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It's been a week on lower pressure and . . . .
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Marnid2014 Offline

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Machine: ResMed S9 Elite
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Sex: Female
Location: Florida

Post: #1
It's been a week on lower pressure and . . . .
A week ago the DME brought the machine down to 6, from 8. The results are somewhat mixed. I have seen an increase in AHI, but still very good, the lowest being 0.6 and the highest 1.8. The leaks have been much better, always under 24, usually On 8 my leaks were usually over the red line, but the AHI was lower, but from what I have gleaned from this forum, those were not true AHI scores.

Pressure 6 results now have been for a week:

MED 7.20 or lower
95% 22.0 or lower
Max have not been an issue.

When I use the P10 mask the leaks go up, I think it's just not tight enough, too much play in the straps so I am going to retro fit it with Velcro I also think I need a new pillow for it, it's a month old, but I have been switching back and forth from that mask to the FX for her.

If you all were me, would you try adjusting the pressure up a half or to 7 or just leave it alone. I have been waking up my usual amount, at least 3 times a night to go to the bathroom, but not sure if that is caused by apnea, I don't see an apnea and then a wake up pattern, the apnea only happens during a longer sleep cycle. it might just be habit to get up, I wish I could stop that.

The chin strap is driving me crazy, it's either too tight or too loose, my claustrophobia is kicking in with it on, and with just the P10, I feel better, but then worry all night about leaks, which is really weird, because I feel nothing, no air coming through the pillows at all, but it still shows a leak, albeit small, Huhsign
04-18-2014 07:38 AM
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robysue Offline
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Post: #2
RE: It's been a week on lower pressure and . . . .
(04-18-2014 07:38 AM)Marnid2014 Wrote:  A week ago the DME brought the machine down to 6, from 8. The results are somewhat mixed. I have seen an increase in AHI, but still very good, the lowest being 0.6 and the highest 1.8.
These are EXCELLENT AHI numbers. You don't need to get hung up chasing a 0.0 AHI night after night. The point is to sleep well with the machine, not to have perfect numbers.

Quote:The leaks have been much better, always under 24, usually On 8 my leaks were usually over the red line, but the AHI was lower, but from what I have gleaned from this forum, those were not true AHI scores.

Pressure 6 results now have been for a week:

MED 7.20 or lower
95% 22.0 or lower
Max have not been an issue.
These are the leak numbers for pressure = 6? If so, you're right, leaks are sufficiently under control that you only need to worry about them if they are waking you up.

Quote:If you all were me, would you try adjusting the pressure up a half or to 7 or just leave it alone. I have been waking up my usual amount, at least 3 times a night to go to the bathroom, but not sure if that is caused by apnea, I don't see an apnea and then a wake up pattern, the apnea only happens during a longer sleep cycle. it might just be habit to get up, I wish I could stop that.
1) I would NOT change anything. You've finally gotten the leaks under control and the AHI is EXCELLENT. There's no need to fix something that is not broken. AND you have a history of things going bad when the pressure is increased in terms of both leaks and quality of sleep.

2) My guess is the wakes are "out of habit" wakes since you say they are not immediately following an apnea. The only way of breaking an "out of habit" wake is with time and learning to NOT worry about it. Some questions about those remaining wakes:

A) When you first wake up, what's the first thing you think and what's the first thing you do?

B) Are you getting up to go the bathroom because there's an urgent need to go? Or are you getting up to go to the bathroom because "I'm already awake so I might as well go even though I don't really 'need' to go"?

C) How long does it take you to get back to sleep once you go back to bed?

D) Are these wakes roughly 90 minutes apart? Or 180 minutes apart?

Quote:The chin strap is driving me crazy, it's either too tight or too loose, my claustrophobia is kicking in with it on, and with just the P10, I feel better, but then worry all night about leaks, which is really weird, because I feel nothing, no air coming through the pillows at all, but it still shows a leak, albeit small, Huhsign
How much do the leaks increase when you ditch the chin strap? If the tradeoff is more comfort for leaks that are still well under the 24 L/min cutoff, you're better off with comfort and more small leaks in my opinion. Once on therapy some mouth breathers wind up turning into nasal breathers and with time the mouth leaks become less of an issue. You may be one of the lucky ones.
04-18-2014 08:40 AM
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Marnid2014 Offline

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Posts: 187
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Machine: ResMed S9 Elite
Mask Type: Nasal pillows
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CPAP Software: ResScan SleepyHead

Other Comments:

Sex: Female
Location: Florida

Post: #3
RE: It's been a week on lower pressure and . . . .
(04-18-2014 08:40 AM)robysue Wrote:  
(04-18-2014 07:38 AM)Marnid2014 Wrote:  A week ago the DME brought the machine down to 6, from 8. The results are somewhat mixed. I have seen an increase in AHI, but still very good, the lowest being 0.6 and the highest 1.8.
These are EXCELLENT AHI numbers. You don't need to get hung up chasing a 0.0 AHI night after night. The point is to sleep well with the machine, not to have perfect numbers.

