Help with Leak Rate Graphs, Please

I've been using my Swift FX and loving it. However, I'm having increasing leak line graphs that look like this:

Am I assuming correctly that this looks like mouth breathing?

I kind of thought that might be what it is, although I do not have any other symptoms of mouth breathing (i.e. dry mouth upon awakening).

So last night, I decided to try taping. But I forgot my tape in the other room. I was too tired to go get it, so I tried using a small, round bandaid. I centered it on my lips and went to sleep, feeling VERY strange having something taped to my mouth! This morning, this is the leak line I got:

WHAT? Am I still mouth breathing? The bandaid was still perfectly in place this morning. Now, granted, the bandaid did not cover my entire mouth, but covered about the middle half of it. (maybe leaving 1/4 on each side not taped) Was that really enough to allow me to mouth breathe?

Also, I saw zero improvement in my AHI.

Is this really worth it? I'm beginning to feel like "good" is never going to happen for me, in terms of AHI on a consistent basis.

That might just be pillow movement. Straps sliding a bit. I sometimes have leaks looking like that especially towards the wee hours of the morning like you show. When I first started therapy and I did do some mouth breathing the leaks were much more spikey and much larger. Try an experiment for about 15 to 30 minutes. Mask up turn the machine on and open and close mouth several times for various lengths of times and look at that leak line to see what it looks like.

So does that mean these leak lines are nothing to worry about?

jbn3boys wrote:So does that mean these leak lines are nothing to worry about?

I have had worse and not worried about them. They are really not horrible leaks and even more important not all that long in terms of time. That last hour of the first example may be pushing things a little but for the bulk of the night they aren't bad at all. Most of us just don't get those nice perfect straight lines all the time. I don't think it was enough to significantly impact therapy one way or the other unless you happen to see a truck load of events at the time of those leaks. Almost every time I have ever had a leak it has to be around 90 or above before I saw events increasing. Did you have any particular increase in events at the leak time?

The fact that you had similar increases with the bandaid leads me to believe it was just pillow movement of some sort.
If this were my report I would just check the top strap adjustment and maybe the back strap, that's where I have most movement. Things are near perfect most of the night.

Here is one of mine. Leak line is more jagged but you get the idea. It's the way this APAP seems to score them. AHI that night was 1.5. This leak line is pretty close to yours.

Please post the pressure line along with the leak line. The two need to be looked at together.

The events chart would also be good to see.

So Well wrote:Please post the pressure line along with the leak line. The two need to be looked at together.

The pressure lines are flat, since I am on straight bi-level, and not auto.

Is it safe to assume you don't feel energetic during the day? Feel fatigue and sleepiness?

I would continue to do some experimenting to absolutely rule out mouthleaking as a problem? I am not a mouth taper myself and don't generally recommend it, but you might want to try it as part of your experimenting.

Too many flags on the therapy chart for me. Too many snores.

But still, I think mouthleaking should absolutely be ruled out as the first priority.

I did some mouth breathing on purpose last night just to see what it for sure looked like. Out of curiosity.
Then this morning I was trying to help someone with some data copying instructions and used my own SD card for steps and inadvertently messed up all those files.. Crap. So I have had to erase the card and start over. Hopefully tomorrow an example will be available.

Your overall leak line doesn't appear to be the cause of all the events. I know you have been through some various trials and have a unique (for lack of better word) thing going on here and while So Well brings up some valid concerns, he doesn't have your whole history here. Like why you are even on BiPap in the first place. Or why reports on the machine differ so markedly from what happens in the sleep study titrations. In your situation with all you have tried in the past we know that it is just more involved than a little tweak in pressures.

jbn3boys,

I too get this "bumps" occasionally. They typically last less than 30 minutes for me, are not accompanied by any dry mouth symptoms, and seldom approach (my intentional leak)+24L/min, which I still typically use as an early warning signal that leaks might be an issue since Resmed uses 24L/min as the RedLine in ResScan. (And yes I know I'm using "apples" to look at "oranges" but since PR won't let us in on what a "large leak" is, a "known apple" is all I have to go by.)

