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Leak Spikes and A Break in Flow
#1
Leak Spikes and A Break in Flow
Hi All! I have been lurking for a week now to see if I can understand what is happening in OSCAR. Unfortunately, no luck so hoping someone can share any ideas they have!

Attached is a screenshot of OSCAR and after sifting through the charts every day, I notice a common theme occurring throughout the night: a leak spike complemented by a break in the flow. Does anyone know why this is? Some nights I have an AHI of 0 but I still wake up feeling the same as usual, while others it goes up to 2 and don't feel much different. Also, I haven't been able to sleep an entire night without waking up in the middle of the night since using the CPAP machine.

I use a P10 mask, sleep on my side, and mouth tape to eliminate any risks of mouth leaks. I am not aware of any mask leaks (never felt it leaking before) and I do wake up with a slightly dry mouth even though the tape is securely attached.

I tried using a soft cervical collar for a few days based on what I read in some other posts and no changes in quality of sleep from what I can tell so far.

Any and all help is appreciated! Thanks so much in advance!!  Smile


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#2
RE: Leak Spikes and A Break in Flow
Appears to be sleep-wake junk to me. You briefly arouse, move your head around a bit, cause a transient leak, then fall asleep again.
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#3
RE: Leak Spikes and A Break in Flow
(04-18-2022, 08:48 PM)Millstone50 Wrote: Appears to be sleep-wake junk to me. You briefly arouse, move your head around a bit, cause a transient leak, then fall asleep again.

That makes a lot of sense, pretty crazy how often it happens though! Any thoughts on how I can stop the arousals from happening to begin with?

Thanks for the insight!!
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#4
RE: Leak Spikes and A Break in Flow
Yes, it looks like you had an arousal, then managed to exhale through your mouth, paused, then settled back into sleep-breathing. (You can insert a red line at the zero point in your flow rate, which helps to clarify when you start inhaling and when you start exhaling.) I buttress my tape with additional tape on the sides, where I tend to develop gaps during the night; you could give that a try.

Honestly, what jumps out at me is how little time you spend in bed at night. Can you try to get more sleep -- 7.5 hours at least, which may mean spending 8 hours in bed? You would probably also benefit from going to bed and get up at generally the same time every day.

In the interests of improving your comfort during the night, there are a few small tweaks to your settings that you could consider. One is to turn off the ramp. You can't get the full benefit of your EPR while you're using it, and your pressures are generally so low that I don't think you'll miss it.

Another suggestion is to set your minimum to 7 and your EPR to 3. (For EPR of 3, you need the minimum to be at least 7, since the lower pressure the machine can generate is 4.) This would just be an experiment. It might help to smooth things out for you and make breathing feel a little easier.
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#5
RE: Leak Spikes and A Break in Flow
As mentioned it is an arousal. It is normal to have some arousals but if they are excessive (lets say 10+ times per hour) it could be an issue. Trying to reduce their occurrence requires trying to determine their cause. In OSCAR all we can really do is look at the breathing prior to the arousal to see if there appears to be a breathing issue (flow limitations, apnea etc) that causes the arousal, that does not appear to be the case here.

Other possibilities include movement disorder arousals or spontaneous arousals. In this specific case I am leaning towards spontaneous arousal and that it actually started ~8 breaths prior to the obvious arousal breath. I have caught some similar looking arousals on video and they are usually slow with eyes opening for a few breaths while awakening process occurs before taking a bigger breath and then changing position (the apnea like period after the breath hints towards a position change occurring).
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#6
RE: Leak Spikes and A Break in Flow
Thanks so much for all the help everyone! I took the advice mentioned in the replies and found the following:
  • Getting more sleep - I spend around 7-8 hours in bed, I usually wake up around 2 am and some days I can fall back asleep with the mask on, others not. I think the two screenshots I chose happen to be shorter days
  • Turn off the ramp - I think I misunderstood and set the pressure to a static 8 (usually the highest it goes from what I can tell in OSCAR), I will keep playing around with this and actually turn off the ramp lol
  • Spontaneous arousals - the description provided really resonates with me, I recorded myself sleeping before seeing a sleep doctor and that's pretty much what I saw and I am guessing is still happening. Do you have any suggestions for how to limit or stop the arousals completely?
Attached are the last two nights, one is less than 5 hours the other over 7.

Thanks again for taking time to take a look and giving my advice on how to better my sleep apnea treatment, I really do appreciate it!!


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#7
RE: Leak Spikes and A Break in Flow
Arousal. How to eliminate them completely? We all do that . . . eventually. Arousals are normal, unless you are having too many of them. Count them and divide by time slept to come up with an index.
Evaluate your sleep when you wake, BEFORE you look at your numbers so they do not influence your response. Write it down.

Talk to your doctor if the index is high, perhaps there is a med to help.
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#8
RE: Leak Spikes and A Break in Flow
It looks like Blu15 has switched to straight 8 for pressure. Should this not change? It looks to me like a range is needed, maybe 8 - 20? I hope some experts will step in for good direction.
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#9
RE: Leak Spikes and A Break in Flow
I think Blu15 is trying to eliminate as many factors as possible that might be disturbing to sound sleep, and for some people, pressure changes can cause wake-ups. Given the good AHI, with few events that could be well-treated with more pressure, a static pressure seems OK to me. But I'd defer to an expert!
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