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Can you post a typical chart or relate what your leak rate is (average, 95%, max)?
What size nasal pillow are you using? Have you tried the next larger size?
A chart would help because we can tell the source of the leak and make better recommendations.
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.
09-17-2017, 08:22 PM (This post was last modified: 09-17-2017, 08:23 PM by Sleeprider.)
RE: Started having major leaks after 2 years
The leaks are almost certainly mouth leaks based on the ragged flat-topped leaks. They are mostly just below the large leak threshold. I'm glad you're not getting a dry mouth, but that is a lot of leaking that may be disruptive to sleep. The machine does not really seem to lose control as shown in your closeup of the flow rate. The respiratory flow is well defined here and surprisingly shows quite a bit of what appears to be obstructive flow limitation as indicated by the flat and downward sloping inspiratory peaks.
I think there are a couple things you can do to help be more comfortable. First, you are not using EPR. Your event rate is low, so I think you might find setting EPR to full time at 1 or 2 will lower pressure on each exhale. That may help you to control the pressure better, and might improve the flow limitation on inhale. Be aware your tongue being firmly along the roof of your mouth and if your jaw tends to drop, we need to find a way to comfortably give support. Some people use a soft cervical collar with success, but I'm aware of your sensitivity to too much stuff and claustrophobia.
On these charts it would really help if you included the left statistics pane with the settings and respiratory data.
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.
(09-17-2017, 08:22 PM)Sleeprider Wrote: I think there are a couple things you can do to help be more comfortable. First, you are not using EPR. Your event rate is low, so I think you might find setting EPR to full time at 1 or 2 will lower pressure on each exhale. That may help you to control the pressure better, and might improve the flow limitation on inhale. Be aware your tongue being firmly along the roof of your mouth and if your jaw tends to drop, we need to find a way to comfortably give support. Some people use a soft cervical collar with success, but I'm aware of your sensitivity to too much stuff and claustrophobia.
Thanks for your response. I thought I had the tongue on the roof of mouth thing down, but something has clearly changed. I set the EPR to 2 and I ordered a cervical collar. I will try those two things for a couple weeks and repost.
I do have one question though. What does this mean in simpler terms?
"...surprisingly shows quite a bit of what appears to be obstructive flow limitation as indicated by the flat and downward sloping inspiratory peaks."
Inspriatory flow limitation is an increasing resistance in the upper airway that slows the rate and volume of inhalation. It is a common component of upper airway restriction syndrome (UARS) and can be disruptive to sleep and cause oxygen desaturation without apnea or hypopnea. A good discussion of this is in Robysue's Beginners Guide to Sleepyhead in my signature links http://www.apneaboard.com/wiki/index.php...imitations
If you look at Robysue's article, you will see some graphic examples of flow limitation. Your FL is not very severe, but it seems to be persistent. Flow limitation can be specifically treated in bilevel PAP therapy by increasing the difference between inspiratory IPAP and expiratory EPAP pressure (pressure support). We can also use the EPR in your Airsense 10 autoset to do the same trick. By increasing EPR we increase what is known as pressure support in bilevel. We may need to offset the reduction in EPAP pressure by increasing the minimum pressure, and we will know that by observing your response to the increased EPR.
I know this has not been the best plain English explanation, but hopefully it gives a clearer idea of a rather technical area of sleep disordered breathing. Links to a couple more articles follow. Keep asking questions, and I'll eventually get my plain English mojo on.
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.
(09-18-2017, 10:19 AM)Sleeprider Wrote: I know this has not been the best plain English explanation, but hopefully it gives a clearer idea of a rather technical area of sleep disordered breathing. Links to a couple more articles follow. Keep asking questions, and I'll eventually get my plain English mojo on.
Sleeprider, your plain English has adequately illuminated the concept. Thank-you. I am beating my head on the desk, but hey, that is sometimes the price of enlightenment. My pressures are quite low 7 minimum and 10 maximum. I did set the EPAP to 2 last night. I will work on my leaks and post some new graphs in a week or so. I am taking those $25 pills to stay awake. It sounds as if there is at least some hope that making some changes in my therapy could have an impact on my sleep and how I feel and maybe I can ditch the drugs at some point. If it comes to that, it will be an uphill battle to convince my doc, but it will save me a lot of money.