HOSE IT GOING?

Last night:
Usage: 6:06hrs
AHI: 0.8
AI: 0.0
Leak: 11L/min
Average pressure: 12.8
EEP: 11
Min PS: 3
Max PS: 13
VT: 315 - 540
Mask: Quattro with mask cover.
Mask fit: Very good

How do I feel: Tired.
I fell asleep without the mask. I slept for about 2 hours before I woke to go to the bathroom.
Now, DH has permission (and is encouraged) to wake me to put on the mask.

Last night:
Usage: 8:41hrs
AHI: 0.4
AI: 0.1
Leak: 10L/min
Average pressure: 12.8
EEP: 11
Min PS: 3
Max PS: 13
VT: 316 - 545
Mask: Quattro with mask cover and strap.
Mask fit: Very good

How do I feel: Very tired.
I woke up once, probably because of an apnea.

Im a somewhat newbie here, but one thing ive noticed is that people treat their "feeling level" in the morning completely with apnea issues---no other correlative factors are considred.

I personally have an auto immune disorder that causes apneas and shortness of breath, which is very closely related to food allergies, eating after 7pm, and not being able to eat dairy, wheat, peanuts, alcohol, MSG, caffeine, and aspartame.

Evaluate the WHOLE picture. For example, are you overweight as well? Is your diet good? Do you have any allergies or potential other sicknesses to address? Do you over indulge in carbs? Do you walk for 45 minutes 5 days a week? All important questions.

Carbs alone can make you feel deathly ill.

Just watch that movie about eating at McDonalds for a months. Think outside the box.

Last night:
Usage: 9:11hrs
AHI: 0.3
AI: 0.0
Leak: 25L/min
Average pressure: 12.8
EEP: 11
Min PS: 3
Max PS: 13
VT: 345 - 533
Mask: Quattro with mask cover.
Mask fit: Very good

How do I feel: Very tired. Sluggish.

máirtín wrote:

so while the Swift FX blew me away on my CPAP and BiPAP, I'm probably going to give it another trial now that I'm on an ASV.

I tried a Swift but couldn't stop mouth breathing. My doctor told me that a FFM is preferred with ASV because of mouth breathing problems.
I'm not convinced that the leaking is compromising therapy. It may be that I am not experiencing an improvement for reasons unrelated to apnea.

Hi máirtín, I've re-read your thread from the beginning, but wanted to go back to this discussion we had almost a month ago. It's great that you are keeping a diary of each day and your settings. However, now that you've collected so much cursory data, I think you have to look at those things that you know are consistent problems.

It seems that leaks are still a major problem. The ResMed ASV in known for being a great machine, but it is also known to suffer in its effectiveness with leaks. You've tried a chin strap, and you've tried a Pad-A-Cheek liner -- and every night, you've felt somewhere between tired and horrible. At this point, I think you have to try a different mask.

According to your diary, you tried the Swift only once. The leak rate that one night was better than your leak rate most other nights on the Quattro. I would try it again and tighten up the chin strap this time. As you have probably seen, some of us also put tape over our mouths when using a nasal pillow mask to reduce mouth breathing. There is a very small but real medical risk in doing so, so while none of us would suggest that you do it for liability reasons, it is something to keep in mind. Anyway, give it a few nights before you give up on it. After all, since you feel terrible every day, you have nothing to lose!

If you really can't get the mouth breathing under control with the Swift, then it may simply be time to talk to your DME about trying a different mask. I too never had any luck getting the Quattro not to leak. The Comfort Gel Full is a somewhat popular mask, but for me it leaked even more. I now use the Fisher & Paykel 432 for my FFM, but I know many people dislike it. Every face is different, and finding the right mask that is comfortable and doesn't leak is a sometimes tedious process of trial and error!

I'm afraid that if you don't get the leaks under control, you're never going to know whether you're getting sub-par therapy and that's the reason for your exhaustion. At this point, I don't see any choice other than to try a different mask.

