CPAPtalk.com

esel wrote:
Hi Beauty,

would you mind posting some of your CPAP graphs, some with and some without insomnia ?

Well, I was surprised to find a lot of detailed data still on my card, so I snagged two representative shots (one from the end of October and one from a few days ago). As I said, I don't know how useful they are for comparison purposes, as the numbers are pretty much the same. (And just an FYI: My machine's clock has always been off. Add to that the fact that I'm in AZ, where we don't change the time twice a year. LSS, the clock isn't accurate.)

Your leak rates look high for me. Is that normal?

Sheriff

Sheriff Buford wrote:Your leak rates look high for me. Is that normal?

It's pretty much normal for her machine at her pressures. Remember how Respironics report total leak and you are used to your ResMed machine reporting only excess leak...the leak line for a Respironics leak is simply going to be a lot higher because of the intentional vent rate being included.
She did have a small brief time in large leak....that black box in the solid green line portion of the leak graph.
It's not enough large leak to be much of an impact on anything though and I wouldn't worry about it.

Sheriff Buford wrote:Your leak rates look high for me. Is that normal?

Sheriff

I'm with you, too high. Cuts down the worth of the data, also need more time sleeping. Jim

I too have been having trouble getting to sleep, go to bed at 2 am, in and out of sleep on good nights after 1 to 2 hours, then good the other 6 hours, If I have a good night it will be followed by a bad one, last night was a bad one, got up early sugar at 66.....

Goofproof wrote:I'm with you, too high. Cuts down the worth of the data

You are certainly entitled to your opinion but that doesn't make it the right opinion.
Her machine uses a lot more pressure variations as well as higher pressures than we normally see and more pressure means more intentional vent/leak rate.
The bulk of the night there is minimal excess leak and there's only a very brief time where large leak territory is reached.

The data is accurate and most likely even accurate in the time of large leak because she barely went into large leak territory.
With this machine at these pressures...accuracy isn't going to be a real problem until total leak exceeds 110 or 120 L/min.
Just because you believe differently doesn't make it correct. I don't care what you want to believe but I don't want people to misunderstand and go into a panic thinking their leaks are bad (by your standards) when your standards are incorrect.

Pugsy wrote:

Goofproof wrote:I'm with you, too high. Cuts down the worth of the data

You are certainly entitled to your opinion but that doesn't make it the right opinion.
Her machine uses a lot more pressure variations as well as higher pressures than we normally see and more pressure means more intentional vent/leak rate.
The bulk of the night there is minimal excess leak and there's only a very brief time where large leak territory is reached.

The data is accurate and most likely even accurate in the time of large leak because she barely went into large leak territory.
With this machine at these pressures...accuracy isn't going to be a real problem until total leak exceeds 110 or 120 L/min.
Just because you believe differently doesn't make it correct. I don't care what you want to believe but I don't want people to misunderstand and go into a panic thinking their leaks are bad (by your standards) when your standards are incorrect.

I use a CPAP pressure of 15 cm, anytime my leak rate passes 40 LPM, I fix it. It makes sense to me that higher leaks interferes with pressure pulses back to the XPAP machine. I know mine works for me, others have to count of what they think. Jim

Over 100 lpm, I can see why they can't keep water in a HH, I couldn't sleep with a tornado coming out of my mouth.

Pugsy wrote:

Goofproof wrote:I'm with you, too high. Cuts down the worth of the data

You are certainly entitled to your opinion but that doesn't make it the right opinion.
Her machine uses a lot more pressure variations as well as higher pressures than we normally see and more pressure means more intentional vent/leak rate.
The bulk of the night there is minimal excess leak and there's only a very brief time where large leak territory is reached.

The data is accurate and most likely even accurate in the time of large leak because she barely went into large leak territory.
With this machine at these pressures...accuracy isn't going to be a real problem until total leak exceeds 110 or 120 L/min.
Just because you believe differently doesn't make it correct. I don't care what you want to believe but I don't want people to misunderstand and go into a panic thinking their leaks are bad (by your standards) when your standards are incorrect.

Yeah, those aren't too bad. The inhalation pressure is higher during leaking phase there around 3-4:30am by around 3-5cmH20...that's probably an additional 5-8 L/min mask exhaust for most masks. The exhaust rate for most of the night was clearly around 45L/min or so, so actual leaks during that period are probably 15-20 L/min. Not great, but certainly not in the therapy modifying range. Keep in mind that as long as the machine maintains the target pressure, therapy should be good. Event detection could suffer a little bit, but not much. At 10-15cm, you've got plenty of flow headroom. Even at 20cm, the machine's going to have enough flow headroom to keep pressure at target even with 30 or 40 L/min of leaks. There's a good video on youtube (I'll try to find it and post) by the guy that runs the freecpapadvice site/forum demonstrating how much leak a for which a machine can compensate. I seem to recall the machine in question was able to overcome 50-60 L/min or so before pressure losses started to occur.

Of course, if leaks are annoying and keeping you up, that's another matter...

