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RE: please help, large leckages, how to solve this
(01-23-2018, 07:57 AM)Walla Walla Wrote: If you use EPR it would allow you to raise the pressure up without the discomfort of a higher pressure. Example would be to raise the minimum pressure by 2cm and also use 2 on the EPR. That allows you to maintain a lower pressure for OA's while increasing the higher pressure for hypopnea's. Sort of a mini BPAP.
Does this mean Obstructive Apneas are treated different than hypopnea´s? Seem´s that i have to learn a lot
RE: please help, large leckages, how to solve this
The principle of using pressure support to treat hypopnea comes from bilevel titration protocols. EPR is in many ways similar to pressure support. PS is IPAP - EPAP, or EPAP+PS = IPAP. With EPR cpap pressure is IPAP. IPAP - EPR = EPAP. Both are a difference in pressure between inhale and exhale, but pressure support adds, and EPR subtracts. Here is how it works in bilevel titration:
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RE: please help, large leckages, how to solve this
@sleeprider: thank you very much for your explainations
I think I will try EPR as per your recommendation in a few days with the nasal masks.
I tried the simplus FF-mask tonight togehter with my collar, the large lecks are mostly gone, but like with all full-face masks, i do not feel well with it. The AHI, flow limitations, pressure went up (also like with all ff-masks), but still acceptable. The tidal volume remained about same, like always. I think i shall keep this mask and the amara view ff-mask as well just for emergency and when I have a cold. I give another try tonight for the simplus and skip the collar, to see what happens... https://imgur.com/a/qoCkq
01-24-2018, 07:49 AM (This post was last modified: 01-24-2018, 07:51 AM by christian4870.)
RE: please help, large leckages, how to solve this
just one more idea: can reflux be the reason of my large lecks?
Because my LL comes only sometimes, but every night, and with all masks, even FF-Mask, and I know exactly, that i am only breathing through my nose (No mouth breathing), even with FF masks I do so. And even with taping I get some LL. I had reflux years ago, but i did not feel it any more in last years, especially in last 9 month with CPAP. But could it be that it comes somehow, somewhen during the night i am burping (bursting) stomach acid and then the large lecks are happening? I did not check this now since about 5 years...
Sorry if i am talking nonsens, but I am looking for every possible reason to solve my problem....
RE: please help, large leckages, how to solve this
I don't think reflux is the cause. Your last chart the leaks aren't bad. Usually with a full face mask leaks happen during the night due to facial muscles relaxing causing the mask to loosen.
Membership in the Advisory Members group does not imply medical expertise or qualification for advising Sleep Apnea patients concerning their treatment.
01-26-2018, 01:35 AM (This post was last modified: 01-26-2018, 01:38 AM by christian4870.)
RE: please help, large leckages, how to solve this
Here is the last night with Simplus FF-Mask, Pressure up 1 mbar, EPR=1, there are some LL but acceptable. Events increased a lot compaired by using nasal masks. I think it is time to finish my tests with Simplus, because everything is much better with nasal masks, exept the LL. These increasing with nasal masks, but because the lecks are mostly always when no events at same time, I do not believe (can not imagine) my treatment with nasal masks is meaningless... https://imgur.com/a/rLgbw
I shall go back to dreamwear mask tonight and if the results are like before, i start with EPR as Sleeprider recommended earlier in this thread.
RE: please help, large leckages, how to solve this
Usually you need to increase the pressure by 1cm or 2cm when going from a pillows type mask to a full face mask. Just something to keep in mind if you try the full face mask again.
Membership in the Advisory Members group does not imply medical expertise or qualification for advising Sleep Apnea patients concerning their treatment.
RE: please help, large leckages, how to solve this
I don't think that reflex will be a direct cause of large leaks, however, using a nasal pillow/mask and if you suddenly try to relieve air/pressure from your stomach out through your mouth, then yes, you will have a large leak. If the 'burp' is short then the machine probably won't record it, but if it keeps happening multiple times then I would suspect the leaks would pick up.
Have you tried specific meds to treat the reflex (if this is the cause), my wife has recently had to take a prescription to cut down on the reflex, perhaps you need something beside over the counter if your not being treated for it already.
02-06-2018, 01:32 AM (This post was last modified: 02-06-2018, 01:33 AM by christian4870.)
RE: please help, large leckages, how to solve this
@sleeprider, wallawalla and all others interested:
I went back to the dreamwear nasal mask and taping and increased EPR to 2. Result is good, OAs increased a little bit, but only very few Hypopnoes. I have to find the best mixture, but this is whining at a high level... Large Leckage is with taping nearly solved. Thank you for your support https://imgur.com/a/phCWY
