Leak Rate and Pressure Advice Needed

I have been wanting to ask for advice about my pressure and leak rate for a while, but was unable to figure out how to post pictures from my Picasa Album until this afternoon.

I have been on CPAP for two months. I started with a Swift LT mask and a PR System One that did not have data. I've had a ResMed S9 for a month now, and the Swift FX mask for 5 weeks.

I had an incredible amount of energy after my first couple of nights on CPAP. Unfortunately, I am still running out of energy by the early afternoon most days. (On the other hand, I am not waking up two or 3 times a night to go to the bathroom anymore.) CPAP is working, but I'm still waiting for that miracle...

Last night, instead of going to sleep, I laid in bed watching something interesting on TV for about an hour after taking a sleeping pill. (My sleep is usually not good when I do that.) This morning my sleep was interrupted at 5 am by my wife trying to call my dog downstairs. (He is an ACD / Blue Heeler and only follows me.) I remember looking at the clock and thinking it is too early to wake-up. That last two hours of sleep was marked by the sensation of my Swift FX leaking around my nares everytime I moved, thoughts of snoring through my nose and vivid dreams that I can almost remember. (I do not believe I breathe through my mouth at night with CPAP.)

It's difficult to keep the Swift FX in my nares because it seals best when loose, but I move around in my sleep a lot. I have been reading a lot of posts about that, and am trying to solve the problem. I used a Swift LT my first 3 weeks. I don't think it leaks as much so I recently got another one. But the darned thing hurts my gums. So I guess I will stick with the FX for now. Should I have the S9 set on "pillows", and what is an acceptable leak rate for the Swift FX?

Pressure is another thing that concerns me. My sleep study calls for a pressure of 6. I hesitate to mess with it too much because there must have been a reason why they chose that pressure. (Perhaps increased pressure resulted in more centrals?) For the first week with the S9, I had it set to 5 and 11. Then I changed it to 6 and 12 for two weeks. Then I bumped it up to 7 five nights ago. If I am reading the ResScan reports correctly I should turn it up again. If I change it, how many nights should it take before I decide to raise it, lower it or leave it alone?

I posted near the end of another thread the other day after a particularly good night. (As I said, I finally figured out how to get the pictures to post today.) That thread is here: viewtopic.php?f=1&t=52395&st=0&sk=t&sd= ... 30#p485657

This first picture is my one month average data:


The next group of pictures is the full report from last night.







I would appreciate any advice.

The pictures you posted don't match - at least not the two with the graphs showing the leak rates? The first one

frh wrote:

Here, you're leaking like crazy.

frh wrote:

Here, you get a flatter line. It doesn't appear same night of therapy?

So the first suggestion is to resolve this. I'm not familiar with S9 but believe setting should be for pillows. If you continue to use the Fx, try the lansolin cream (do search for this) to help with the seal, or use a large size pillow.

dtsm, thanks for the reply. ResScan 3.10 has a split screen view. The screens labeled 4 of 7 and 5 of 7 are a 10 hour view in the top screen. I was looking at 30 minute detail data in the lower screen before I printed the report. Pages 6 of 7 and 7 of 7 are the detail from 5:05 am to 5:30 am. It is the same night.

After my first night or two with the Swift FX, I discovered the large pillow leaks less, so that's what I use. I tried their Lansinoh cream every night for about 2 weeks. Not as often now. It seems to make a difference early in the night, but a lot of my events happen later in the night. Thanks to ufo13, I now have a PapCap. I am trying to figure out a way to use it with the Swift FX. If I can get the swift FX to stay put when I roll over, I think my leak problem will be solved.

Any advice about my Pressure?

I've looked over your equipment and data...
I understand that the later graphs are just a close up, shorter time period for the same bad night.

From the graphs... your machine pressure is topping out at 12 when your have "problems" between 5 and 6...
but you really don't know this as long as your leaks are a problem... and they are.
That is your first problem to work on so you can understand where your therapy needs to go.
You are probably mouth breathing and with the pillows masks... you will need to "tape" or chin strap for several nights to check.
It also sounds like you have the mask too loose... it needs to be snug but not tight.

Start there and make sure that your machine is set to the correct settings for mask or EPR...
Then worry about other things.

Nord

Nord, If I have the mask any looser, it leaks and won't stay in my nose. If I have it any tighter it leaks. I think I have it set correctly as long as a lay on my back. But I don't. The leaks happen when I roll over.

I am pretty sure I am not mouth breathing. Thanks to the help I get from Nasonex, my sinuses are clear every night now. When I put the mask on, I can feel the pressure closing the flap at the back of my mouth / throat. With the pressure, breathing through my nose with my mouth closed seems quite natural.

I have two other reasons to believe I am not mouth breathing. If I take a nap without CPAP, I will wake-up with a dry mouth. With the CPAP machine, my mouth is just fine in the morning. Also, my wife tells me, except when I roll over and dislodge it, the noise the mask makes is the same all night.

frh wrote:Nord, If I have the mask any looser, it leaks and won't stay in my nose. If I have it any tighter it leaks. I think I have it set correctly as long as a lay on my back. But I don't. The leaks happen when I roll over.

I am pretty sure I am not mouth breathing. Thanks to the help I get from Nasonex, my sinuses are clear every night now. When I put the mask on, I can feel the pressure closing the flap at the back of my mouth / throat. With the pressure, breathing through my nose with my mouth closed seems quite natural.

I have two other reasons to believe I am not mouth breathing. If I take a nap without CPAP, I will wake-up with a dry mouth. With the CPAP machine, my mouth is just fine in the morning. Also, my wife tells me, except when I roll over and dislodge it, the noise the mask makes is the same all night.

Believe me... you do not know what happens when you are sleeping... its just a guess.
I kept trying to solve mask leaks and took my own advice... I did not suffer dry mouth...
Withe some masks I do not mouth breathe... with the FX... I do.
Try taping to test for several days... if you want.

The FX has two straps to adjust and 1 will adjust the angle of the pillows and pull it closer to the top lip. I find nose hairs and not shaving affects my leaks as well.
I move around a great deal and normally side and stomach sleep.
Your head pillow will also make a difference. There are many choices... I find stiffer head pillows also knock the pillows off the nares when I move my face.
If you want to succeed in your therapy... you really have to control your leaks first.

Nord