Quote:The leaks have been much better, always under 24, usually On 8 my leaks were usually over the red line, but the AHI was lower, but from what I have gleaned from this forum, those were not true AHI scores.

Pressure 6 results now have been for a week:

MED 7.20 or lower
95% 22.0 or lower
Max have not been an issue.
These are the leak numbers for pressure = 6? If so, you're right, leaks are sufficiently under control that you only need to worry about them if they are waking you up.

Quote:If you all were me, would you try adjusting the pressure up a half or to 7 or just leave it alone. I have been waking up my usual amount, at least 3 times a night to go to the bathroom, but not sure if that is caused by apnea, I don't see an apnea and then a wake up pattern, the apnea only happens during a longer sleep cycle. it might just be habit to get up, I wish I could stop that.
1) I would NOT change anything. You've finally gotten the leaks under control and the AHI is EXCELLENT. There's no need to fix something that is not broken. AND you have a history of things going bad when the pressure is increased in terms of both leaks and quality of sleep.

2) My guess is the wakes are "out of habit" wakes since you say they are not immediately following an apnea. The only way of breaking an "out of habit" wake is with time and learning to NOT worry about it. Some questions about those remaining wakes:

A) When you first wake up, what's the first thing you think and what's the first thing you do?

B) Are you getting up to go the bathroom because there's an urgent need to go? Or are you getting up to go to the bathroom because "I'm already awake so I might as well go even though I don't really 'need' to go"?

C) How long does it take you to get back to sleep once you go back to bed?

D) Are these wakes roughly 90 minutes apart? Or 180 minutes apart?

Quote:The chin strap is driving me crazy, it's either too tight or too loose, my claustrophobia is kicking in with it on, and with just the P10, I feel better, but then worry all night about leaks, which is really weird, because I feel nothing, no air coming through the pillows at all, but it still shows a leak, albeit small, Huhsign
How much do the leaks increase when you ditch the chin strap? If the tradeoff is more comfort for leaks that are still well under the 24 L/min cutoff, you're better off with comfort and more small leaks in my opinion. Once on therapy some mouth breathers wind up turning into nasal breathers and with time the mouth leaks become less of an issue. You may be one of the lucky ones.


I have to laugh at the question about getting up, the first thing I think is "Is my mask leaking" I know this is stupid and a waste of energy. As far as getting up to go, a few times I do have to go, the other is "well, I am awake, so I should go". They seem to be at a usual time as well, around 2:00 and 4ish. As far as getting back to sleep, it's right away. I agree about the comfort, it's important. I just have to learn to let it be, which is NOT easy for me. Sigh
04-18-2014 09:52 AM
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robysue Offline
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Other Comments: Papping since September 2010

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Location: Buffalo, NY

Post: #4
RE: It's been a week on lower pressure and . . . .
(04-18-2014 09:52 AM)Marnid2014 Wrote:  I have to laugh at the question about getting up, the first thing I think is "Is my mask leaking" I know this is stupid and a waste of energy. As far as getting up to go, a few times I do have to go, the other is "well, I am awake, so I should go". They seem to be at a usual time as well, around 2:00 and 4ish. As far as getting back to sleep, it's right away. I agree about the comfort, it's important. I just have to learn to let it be, which is NOT easy for me. Sigh
Sounds to me like:

1) You've got the usual Newbie worries about LEAKS, LEAKS, LEAKS. Some newbies worry way too much about leaks. If you don't feel any leaks and your leak line looks acceptable night after night, you'll eventually quit worrying quite so much about them.

2) If you do wake up to the occasional leak, the "right response" is to notice the leak, fix the leak, and settle back down and go back to sleep. Eventually you may not even remember waking up and fixing the stray leak here and there.

