Very High Leak Rate

[Sleeprider]

That looks pretty good.

Now I remember the ST story. Try to get the Auto BiPAP or Vauto.

The problem is not the pressure 10/16, it is the time it takes you to reach that pressure with a 45 minute ramp. You need to shorten the ramp time.

Good luck with the mask.

[Grmato10]

I shortened the ramp time to 10 minutes, I might just turn it off - I think I would be okay with that.

[Grmato10]

well, I just got the F20 mask and first night last night; leak rate "improved" at 58% but AHI up to 35.88; the last few nights before that it was running in the teens for the ahi.
here is the whole chart; I'll try to do a short segment after.

here is a couple minutes with apneas:

I am at a loss.
The provider is going to ask the dr about getting the other machine but that will take a few days to arrive too.
Here is what I think is happening: The machine senses I quit breathing; it lights up and turns off (thinking I disconnected the hose); I wake up from the light and lack of air, and take 4-5 deep breaths and the macine kicks back on.
That really shouldn't be the way it works, should it? The machine is supposed to help when I quit breathing, isn't it?
If I don't respond to posts, I will be gone a few hours to church and will check back this afternoon.
Thanks for any help.

[Sleeprider]

This is awful. I think you actually need an ASV machine with a backup rate that will prompt you to take a breath. I also think your sleep study completely missed the mark, and should be re-done evaluating for ASV.

Would you be willing to try something really radical? I'm talking about fixed pressure at 9.0 with no pressure support. Turn the machine to CPAP mode and set the pressure at 9.0. I don't see how it could be worse than this. If you find it intolerable, just reset the machine to VPAP S mode, and your current settings will still be there. I just would love to see what happens on a fixed pressure.

[Grmato10]

Sorry I haven't updated for so long; just lots of things to deal with. The equipment provider is still working on getting the okay to order the auto machine; she doesn't see a problem with it. But after a couple bad nights, we turned off the smart start/stop. and the ramp is turned clear off now; I had a much better night last night - still need to work on the leak rate, but it is greatly improved. So, we are gradually making progress. I will be glad to get a different machine too.
here is a screenshot of the whole night:
http://imgur.com/zTdbXXx
here is a screenshot of just a few minutes during which I had some events:
http://imgur.com/3CVsXzJ
any comments??
Thanks for all the encouragement and advice you've given me.

[Sleeprider]

Looks better. The events don't look accurate due to leaks preceding them. The first UA looks like an arousal, and the H event looks like an anomaly from the leak If you add a zero line on the Flow rate, it is unlikely you would ave both inspiration and expiration below the zero line. Overall , looks much improved.

[Grmato10]

Hi its me again - still here.  Still struggling with very high leak rate; I've tried various masks; For the last week I've been using the Amara View.  Its more comfortable and I feel like its doing well, but in the morning my numbers are still terrible.
So I'm messing with the pressure - Friday night changed the pressure to 20 and 16; large leak rate 52%; AHI 3.46
Saturday night changed the pressure to 18 and 14; large leak rate 60%; AHI 14.08.
But I really think the AHI is inaccurate - according to sleepyhead, they seem to happen at the times of large leak; when the leak rate is minimal or lower, I don't seem to have events.
Any suggestions at this point?  They want me to see the sleep dr in person but I can't get in for 3 weeks or something.
I have attached screen shot of the whole night, and also a small segment of the night.
Thanks!
Oh, and I might add - my dme has ordered me a new machine so we can do auto mode if the dr will give the okay, but it hasn't come.

[Grmato10]

Okay, I have another night's data
so my ongoing experiment - the second night on 18-14 pressure, my leak rate was 65%, AHI 3.21; again seemed like most of the events were during large leak times;
Here are a couple screen shots from last night, I lowered the pressure to 17-13. Leak rate was 55%, AHI 11.22.
Again most of the events were during large leak times; the second chart showed a very short period of time with no leak, but a couple events.
Any comments? Please?
the dme suggested a chin strap, it should arrive today;
Obviously the treatment is helping, my sleep study showed over 100 events per hour; but the leak rate is really annoying, and I don't know what to try next.
I've tried the F10 medium and small; the F20 medium; and Amara view medium and small.
Thanks for any comments.

[Sleeprider]

I missed this for a few days. I have to say congrats for sticking to it. I think we have gradually worked with lower pressures and had some reduction in leaks and surprisingly, events are less than half what we started with. Excellent! Keep going to 15/11 pressure, and keep working on the leaks. As long as we are not making anything worse, I'm going to advocate for more comfort and lower pressure.

[Grmato10]

Thank you for the encouragement! I will keep lowering the settings gradually and see how the numbers respond. I appreciate your insight and knowledge!