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Screen shot of sleepyhead data

Here is a screen shot of two nights ago sleep data.

While I don't seem to have that many AHI I do have significant leakage.
I still feel very tired and achy and lack motivation -

Heres what the sleepyhead program told me:
"You had significant periods of major mask leakage"
Your pressure was under 8.04cmH2O for 95% of the time."

I am using a nasal pillow xs resmed airfit P10 and I have also used a full face but got the same note -" big air leakage ". I do notice that I sometimes feel like a cannot breath through my nose when I have the nasal pillow on. I know I have always kept my mouth open while sleeping. I do use the chin strap when I use cpap, but I think I can still open my mouth slightly no matter how tight I wrap it.

I am getting an oximeter today - my oxygen was as low as 84% in the original sleep study

any comments would be greatly appreciated _ i have high hopes for cpap in getting my life back. I've been exhausted for years and no one ever suggested a sleep studyOh-jeez

This board is amazing BTW - I am slowly exploring the wealth of info -Thanks
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Your machine is set wide-open, and it's likely that 4.0 cm is not comfortable for you. If you're still feeling tired, it would be a good idea to increase the minimum pressures. Other than that, you are getting very good results. You can disregard the CA events as they won't respond to pressure, and may or may not be true apnea. They can occur when you change position or transition in sleep stage. Another possibility is that the CA is a response to the EPR (pressure relief) when you are at higher pressure.

Notice in your graph, when you start therapy the machine is at 4.0 steady pressure. As the pressure increases, the EPR begins to take effect giving you an exhale pressure that stays around 4.0 -6.0, and inhale pressure up to 9.0 (EPR is set at 3.0). That's fine for now, but if CA is sometimes reduced when your EPR pressure does not vary as much.

I think you'd do better with a minimum pressure of 6.0, especially if you feel a bit air-starved. Using the median pressure is a pretty good starting point, and might keep the machine from increasing quite as high. Those increases are a result of flow limitations and snores that might be prevented at 6.0. Other than increasing minimum pressure and getting the leaks under control, you're doing very well.
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You're doing well Sleepy. I think if it was my cute little body I would up the low end pressure to about 7, and set the high end to 9. Maybe 10. Then I'd watch and wait. Or wait and watch if you prefer.

The leak numbers aren't too bad, but you probably are leaking through your mouth.

About the chinstrap. Don't be cranking down on that thing all that hard. What it is supposed to do is "gently encourage" your jaw to stay forward when you fall asleep. The tendency is for it to do otherwise, and if it falls back you cannot effect an air block with your tongue, which is the goal. The other thing is if the chinstrap is too tight, it can cause stress, which can result in you feeling achy and out of sorts in the morning. I was actually out of sorts yesterday morning, but I picked up a new supply, so if you need some sorts, let me know.

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Many people cannot successfully start at 4 cm-H2O pressure.
You must control leaks for successful therapy.
With high leak rate the data is all GIGO. (Garbage In, Garbage Out.)

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thanks for the quick replies!

so are you saying to go into the machine and adjust the ramp from 4 to 6 or 7? all of my events seem to be Clear airways apneas - that makes me nervous because sometimes when I start to doze off I get the feeling that I just stop breathing for no reason at all. I don't sense any obstruction or change position - I just get a funny feeling that the nervous system stops sending a signal to breath. Is that possible?

als, how does one go about controlling leaks ? change masks until you find one that does that?

my chin "strap" isn't really a strap -its a wide band of elastic cloth that velcros on - my mouth just seems to have to stay open a tiny bit no matter what I do! Is this the cause of the leakage?
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Your machine cannot actually treat apnea's while you are in "ramp" mode. So I would definitely set the ramp to a start pressure higher than 4, and limit the length of time it stays in ramp.

Again, don't worry too much about that single instance or two of high leakage. What you're looking for is to keep the apnea's controlled with leak acceptable leak numbers most (90%) of the time.

Your AHI is not a significant concern at this time. Even the CA's are not all that important. You will probably see them resolve by themselves as you get more comfortable with the therapy.

So it becomes a matter of getting you more comfortable. That says we need to get your minimum pressures off the ground.

So yep, change the ramp settings and change the minimum/maximum APAP settings. If you don't have the clinicians manual that tells you how to do that yet, you can get it from the link at the top of the page.

The chinstrap sounds good to me. If when using it, it feels normal to keep the lips closed, but very easy to open them, and even talk if you wanted to, then it's right.
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My 2c don't be afraid of making reasoned changes.
Best thing I did was turn ramp off. My low setting is now 8 or 9 and is very comfortable for me at least. I spent the first ten days experimenting and with the recommendations I received here it going well. Still tired in the morning but much better than prior cpap. Have't needed a nap for over a week Smile !
Now I need to be patient and settle.
I use my PAP machine nightly and I feel great!
Updated: Philips Respironics System One (60 Series)
RemStar BiPAP Auto with Bi-FlexModel 760P -
Rise Time x3 Fixed Bi-Level EPAP 9.0 IPAP 11.5 (cmH2O)
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(05-18-2015, 11:42 AM)sleepyandsore Wrote: thanks for the quick replies!

so are you saying to go into the machine and adjust the ramp from 4 to 6 or 7? all of my events seem to be Clear airways apneas - that makes me nervous because sometimes when I start to doze off I get the feeling that I just stop breathing for no reason at all. I don't sense any obstruction or change position - I just get a funny feeling that the nervous system stops sending a signal to breath. Is that possible?...

It is entirely possible; that is exactly what the definition of a CA event is. But if the doc thought that you had a preponderance of CA events, he probably would not have prescribed an APAP, and would have prescribed something else along the lines of a ventilator/ASV. Good question for them to answer for you on your next visit.

I do not want to speak for the others, but I do not think your question interprets what they are saying properly. I agree with RG, but it is difficult to really see the entire pressure graph in the attachment (which seems to be the same attachment three times).

Also, you do not want to make changes based on one night. Get a couple of weeks of data first.

You may notice that, while wide open, you never went above 10. So you may not ever need pressure above 10-12. But it is the min pressure we are probably concerned about here.

I do not think these suggestions have much to do with the ramp; I think they are saying that maybe the min pressure is too low. I would dispense with the ramp, unless you think not having the ramp is interfering with falling asleep. Ramp means the therapy is sneaking up on you so that you won't notice until you are mostly asleep (and then may not be fully asleep)

You do have more CA events, but that may be normal, and they may be false positives. I had less than 2% CAs reported in my unaided home study, but have twice the CAs that I do everything else ever since, while on xPAP. But I average 1.4, so it probably does not matter.

At a minimum, you should have a PSG and consultation. Often the docs will start you at wide open on a APAP to see what the machine does regarding where it thinks your pressure should be. But wide open is not optimal therapy; you need a min pressure that makes sense, and a max pressure that makes sense. A tuned APAP can be like a laser-sighted rifle once dialed in, but until it is, its like a sawed-off shotgun without sights.
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