[Treatment] Please Help - CPAP Leak - Unrefreshing sleep with low AHI and good usage

[Knightfire]

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?

7/10 so pretty good for me

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

Thanks, just trying to see what works when zoomed in. Just discovered the "clone graph" feature
I screwed up the zoom-out for the flow rate in that screenshot. I wanted to show where the zoomed section was on the total duration
Fields: Leak, Snore, and Flow Limit. Looks like those can be zoomed out without losing too much information

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.

I will increase pressure and EPR by 1 to 12.0, EPR 3

Yea, if I wake up refreshed, events don't even matter
Another event zoomed in without arousal using "Advanced Graph"

           

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.

This will be bureaucratically challenging. I will follow the Wiki for the template and hope for the best
Are you suspecting anything? My lungs were tested and was fine. Likely suspect is from my chronic partial congestion (allergies) and mild deviated septum
Only realized nasal breathing issues when I started CPAP therapy. Daily usage of prescribed nasal spray

I should've bought the VAuto yesterday instead of the AutoSet For Her... meh

[Gideon]

It's just that I don't understand why your volumes are on the low side. What is apparently happening, and correct me if I am wrong, your fatigue is decreasing as your 'volumes' increase. I understand what the PAP is doing and why it is helping you. I can't even guess at the cause, thus the suggestion to see someone with expertise in the area, a pulmonologist, a specialist in lung function.

[SarcasticDave94]

I too see that a BPAP like a VAuto may benefit due to more PS. And it would be good to get a medical opinion on the low stats being dealt with.

[Knightfire]

It's just that I don't understand why your volumes are on the low side.  What is apparently happening, and correct me if I am wrong, your fatigue is decreasing as your 'volumes' increase.  I understand what the PAP is doing and why it is helping you.  I can't even guess at the cause, thus the suggestion to see someone with expertise in the area, a pulmonologist, a specialist in lung function.

Trying to find out. I wish I started using OSCAR earlier, didn't realize how bad ResMed. Only have data in OSCAR starting from Nov 2020

In terms of just the general stats given: AHI, Tidal Volume, etc. I should be sleeping good every day without much fluctuation

However, I don't wake up refreshed very often. The most recent tidal volume wasn't much different from the rest
Not any significant CPAP stat changes from but these definitely helped
1. Increasing the pressure from 6.0 to 9.0 was NIGHT AND DAY. (Waiting for the AutoSet to arrive now)
2. Mouth taping
3. Cervical collar
4. Nasal Strip

Full mask
F30i - Hybrid Mask. 0 AHI, but a lot of RERAs on the first night
Nasal Strip on the second night it reduced RERAs a bit

Bizarre right? I just hope it's my mild deviated septum + allergies. I just want to consistently wake up refreshed.


Timeline AHI < 1 ( Since I started three years back)
Tidal volume: median / 95%

1. November 2020 to Jan 2021 6.0 cmh20
Tidal volume: median: 260 / 95%: 340

2. Past two weeks @ 9.0 - 10.0
median: 260 / 95%: 340

3. First post (two days ago)
Tidal volume: median: 180 / 95%: 300

4. Last night
Tidal volume: median: 200 / 95%: 340

Not much stat change right? But I was mentally exhausted until I borrowed a AutoSet and then increased the pressure this Jan.

Just staying positive. Trying not to over analyze or self diagnose. Free HealthCare in Canada is basically a waiting game, COVID doesn't help.
It's just interesting learning from Gideon-sensei and the community

[Gideon]

blushing

1. November 2020 to Jan 2021 6.0 cmh20
Tidal volume: median: 260 / 95%: 340

2. Past two weeks @ 9.0 - 10.0
median: 260 / 95%: 340

3. First post (two days ago)
Tidal volume: median: 180 / 95%: 300

4. Last night
Tidal volume: median: 200 / 95%: 340

The 260 to 180 is a significant drop.
FYI, typically Max(even 95%) and Min mean little, the median is more significant number.

Attach dates to this info and ask your pulmonologist why? And let him know you have charts of both thru the night,  Take these charts when you go see him.  I'd take these charts and a laptop with OSCAR to allow him to look at the details.
and please let us know.

[Knightfire]

The 260 to 180 is a significant drop.
FYI, typically Max(even 95%) and Min mean little, the median is more significant number.

Attach dates to this info and ask your pulmonologist why? And let him know you have charts of both thru the night,  Take these charts when you go see him.  I'd take these charts and a laptop with OSCAR to allow him to look at the details.
and please let us know.

Interesting point about the median. I'll keep that in mind and do a proper analyses when I have energy. I've felt good / bad at the same tidal volumes so meh


I will when I can. Because of COVID, phone call appointments only...
This week, talked to my Sleep Specialist. He is referring me to an Internist for second opinion. 
Honestly, if I didn't join this board. I wouldn't even know to tell him about Tidal Volume, they never asked
I asked about ASV which he rejected. I wonder if he would've said okay to BPAP
I thought BPAP and ASV were the same. If only I read the Wikis earlier...


Pulmonologist... we'll see
Got my ENT referral in Oct 2020, waited until March, CT scan in April, follow up in June 2021
FREE HEALTH CARE so good



Thanks! I'll report back after I collect some more data

[Knightfire]

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.

Hi Dave,

Any suggestions on fitting the ResMed P10 nasal pillows? (P10 is only three characters, too short to search on the forum)
I was experimenting with the difference sizes
S, M (current) and L
They all seem to fit. Now I'm wondering if I've been using the wrong size all this time

[SarcasticDave94]

I don't have the P10 myself but those that do state use larger than you'd think on cushions. I also seen to recall somebody modified their P10 with a clip or something to help with leaks. Sorry I just don't remember the details.

[Crimson Nape]

Use the largest size that will fit.  I experienced some flow restriction simply using the recommended size.

As far as searching, using the search function here, put the P10 within quotes and add a space before and after the word, (" P10 ").  Another option is to use Google.  Type something like this in its search box, site:apneaboard.com p10.

[SakimaStorm]

You mentioned mouth taping. Are you covering your lips end to end or just a small piece in the middle? I ask because w/o PAP therapy, just a small piece of tape works to help keep your mouth shut. But with PAP therapy, the pressure will force the air to escape from the side of your mouth especially in deep sleep and REM sleep. My mask leaks looked very similar to yours until I taped my entire mouth and then my leaks dropped to zero (along with using 2 good fitting masks; the F&P Evora and the Dreamwear with nasal cushions).

I second the recommendations made earlier of bumping your pressure up by 1 and using EPR3. That made a huge difference for me, both comfort wise and in lowering my flow limits. And with lower flow limits even though my AHI hasn't changed much, I am sleeping better and feel more refreshed in the morning.

I hope this has been helpful.