you wake up is the tape loose or still secure?

What other masks have you tried? Any kind? I am wondering if the leaks shown are mask movement and not mouth opening....maybe something a little more stable than the P10 might work better.

One of the drawbacks to the P10 is that with those tiny straps it isn't maybe quite as stable as something like the Swift FX nasal pillow mask might be.

The leaks are ugly but for the most part don't appear to be large enough to seriously impact the therapy itself.
They could of course cause arousals and/or awakenings which of course isn't going to help your already fragile sleep architecture.

Pugsy wrote:I assume you are taping your mouth.....if so, when you wake up is the tape loose or still secure?

What other masks have you tried? Any kind? I am wondering if the leaks shown are mask movement and not mouth opening....maybe something a little more stable than the P10 might work better.

One of the drawbacks to the P10 is that with those tiny straps it isn't maybe quite as stable as something like the Swift FX nasal pillow mask might be.

The leaks are ugly but for the most part don't appear to be large enough to seriously impact the therapy itself.
They could of course cause arousals and/or awakenings which of course isn't going to help your already fragile sleep architecture.

Hi Pugsy. Good to see you!

Yes, I am taping my mouth completely. Sometimes I'll wake up because the tape is allowing a small leak. Or because I've drooled it up and it's damp. But I think you're right about the high leak rates: the nasal pillow itself must be getting dislodged. Just did an experiment with hubby, who is always saying how loud my machine is at night. When I have the P10 on properly and the machine turned on, he agrees it's super quiet. If I open my mouth, it makes some noise, but not loud noise like he's describing. If I pull the pillow away from my nose, he agrees the sound of the air coming out is what he hears at night. So why doesn't that wake me up??? Every other little thing wakes me up, and this is noisy for sure.

Re types of masks: I used a Quattro FX the first few months. It didn't fit my face well and I constantly felt small air leaks under my cheek bones. And they would wake me up (go figure!). I added a padacheek mask liner, which helped some, but I still felt like I was being woken up all night long by those little leaks. Many times I would adjust and adjust and adjust and be unable to get the leaks to stop. I need to go back and check Sleepyhead to see what my leak rates were during those months.

Later, I switched to a Mirage Quattro. Tried it with and without a PAC liner. Still got the annoying small leaks. And really disliked how heavy the mask is.

That's when I decided to try a nasal pillow. Figured there was much less area that needed a good fit, so it might be worth a try. I like it sooo much better than the FFMs. I'm truly surprised at how bad the leaks look 'cuz I feel like I'm tolerating it so much better than the FFMs.

You think I should order in a Swift FX to try?

More and more I'm feeling like I've got three distinct issues here:
* Insomnia / fragmented sleep
* Leaks
* Unresolved apnea / hypopneas

Thanks, as always, for the input! <3

It's always been amazing to me what leaks I have slept through.
I do agree that you have multiple issues going on that very possibly are totally independent of each other.
Unfortunately all I know to offer is to keep trying to improve on each in hopes that it spills over to the main problem of fragmented sleep from unknown causes.

The Swift FX nasal pillow I used for a couple of years. It's a lot like the P10 except the headgear is more adjustable and thus the chances of the nasal pillows sliding out of the nostrils is reduced. The venting is a bit louder on the Swift FX but not horribly loud and probably not as loud as the vent noise on the full face masks that you tried.

Are you buying these masks out of your own pocketbook?
I have some Swift FX nasal pillows you can just have...new unused...we might be able to find you the headgear and short hose elsewhere and save you a little bit of money.
Maybe a forum member has a spare they don't need or want.
Let me know if you are footing the bill for the mask experiments....maybe we can help.

Yes, I am paying for everything out of pocket. Thanks to my obscenely large insurance deductible.

On top of that I got royally screwed by the DME company. They quoted me a price that was just a little higher than what I would have paid online. At the time, I thought it would be worth it to have the customer service. They said that since insurance was not going to pay any of it, I had to pay 100% before they would order the machine. I paid it in full, the machine showed up, and months later I started getting invoices for machine rental. WTH?? When I complained, I got nothing but lies and runaround. Of course. In the end, I paid about 3X what they had originally quoted me. And got NO customer service. Just abuse and aggravation.

So absolutely -- any donation of unused parts would be very much appreciated. You are a sweetheart to think of it!

The AirFitP10 small pillow fits my nose quite well, but I've been using the medium based on threads I read here. It fits great, too. I don't have a large, but I'm guessing it would be too big.

Hi RubySnooze,

I feel your frustration, been there and it's not funny... And don't worry, unless you stop posting completely, I'll check your thread every day or so to check on you. I'm just a bit more busy these days. I'll try my best to help you but I really hope that your new sleep doc will be of some help here... I can't really help you more than Pugsy on the leaks problem because after my septoplasty I could wear a nasal pillow and never really had any leaks problem with it. I don't remember if it's been suggested (or tried) before, but have you tried a different pillow size? My P10 came with 3 sizes pillows. My only problem with the P10 is that I wake up without it during the night sometime but I'm working on that... As for Respironics leaks numbers, I had less than a week on Repironics so not much experience with that. But my understanding is that at those leaks numbers the machine should still be able to "compensate" for the leak and since you're on fixed pressure, APAP algorythms is not a concern.

Ok for your pressure now, the best goal here (I think) is to get some data for your new sleep doc and hopefully save some time after you meet him. Since your best titration pressure was 13 during your titration night your doc would probably want you to try or at least see some data at that pressure before recommending something else. If you have a 1 or 2 weeks of data at a fixed pressure of 13 (and even at 14 for some days) you probably wont have to "try" it after you meet him and you will be ready for the next step. If your AHI is good at a pressure of 13 (or 14), everyone is happy. If not, a full night titration would probably be the best BUT make sure they can switch to bi-level and/or ASV during that night in case it's needed. It's most likely that you'll need an others kind of machine to resolve those stubborn apnea/hypopneas. He might recommend you something else but if I were him I would minimally want to see some data at a fixed 13 before making you spend more money...

Since you'll see your new Doc in a few weeks I think it's your best move until we see what he come up with, what do you think?

Okay, OSAHell. I feel well watched-over knowing you will be checking every day or so (thanks!).

With the P10, the small pillow looks like the best fit and I've used it some (seems fine). Lately have been using the medium based on comments on the forum that you may get a better seal going up a size. It also seems to work fine and I always feel like I'm getting a good seal when I put it on.

Last night I actually taped the headgear to my face hoping to eliminate any shifting of the mask. And got...worse leaks than before! I'm like a bad sleep sitcom.

I'll follow your advice on what to do until my doctor's appointment. Although I wouldn't mind figuring out how to get a night or two of decent sleep. I've been at 12/12 pressure for two nights now. Will push my way up to 13/13 next.

Just for giggles, here's last night's SH stats: