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Help with Leak Rate - Printable Version

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Help with Leak Rate - Steve4cr - 08-18-2020

Hi
I am sort of new on CPAP. Had Resmed Airsense for 3 years but Apnea is getting bad so I have been on regular for a few months. Struggling with leaks. Tried 3-4 maks. Can't use Nasel pillows. Full face sometimes causes clastrophobia. I do not stay in one position. Back, sides. Any help will be appreciated.
Attached last night but all over the place. Is this bad?
[attachment=25781]


RE: Help with Leak Rate - Sleeprider - 08-18-2020

Results are good with less than 1-AHI. Since there is RERA and flow limitation, I think you should try EPR which reduces exhale pressure by 1 to 3 cm and works like bilevel therapy. It can relieve flow limits, RERA and hypopnea, but may increase CA. Try turning on full time at 2 and see if you like it.


RE: Help with Leak Rate - Steve4cr - 08-18-2020

(08-18-2020, 03:26 PM)Sleeprider Wrote: Results are good with less than 1-AHI. Since there is RERA and flow limitation, I think you should try EPR which reduces exhale pressure by 1 to 3 cm and works like bilevel therapy. It can relieve flow limits, RERA and hypopnea, but may increase CA. Try turning on full time at 2 and see if you like it.

Hi, thanks for the quick response. I turned that off to try and correct CA as advised form another channel. Do you think the leak is excessive?
Steve


RE: Help with Leak Rate - SarcasticDave94 - 08-18-2020

FWIW that chart shows CA being at 0.39 so I'd go for the EPR setting and just keep an eye on CA levels. Even if CA goes up a little, it may be a good tradeoff for comfort. The thing about the leaks to keep a better track on these is to access OSCAR and add a line onto the leak graph at 24 L/min and you'll know instantly if you have a leak issue if it goes above that line.


RE: Help with Leak Rate - Sleeprider - 08-19-2020

I was not aware you had switched off EPR due to CA. You can try re-introducing it slowly if and when you want. Your leak rate is tolerable if it is not disruptive. Most of it appears to be mouth leaks below the large leak threshold and might just be looking for some help from the "tongue suck" technique or some light jaw support.


RE: Help with Leak Rate - mesenteria - 08-19-2020

(08-18-2020, 03:00 PM)Steve4cr Wrote: Hi
I am sort of new on CPAP. Had Resmed Airsense for 3 years but Apnea is getting bad so I have been on regular for a few months. Struggling with leaks. Tried 3-4 maks. Can't use Nasel pillows. Full face sometimes causes clastrophobia. I do not stay in one position. Back, sides. Any help will be appreciated.
Attached last night but all over the place. Is this bad?

If you look at the left side of your pressure chart, do you see that abrupt vertical rise after a steady decline?  Now drop your eyes to the Leak Rate chart below it, and you see the same time-lined almost vertical drop in leakage?  And two above that, in 'Flow Rate', the same vertical line, but it shows the yellow line through it...it's an RERA....Respiration Event Related Arousal.  These are obviously coincident.  You had an ever-increasing amount of leakage, leading to an arousal that caused your mask to reseal, at which the machine recorded your arousal.  When your mask resealed, maybe just by you lifting your head or turning it slightly as you became more alert to the leakage, the pressure arose abruptly to reflect the newly regained seal.  

The steady increase in leakage could be caused by two things: the head steadily sinking into the pillow, or merely rotating with the loss of muscle tone in the neck, and the mask began to be both displaced AND deformed.  The second possibility is that, in addition to your head causing the deformation and displacement, the material of the cushion also continued to yield to the increasing pressures on it caused by contact with whatever it was.  But what matters is that, as the air leakage intruded more and more into your sleep, you became aware and adjusted your head's position.  The machine recorded that as an RERA.  

I could see that mouth breathing, caused by lips parting due to slackness in the jaw, could also be at play here, but people most often report that they KNOW this is happening...it awakens them sufficiently that they remember the events next day and inquire here how to deal with mouth breathing.  In my own case, I have to tape my lips, but I don't often know when I'm getting blow-by around my nasal mask.  Yet, I do get leakage, as is evinced by my report next day.  It could be that you aren't sufficiently aware of either form of leakage if/when they occur.