AHI 131 !! - Help me understand my SleepStudy & CPAP results

Pugsy wrote: Looks like the padacheek liner was creating more leak issues...it can happen that way for some people.
Bummer because the comfort is nice and not everyone has that happen but you drew the short straw in that regard.

I liked the mask liner, as it felt soft, and I'm a drooler and sweat sometimes at night. When I took the mask liner off last night before going to bed, the lower part (below my mouth) of the cloth liner was kinda crusty from my drooling. Last night, when I woke up...had to wipe away some drool and it made the lower part of my mask slippery. Just can't seem to win.

Kenwood wrote:Just can't seem to win.

There's always something.
Maybe you could fix up just a little something for a liner for the lower part of the mask to help suck up the drool a little.

Here are Saturday and Sunday stats with EPAP bumped up to 16:

Leaks were an issue Sunday night...see the line up around 100 L/min for a good bit of the time? I am thinking the decrease in snores may be from the machine missing them when the leak was up around 100.

Still you see the difference EPAP makes on Saturday night. How was the sleep quality?
AHI is fine. Snores were ugly but if you slept great and felt great then maybe I wouldn't care.

Sometimes we have to make compromises....if you increase EPAP again...then I would also increase IPAP...keep a 4 cm Pressure support because it is easier to breathe with and maybe the added IPAP will help with the snores if they are tending to lean towards hyponea type of flow reductions...
because we do EPAP for obstructive and IPAP for hyponeas.

Though for next couple of nights...I wouldn't change anything but instead I would work on mask fit again.
At these pressures leaks are going to be a challenge with any mask out there.

I always sleep good and feel okay in morning (maybe wishing the alarm wasn't going off)- I rarely notice a difference from one night to another. I also fall asleep quick too. I might wake up a few times during the night and readjust the mask - which is usually pulling it down more towards my chin. But Saturday night, I went to sleep with a quite mask, but Sunday went to sleep with leaks.

The only thing that has been effecting my sleep the last couple weeks has been my back. Ever since I have been using CPAP, my back has been KILLING me. I've been a life long stomach (face in pillow) sleeper. So I've been going to the Chiro trying to help with this back problem. Even had my back massaged out. Its been a very long time since I've had a back problem last this long. The Aleve is not helping either. Even tried sleeping on my back too.

I have a lot of pain when I sleep on my back also.
So much pain that it wakes me up and I lay there knowing I need to turn over but delaying doing it because it hurts.
I probably should build another wall to keep me on my side but I keep putting it off.

When we sleep on our back the oral tissues and the jaw and the airway tissues tend to fall down due to gravity and hence we get more snores and maybe more apnea events and/or maybe a need for higher pressures when on our back.
I never really saw any difference in pressure needs or apnea events when I sleep on my back and no particular increase in FLs or snores even...so from that aspect of things there is no real need to stay off my back but from the pain aspect I need to stay off my back because the pain itself disturbs my sleep.

If you are sleeping good and feeling good...just work on mask leaks for now and finding a position where you can sleep without pain. Maybe the snores will be less ugly if you can stay off your back.
At least you now have an AHI that is well within acceptable limits and sleeping well and feeling decent.

I just reread your first post with your sleep study...you didn't get any REM sleep....and most of your events were non supine sleeping...so we don't know how much supine sleeping or REM factors into your snores or pressure needs.
Both are common causes for more pressure needs and more events in general.
We can't control REM...so if your issues are REM related...well we just deal with them
Mine are REM related...so I just let the machine do its job...and this is when auto mode comes in handy.
But you can still get good therapy with the fixed bilevel and actually as far as leak control...it's better to use the fixed bilevel pressures anyway. It's hard enough to adjust the mask to these pressures without adding variable hurricane force winds into the picture.

I think if you can keep the leaks under around 85 L/min for the majority of the night we can consider it a success.
Leaks are always going to be a war we never truly win...sometimes we win the battle and sometimes the leaks win the battle.

Pugsy wrote: When we sleep on our back the oral tissues and the jaw and the airway tissues tend to fall down due to gravity and hence we get more snores and maybe more apnea events and/or maybe a need for higher pressures when on our back.

I just reread your first post with your sleep study...you didn't get any REM sleep....and most of your events were non supine sleeping...so we don't know how much supine sleeping or REM factors into your snores or pressure needs.

Nope....never had REM sleep (or R3). I also NEVER sleep on my back (supine). If fact, I've only sleep on my left side of my stomach my entire life. Since I've been on CPAP, I've been sleeping on my left side. Per my Chiro, he asked to try and sleep on my back the last week to see if it would help relieve the pressure on my lower back and get my back muscles to relax.

