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Air leaks plus I feel like i'm not getting enough air
#1
Air leaks plus I feel like i'm not getting enough air
My AHI has drastically improved from 95 down to about 3-4 on average over the past 3 months or so.  

However, over the past few nights, it seems like I'm struggling to breathe with the cpap on.  My pressure is between 14-16.  I'm using the Dreamwear masks with the Philips Respironics.  I've switched between the cushion and the pillows, but over the past week, i've struggled to breathe and my AHI has jumped up to about 6-7.

On top of that, I can't seem to stop the air leaks without pulling the mask so tight it's uncomfortable.  

I've already spent a fortune on masks and really don't want to start looking again.  Any advice/thoughts/etc?  Thanks everyone!
3 out of 4 people make up 75% of the population.
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#2
RE: Air leaks plus I feel like i'm not getting enough air
What is your leak rate like? Sharp increases? Puncture in the hose? Leak in the humidifier seal? Does the machines seem like it is louder or working harder? When have you changed the filters?

Auto ramp on? Maybe turn that off.

Plugged up nose? Allergies? Cold?

How old are the masks? Maybe it is time for a new one?

Just some ideas ...
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#3
RE: Air leaks plus I feel like i'm not getting enough air
If you download free OSCAR software  https://www.sleepfiles.com/OSCAR/  and post some data (see links below for how to post and format/organize daily charts) we will have better information to work with in helping you.
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Soft Cervical Collar

INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.

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#4
RE: Air leaks plus I feel like i'm not getting enough air
A 14-16 pressure is pretty high. I'm not surprised you are having a hard time breathing. 

Did you increase the pressure recently or was it always like that?
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#5
RE: Air leaks plus I feel like i'm not getting enough air
If you feel like your not getting enough air it's not because your pressure is at 14-16. Is your machine set at 14-16 or 6-20 as stated in your profile. Feeling starved for air is associated with a low pressure.
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INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.

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#6
RE: Air leaks plus I feel like i'm not getting enough air
Ministerman, I see you have 3 different threads dealing with your therapy. As you've been told before, it's best to keep everything in a single thread. It makes it harder for those trying to help you.
Download OSCAR

Organize Charts
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Mask Primer
Soft Cervical Collar

INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.

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#7
RE: Air leaks plus I feel like i'm not getting enough air
(08-08-2019, 04:26 PM)alexp Wrote: A 14-16 pressure is pretty high. I'm not surprised you are having a hard time breathing. 

Did you increase the pressure recently or was it always like that?

I call foul.

Please do my favorite experiment.
Get a tall glass of water and a straw.
immerse the straw at least 8 inches into the water,
blow bubbles.

Any trouble?  didn't think so.
That is the maximum pressure that your CPAP is capable of producing, 20 cmw / 8 inches of water.  Your CPAP cannot produce enough pressure to blow up a balloon.

Airflow, especially with leaks, can cause a problem but I assure you, unless you have extremely fragile lungs due to disease, it is not the pressure.
Fred Bonjour - Project Manager and Lead Tester for OSCAR - Open Source CPAP Analysis Reporter 
OSCAR

Download OSCAR
New to Apnea? Helpful tips to ensure success
Soft Cervical Collar
Mask Primer
Dealing with a DME
Organize Charts
Attaching Charts

INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#8
RE: Air leaks plus I feel like i'm not getting enough air
(08-08-2019, 07:34 PM)bonjour Wrote:
(08-08-2019, 04:26 PM)alexp Wrote: A 14-16 pressure is pretty high. I'm not surprised you are having a hard time breathing. 

Did you increase the pressure recently or was it always like that?

I call foul.

Please do my favorite experiment.
Get a tall glass of water and a straw.
immerse the straw at least 8 inches into the water,
blow bubbles.

Any trouble?  didn't think so.
That is the maximum pressure that your CPAP is capable of producing, 20 cmw / 8 inches of water.  Your CPAP cannot produce enough pressure to blow up a balloon.

Airflow, especially with leaks, can cause a problem but I assure you, unless you have extremely fragile lungs due to disease, it is not the pressure.

Ok. You are right about that but I'm not sure I follow then. Why do some people have a hard time exhaling when the pressure is let's say over 15 and they get switched to a bipap? Or why do people use EPR at all? I'm not saying I'm right just trying to understand.

Thanks!
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#9
RE: Air leaks plus I feel like i'm not getting enough air
For an example of believing there’s an exhale issue that one believes they need BPAP, myself. I had not joined AB yet, the pulmonary doc was not interested in looking at data nor telling me what was wrong, and COPD was not yet diagnosed. All the above while on CPAP with no EPR, set to 18...I admit I felt like I was struggling to exhale. I eventually got onto a BPAP...worse because of lots of central apnea that they finally discovered. Now on my ASV no exhale issue.

No that’s not a reason for everyone to try ASV.
Dave

OSCAR
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INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEBSITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#10
RE: Air leaks plus I feel like i'm not getting enough air
Put on your CPAP start it up then open your mouth, It will likely feel like you are blowing out a hurricane. The CPAP will speed up to compensate and increase flow to maintain the set pressure. That high flow does not feel good. That flow is what most people are referring to as pressure. Keep in mind that it is EPAP pressure that splints the airway open so when you start EPR the EPAP pressure is lower than before the airway may not be splinted as well as before resulting in a more restricted breath. When applying EPR consideration must be given to a pressure change to compensate.
You can run into congestion caused by using a CPAP system, the mask pressing on sinuses, especially if tightening "too tight" tp stop leaks.
The pressure difference between inhale and exhale can provide a small assist in breathing. More importantly, this pressure difference can treat hypopneas, flow limitations, RERAs, and Snores.

Sometimes it is just the fact that there is some pressure there, not too much pressure, just some pressure. Before CPAP, how much time have you spent breathing air under any pressure? Sometimes it is the masks physical size. Pure physics, the more are covered by the mask the more lifting force generated at any given pressure.

Sometimes it starts with the question you asked. If it's not the pressure then what is it?

Ministerman said "I'm struggling to breathe with the CPAP on" do you have the same trouble with the CPAP off? Is the trouble with inhaling? or exhaling? Why do you think that is?

The charts of this instance were not provided, it always help to see a zoomed view, about 2 minutes, of a problem area. Did your events increase? Which events did you look for. Flow Limits, RERAs? Hypopneas? It all comes into play when trying to figure out what is actually happening.

I hope this helps you understand.
Fred Bonjour - Project Manager and Lead Tester for OSCAR - Open Source CPAP Analysis Reporter 
OSCAR

Download OSCAR
New to Apnea? Helpful tips to ensure success
Soft Cervical Collar
Mask Primer
Dealing with a DME
Organize Charts
Attaching Charts

INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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