AHI over 5, what happened with my machine.. Leaks?

[Cowboy Casey]

***** I just saw to post links not pic's, If I need to change it just let me know ****
Hey everyone, its been Awhile but I still stop by and check everything out, Speaking of that... Welcome back Pugsy

So many things have happened and I know I am not your normal user here... I have confirmed Sleep Apnea, on an ASV, and I have Narcolepsy just to make my life interesting...

My doctor has been changing my meds around, the days I am posting there is no change in meds for the last week.. I only woke up 2 times last night, AWESOME, I can be up 5 to 10 times a night in 8 hours when I am not on meds.

I am posting last night first and then the past 3 day's.
It looks like my machine was raising EPAP, IPAP, and PS with no apnea and then go back to normal and would create an apnea, what does everyone think? It looks like my mask was leaking so it raised my pressure which made my mask leak more and then at 19/20 pressure it stopped leaking and I would have an apnea..
Leaks: I am using the Pilairo Q and it works great for me but once my machine goes above 13/15 pressure sometimes it just leaks like last night, other times it does not.. not sure what is happening..

I would like to thank everyone who helps people on this site, you are all saints

If you need a section zoomed in more just let me know..









ResMed AirCurve 10 ASV (37043)

[ajack]

For me, it's hard to say exactly what is going on with your settings.
It seems you can't fix your leaks/mouth breathing. That has to be sorted before you go any further.
I'd start with a FFM, while you are sorting it out. To cut out a mouth breathing variable.
Then the min epap 9 may be enough, I'd lift max PS to the default 15

An initial guess is there may also be some positional apnea in there, perhaps chin towards chest, chin tucking? Wait and see, it's a pretty messy chart.

[Pugsy]

Embedded images are just fine.
When you are grabbing the links at imgur....grab the linked BBCode link instead of the whatever you are choosing.
If you use the linked BBCode we can then click on the image and enlarge it for easier viewing of the numbers.
Linked BBCode is the last line in that little box of addresses.

No need to redo these images though...they are a mess and being able to see it up closer isn't going to change the fact that they are a mess.

Your Mon Feb 5 report as well as Tues Feb 6....decent enough except for the breaks in therapy..what's going on with that causing the breaks in therapy? Is this normal for you or was this pre the medication change that you were talking about?

Usually IPAP is used for hyponeas.
What is your minimum and maximum EPAP setting? I can't see it on the report...I see minimum looks like 9
It appears that the max EPAP reported is 10.something...is it because that is the max setting available or because it just doesn't want to go higher?
I ask because IPAP is going to be a part of whatever max EPAP is plus any PS. I wonder if the machine's settings are restricting the machine from being able to deal with whatever is causing the increase in hyponeas...whatever they are (central or obstructive).
Having more PS available may or may not be the fix. Worth trying though.

Is it possible that the new medication has had some sort of affect on the airway tissues (more floppy) or on your respiratory drive thing...meaning maybe suppressed the respiratory drive a bit more.
So it's obvious something changed and since you mention medication...is it possible the change is from the medication change?

[Cowboy Casey]

Thank you both

Pugsy, imgur does work better using the last line...

I know I am not your normal CPAP user but I think this will help others like me, Let's see if I can do this..

The Doc changed/dropped my meds because I was going to switch to a new med, I did research on it and decided I was not going to do that (depresses your ability to breath and I already have that problem) so I am staying with what I have been on for the past year just a lower dose now (lower dose could also be the issue).. Narcolepsy is no fun, That is the reason for all the awakenings.. These are actually good days with only 2 or 3, when it gets up above 5 awakenings it is like having an AHI of 10 or more... The most I have recorded is 12 times in an 8 hour period/night.

I have my EPAP set at 9, IPAP set at 25 and my PS set at 1 to 10 I have raised my EPAP from 7.6 to 9 over the last month trying to get my AHI down, it seems to work better until last night.

