Hi from new member (tried taping my mask)

DreamStalker wrote:The absolute value of the leak rate is less important than the variability of the leak rate throughout the night ... in other words, you want your leak graph to show as close to flat line as possible. Obviously you do not want the leak to be flat line off the scale because the mask has fallen off your face and as Pugsy noted, you do want to be in the ball park of the estimated vent rate for the mask (each mask is different based on machine pressure setting ... your mask manual should have come with a graph to estimate vent rate based on CPAP pressure).

Thanks - for all my blathering on this forum, it's probably evident that I still don't really understand how a CPAP machine works (other than that pressurized air acts as a 'stent' to keep the airway open). I don't quite get exactly what input variables are monitored by the machine, and how these are used to adjust outputs (nor by what algorithm). I'm very motivated to figure this out (and think it will be critical to success of therapy) but other aspects of my messy life keep interfering... I have to keep reminding myself that nothing is likely to get better until I am actually getting some sleep.

I wonder if learning the secrets of sword swallowers and intubating myself every night might be an easier solution? (just to be clear, that was a joke - being intubated is no fun and I'm sure the complications would be horrible).

DreamStalker wrote:The absolute value of the leak rate is less important than the variability of the leak rate throughout the night ..

leaks on an autosetting respironics will *not* be flatline throughout the night, since intentional leak rate increases with pressure increases.

palerider wrote:

DreamStalker wrote:The absolute value of the leak rate is less important than the variability of the leak rate throughout the night ..

leaks on an autosetting respironics will *not* be flatline throughout the night, since intentional leak rate increases with pressure increases.

Yes. I know that. But you missed the point. The "goal" or "target" is to "minimize the variability" of the leak rate regardless of whether one is in CPAP or APAP mode.

DreamStalker wrote:

palerider wrote:

DreamStalker wrote:The absolute value of the leak rate is less important than the variability of the leak rate throughout the night ..

leaks on an autosetting respironics will *not* be flatline throughout the night, since intentional leak rate increases with pressure increases.

Yes. I know that. But you missed the point. The "goal" or "target" is to "minimize the variability" of the leak rate regardless of whether one is in CPAP or APAP mode.

yes, I know that, but you missed the point. if you look at the reliable leak line from a respironics machine, which is the total leak line, then even with a perfect mask seal, no excess leaks, that leak line will vary during the night, and there is nothing you can do about it.

telling people they should strive for a consistent leak is setting them an unattainable goal.

aside from that, this is the first time I've ever heard of anybody suggesting that one should minimize variability in leaks, the "goal" or "target" has always simply been to keep leaks within an acceptable range wherein they a) aren't exceeding the particular machine's parameters, and b) aren't disturbing the sleeper or their partner.

with note that different manufacturers have different criteria for a) above.

palerider wrote:

DreamStalker wrote:

palerider wrote:

DreamStalker wrote:The absolute value of the leak rate is less important than the variability of the leak rate throughout the night ..

leaks on an autosetting respironics will *not* be flatline throughout the night, since intentional leak rate increases with pressure increases.

Yes. I know that. But you missed the point. The "goal" or "target" is to "minimize the variability" of the leak rate regardless of whether one is in CPAP or APAP mode.

yes, I know that, but you missed the point. if you look at the reliable leak line from a respironics machine, which is the total leak line, then even with a perfect mask seal, no excess leaks, that leak line will vary during the night, and there is nothing you can do about it.

telling people they should strive for a consistent leak is setting them an unattainable goal.

aside from that, this is the first time I've ever heard of anybody suggesting that one should minimize variability in leaks, the "goal" or "target" has always simply been to keep leaks within an acceptable range wherein they a) aren't exceeding the particular machine's parameters, and b) aren't disturbing the sleeper or their partner.

with note that different manufacturers have different criteria for a) above.

Dude! Your panties are all in a wad. Chill out man!

I AM NOT setting anyone up for an unattainable goal. You missed the WHOLE fricken point! Again! I'm suggesting the direction that one needs to orient their CPAP data towards, in this case, specifically mask leaks ... which is totally a separate issue from mouth leaks. Letting the leaks vary all wacky and thinking the AHI data has any meaning is what leads people to an unattainable goal of effective therapy.

