Just got new BiPAP machine, need help with treatment/optimization

[Ratchick]

I tend to find that I leak at the corners of my mouth if I'm going to. I use the 3M transpore tape which despite the name, isn't very porous! But I have woken up at times feeling just a teensy bit of chipmunk cheek (or in my case, between the lips and front teeth, which then sloooooowly seeps out of a teeny tiny gap that has formed at the corner of my mouth. In my case, it's probably because I have some sensory nerve damage there from surgery, and it's kind of numb, so I tend to drool from that side more when I am mouth breathing. Most nights I stay sealed, though, and the combination of a chinstrap or a collar and tape works for me. If your leaks are generally steady and not waking you, though, I wouldn't worry about them if they aren't too high. Concentrate more on how you feel and how rested you are.

[blancobonzo]

The tape stayed on the whole night (Pretty sure based on ) I feel pretty terrible despite low AHI. My question wasn't regarding the tape. Sorry if this sounds rude. Something did wake me, however; and it wasn't a high leak rate. I was wondering if perhaps despite seemingly having treated the flow limitations what if some are unflagged and untreated. Is the previous attachments breathing pattern normal? It seems that the inspiration is in 2 phases and looks flow limited based on my observation of other threads and the apnea board wiki.

[Ratchick]

It doesn't sound rude at all. Unfortunately, I'm not very good with BiPAP so hopefully some of the others can give you some advice - I would suggest adding the zero line to the flow graph though - right click over the name on the left and look under dotted lines. It just makes it a little easier to see exactly where you switch from inspiration to expiration.

How long have you been on BIPAP now? While a lot of people feel better right away, for some it can take a while longer to feel more gradual benefits. It may be that you just need to hang in there a little longer to really feel the effects, or of course, there might be something else going on that's also making you feel like crud too.

Hopefully some of the others will be able to let you know about that chart.

[SarcasticDave94]

Pattern looks off a bit but I'm not anywhere near Jedi master. I'm barely Padawan. I keep having trouble with the pesky crystals for the lightsaber project. Apparently it didn't like being doused with coffee.

Count this as a bump.

[blancobonzo]

Hello, last night for the first time the mouth tape stayed on the whole night (3m transpore tape). It was stuck to my face and the some of the adhesive is still on my face. Despite this, I seemed to have had more leaks than when other tape came off partially during the past few nights. I woke up at like 5:30 am (time is off) and couldn't fall asleep again. I was wondering where the leaks could possibly be coming from. I already use a cervical collar alongside the tape. If I can't find the source of the leaks should I go back to FFM? Is the efficacy of BiPAP reduced with FFM vs Pillows with no leaks? Thanks for the help. Oscar data is attached.

[Ratchick]

OK so my understanding is that getting a perfect seal with pillows at higher pressures, like yours, is sometimes hard. If you are using tape, and a collar, and you're seeing pretty steady leaks, I'm wondering if it's not just the seal.

That said, my understanding is that initially, nasal only masks were the norm with CPAP and the general use of FFMs came around because of BiPAP use, which often required significantly higher pressures. It may be that a FFM gives you a better seal than a nasal-only route... but really I think that's got to be up to you.

The level of your leaks is within the range that the machine can work with apart from that single area of large leak (and even that doesn't look to have really risen to a problematic level - in reality, the machine can usually tolerate significantly more leak, but it warns you at a level to give you a safety zone. So while it would be nicer to have less leak, the fact that it's fairly steady and following the pressure changes to me personally, I'd be wondering if maybe fit is an issue.

YMMV but I found that I had leaks when the pillows were too big, as well as too small - when they were too small, it was just a constant leak of around 14l/m while at 15cmH2O pressure. When they were too large, it would be sporadic spikes as I moved, or my nose twitched or whatever, where the seal would break for a little until it shifted back into place.

But someone far wiser than me on here said that we're not necessarily looking for ZERO leaks - that's often not possible. We're looking for leaks at a tolerable level where it's not impacting therapy. It may help to try switching up or down a size for the pillows, but ultimately, go on how you are feeling. If you are sleeping well, and you're not feeling as cruddy with the aerophagia and whatnot, then stick to what you're doing.

[blancobonzo]

Hello, I've decided to go back to using a FFM due to leaking caused by mouth tape coming off. I have been having a lot more OA events relative to when I used the nasal pillows and FFM on the AutoSet. The Central Apneas are completely gone with higher trigger sensitivity. There seem to be very little flow limitations in the chart but despite this I had a rather high (relatively) amount of apneas. Could anyone point me to a possible cause and how to fix it? Thanks for your help. Also, I used a cervical collar last night.

[blancobonzo]

Also, the obstructive apneas were relatively long (15-20 seconds). Could it be positional apnea despite the cervical collar?

[SarcasticDave94]

Can we see the OSCAR data so we can assist? Standard type first.

Events that go up when leaks go down typically will be a case of leaks were very high, too high to have accurate data as the leaks were probably runaway bad. Meaning the PAP couldn't keep up. Now that leaks are better than prior and events going up, this is my clue to what I'm saying. But we still need OSCAR.

[blancobonzo]

Hey sorry I forgot to attach the OSCAR data. Here is last nights. This AHI is higher than my sleep study and most of the nights with the AutoSet, which seems strange given that there are no clear airways.