As crazy as it sounds my mask/Pilairo Q may be the problem, I am going to try a new pilairo and also try out the F&P Eson 2.. Maybe my machine is trying to do its job and my mask is just failing.. I have not opened my mouth the last 5 years so no issues there.

[Pugsy]

With the awakenings we always run the risk of SWJ flagged events throwing the AHI off.

You have a couple of new variables in the mix..the lower dose is a variable...so might be a factor in something even if it is the same medication.
Leaks are definitely a trouble spot and it might well be the mask....so you know how to eliminate or try to...that variable...get a new mask or a different mask.

Do you not have a max EPAP setting available? I thought auto SV mode offered a max EPAP....now I now the regular ASV mode only offered the minimum EPAP. Maybe you aren't using auto SV mode????
At least that is the way it worked with my ResMed Adapt which is the older brother of your machine. Maybe they changed more than the packaging...I haven't seen an AirCurve 10 ASV to see what it offers.

Max EPAP of 10ish...if that is what you have going...plus the restricted PS max of 10 is going to tie the machines hands a bit and restrict IPAP to at the most 20ish.
The general rule of thumb...IPAP for hyponeas (assuming these are obstructive in nature but it's not totally impossible for them to be central in nature) and your machine can't go higher because of the restrictions. Maybe you just need more IPAP than you are getting.

I dunno why...and I don't know that I would necessarily go making changes on the results from just a couple of bad nights.
But the first thing I would try if it were me and I decided to try something would be open PS to 15 and see if the machine wants more IPAP and if it does...will more IPAP help. It might not want to do more but it could...and it might not help but we don't know that until we try.
All that is assuming that the last report is so ugly is now the new norm.

So I would try mask first since you know you need to fix the leak issues anyway.
By the time you have done that with the new mask you will have more time to see if last night's ugly has now become the new norm and needs to be worked on.

[ajack]

with bpap, you raise the ipap/minPS for H. With ASV. the titration guide says you raise the min epap.
https://www.scribd.com/document/3676589 ... Amer-Eng-1

the machine thinks epap range is 9-11, going by sleepyhead. If you have your max epap at 13, it should be out of the way. I would fix the leaks and consider whether there is any chin tucking to constrict the airway. A $10 soft foam cervical collar will tell you. The last chart shows it's not a regular thing and would suggest a positional event.
I would raise the max ps to 15, the machine is maxing out on your current setting.

[Cowboy Casey]

Hey there, so I did not remember where I had EPAP set at, go figure I also forgot to put my card back in my machine last night so no data on my new mask...

I changed my EPAP and PS, Because I changed to the F&P Eson 2 Nasal mask I changed my min EPAP down to 8... I know there is not suppose to be a difference between nasal and pillow but it is very noticeable on exhale for me...

my new Machine Settings

ModeCPAP Mode ASVAuto
Min EPAPLower Expiratory Pressure 8.00 cmH2O
Max EPAPHigher Expiratory Pressure 15.00 cmH2O
Min IPAPLower Inspiratory Pressure 9.00 cmH2O
Max IPAPHigher Inspiratory Pressure 32.00 cmH2O
PS MinPressure Support Minimum 1.00 cmH2O
PS MaxPressure Support Maximum 17.00 cmH2O

[Pugsy]

So you don't have detailed information last night but you do have summary information available both on the LCD screen and if you put the SD card back in the machine it will write the summary data to the card and then you can use the SleepyHead software and get the summary data. No graphs for detail but you still have the basics.

What was last night's AHI with the new settings and new mask?

[Cowboy Casey]

My machine says Events per hour 2.5 and sleepyhead says AHI 0.37, If that is the case it looks like my old mask may have just been shot or somehow had a blowout I do think my pressures are just to much for the Pilairo Q (even though I love it, the best mask I have had for over 2 years).. This Eson 2 is just a whole bunch of mask and harness going on... I am wondering/looking at the dreamwear, it looks like it may work, the problem I have seen is even though they say it will handle pressures up to or above 20 they start to leak bad at 15 or so...