I know fricken well that leaks can and do vary all night and that it's still possible to get effective therapy. After all, I've been using my machine with 100% compliance for over 119 months now. And I also know that a completely flat leak line is attainable because I have done it (and more than once) ... so it IS doable at least for ME. I have also achieved ZERO AHI for multiple nights in a row ... it too is doable. And I have achieved a very long-term AHI of less than 1 -- because yes, that too is doable. I really do think I have learned to control my leaks (both mask and mouth) and maintain very very effective treatment for my OSA. And I offer my experience to any who might have an interest.

You obviously don't. What do you have to offer? If you have a better method of achieving those goals -- go for it! But getting your panties all in a wad and telling people NO you can't do that is no use to anybody. Sometimes you're comments are funny, but a lot of times you're just annoying. So there is no point in discussing anything with you. Have a great night nonetheless!

DreamStalker wrote: I have also achieved ZERO AHI for multiple nights in a row ... it too is doable.

and, what *kind* of machine are you using?

DreamStalker wrote: You obviously don't. What do you have to offer? If you have a better method of achieving those goals -- go for it! But getting your panties all in a wad and telling people NO you can't do that is no use to anybody. Sometimes you're comments are funny, but a lot of times you're just annoying. So there is no point in discussing anything with you. Have a great night nonetheless!

I'll stick with Pugsy's advice on the subject... I can dig it up for you, if you like, but basically, it's 'as long as the leaks aren't bothering you, and you keep the large leaks/over the redline (depending on which brand of machine you have) under 10% of the night, it's good enough.

As an experiment, I dialled (or should I say wing'ed?) the minimum pressure back down to 7 cmH2O, thinking that with better seal (straps tightened, clean shaven) it would be relevant to see if AHI is better or worse than with recent high pressures. The assumption is that my AHI actually sucked at high pressure when the mask was tight enough to minimize leakage.

Overall, the night of sleep seemed better. The AHI was 11 (see below) rather than 20+k, and I slept through the night for once. I also felt much better upon waking than in the last few mornings. I can say that the pressure I was at (10.5) 'felt' kind of high, in that it seemed to be driving leaks as well as cheek inflation and aerophagia. The setting of 7 felt a lot more comfortable (at one point I wasn't sure machine was on) and subjectively the leaks were not notable (SH seems to bear this out).



Interestingly, the overall pattern of events in the night is very familiar. A cluster of apneas right after lights out (yes I am asleep) followed by two big clusters spaced out over the rest of the night.

The clustering...and the obvious need for higher pressures during those clustering...2 main suspects
1...supine sleeping
2...REM stage sleep
or maybe a combination of the 2

Did you ever try going up slowly from the 7 cm minimum or did you jump from 7 to 10 in one big leap?

Interesting that the AHI doesn't have many centrals flagged and in the same breath you say you slept much better which makes me think/confirm that in the past those central clusters were awake/semi awake breathing irregularities.

Pugsy wrote:The clustering...and the obvious need for higher pressures during those clustering...2 main suspects
1...supine sleeping
2...REM stage sleep
or maybe a combination of the 2

Did you ever try going up slowly from the 7 cm minimum or did you jump from 7 to 10 in one big leap?

Interesting that the AHI doesn't have many centrals flagged and in the same breath you say you slept much better which makes me think/confirm that in the past those central clusters were awake/semi awake breathing irregularities.

Very likely did sleep supine through night - been having issues with side sleeping (mask leak even with cpap pillow, old rib injuries). My gut feeling is that the benefits of supine outweigh the detriments, but cpap will have to be dialed accordingly.

I did dial up from 7 - 10.5 gradually (three nights at each setting). My last few nights at 10.5 felt horrible (during night and upon waking). Today I would consider 'good'. If it can get better than this, I will be a very happy guy.

You know if you were chasing awake/semi awake breathing events with more pressure and the more pressure in turn created issues with leaks and comfort and then more awake/semi awake breathing events....might be feeding a vicious monster and you end up chasing something to fix it that is creating the very problem you are wanting to fix...chasing your tail.