Well if we can't blame your snores on supine sleeping then we just blame them on not quite optimal pressure or simply snore artifacts.
There's too many of them all night long to blame them all on REM stage sleep but REM might impact things somewhat.

I think it is up to you how aggressively you want to try to deal with the snore issues.
Do make sure that the hose isn't rubbing against something that might be fooling the machine...like in my case the hose uncovered and antique iron headboard...the movement of the hose on the ironwork makes a bit of noise.
Hose cozy would fix that issue for me or not route the hose through the ironwork.

Pugsy wrote: Do make sure that the hose isn't rubbing against something that might be fooling the machine...like in my case the hose uncovered and antique iron headboard...the movement of the hose on the ironwork makes a bit of noise.
Hose cozy would fix that issue for me or not route the hose through the ironwork.

Hmmmmmmmm? I just let hose hang.
I don't really move around much when I sleep. Sometimes waking up in the exact same spot in the morning. My machine is on my nightstand (which is a bit lower than the bed) and just hangs off the nightstand - to the edge of my mattress - to my big ole face. I sleep facing my machine - on the left side edge of my bed, on my left side - so it's a very close distance. Tonight, I'll drape a towel over the nightstand so the hose rests on the towel and see if there is a difference. You think of everything....that would have never crossed my mind!

It's unlikely that the snores are artifacts but it isn't impossible.
I think I told you about my Pug dog and his snores.
Fortunately I wasn't having enough of them for me to want to go into "fix it " mode or I would have been real unhappy to find out I went to a lot of work trying to fix something that couldn't be fixed.
People would say to me "what's the deal with your snore line" and I would say "gosh, I don't know but it seems random so I don't worry"

Yours are probably real and when they disappear and your leak is up around 100 L/min...they weren't gone I don't think.
I think the machine couldn't sense them.

Check out these low leaks....although a higher AHI of 8.6
(used a towel under the hose hanging off my nightstand)

Your AHI is higher because the machine didn't miss so many events. Bummer huh?
When large leak is present the machine misses events giving you a "false low" AHI. That's why we can't trust what we see during times of large leak.

The first cluster of events...and a nice lower leak...I bet those are occurring during the first REM stage sleep of the night.
They happened because you need more pressure during that REM stage sleep to prevent those events from materializing.
I think the snores are real and not artifacts. I think we can safely assume that fact.

This is where it would be nice for you to have the Auto BiPap...the machine could then have increased the pressure on its own in an attempt to prevent those events (which obviously require higher pressure) from materializing.

The 3:00 cluster.. probably REM again but leak was greater so we can't say with absolute certainty that more pressure was needed at that time...but I bet it was REM and more pressure was needed just like the first cluster. There's a good chance it would have occurred even if the leak was lower.

Pugsy wrote: They happened because you need more pressure during that REM stage sleep to prevent those events from materializing.
I think the snores are real and not artifacts. I think we can safely assume that fact.

This is where it would be nice for you to have the Auto BiPap...the machine could then have increased the pressure on its own in an attempt to prevent those events (which obviously require higher pressure) from materializing.

Wow...more pressure than a 20!? I haven't seen many members over 20. Can't image those leaks. LOL

Kenwood wrote:
Wow...more pressure than a 20!? I haven't seen many members over 20. Can't image those leaks. LOL

Don't know about IPAP over 20...maybe
But likely more EPAP for sure.

Don't know for sure though. Sometimes all that might be needed to prevent those clusters is another 0.5 cm. We just don't know what is the final pressure need might be for a few stubborn events.

Yesterday, I received replacement's from the DME for my "Gel Cushion and Silicone Membrane Flap" for my FF mask. I had 40 nights on my previous original Gel Cushion/Flap that I got with my CPAP machine. Last nights leaks were much lower - under 77 L/min the ENTIRE NIGHT!!!! But I'm going need to see some consistent nights to see if this helps lower my leaks below that 100 L/min line.

But on Monday, April 8th during my follow-up Sleep Dr appt, I'm still going push for my doctor to send that specific RX she wrote for a Quattro Mirage FF mask to a DME that has ResMed masks, as my current DME only does Phillips Respironics products. The leaks using the Quattro were a night/day difference at the Sleep DR mask refit appt I had last month. It just fit my big ole face better.

Tuesday's stats/charts with new Gel Cushion/flap for my FF mask