Sometimes this machine is bipolar, My AIR says your mask is leaking to much (31L Per minute) but on my machine I have a big old smiley face saying I have a good mask fit...

I really need good data to see what is going on, maybe a good mask fit 98% of the time and 1 or 2 times leaks went to 31.. I have replaced my card so we will see..

[Pugsy]

The machine display shows the last session and not necessarily an all night average. If the machine was turned off at anytime during the night and a new session gets started the LCD display can be be off.
SleepyHead needs some of the missing data files to be totally accurate in calculating the AHI.
Usually off like maybe 1.0 or thereabouts.

Not a big deal either way..and obviously less that what it has been.

Don't know if the less AHI is because of the new/different mask or the changes you made in your settings. Could be either or even a both thing.

Here's how Mr Smiley works...he shows up as long as you don't spend 30% or more of the night in large leak territory and of course 24 L/min line is the beginning of large leak territory.

Your MyAir number of 31 L/min is what we call a 95% number...all it means is that you are at OR BELOW that number for 95% of the night. It is NOT where you spent 95% of the night. People often forget or don't know about the "or below" part of the definition.
95% numbers are easily skewed higher by relatively short periods at the higher numbers.
Example...I had a night with a 95% leak number of 37 L/min....sounds horrible but when I looked at the leak graph itself I had only spent 20 minutes in large leak (went to 40 max briefly and spent the bulk of the 20 minutes at around 35 L/min).
The rest of the night I was well below 24 L/min. So the 37 L/min sounds awful but in reality only 20 minutes out of a 7 hour night was spent in large leak...I shrug my shoulders and move on...20 minutes of large leak no matter how big it is...as long as I sleep through it I don't care. It's not the end of the world.

I did use the DreamWear when I was using the S9 ASV and I routinely saw pressures over 20...it wasn't any more leaky than anything else at over 20.
I don't blame you for what you feel about the ESON...that's a lot of stuff on your face and head...it would bug the crap out of me.

You know what I would do..I would try the Pilairo again...maybe it was the pressure changes you did that brought on the better results last night.

[Cowboy Casey]

Good Morning everyone

Well, leaks, leaks, leaks and well, more leaks.. What I find interesting is the leaks in the Eson 2 are WAY more quiet than the Pilairo.. Because there are SO MANY straps on this thing I am not sure where to adjust it to make it stop, I changed the bottom straps, the middle straps, the the upper straps and had the same exact leaks, I also tried to have it loose but that bothers me more than having it tighter.. When it is loose it pushes away from my face and creates pressure then seals then leaks... it feels like something is growing on my nose every 2 seconds, up>down>up>down for the love of god please stop, I am trying to sleep here I have never been able to get a good seal with these type masks, I have very oily skin, within an hour or so of washing my face at night my skin is oily again...

I am going to try it again tonight and see if the leaks can go away, if not I am giving the dreamweaver a try unless I find something else better than the Pilairo (I tried the Brevida and that thing is also a leak monster)

With all that said, my AHI was lower




I do not understand what is going on here, its like my machine just decided it needed to max everything out, I can not see anything that it saw where it needed these kind of pressures.. EPAP 8, IPAP 25, PS 17 Can you believe I slept through this, that's almost 5 minutes with a leaf blower in my nose, crazzzy.....

[Cowboy Casey]

Good morning

I could not take the leaks any more and changed out the Eson... I think most every mask will leak at IPAP 25 and PS at 17 so I changed back to my go to mask the Pilairo Q and figured out it is a rockstar... yes it still leaked but nothing compared to the Eson 2.. I hope this is helping some

I have my eye on the following masks to give them a try.. dreamwear and Swift FX, the swift fx nano looks almost the same but people don't seem to like it..

here are last night results:


This was the Eson 2


This was the Pilairo Q