Sleep in any position you feel that you sleep the best in.
I mention the supine sleeping just as an explanation for the obvious increase in pressure needs.

Perhaps revisit going up slowly with that minimum but allow more time at the new minimum to get a better feel for what the pressure is doing and maybe now you will sleep a little better at the lower settings and have less chance for awake/semi awake breathing stuff messing with the evaluation process.

If it wasn't for the 2 clusters...your AHI would have been considered really good. I don't know that I would try to totally eradicate the clusters...maybe just make them a little less ugly.

Remember the number one goal....get good sleep and feel good during the day.

Your leak rate plot looks more stable than your previous plots. It can take time to dial everything in but it is worth the time and effort.

One of the first things I learned from our fellow forum member Goofproof (Jim) when first beginning my therapy, was that until the leaks are completely under control, adjusting pressures only leads to one chasing their tail. That means finding a mask that is leak free for the range of pressures at or preferably above your therapeutic level ... which is what you are trying to find out at the same time.

Just keep on keeping on and you'll get there.

Thanks Pugsy, Dreamstalker - there was definitely something that clicked last night even though the AHI was not so low overall. I can totally see how the leaks would cause the whole thing to fall apart...

Didn't really change anything, but had another reasonably decent 'nominal' AHI of 6.45. It looks like the machine started boosting my pressure in response to a cluster that came on at around 2:20am. I am realizing, thanks to guidance received here, that my mask seal starts failing at these higher pressures and that this both interferes with the therapy and contributes another source of arousal due to the sound and tickling vibration (sorry if it sounds like I am describing some kind of sex toy).

The pause at 4:30 was because the leaks just became too annoying. I actually got up to go pee, pausing the machine. I think the sensations from the leakage are almost as bad as the apnea in terms of arousal. During a semi-conscious moment it occurred to me that the mask was kind of riding upward on my face, causing the seal on the lower edge to approach the corner of my mouth. The mask/lip interface does not give a good seal, made worse by some slight drooling. Slight tickling on the lips has an insidious effect on one's ability to sleep properly...



I'm thinking of doing an experiment tonight where I keep the pressure at 7 cmH2O and create a 'perfect' seal using Tegaderm surgical tape (I appreciate the slight risk involved). This would indicate how effective the pressure is, hopefully removing leaks from the equation.

If all else fails, there's the mask recommended by DreamStalker...

Anything that disturbs our sleep is unwanted. Our sleep is already fragile enough as it is.
That's why I tell people that even small leaks must be dealt with if they wake us up. Those wake ups from leaks and fiddling with the mask are just as detrimental to our sleep quality as the arousals from apnea events.

leptic wrote:Didn't really change anything, but had another reasonably decent 'nominal' AHI of 6.45. It looks like the machine started boosting my pressure in response to a cluster that came on at around 2:20am. I am realizing, thanks to guidance received here, that my mask seal starts failing at these higher pressures and that this both interferes with the therapy and contributes another source of arousal due to the sound and tickling vibration (sorry if it sounds like I am describing some kind of sex toy).

The pause at 4:30 was because the leaks just became too annoying. I actually got up to go pee, pausing the machine. I think the sensations from the leakage are almost as bad as the apnea in terms of arousal. During a semi-conscious moment it occurred to me that the mask was kind of riding upward on my face, causing the seal on the lower edge to approach the corner of my mouth. The mask/lip interface does not give a good seal, made worse by some slight drooling. Slight tickling on the lips has an insidious effect on one's ability to sleep properly...

I'm thinking of doing an experiment tonight where I keep the pressure at 7 cmH2O and create a 'perfect' seal using Tegaderm surgical tape (I appreciate the slight risk involved). This would indicate how effective the pressure is, hopefully removing leaks from the equation.

If all else fails, there's the mask recommended by DreamStalker...

Ummm ... actually, that mask was suggested in jest ... but whatever works I guess.

As for sex toys, I've been quite satisfied with my machine's nightly blow jobs during the past decade.