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[Treatment] Please Help - CPAP Leak - Unrefreshing sleep with low AHI and good usage
#11
RE: Please Help - CPAP Leak - Unrefreshing sleep with low AHI and good usage
OK as you say there's no desaturation I'd not complicate matters. Maybe monitor it occasional.
Dave

OSCAR
Standard OSCAR Chart Order
Mask Primer
Dealing With A DME
Soft Cervical Collar Wiki
INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEBSITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#12
RE: Please Help - CPAP Leak - Unrefreshing sleep with low AHI and good usage
(05-21-2021, 12:04 PM)Gideon Wrote: EPR is off, the first step would be looking at which setting is more comfortable, EPR OFF vs EPR On (fulltime).
I'm not convinced there is a problem. Is this just a low normal breather which is what it looks like to me.
Slowly titrating EPR up against user comfort is fine for now.

Do you have a recording Oximeter? if the volumes are causing an issue it would likely show as a DeSat.

(05-21-2021, 01:06 PM)SarcasticDave94 Wrote: OK as you say there's no desaturation I'd not complicate matters. Maybe monitor it occasional.

Thanks! Last night I tried EPR at 3. probably too high.
1 makes more sense so the pressure is between 9 - 10

I just bought the AutoSet for Her. S11 is not worth the wait
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#13
RE: Please Help - CPAP Leak - Unrefreshing sleep with low AHI and good usage
That's fine, controlling your settings as all about making therapy and comfort the best possible.
Dave

OSCAR
Standard OSCAR Chart Order
Mask Primer
Dealing With A DME
Soft Cervical Collar Wiki
INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEBSITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#14
RE: Please Help - CPAP Leak - Unrefreshing sleep with low AHI and good usage
Forgot about the leak. Any suggestions?
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#15
RE: Please Help - CPAP Leak - Unrefreshing sleep with low AHI and good usage
I forgot which mask you're on currently.

Try this on any mask:
Lying back on the bed, put the mask on without straps, just hold it with finger tension, turn PAP on normal therapy settings, adjust finger tension to minimize leaks, put straps on and adjust to mimic the finger tension, move mask around slightly to see if it moves or leaks, tweak adjustment if needed, never tighten so far it hurts

Gauge leak by OSCAR chart and if there were disturbing leaks or not. The goal isn't zero leaks but minimal and controllable.
Dave

OSCAR
Standard OSCAR Chart Order
Mask Primer
Dealing With A DME
Soft Cervical Collar Wiki
INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEBSITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#16
RE: Please Help - CPAP Leak - Unrefreshing sleep with low AHI and good usage
Try the highest EPR you feel comfortable with. EPR will help somewhat with your breathing volume, and that could at least be part of why you are feeling fatigued.
In our case I'd bump up the min to match the EPR. for example Increase EPR from 1 to 2, also Increase Min pressure by 1
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#17
RE: Please Help - CPAP Leak - Unrefreshing sleep with low AHI and good usage
(05-21-2021, 12:04 PM)Gideon Wrote: Do you have a recording Oximeter? if the volumes are causing an issue it would likely show as a DeSat.

Agreed! Not going to worry about it

For my education purposes:
I thought  Oximeter only shows Oxygen level, not Carbon Dioxide.
Unlikely but, Strong inhale with weak exhale can lead to both saturation of oxygen and carbon dioxide levels
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#18
RE: Please Help - CPAP Leak - Unrefreshing sleep with low AHI and good usage
Yes, but we cannot monitor CO2 levels. At times we can see CO2-induced breathing in the flow rate but no direct measurement. the symptoms point to possible consistent O2 desats. Low volumes imply a possible insufficient air exchange leading to O2 Desat.
In this case we are using EPR as Pressure Support (PS) similar to what we would do for a patient with mild COPD. Higher PS increases the breathing depth resulting in higher air exchange. If we see a significant improvement I'll suggest you see a pulmonologist and possible get a BiLevel to give you even more of an assist.
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#19
RE: Please Help - CPAP Leak - Unrefreshing sleep with low AHI and good usage
(05-21-2021, 01:47 PM)SarcasticDave94 Wrote: I forgot which mask you're on currently.

Try this on any mask:
Lying back on the bed, put the mask on without straps, just hold it with finger tension, turn PAP on normal therapy settings, adjust finger tension to minimize leaks, put straps on and adjust to mimic the finger tension, move mask around slightly to see if it moves or leaks, tweak adjustment if needed, never tighten so far it hurts

Gauge leak by OSCAR chart and if there were disturbing leaks or not. The goal isn't zero leaks but minimal and controllable.
Mainly P10 Nasal Pillows. P30i hurts my nose, need to experiment more

It's so random, it's most likely from mask leak but it's hard minimize


(05-21-2021, 03:42 PM)Gideon Wrote: Try the highest EPR you feel comfortable with.  EPR will help somewhat with your breathing volume, and that could at least be part of why you are feeling fatigued.
In our case I'd bump up the min to match the EPR. for example Increase EPR from 1 to 2, also Increase Min pressure by 1
Tried 11.0 cmH20, EPR 2
Feeling pretty good today. Going to try this for a bit and hope for the best.

Thanks you Dave and Gideon!


Last night's data, let me what you think of the format
   
   
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#20
RE: Please Help - CPAP Leak - Unrefreshing sleep with low AHI and good usage
Note that your Tidal Volume, the volume you move in and out of your system has increased and so has your Minute Vent, the amount of air you breathe per minute (liters).
Specifically, how is our Fatigue?

The format is confusing. You have different time scales depending on which charts you look at.
Post two sets plus areas you question.

The first one Standard charts This covers most situation
The second the Advanced charts as these include the Tidal volume and Minute Vent.

In OSCAR select View/Reset Graphs/Standard and then View/Reset Graphs/Advanced and screenshot each

The CA you zoomed in on resulted from arousal immediately preceding, It looks CO2 driven so a 'real' CA but discounted because of the arousal.

I would like you to try EPR = 3 but do comment specifically on your fatigue.

Even if this helps our fatigue I think you should talk with a pulmonologist and advise him of this. A topic is to get a VAuto to allow a higher PS (via a BiLevel such as the VAuto) to assist with your ventilation.
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