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[Treatment] Can a Sleep Number bed change my treatment?
#11
The AHI can not necessarily be trusted with large leaks. When the leaks are too high the machine can not discriminate the apneas. You need to fix the leaks first and then work on your apneas.

Best Regards,

PaytonA
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#12
doickle,
Just to add what Payton is saying about leaks.

Look at your pressure graphs and event graphs.  When you start to experience a leak, the machine at first tries to compensate by raising the pressure, then drops the pressure almost immediately, simply because the machine cannot keep up the proper flow with contnued leaks.  When that happens, you cannot trust that the machine will detect apnea events.

So in your case, the AHI may not be accurate with the continued leaks.  

This should be a priority.  Try a different mask if need be.
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#13
(02-20-2017, 10:39 AM)doickle Wrote: I appreciate all of the responses and help.
I have adjusted my settings slightly as was suggested and I think (after one night) that it has worked good.
However, the leak issue is getting worse. The strange thing is, from my rookie perception, that the leaks are having no effect on the therapy. My AHI is still pretty low.

I have attached two screenshots below, any insight is welcome.

 [Image: 7tCLoekl.png]

[Image: jRGkMAVl.png]

I quoted your post to bring it to te new page.  I'd like you to do a couple things with your graphs please.  First minimize the monthly calendar using the triangle in the date line.  We need Events, Flow, Pressure, Leaks, Flow limitation and Snore. We don't need the AHI chart.    

I think you'd benefit from an ergonomic pillow to go with your new bed.  Letting your chin drop towards your chest causes flow limits and can cause obstructive events.  Something that keeps your chin up whether you are on your back or your side will really help.  These pillows often have a neck roll or are higher on the edges than in the middle.

For settings, you need a minimum CPAP pressure of 10.  No change is needed to the maximum.  This is actually less than your median pressure, but it is within 2-cm of your 90% pressure.  This is going to greatly stabilize your pressure throught the night.  Your titrated CPAP pressure of 10 did not account for EPR, and using a minimum pressure of 10 with EPR should result in a comfortable pressure that will vary by only about 2-3 cm through the night, and that's exactly what we're looking for to extinguish these obstructive events, resolve the residual snores and RERA. 

Good luck!
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#14
Thanks for the input. I have attached the graphs with the requested changes.
It does make sense to increase the lower limit and reduce the range between lower and max pressure.
I will try and adjust my current pillow and perhaps lower the head of my bed a bit as it was the increasing of this angle that initiated the leaks in the first place.

[Image: q3ClFBBl.png]
[Image: EyUPSNHl.png]
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#15
Great job on the graphs. We can now see the events are related to flow limitations and the increased minimum should help. We can now see how the machine keeps trying to return to 8 cm, but doesn't make it until about 6:00 AM, where it again needs to rapidly increase pressure. I'd like to see this at a minimum of 10, but I could see being in the mid-9 range. I'd still like to see flow limits on the same graph as pressure, but this is a big improvement. BTW, your tidal volumes and other respiratory parameters are in very good condition. No restriction there.
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#16
Good Morning,

I just wanted to post an update and say thanks for the help.
I played with mask adjustment last night and was able to reduce the leak rate significantly.
I also increased my lower limit to 10 as suggested. 
There is still some flow limitation and I am still a little unsure as to what the cause of this is or what exactly it means in regards to my therapy.

[Image: 3aE5r4ql.png]
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#17
Still showing obstruction.  Take the maximum pressure up to 15, and hopefully that helps it to clear. Great job on clearing up some leaks.  I think you're on the right track here.  It might help if I explain a little about what is going on. We use the EPAP pressure to keep the airway patent and avoid the obstructive apnea.  Ventilation is supported by the IPAP pressure, and this is where we should see reductions in flow limitations.  With your EPR set at 3, your new pressure range will be 10/7 to 15/12.  I expect that with an increase in maximum pressure, your median and 95% pressures will both rise a bit, and we should see a reduction in the OA, H and FL.

Inspiratory flow limitation is not something we specifically target.  If you look closely at the flow rate graph during period of high FL, you will see a good strong inhale that slows down and descends instead of reaching a clear peak. This is a slower rate of inhale, and is often related to an obstruction in the airway.  The CPAP machine cannot directly measure FL which by definition includes respiratory effort (chest expansion), and instead uses flow and pressure sensors in the machine to detect its likely occurrence.  To put it simply, in treating obstructive apnea, it is generally beneficial to reduce flow limitation.  You can search on "inspiratory flow limitation" and find a lot more than you ever wanted to know.  Take a closeup view of your Flow graph and see if you see something like Robysue describes in her Beginner's Guide to Sleepyhead. (search Flow Limitations).

[Image: Flow_limitation_images_zpsdb148d1f.jpg]
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#18
That is a great chart.
I am learning a ton already and I am trying to remember patience. 
Could a flow limitation be caused by a deviated septum?
Could I diagnose this by taking a close look at my flow patterns?
I do have a a severely deviated septum and will be having it fixed in March.

Thanks so much for all of the help and info.
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#19
Nasal restrictions can be a source of flow limits. You can zoom in on the flow rate graphs and see these pattern very clearly. Here is an example from my graphs. You can see the close association with OA.

[Image: LVKATjgh.png?1]
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