3) Sounds like most of the wakes are a combination of "habit" and "need to go" and possibly "normal post REM wake". We are creatures of habit and if you've been briefly waking up at 2:00AM to go to the bathroom for 10 years, the body (and bladder) kind of expect to "wake up" then. The serious "need to go NOW NOW NOW wakes" of nocturia should decrease with time now that your are on CPAP since nocturia can be a symptom of untreated OSA. But a lot of people will wake up not needing to go, but figure, what the hey, since I'm awake anyway, lets make sure everything is good and comfortable. Post REM wakes are actually common and most people don't remember them because they're so short: Many normal sleepers will wake up just enough post REM to make sure there's nothing out of the ordinary that needs to be attended to and then fall back asleep as soon as they notice there's nothing that caused the wake and everything is OK. They don't even remember these wakes in the morning because they're so short.

4) Hard as it is to do, the absolute best thing you can do about these relatively few wakes is DON'T WORRY OR FRET ABOUT THEM. Seriously, the more you worry or fret about them, the more likely you are to prolong them to the point where you remember them each night and the more likely you are to prolong their happening every night. Sometimes the best thing to do about a small handful of short middle of the night wakes is literally to just ignore them and go back to sleep (with or without a quick trip to the bathroom).
04-18-2014 04:22 PM
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PaulaO2 Offline
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Post: #5
RE: It's been a week on lower pressure and . . . .
I totally agree with what Robysue is saying.

Leave it alone, keep watching your data, and let it all settle. Stop worrying about it.

PaulaO2
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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.
04-19-2014 06:01 PM
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Gabby Offline

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Post: #6
RE: It's been a week on lower pressure and . . . .
Marnie I did some needlework on the straps of my Airfit P10, tightening it up and it has reduced the leaks remarkably while still keeping it a comfortable mask.
Worth giving it a try.
Best of luck!

Sleep Tight...
Gabby
04-19-2014 09:24 PM
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Sleepster Offline
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Post: #7
RE: It's been a week on lower pressure and . . . .
(04-18-2014 09:52 AM)Marnid2014 Wrote:  I have to laugh at the question about getting up, the first thing I think is "Is my mask leaking" I know this is stupid and a waste of energy.

This is all part of the adjustment to CPAP therapy. You just have to tell yourself that you don't need to worry. About anything.

Soon you'll arrive at a new normal.

Remember that for a long time you had untreated sleep apnea, so your body and mind had plenty to keep itself busy. It had to constantly keep waking you up to breathe. Now that it no longer has to do that, it's freaking out. You're in recovery.

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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.
04-20-2014 07:48 PM
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herbm Offline

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Post: #8
RE: It's been a week on lower pressure and . . . .
First, everyone else is correct that the LEAK NUMBERS are acceptable.

However, there is NO GOOD REASON for those leaks to be that high with a P10.

There are only two places for leaks with a P10 or other nasal pillow mask.

It is either leaking around the pillows in which case you will hear and/or feel the leaks. Fix that.

Or it is through your mouth - probably after you fall asleep.

That is no big deal IF it doesn't bother you.

Sweet Dreams,

HerbM
Sleep study AHI: 49 RDI: 60 -- APAP 10-11 w/AHI: 1.5 avg for 7-days (up due likely to hip replacement recovery)

"We can all breathe together or we will all suffocate alone."
04-20-2014 08:12 PM
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Marnid2014 Offline

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Post: #9
RE: It's been a week on lower pressure and . . . .
(04-20-2014 08:12 PM)herbm Wrote:  First, everyone else is correct that the LEAK NUMBERS are acceptable.

However, there is NO GOOD REASON for those leaks to be that high with a P10.

There are only two places for leaks with a P10 or other nasal pillow mask.

It is either leaking around the pillows in which case you will hear and/or feel the leaks. Fix that.

Or it is through your mouth - probably after you fall asleep.

That is no big deal IF it doesn't bother you.

Still struggling with the P10, I sewed the straps tighter and I still think it's not tight enough, there is so much play.
The leak rate is still ok, my CA is up a bit, so I don't know what that is about??????? The AHI is fine, 0.66 last night. I think I need a new set of pillows, they are a month old, so hopefully the DME will deliver the new ones soon.

I check that mask and I cannot for the life of me feel any leaks anywhere around the pillows so I don't know where it's coming from. Even when I get up to bio break, I feel before I get up and there is nothing coming from the nose. I tape my mouth shut so it's not from there as well. ugggg
04-21-2014 04:50 PM
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Marnid2014 Offline

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Post: #10
RE: It's been a week on lower pressure and . . . .
(04-19-2014 09:24 PM)Gabby Wrote:  Marnie I did some needlework on the straps of my Airfit P10, tightening it up and it has reduced the leaks remarkably while still keeping it a comfortable mask.
Worth giving it a try.
Best of luck!

I did that as well, I might try putting Velcro straps on as well, I am tightening it a bit more now.
04-21-2014 04:57 PM
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