Side question: why are you taking the Requip some days but not others? I would take it consistently, every night.

If you had your leaks under control, with your AHI low, and you were taking your Requip every day, then I think you'd have something much stronger for your doctor to review. Good luck to you!

Thanks Brian for your insights.

I think you have to try a different mask.

I am going to try a different mask. Right now I am in France so getting a new mask presents tactical challenges. Also, my insurance only covers a new mask every 6 months - I have a ways to go on that yet. I would like to try the hybrid.
I am not convinced that leaking is a big factor. It seems to me that the machine is designed to deliver big spikes in pressure to deal with Central events. These spikes inevitably cause some leakage. I find it hard to believe that ResMed engineers have not factored that into the efficacy calculations. My conclusion is that the AHI numbers are accurate - my general feeling of grottiness may have other origins (From my review of posts on this board it is clear to me that people who only have OSA find it hard to understand what CSA and CSR are all about. Present company excepted)

some of us also put tape over our mouths when using a nasal pillow mask to reduce mouth breathing

This is simply not an option for me. I appreciate your suggestion and am aware that some people enjoy a great benefit from mouth taping but I am not going to try it unless it is closely supervised during a PSG.

why are you taking the Requip some days but not others?

I took Requip for about six months without seeing any difference. I started taking it again when I had the possibility of getting a data capable machine that would give me daily reports about the effect of Requip. Unfortunately, I did not get the machine before I left for Europe so I stopped taking it again.

máirtín wrote: I am not convinced that leaking is a big factor. It seems to me that the machine is designed to deliver big spikes in pressure to deal with Central events. These spikes inevitably cause some leakage. I find it hard to believe that ResMed engineers have not factored that into the efficacy calculations. My conclusion is that the AHI numbers are accurate...

You are absolutely right that it will try to respond to leaks. ResMed markets this as their "Vsync" technology (http://www.resmed.com/au/products/s9_vp ... c=patients). However, it will do so less effectively when larger leaks are present. Case in point: I have seen examples of people appearing to have fewer events when their leak lines are higher and/or spiky. Were they really having fewer events? It is unlikely; those periods with their compromised data were probably just more difficult to score.

The other thing about your machine is that unlike my Respironics ASV, the algorithms of which are designed to respond to flow, your ResMed ASV's algorithms are based more on volume and rate. (Attribution: dsm, 3/9/2008) This could make the leak situation even stickier for you than it is for me.

Your last sentence easily could be right. You could get your leaks under control, and your AHI numbers might not change. But if you did that, we'd at least be able to rule out arousals directly due to leaks, and to confirm your AHI readings, which is a start. At this point, we don't even know whether your nights with slightly higher HIs are consisting of obstructive or central events, which is significant.

máirtín wrote:my general feeling of grottiness may have other origins

Very true; Pugsy mentioned this first, and it resonated with me then too. I know a small percent of people take a very long time to acclimate to their therapy. In cases like yours, though, it does seem possible that something else is going on.

Once you finally do get your hands on your software, it might give us some insights here too. For example, when I was on my BiPAP S/T, I was able to figure out that an EPAP of 13 and an IPAP of 20 resulted in a low AHI, but I felt horrible. Only by looking at the data was I able to determine that those settings also dramatically reduced my patient-triggered breathing.

máirtín wrote:(From my review of posts on this board it is clear to me that people who only have OSA find it hard to understand what CSA and CSR are all about. Present company excepted)

I think it's challenging even for medical professionals. In reading some of the academic literature and discussions from sleep professionals, I have noticed many disagreements about the nature and origins of CSA and how effective different types of treatment are.

máirtín wrote: This is simply not an option for me. I appreciate your suggestion and am aware that some people enjoy a great benefit from mouth taping but I am not going to try it unless it is closely supervised during a PSG.

