Quick question on mask leak

Yes, thank you. That pretty much confirms my earlier thoughts.

Your pressure isn't sufficient to hold the airway open. What you want to do about it is up to you. I don't know how much more pressure you are going to need but it might be significant.
Sometimes we can turn off EPR and help things out but it won't be enough in this situation and at the pressures I suspect you are going to need I imagine you will want to use EPR.

Were you awake from 2:45 to 3:30? That's the only good spot in the report. Makes me wonder why it was so good. Did you lay there awake for that period of time?
The other break at 4 AM I imagine you woke up and turned the machine off.

Are you up to doing this yourself or would you feel better if your doctor was the one to make the changes because changes are going to have to be made.....and probably some significant changes.

you can grip the title of a graph and drag it to new positions,

you can also grab the line between them and shrink them down so that some don't take up as much space, and then you can get events, flow, pressure, snore, leak, and flow limit on one page. also, hit the ^ by the calendar... it doesn't help any

my first thought is that you need more than 13cm pressure now that you're getting a handle on the leaks.

I'm up for whatever it takes, I'm just not sure what I should do. I did go get a sleep study, though it was a year ago. My original doc that ordered it didn't follow through with the prescription for some reason. So fast forward a year and my current Doc says I need to lose weight and I need to get on a CPAP machine. He used the old sleep study, in which they recommended 13 as the setting. So I've been working with a local DME who set the machine up. She seems nice enough, but doesn't seem overly interested in my success if you know what I mean. It's more like - "go take this stuff and come back in a month so I can read the data." I think she's just threatened by how much I've learned on this forum
Anyway, I'll go through the weekend with the current mask to see if I can get it to work well or not. Then I guess I'll drop by the DME and see what her thoughts are. If the therapy isn't doing anything I need to change it up.

Also, I don;t remember what that hour was. I think in my grogginess I might have turned things on or off or back to ramp... I can;t remember. I had the mask on and off a couple times...

If you had taken the mask off during the 2:45 to 3:30 time frame we wouldn't have flow rate showing on the graph....so the mask was on and machine running. Doesn't appear to have been switched back to ramp as the pressure line is consistent and if ramp had been used it would have dropped back down and shown up during that time frame. Leaks were greatly improved during that time frame also.

Since your titration was over a year ago and we have no idea how accurate it was then that explains why 13 doesn't seem to be working so well.

Personally if it were me I would switch it over to apap mode with minimum of 13 and let the max go to 20 and see where the pressure wants to go. Keep your EPR at 3. Might need to raise the minimum up a bit after we see where the machine wants to go. Might get lucky and not have to raise it much. Don't know till you try.

FreeIndeed wrote:I'm up for whatever it takes, I'm just not sure what I should do. I did go get a sleep study, though it was a year ago. My original doc that ordered it didn't follow through with the prescription for some reason. So fast forward a year and my current Doc says I need to lose weight and I need to get on a CPAP machine. He used the old sleep study, in which they recommended 13 as the setting. So I've been working with a local DME who set the machine up. She seems nice enough, but doesn't seem overly interested in my success if you know what I mean. It's more like - "go take this stuff and come back in a month so I can read the data." I think she's just threatened by how much I've learned on this forum

many, if not most, DMEs are just trying to make a buck, or a whole bucket load of bucks, and don't care about anything else, (like most businesses these days) ... which is why the entire focus is on "compliance" (I hate that word, "GO DO WHAT WE TELL YOU TO DO!") and not on effectiveness. "working? we don't care if it's working, just that you use it long enough for us to get paid by the insurance company, who also doesn't care if it works".

sorry, *kicks soapbox out of the way* where'd that come from?

ANYWAY...

if it were me, I'd take advantage of the fact that I've got an autoset, and I'd pop open the provider menus on that puppy (hold down setup and the knob for a few seconds to unlock them) and I'd change the settings to autoset mode, instead of cpap, with a minimum pressure of 11 or 12, and a max of 15, and then I'd see how things went tonight.

having just seen what pugsy posted, I'd defer to her on pressure settings. she da man, er, woman.

palerider wrote:I'd change the settings to autoset mode, instead of cpap, with a minimum pressure of 11 or 12, and a max of 15, and then I'd see how things went tonight.

having just seen what pugsy posted, I'd defer to her on pressure settings. she da man, er, woman.