There is one time I do worry about this kind of bump, however: It's when it feeds the Energizer Bunny Chapped Lips syndrome. That's a major comfort issue that also directly affects the way I feel and look---sometimes for days. I'm not vain, but I do NOT like running around with chapped lips that make me look like a sad clown for crying out loud.

And for what it's worth, I think Pugsy's right: I think this kind of bump may well be due to the pillows shifting around a bit.

I really don't want to tape on a nightly basis, but I did try taping last night, just to see if it would help. I used blue painter's tape. By this morning, there was one side that was not stuck tight. This is what last night's graphs looked like:


From what I understand, the VS (or snore) on the PR machines is something that should be ignored. It can be something as simple as the hose rubbing against the sheets.

I'm amazed how much difference there can be for me between an AHI of 2.something and anything over 4. If I can keep my AHI below 3, I feel SO much better. It has just been such a struggle to get there. I have days that give me hope, but then I have days that my AHI is up over 5 again. I know there has been improvement, since I didn't used to get anything every under 5. I just want this therapy to finally WORK for me, and work consistently.

And as far as these leaks go, it's just so frustrating, because I have had leak lines that look like this:

robysue wrote:And for what it's worth, I think Pugsy's right: I think this kind of bump may well be due to the pillows shifting around a bit.

So just how do we keep these silly pillows from shifting around???

I have tightened my top strap a notch, and tightened both side straps up a bit. They are not "tight", but they are far from "loose" like they say to wear this mask. I also removed the padding, to see if that would help any. I haven't noticed any difference at all since removing them.

Last night's leak line with that little blip at the end is nothing. It may not be straps that need adjusting. Sometimes just moving around (putting face in bed pillow) will dislodge the pillows just a little. The bulk of the night is near perfect. Short of Duct tape and Super Glue we are just going to have some movement at times.

Regarding the snores... I was just trying to compose something about them. Thinking outside the box a little. What if they aren't hose noise? What if they are real? They are significant enough to therapy to be scored and my APAP will try to kill them if other event triggers are present. You had them almost all night long. Pretty constant. Only last hour or so was snore free and also pretty much event free. I still don't think that small amount of leak is making any difference.
If you look back on other nights and look at snores and events at same time is there a pattern? Do you have any nights with minimal snores.

Again, just thinking outside the box at "what ifs". While we would assume that with mouth taped we should have zero or near zero snores, maybe it is a nasal sound. Can a person have a nasal snore? Beats me.
I don't know what all you have tried in the past. If your minimum pressure (however it is figured on Bilevel machine) was a bit higher in the past, was there any difference in VS? Hose management? Hose cozy? Anything that should at least in theory reduce potential hose noise?

Re the snoring for both Pugsy and Jbn:

Yes, that's another elephant in the room with the System One machines. I know for sure that sometimes those snores are real and sometimes they aren't on my machine. Confirmation is through my hubby and looking at the wave form data. Sometimes hubby tells me that I was most definitely NOT snoring (when he was awake---most likely just before we get up) and the machine says I'm snoring big time. And sometimes hubby tells me I WAS snoring and so does the machine. Likewise with the wave form data: Sometimes those tell-tale squiggles on the wave form are present when the machine says I'm snoring and sometimes the wave form looks just fine. I'd say more here, but I don't want to hijack this thread.

robysue wrote: Sometimes those tell-tale squiggles on the wave form are present when the machine says I'm snoring and sometimes the wave form looks just fine. I'd say more here, but I don't want to hijack this thread.

You can hijack my thread anytime, robysue!

What do those tell-tale squiggles look like on the wave form to indicate a snore? I'm still trying to figure out what all the different squiggles mean, and I'd be happy to check for snores, if I knew what I was looking for.

I looked back at several different reports that I had saved. My snore usually runs between 5 and 15, with a few nights lower and an few nights higher. I really have no clue what the difference is. I guess I could try out my hose snuggy and hang my hose up again. I really didn't see any improvement in AHI or how I felt when I used the hose management system that I came up with, so I quit using it. But I could give it another try now an look at the snore data.

jnb,

I just posted a new thread on the snoring complete with a figure that somebody (-SWS or NotMuffy I believe) once upon a time posted to show what flow limitations look like.