CPAPtalk.com

Wulfman... wrote:I see a recipe (configuration) for disaster.

Did they prescribe a fixed pressure for you in the titration portion of your sleep study?
If so, I'd suggest setting your machine in CPAP mode at that pressure.

If some of the leaks are coming from your mouth, tape your mouth shut or get a full face mask.

Yes, the sleep study showed that I needed a pressure of 12. I have reset my machine to that setting.

I taped my mouth shut last night. I'll post the results in a few minutes.

Thank you for your suggestions

WOW!!!!

I taped my mouth shut last night (wife had all kinds of commentary with this) and it all but gave me a 'flat' leak line... YEE HAA!

I'll get a chin strap (and probably a full face mask) as well.

Below are my results from last night. My AHI went up a bit and I've got what I would think are quite a few 'Events'. I presume the data is much more reliable now that there are no leaks.

The only other tweak I made was to set my machine to a pressure setting of 12.

Thanks again to all who chimed in... it's really made a difference.

Again, if you see something...have any thoughts, suggestions or observations, I would greatly appreciate them:

Good job. I also had a bit of a mouth breathing issue when I first started. Likely from habit of nightly gasping for breaths before cpap treatment started. I taped for a couple of months (also tried chin strap and polygrip). After a couple of months I started getting lazy and "forgetting" to tape and to my surprise the leak lines didn't revert back to the way they were when I first started. So sometimes we can "relearn" that nose breathing only habit. For my own personal reasons I didn't/couldn't go down the full face mask road. Read all the scary stuff about taping and tried it anyway. First night I taped had a power failure. Woke up just fine. No distress at all. Also I discovered that if I really wanted to open mouth with tape that I could. It isn't like cement.

drjsparker wrote:WOW!!!! I taped my mouth shut last night (wife had all kinds of commentary with this) and it all but gave me a 'flat' leak line... YEE HAA!

Sorry, I must be missing something about this strategy.
You were concerned about leaks, you now know that they are mouth leaks. After taping the leaks went away, but the AHI went up somewhat during REM sleep. Why switch to constatnt CPAP; why not let APAP try to fix those apneas with a higher pressure?
You could also have trained to reduce mouth respiration to just when absolutely needed.
I see these as minor issues ... what did CPAP do to your quality of sleep?

drjsparker wrote:WOW!!!!

I taped my mouth shut last night (wife had all kinds of commentary with this) and it all but gave me a 'flat' leak line... YEE HAA!

I'll get a chin strap (and probably a full face mask) as well.

Below are my results from last night. My AHI went up a bit and I've got what I would think are quite a few 'Events'. I presume the data is much more reliable now that there are no leaks.

The only other tweak I made was to set my machine to a pressure setting of 12.

Thanks again to all who chimed in... it's really made a difference.

Again, if you see something...have any thoughts, suggestions or observations, I would greatly appreciate them:

Glad to hear that.
I'd suggest using your prescribed pressure for a while to see what happens. Typically, the event numbers tend to come down. You may also need to select a different EPR setting........in case your apneas are occurring at the end of your exhale cycle and the beginning of your inhale cycle, or, slightly raise your therapy pressure by a centimeter or two to compensate for the pressure loss at that time of your breathing cycle. For some people that is important if they're susceptible to apneas at that point. I'm sure they weren't using EPR during your sleep study.......just straight pressure.


Den

not relevant

AMUW wrote:Why switch to constant CPAP; why not let APAP try to fix those apneas with a higher pressure?

Great question... I switched it back to an APAP a couple of nights ago. I've posted my stats for the last few nights below.

AMUW wrote:You could also have trained to reduce mouth respiration to just when absolutely needed.

I'm not quite sure what you're meaning here

Wulfman... wrote: You may also need to select a different EPR setting........in case your apneas are occurring at the end of your exhale cycle and the beginning of your inhale cycle, or, slightly raise your therapy pressure by a centimeter or two to compensate for the pressure loss at that time of your breathing cycle. For some people that is important if they're susceptible to apneas at that point. I'm sure they weren't using EPR during your sleep study.......just straight pressure.

Couple of thoughts on this:
-You are correct as to the sleep study...straight pressure [12] was used.
-I'm not sure I understand the concept of the EPR. My assumption is that it backs off the pressure when you exhale. Mine has been set at 3.