Her average leak rate is 45 and 49 on the 2 nights. And looks like pressures between 12 to 20. At those pressures her DreamWear mask would have venting of 30 to 40 LPM. Doesn't add up to a large leak for me. There were 5 mins and 3 mins recorded as large leak. Not much time in leak compared to her time slept.

Goofproof wrote: I use a CPAP pressure of 15 cm, anytime my leak rate passes 40 LPM, I fix it. It makes sense to me that higher leaks interferes with pressure pulses back to the XPAP machine. I know mine works for me, others have to count of what they think. Jim

I have long been aware of your own personal standards for leaks. It's not worth it to me to try to get you to change the way you view things but I just wanted to make sure that someone else doesn't go trying to fix something that doesn't need fixing and maybe cause undue stress because of it.
I hope you never have to use this type of machine for centrals...there's no way you could keep your current 40 L/min line in the sand when treating centrals.

For everyone else who wants to learn more about the leak line on this report...
Bleeping Beauty is using a machine that does some rather rapid and large pressure changes because she has complex sleep apnea and the centrals require the machine to do things that regular cpap/apap machines can't do. Those higher pressures are going to impact that intentional leak/vent rate number...it's normal..remember higher pressures equal higher vent rate in all machines and all masks. Her leak line is always going to vary quite a bit. If it didn't then I would worry.

Now of course if the pressure changes disturbed sleep that would be another topic for discussion but based on the numbers alone...the leak line above on those reports really isn't bad at all. Minimal time was spent in large leak and even then barely into large leak territory. Leaks are NOT an issue in terms of impacting therapy itself. Plain and simple no matter what Jim wants to believe or do about his own therapy.

Big decision ... who will I take advice from... Pugsy or Goofproof... that's a hard one.

Lucyhere wrote:Big decision ... who will I take advice from... Pugsy or Goofproof... that's a hard one.

I support Pugsy on this, and I'm an engineer with 30+ years of signals and systems analysis under my belt (and EE degree in same). I know how stuff works . You're clearly not having much in the way of events recorded at this point, and there's no sign the machine is struggling to maintain pressure. The possible impact of leaks on event detection is not very much until you get to the point where the machine can't maintain target pressure. This is because the leak "signal" is very slow moving compared to the higher frequency events like your breathing. Fundamental to any system like this would be a high pass filtering of the flow signal to mask out slow moving things like leaks. It can have a small effect, but it's really limited unless you're constantly (and rapidly) changing from a mode of not leaking, to a mode of leaking. One might expect some possible errant events on those transitions from not leaking to leaking, but I don't really see much evidence of that. You've got a little snoring detected, which may well be bogus, but you could try a tiny pressure bump to see if they reduce. Sans that, if the leaks aren't actually waking you, I don't think you have anything to worry about here.

Pugsy wrote:

Sheriff Buford wrote:Your leak rates look high for me. Is that normal?

It's pretty much normal for her machine at her pressures. Remember how Respironics report total leak and you are used to your ResMed machine reporting only excess leak...the leak line for a Respironics leak is simply going to be a lot higher because of the intentional vent rate being included.
She did have a small brief time in large leak....that black box in the solid green line portion of the leak graph.
It's not enough large leak to be much of an impact on anything though and I wouldn't worry about it.

Thanks for (as always) pointing out the facts re: my machine and the data.

FWIW, when I sleep, I sleep pretty well. Larger-than-normal leaks (even the short time that the data shows large leaks) are undoubtedly caused by the mask shifting and not mouth-breathing, and they never wake me.

Goofproof wrote:

Sheriff Buford wrote:Your leak rates look high for me. Is that normal?

Sheriff

I'm with you, too high. Cuts down the worth of the data

Once again, I'm glad Pugsy is a presence on this forum. She has the patience of a freakin' saint.

also need more time sleeping. Jim

Um, hello? The thread (and the article) is about election-induced insomnia, and my data above shows clearly that I'm experiencing it. I was getting a normal night's sleep before the election (averaging 8-9 hours each night), and since, my average is only 5-6 hours a night (when I can sleep at all).

Reading comprehension goes a long way...

Thank you BB for posting the data. And thanks Pugsy for the leak info.

It looks like that the autoSV is not showing any difference regarding stressful and non stressed situations.

Is it because the machine is doing a great job eliminating events ?

Would one see any difference if the machine was set to CPAP fixed Min epap = Max epap = 4 ?

esel wrote:Is it because the machine is doing a great job eliminating events ?

Yes

esel wrote:Would one see any difference if the machine was set to CPAP fixed Min epap = Max epap = 4 ?

Most likely those settings would allow a truckload of obstructive apnea events to happen. Wouldn't be a good idea to tie the machines hands like that. That's a recipe for disaster in this situation.

There's nothing on the reports that might explain poor sleep quality....we just see evidence of poor sleep reflected in the hours slept.
Life stressors can cause insomnia too. Not everything can be blamed on sleep apnea and not everything can be fixed by cpap/apap whatever pap. No matter how much we might want it to.
In this situation with BB...the life stressor is our new President and not anything related to sleep apnea or her therapy.