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oxygen or AHI more important
#11
RE: oxygen or AHI more important
I would focus on the leaks now.   Not that they're huge or hugely problematic, but they WILL disrupt your sleep cascade if they keep arousing you...which is highly likely.

Masks leak due to poor face-mask fit, poor tension or imbalances in tension on one or more straps, deflection when sleeping on one's side, deformation when pressed up against something, headgear slipping due to pressure and friction on the pillow as the head sags over time and the pillow alters its shape....I can think of others, but that's a good start.

As the previous person pointed out, it might be mouth leaking.  If the recorded events come in clusters, we recommend a soft cervical collar because clustering often means the tucking of one's chin, usually when sleeping supine.  Or, the chin strap which are sold on line.  I happen to need to tape because even if I manage to keep my lips closed with some other contrivance, they'll open eventually regardless of how I'm sleeping.  If you think you'd like to give it a shot, my tape of choice is the 3M Nexcare 'water resistant' white tape in a plastic spool.  Before you tear off a strip long enough to be suitable for covering your mouth, fold a bit of it over on itself at the end you'll lift to do the tear.  Later, when you go to remove it, just grasp that handy tab.
Serial Tapist
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#12
RE: oxygen or AHI more important
I have both masks P30i and N30i.  I switch back and forth both working better than any other i've tried.  Having the air supply hose pivoting on top is a godsend since tend to rock and roll as i sleep.  I still get leaks when changing positions but waaaay better than any other mask.  The P30i, for some reason makes my nose sore.  The N30i is a bit harder to keep sealed but more comfortable.  I don't have problems with mouth breathing/leakage.  Somehow my body has adapted and my mouth stays closed.

I will take the advice about epr and increase it to 3 tonight.  I see how it would make it easier to exhale and thus taking in more air.

It seems to me the smaller and more flimsy/flexible the mask, the more comfortable it is. BUT, a really big BUT, I think these really comfortable masks do not handle higher pressures very well. I've tried pressures up toward 15, but one the masks thin edges blow out, you have to shut machine off and start over. I am rarely ever able to reseat with pressure still on.

I started this adventure 7 years ago with full face mask and single set pressure of 15. I damn near suffocated. Thanks to this forum i found the way. My sleep doctor was little or no help.
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#13
RE: oxygen or AHI more important
I have both masks P30i and N30i.  I switch back and forth both working better than any other i've tried.  Having the air supply hose pivoting on top is a godsend since tend to rock and roll as i sleep.  I still get leaks when changing positions but waaaay better than any other mask.  The P30i, for some reason makes my nose sore.  The N30i is a bit harder to keep sealed but more comfortable.  I don't have problems with mouth breathing/leakage.  Somehow my body has adapted and my mouth stays closed.

I will take the advice about epr and increase it to 3 tonight.  I see how it would make it easier to exhale and thus taking in more air.
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#14
RE: oxygen or AHI more important
Do you feel like the P30i makes your nose sore because it feels like it is squeezing your nose/septum? That was my problem at first, changing to a large pillow made a huge difference.
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#15
RE: oxygen or AHI more important
I'm a bit late to the game, and will offer my 2-cents worth. Your therapy looks pretty good, including SpO2. With the exception of a single erratic data point at 88%, the average is 94 and stays above 90% all the time and 92% most of the time. The SpO2 chart is not time-stamped, but to my eye, the largest sustained desaturation appears to line up with the flow limitation event at 00:45 in OSCAR. With pressure of 8 minimum, 9 maximum and EPR 2, your therapy yields very low AHI and normal oxygen saturation levels. Pressure hovers near the maximum of 9.0 due to low-grade flow limitation through the night.

In my opinion you don't have to do anything to improve on this, however the flow limits act to suppress the inspiratory flow rate, and therefore is the biggest limiter of tidal volume and minute vent. We know that you can reduce flow limitation with greater pressure support (EPR). Oxygen saturation is strongly related to positive end expiratory pressure (PEEP). Feel free to fact check that last statement with a Google search. PEEP in your case is about 6.5-7.0 cm (equal to EPAP pressure). If you want to increase O2 saturation to any observable degree, your minimum EPAP (PEEP) must rise, so adding more EPR is not the solution. Instead you must add both maximum pressure and EPR. This combination will maintain or increase EPAP to maintain SpO2, and improve ventilation, reducing Flow Limitation. The only thing keeping you from accomplishing these changes is your mask fit or mouth leaks, so in a way, that is your current root cause of any therapy issues.
Sleeprider
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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.
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#16
RE: oxygen or AHI more important
Sleeprider, my problem is when i raise pressures higher, my leaks get way out of control.  I don't have problems with mouth breathing.  I have experimented with many different masks, and with adjustments of head gear.  Only way i can noticeably reduce high pressure leaks is tighten head gear and then i get dents in my face and very sore nose.  I have tried making small incremental adjustments but have not found utopia....yet.
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#17
RE: oxygen or AHI more important
Are you 100% sure they are not mouth leaks? People that don't mouth leak at lower pressures do start doing so at higher pressures.

You aren't even anywhere near high pressures so it seems your mask either doesn't fit you well or the issue is something you don't realize (like mouth leaks).

Over tightening the mask causes leaks as well.
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#18
RE: oxygen or AHI more important
The signature of a mask leak is a spiky leak rate that rises very quickly as the seal is lost. The signature of a mouth leak is a gradual rise in leak rate that reaches a maximum as the air leaks from the lips.  The most likely mask seal leak in this image is at 01:40. Most of the rest looks typical for mouth leaks.

Even hard to fit faces will have near-zero leaks with nasal pillows.  Have you tried them?

[Image: attachment.php?aid=20033]
Sleeprider
Apnea Board Moderator
www.ApneaBoard.com

____________________________________________
Download OSCAR Software
Soft Cervical Collar
Optimizing Therapy
Organize your OSCAR Charts
Attaching Files
Mask Primer
How To Deal With Equipment Supplier


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.
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#19
RE: oxygen or AHI more important
Sleep rider, i have tried most every nasal pillow available, mostly at my own expense since insurance limits how often you can replace.  I have tried all sorts of things....shaving before bedtime, trim nostril hair and infinite adjustments with head gear.  It seems that when i raise pressure above 10 i can't stop leaks without tightening to the point of making me sore.

Right now i am using Resmed Airfit N30i  and/or Airfit P30i,  they are the best of everything i've tried.  One is nasal pillows, the other fits across both nostrils.  You mentioned "near zero" leaks with nose pillows.  I don't think i've ever had near zero.  Maybe i should not whine since my AHI and oxi are both good.  I toss and turn a lot when sleeping.  The top connecting air hose has been an immense help.  I've had the people at my DME help adjust headgear, check fit, but once i go to sleep the leaks start.  I suppose if one was able to sleep on their back peacefully all night, it would be easier.  Thanks for the help and advice.
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#20
RE: oxygen or AHI more important
It sounds to me like you are probably using too small of a pillow size if you feel you have to pull it so tight it hurts in order to stop leak. The opening of pillow should just barely fit inside your nostril leaving the majority of the pillow to act as a spring helping seal both along the inside of nostril and on bottom of nostril. You should be able to leave the P30i significantly looser than the N30i and it should seal better when tossing and turning, if that hasn't been your findings then I can't help but feel something isn't sized right etc. Sleep therapists didn't size me right either, my P10 came with all the different size pillows and I just tried the large and noticed it was 10 times better.

All these comments are doing is trying to provide ideas to control leak and confirm actual leak location. A lot of people don't believe they mouth leak but actually do especially in rem when muscles relax.
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