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[Diagnosis] Looking For Assessment
#1
Looking For Assessment
Long time CPAP user - 19 years.  Has made a huge difference over the years.  Have used ResMed Airsense 10 Autoset for a few years with nasal pillows.  I like the nasal pillows because my eyes always got awfully dry with all sorts of nasal masks. Not with the nasal pillows. I use a chinstrap because I seem to mouth breath sometimes and it seems to work.  I usually wake up with gunky mouth with lips stuck together, so I don't see how I could open the mouth much. Tried full face mask but it caused chipmunk cheeks to an extreme and constantly and I could not sleep. Thought I was OK, although the machine occasionally showed a leak problem.  Then I downloaded Oscar and purchased the ResMed card - and now have a few weeks recorded.  It seems to show an issue with the leak rate...  And I'd be interested in any other comments.  The machine randomly stopped "phoning in" data to my doctor last year so I can't ask him.  I have an appointment in May and will bring the card to him.


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#2
RE: Looking For Assessment
Yep! Leaks and a lot of them. But also a lot of flow limitations, which are driving up the pressure, which is making the leaks worse - sort of a vicious circle.

I see you're not using EPR - I suggest you set this to 3, which will lower the pressure as you exhale. This should be beneficial for both leaks and flow limitation. Try that for a few nights and see how it goes. I wouldn't be surprised if we have to make a subsequent pressure adjustment to re-stabilise the AHI.

Quote:The machine randomly stopped "phoning in" data to my doctor last year so I can't ask him.

If it's an older machine it might use a now-discontinued cellular phone system. The early generations are being / have been phased out.
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#3
RE: Looking For Assessment
Thanks. I set the EPR as indicated last night. No noticeable issues last night, slept well. The Airsense, at least, didn't have the unhappy face this morning. Will try a few more nights then repost Oscar screenshots.
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#4
RE: Looking For Assessment
(03-22-2020, 12:03 AM)DeepBreathing Wrote: Yep! Leaks and a lot of them. But also a lot of flow limitations, which are driving up the pressure, which is making the leaks worse - sort of a vicious circle.

I see you're not using EPR - I suggest you set this to 3, which will lower the pressure as you exhale. This should be beneficial for both leaks and flow limitation. Try that for a few nights and see how it goes. I wouldn't be surprised if we have to make a subsequent pressure adjustment to re-stabilise the AHI.

Quote:The machine randomly stopped "phoning in" data to my doctor last year so I can't ask him.

If it's an older machine it might use a now-discontinued cellular phone system. The early generations are being / have been phased out.

I turned on the EPR and set it at 3 as suggested.  I didn't notice any difference sleeping, although I did seem to sleep a little longer.  The leak rate seemed quite different  Saturday and Sunday nights, but went up last night. Not sure what's going on.  I attach Sunday and Monday and appreciate any insight.

       
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#5
RE: Looking For Assessment
Your flow limitations have gone down which is a good thing and probably a result of your EPR providing pressure support.

As for your leaks, if they don't impact your sleeping, you can continue on or experiment with different types of chin straps if your mouth breathing is an issue, or taping. I've never used pillows so I can't advise too much.

John
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#6
RE: Looking For Assessment
I agree with John - the EPR has reduced flow limitations, which in turn has stopped the pressure going quite so high. The leaks are within an acceptable range, but may be disturbing your sleep. It still looks like the major leaks are via your mouth, so you need to find a way to keep your mouth closed and sealed. An angry look from SWMBO usually does it for me. Smile
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#7
RE: Looking For Assessment
I originally had an issue with mouth breathing but moved to a chinstrap many years ago and it seemed to go away. Maybe it comes back sometimes now, but I usually wake up with my mouth kinda sealed shut, if you know what I mean. Don't know how I could have opened it much. I tried a full face a long time ago but the chipmunk cheeks were so extreme I had to immediately abandon. I'll try tuning up my present chin strap.

Any comment why the leak rates for the two nights appear so different?
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#8
RE: Looking For Assessment
Never mind. I see the vertical axis for the two nights was different and the readings were not that different. Don't know why the vertical axis changed parameters between the two nights. I didn't do anything intentionally.
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#9
RE: Looking For Assessment
You can set the vertical axis on most of the graphs - just right-click in the title area at the left of the graph. A drop-down menu will appear, select Y-axis | Scaling Mode. Select Override and set the numbers to something that makes sense for your results. In your case I'd set the maximum leak to 40 or 50 - if it goes above that you know you're in excessive leak territory. The default setting sets the scale according to the highest value recorded so if you have a single very high outlier it will skew the appearance of the whole graph.
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#10
RE: Looking For Assessment
How long have you been using the same headgear for your P10? I ask because they are notorious for stretching out. It helps to wash them -- they shrink a little as they dry -- but at a certain point they need replacing. Back when I was using a P10, I needed to replace the headgear around every 1-2 months, as I recall.

I tape my mouth with Somnifix, and most of the time it works perfectly. But I had to peel it half off last night so I could cough; I stuck it back on and thought all was well -- until I looked at my chart this morning and saw I'd leaked like a sieve.

So it can be hard to be sure whether mouth leaks are occurring. If you're curious about that, you can always try some Somnifix yourself.
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