Stats:

Date____Mode___Pressure______EPR____AHI_____LEAKS 95%____LEAKS MAX
June 1___cpap___12____________3______3.3_____0.0__________1.2
June 2___cpap___12____________3______2.1_____0.0__________1.2
June 3___apap___10 - 16________3______.6______1.2__________6.0
June 5___apap___10 - 16________3______.7______0.0__________1.2

drjsparker wrote:-I'm not sure I understand the concept of the EPR. My assumption is that it backs off the pressure when you exhale. Mine has been set at 3.

On the ResMed machine each setting equals a single full cm drop in pressure during exhale. A setting of 3 means a drop in pressure of 3 cm. So if you are using 12 cm when you exhale your pressure drops to 9 cm. Roughly half your sleep time will be at the lower number when you are exhaling. For some people that reduction is enough to allow some events to occur.
Not everyone though. Your recent data points to being very good and I wouldn't see a reason to alter pressure to give you a little higher pressure on exhale. Now if you still had a much higher AHI, then your choices would be a higher pressure or lower EPR so that your pressure on exhale was a bit higher.

Wulfman... wrote:Glad to hear that.
I'd suggest using your prescribed pressure for a while to see what happens. Typically, the event numbers tend to come down. You may also need to select a different EPR setting........in case your apneas are occurring at the end of your exhale cycle and the beginning of your inhale cycle, or, slightly raise your therapy pressure by a centimeter or two to compensate for the pressure loss at that time of your breathing cycle. For some people that is important if they're susceptible to apneas at that point. I'm sure they weren't using EPR during your sleep study.......just straight pressure.
Den

Well, I tried setting my EPR to 0, but about 3 1/2 hrs into the night my hose became disconnected from my mask....not sure how that happened.

Below is a close up shot of a couple of apneas from several nights ago (mode was APAP; pressure range was 10 to 16; EPR set at 3)

As always, any observations/thoughts would be appreciated.

drjsparker wrote:Greetings: Below are last nights results... good news/bad news... good news is it looks like my snoring is in good shape (not keeping my wife up); bad news is now all of the leaking is keeping her up.

Some questions:
-What do 'Median' and '95th percentile' mean with respect to Leaks?
-Is an AHI of 1 considered normal or do I need to keep tweaking until I get to 0?
-In the 'Events' Section, what do the numbers (10, 11, 12, etc...) at each event represent?
-Most importantly, what in the world can I do to prevent these leaks?!? [Very Frustrating]

Any thoughts and/or additional observations would be GREATLY appreciated. Thank You

The report looks pretty good. It seems to show you don't need much more than 10 cm. of pressure.

How's the "leaking" thing going? Is your wife happier?


Den

Wulfman... wrote:The report looks pretty good. It seems to show you don't need much more than 10 cm. of pressure.

How's the "leaking" thing going? Is your wife happier?


Den

Much happier, thanks. The leaks are good when I tape my mouth shut and use a nasal mask (as opposed to a pillow mask) with a pressure range of 10 to 16 and EPR at 3.... that's the best combination I've found.

Can you tell from the graphs if I have my EPR set too high?

drjsparker wrote:

Wulfman... wrote:The report looks pretty good. It seems to show you don't need much more than 10 cm. of pressure.

How's the "leaking" thing going? Is your wife happier?


Den

Much happier, thanks. The leaks are good when I tape my mouth shut and use a nasal mask (as opposed to a pillow mask) with a pressure range of 10 to 16 and EPR at 3.... that's the best combination I've found.

Can you tell from the graphs if I have my EPR set too high?

If the EPR drop in pressure was affecting your therapy, you would probably seeing more events (apneas) showing up. For some people it affects their therapy and for others it does not.
I'm not intimately familiar with interpreting ResMed reports, but I do understand some of it. I'm not sure what those wavy lines on the "Flow" chart portion mean. Maybe somebody else can explain them.
For all intents and purposes, you could probably set your machine to CPAP mode with a pressure of 10 or 11 and be just fine. What this report shows is that either of those pressures would provide very good therapy. Flow limitations and snoring are primarily what drive pressure increases in APAPs........and, for the most part have little actual affect on OSA or this therapy. So, if APAP mode in a range of pressures should start disturbing your sleep, you might keep that in mind.

This therapy and the data from the machines is about "averages" and finding the right configuration for each person.


Den