I did think about a slightly lower minimum (very briefly though) but the reason I went ahead and said 13/20 max was because of 2 things.
1.. being that EPR is being used so that lowers the overall pressure a bit and I just don't see reducing EPR or turning it off helping all that much and it sure could be uncomfortable.
2.. being it's painfully obvious that at 13 things have gone to hell in a hand basket and I suspect that pressures in the upper teens are going to be needed. Since he's already used to 13 anyway...might as well use it to start with. Once a person is used to a higher setting I find that going down takes about as much adjustment as going up...feels a bit stifling...been down that road myself in one of my many experiments.
I would really be surprised if a minimum of 13 gets the job done. I hope I am wrong.
If his AHI wasn't so god awful horrible...like maybe in the teens then yeah, maybe use apap with minimum of 11 or 12 and a lower maximum around 15ish but in this situation I suspect the machine is going to want to go above 15 or 16. Again...hope I am wrong just from the comfort aspect of things.

Pugsy wrote: 1.. being that EPR is being used so that lowers the overall pressure a bit and I just don't see reducing EPR or turning it off helping all that much and it sure could be uncomfortable.

I was thinking of a reduction in epr, because the way it works, he's actually using a pressure of *10* except when he starts an inhalation, which, of course, he can't do if the airway has blocked off...

I used to think that it was a exhalation relief, based on the name, but looking at the published pressure waveforms, and the waveforms from sleepyhead, it really is a reduction of epap much like a bi-level with a ps of 3. it stays at the lower pressure and only bumps up to ipap on an inhalation, then drops again.

eg:

Here is last night's data:



I was thinking about what might have been different about that hour from the last night that was good... and all I could think of was that maybe I was on my side. So last night I purposefully tried to fall asleep on my side to see if made any difference. I'm getting the mask to fit better; it still leaks a little at the bridge of the nose, but apparently not enough to matter. The AHI was better. Do you think side sleeping might help clear the airway obstruction?

Today I'm going back tot he DME to return masks that didn't work and ask questions. I might like to try the liberty mask still, just to see if it's more comfortable. Mainly I'm going to tell her that the CPAP setting of 13 obviously isn't working and I want to get changes made ASAP. If I need to get the ok from my DOC, then I'll get that going on. I'll try to force the issue of getting it switched over to APAP so we can see where it goes. I thought it over and I think i'll try to work through the DME first. IF she doesn't go along, then I'll just do it on my own. Your help has been invaluable!

Side sleeping vs sleeping on your back could make a huge difference in your pressure needs. When we are supine/on our back the air way tissues often flop more and simply need more pressure to hold the airway open.
I know one man who needed 18 or 19 when on his back and only around 9 when he was on his side. If a person can train themselves to stay on their side and off their back then often they can get by with less pressure all night. It isn't always so easy to train the body to stay off the back though. When there's a big difference in pressure needs and a person can't seem to stay off their back (it is easier said than done) then that makes a good argument for full time apap mode. Use the lower pressure when on the side and let the machine increase as needed if a person should happen to roll onto their back and need more pressure.
I have a similar issue with pressure needs due to REM stage sleep. In REM I often need twice the pressure I need in non REM sleep.
That's why I have always used auto adjusting mode of any machine I have used. I sure didn't want to use 18 all night and we have no control over REM sleep so I just let the machine do its job and figure things out for me. Main thing is to start with a good enough minimum pressure so the machine can get to where it needs to be for those super stubborn events in a timely manner.

If you want to play around with trying to stay on your side then you might be able to use 13 cm all the time and have some nice boring reports.

and have some nice boring reports.

Is that what you call the people who can keep the AHI under 5 or whatever? I'd take that! I'm not sure if I can stay on my side either. Well see how the visit with the DME goes today....