That is absolutely and totally fair. I was very careful to pick my words not to advise you do it; I just wanted to mention that some of us do.

máirtín wrote:I took Requip for about six months without seeing any difference. I started taking it again when I had the possibility of getting a data capable machine that would give me daily reports about the effect of Requip. Unfortunately, I did not get the machine before I left for Europe so I stopped taking it again.

Got it. I've not felt better while taking Mirapex, and I know clonazpeam didn't have much impact on my PLMD and my PLMD-based arousals, so Requip is next on my list.

I hope you are able to enjoy your trip to Europe despite all of this. I do know how difficult it is to live and enjoy life when you're tired, but perhaps the chance of scenery will give you some extra energy.

máirtín wrote:I am not convinced that leaking is a big factor.

Unacceptable leak rates DO impact the data and the efficacy of treatment. Think about it. If the mask is leaking so much that the machine can't compensate for it, how can it deliver effective treatment? Until the leaks are under control, the data is suspect. But unless/until you ARE convinced of that, all anyone here can do is wish you luck in the quest for good therapy while the large leaks continue unabated.

It seems to me that the machine is designed to deliver big spikes in pressure to deal with Central events. These spikes inevitably cause some leakage.

Yes, an ASV will raise the pressure very quickly to deal with events. But no, leaks are not inevitable. My mask maintains its seal, even when the pressure zooms up from 10 to 20.

Last night:
Usage: 10:41hrs (includes afternoon nap)
AHI: 0.6
AI: 0.0
Leak: 28L/min
Average pressure: 12.8
EEP: 11
Min PS: 3
Max PS: 13
VT: 308 - 568
Mask: Quattro with strap.
Mask fit: Excellent

Comments: I used the mask without the insert but I did use the strap.

leaking is a big factor

This topic needs it's own thread.
I don't know how to roll the pertinent comments from this thread into a new thread.

Last night:
Usage: 9:19hrs
AHI: 1.5 (big spike)
AI: 0.0
Leak: 19L/min
Average pressure: 12.8
EEP: 11
Min PS: 3
Max PS: 13
VT: 308 - 542
Mask: Quattro with strap (started out with Swift but leak alarm woke me. Switched to Quattro for the rest of the night).
Mask fit: Good

Comments: I tried to use the Swift because of the sore on my nose getting worse. I had to change masks in the middle of the night because of leaking. The AHI number would seem to indicate that the Swift is not a good mask for me.

Last night:
Usage: 9:43hrs
AHI: 0.6
AI: 0.1
Leak: 20L/min
Average pressure: 12.8
EEP: 11
Min PS: 3
Max PS: 13
VT: 326 - 540
Mask: Quattro with strap
Mask fit: Very good

Comments: I had dinner with friends so didn't get to bed until after midnight. I woke during the night and adjusted the mask. The sore on my nose is getting worse again - don't know what to do about it.

Last night:
Usage: 8:05hrs
AHI: 0.7
AI: 0.0
Leak: 25L/min
Average pressure: 13.2
EEP: 11
Min PS: 4 (change from 3)
Max PS: 12 (change from 13)
VT: 339 - 602
Mask: Quattro with strap
Mask fit: Good

Comments: I woke up about 3am. My AHI at that point was 1.6 for 3 hours. It seems from the average that most of the hypopneas are happening in the first half of the night.

Last night:
Usage: 9:09hrs
AHI: 0.6
AI: 0.0
Leak: 33L/min
Average pressure: 13.2
EEP: 11
Min PS: 4
Max PS: 12
VT: 351 - 543
Mask: Quattro with strap
Mask fit: Very good

Comments: Bloody nose this morning from the Sore That Won't Go Away.

Last night:
Usage: 7:10hrs
AHI: 0.0 (First goose eggs ever!!)
AI: 0.0
Leak: 33L/min
Average pressure: 12.8
EEP: 11
Min PS: 3
Max PS: 11
VT: 345 - 551
Mask: Quattro with strap
Mask fit: Very poor

Comments: Leak alarm woke me several times.