[Treatment] CPAP Data Question

[dlbzone]

Hi everyone,

First Post here...  I have been a long-time CPAP user.  Recently haven't been feeling that great, more daytime sleepiness, etc so I started looking at my data for the first time in a while.


In last nights data I have about a 20min and about a 45min section of sleep where there is almost no negative flow rate.  See the yellow highlighted sections in the attached image.
   


Here is a zoomed in view of the start of the 20 minute section with two Obstructive Apnea events and then very minimal negative flow rate which then continues for 20 minutes.  I highlighted the "normal" section in green to show the difference.
   


Does anyone know what is happening and if this is normal or cause for concern?

A few additional notes:
No Snoring during this time.
Mild increase in Leak Rate during this time.  Could I be exhaling through my mouth?
Reduction in Respiratory Rate during this time.
Reduction in Tidal Volume during this time.
Significant reduction in Minute Ventilation during this time.

Thank you,
DLB

[Sleeprider]

It appears you are using an EPAP min pressure of 10.5, and PS of 0.0 to 14.5 cm. The OA event you highlighted begins with a large inhale and no exhale, so you either were breathing around the mask, or this is a breath hold rather than an apnea that arises out of a failure to take a breath. There is no response to the triggered breaths because there is no place for the air to go since you're holding your breath. After the recovery breaths, we see a number of breaths with no exhale. The only reasonable conclusion is you're exhaling through your mouth. and blocking the pressure from the machine. Breathing is normal until 4:07:00, but after that you seem to mostly exhale orally.

I think for comfort purposes, you might like a PS min of 2.0 rather than zero. I think you need to look into what is going on with the breathing around your nasal pillows mask. There are relatively few machine triggered breaths and they seem to mainly occur in clusters. Is it possible you are experiencing a positional apnea from chin tucking?

[jaswilliams]

I agree you seem to be breathing round the mask so no exhale doing detected by the Philips

[ardenum]

If you replaced mask pressure with leak chart, i think it would show us that youre getting leaks

[dlbzone]

I think I am exhaling through my mouth.  I ordered some chin straps to try.

I have tried a PSmin >0, but my AHI goes up so I put back to 0.

I don't think I am chin tucking as I use a cervical pillow to prevent this from occurring.

Thank you for your inputs.

[Sleepster]

I think I am exhaling through my mouth.  I ordered some chin straps to try.

I think that's a good thing to try. Post your leak rate graph, it should confirm mouth leaking.

After all these years, your chin-closing muscles decided to take a holiday. That would explain why you're not getting a good night's sleep. Have you thought about a full face mask?

[ajack]

Do you have a FFM, it would make it easier to remove one variable
I also think I should have some more min PS, if the tidal volume stays low, I would increase more than PS2. we can work out the apnea later, you have a machine that when adjusted can regularly produce very low numbers.

[dlbzone]

Sleepster: 
My Leak rate runs from 37-40 LPM normally and goes to 44-47 LPM during the mouth exhalation.  This is not as big a change as I would expect, which is why I didn't really notice it.

I just happened to have a new never opened full face mask that I purchased just in case I ever had very severe sinus issues where I needed to mouth breathe.  My leak rate with it is all over the place and it was extremely uncomfortable causing me to rip it off after a few hours and go back to my nasal pillow mask. 

As I said, I ordered some chin straps to try, but then couldn't wait for them to arrive so I made my own using an old ballcap and some velcro.  Initial results confirm that what I was seeing is mouth breathing.  Unfortunately, though my AHI numbers went up.  I presume the chin strap is pushing my jaw back somewhat assisting in the obstruction of my upper airway.  So, then I pulled out an oral appliance that is molded to my teeth to keep my jaw forward while using the chin strap to keep my mouth closed.  I also upped my EPAPmin because I was getting desperate for some uninterrupted sleep.  My Flow Rate graph looks significantly better and most importantly, I feel better today, and my AHI was improved.

Unfortunately, Sleepyhead and OSCAR puked on my 560 BiPap ASV data so I spent some time downloading and installing Encore Basic to run a report to get at my data for the night.  My AHI was 3.7, CA=2.5, OA=0.3, H=0.9.  I may have upped my EPAPmin a little too much as this is usually when I start to see the CA creep up like this.  I am thrilled with the OA and H numbers for the night.  I recovered from every apnea and hypopnea very quickly.  None of the mouth breathing waveform was observed.  I also ran oximetry with my CMS50 and only had 9 SpO2 desaturations vs 120 SpO2 desaturations each of the previous nights.  
 
Not sure if I can adapt to always using the mouth appliance and chin strap, but will give it a couple more days at least and go from there.

[dlbzone]

I wanted to comment on Sleepyhead only showing partial CPAP data  for my PR S1 Bipap Auto SV Advanced (560).  It seems that as long as I am using in ASV mode by setting BPM to anything other than "off" sleepyhead will read and display the data for the full night.  If BPM is set to "off" effectively disabling the servo ventilation feature, sleepyhead is not able to read and display the full nights data and it is usually only the first few minutes that are displayed.  I seem to do best with this feature on "Auto" anyway, but was experimenting with settings and turned it off for a few days.

[Sleepster]

None of the mouth breathing waveform was observed. 

Hmmm... Are you talking about your leak rate graph?

The breathing waveform is another thing, it's a graph of volume flow rate (with the convention chosen so that inward is positive).