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1st doc visit after using APAP
#1
Finally saw the doc today.
Had a home test about 3 months ago. found out today I had a " 68 ".
I've been using an autoset S-9 for 2 months.

Doc pointed out a high leak rate of 20.56 over a month.
I'm surprised, I thought it felt good? my only complaint is waking up with what seems like high pressure filling my mouth, expanding my cheeks and mask farts/leaks. This is when I take the mask off for the night..

Doc hadn't gotten a report from supplier (DME?) so I showed him my sleepyhead report. He never heard of it. The suppliers report then came in and Doc gave me a copy as he saw I was interested. Sleepyheads is much more detailed and easier to read.

One conflict is pressure, they say I max out around 13.5 sleepyhead shows in the 17s... ( again, I feel like the pressure ramps way up as noted above? )

Doc is going to contact supplier about the high leak rate..

Oh, I do have a short beard and breath through my mouth

steve


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#2
Can the APAP be used to test for apnea? If I were to lower the max pressure below what I need. would I then register the high number ( 68 ) I had on the " official " home sleep study. I would be curious to try this to see if the numbers rise?

Steve
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#3
You need to look into that leak rate. Look at your daily data and figure out when you're leaking and why.

Is your machine actually set to 4-20 pressure range? If so, you probably need to raise your minimum pressure. Large pressure changes make it much harder to fix leaks and adjust to the pressure. Many people set their minimum pressure a bit below their 95% number.

Look at the daily results to see what your pressure is doing, as well. They probably were looking at a 95th percentile pressure number or a monthly pressure number. The 95th percentile number means you spent 95% of the time at that pressure or below.

In theory, if you turn your pressures down, when you get it too low, your reported AHI will start to go up.

You may want to use a chinstrap to keep your mouth closed. This helps keep air from getting in your mouth, even with a FFM. Try to keep your jaw closed, and keep your tongue pressed against the roof of your mouth and the back of your front teeth. This helps block off the air at the back of your mouth.
Get the free SleepyHead software here.
Useful links.
Click here for information on the main alternative to CPAP.
If it's midnight and a DME tells you it's dark outside, go and check it yourself.
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#4
With the exception of a leak issue, your numbers look great! It appears the machine is set to min 5, max 12.38, and an EPR of 3. That's probably a good place for you at this time, given your AHI is coming in at .2!

So the thing to do is work on the leak. Your average leak rate of 19.57 is high, but not outside the "magic number" of 24 that Resmed works with. The "Below 90% of the time" mark of 34.8 is a bit high, but without seeing a graph of the leak data for that night it's pretty hard to say if it really would have impacted your therapy or not.

Revisit the mask fitting guidelines. Use a liner with the full face mask, or make one yourself by cutting out a liner from an old t-shirt (how come we always say use an old t-shirt.... Why can't we use a new t-shirt if that's what we want to do?) --- but I digress.

I would not mess with the pressures at all at this time. You can't improve a whole lot on .2, and you sure can muddy the waters if you lower it below your therapeutic need. So focus on the leaks!

Even consider changing to a different type of mask if you need to. Such as my favorite, the Resmed P10 pillows mask. But whatever, just know you're doing great!
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#5
Your median leak rate can be 20 and you can still be spending 45% of the night above a leak level of 24. So yeah, it would be really helpful to see the detailed graph.

According to ResMed, you can't trust the event detection during the portion of the night that the leak is above 24 - that's why ResMed uses that as a "magic number". It is unlikely to be good enough for your median leak to be as high as 20.
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#6
Perhaps you could try adjusting the mask straps, liner, etc. while sitting awake in your recliner during the day. Sometimes we have the straps a little too tight and could get a better seal by allowing the mask to float on the face with the cushions fully inflated. It would be helpful to know what full face mask you are using.
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