Newbie

[gwfl]

Just recently dx after sleep study with an AHI of 45.0. (70 yr. male) Been reading and trying to interpet the tons of info available here. Just managed to get OSCAR and download and print my last 11 days of stats since I started. Some questions that com up are:
What is the difference between "mask fit" and "leak rate"? My mask fit is almost 100% according to my phone app. but avg. leak rate is 26.
After 11 days I'm getting my AHI down to almost 30 but I thought It might drop faster...just needing more time and longer uninterrupted sleep time?
My mask seems difficult (Airfit F10) to reduce small leaks and produces a sore nose bridge which all limits my sleep time (about 2 hrs max before having to wake and adjust). Thinking about the Amara View mask. Might this help as it doesn't cover the whole nose?

Gary

[Miss Emerita]

Welcome, and congratulations on starting treatment for your apnea! The experts here will be happy to help you get that AHI down and answer your questions about mask fit and leaks, but first they need to see a recent Daily chart from Oscar. Could you upload a screenshot after taking these steps:

turn off the calendar (little triangle to the left of today's date)
turn off the pie chart (File - Preferences - Appearance - uncheck pie box
stack your graphs like this:
events
flow rate
pressure
leaks
snores.

[gwfl]

Think I got it.

screenshot-20200315-182725.png (132.5 KiB) Viewed 12829 times

[Pugsy]

What is the difference between "mask fit" and "leak rate"? My mask fit is almost 100% according to my phone app. but avg. leak rate is 26.

Mask fit of 100% means you never had any leaks that were in large leak territory.

Without seeing where you are getting the average leak number of 26 from the software statistics I can't be sure but I think you are just seeing average total leak which is the mask's expected/intentional vent rate plus any excess leak. All masks have an intentional leak rate for venting. Again I need to see for sure where you are picking that number up from. I suspect that you are seeing a very well controlled leak rate since the machine is reporting 100% fit to your DreamMapper app. Unless leaks are waking you up...not a problem at all.

After 11 days I'm getting my AHI down to almost 30 but I thought It might drop faster...just needing more time and longer uninterrupted sleep time?

Again need to see what the AHI is composed of and what settings you are using.
So a detailed report then we can explain or offer ideas on how to proceed. AHI of 30....way too high.
viewtopic/t158560/How-to-post-images-for-review.html

[Pugsy]

How did they come to decide upon this pressure of fixed 11 cm?
Did you have an in lab titration sleep study where you were hooked up to a mask and machine?

[Pugsy]

Omit the snore graph and make the other graphs a little bit larger and easier to see.
No need for the snore graph since snores are flagged up on the events graph. No need to redo this image though...just mentioning it for future reference.

Lots of fragmented sleep....are you actually sleeping with the mask on or not?
Or are you doing a lot of tossing and turning trying to go to sleep but not having a lot of success?

[Pugsy]

Are leaks waking you up at all?
Your 26 L/min number isn't what I thought it was but it isn't horribly horrible. You've got some excess leak going on but apparently not to the point of being in large leak territory very much. See the LL line on the events graph....that's large leak and if you don't see much flagged up there you didn't have much large leak.
Large leak territory is going to be up around 90 L/min when using the total leak number as a reference....you are getting close at times but if you are hitting large leak territory it isn't for very long. Everything is so scrunched together it's difficult to see for sure.

[Pugsy]

You have the wrong machine chosen in your equipment profile.

This is what you need to choose.
DreamStation Auto CPAP machine

[gwfl]

Will have to work on this tomorrow. Thank you for the responses.

[gwfl]

Thanks Pugsy. My max pressure was set by a lab sleep study titration.
I'm not getting good sleep with the mask on. I wake after about 1.5 t0 2 hrs, mostly I think because of the mask hurting my nose, maybe having to pee and dry mouth...not because of mask leaks. I have trouble falling asleep when I'm hooked up and I toss around a bit. Prefer side sleeping but mask leaks more that way. I take the mask off for a couple of hours to get some rest and when super tired put it back on.
I got the 26% average leak rate from the usage statistics....I'll try to post it.

screenshot-20200316-093900.png (68.2 KiB) Viewed 12793 times

[Pugsy]

You still don't have the correct machine chosen in your profile.
You have the DreamStation CPAP machine chosen...you need to choose the DreamStation Auto CPAP machine.
Nit picky I know but it's best fixed now to avoid confusion later....and could you use text instead of icony please. The images all look alike and it's more work to click on or hover on the image to see the model name.

Let's fix the leak rate % problem.
OSCAR/SleepyHead defaults to a ResMed leak number for excess leak % calculations of 24 L/min.
Respironics doesn't have a static number for one thing and the other thing the threshold for large leak is much higher because Respironics machines report total leak and ResMed machines report excess leak only.

Go to Preferences/CPAP tab and change the 24 L/min red line threshold number to something more in line with the Respironics threshold.
It varies with pressure and mask used but something around 70 L/min is a nice conservative number to use.

Look at the Events graph....see the LL line? If you aren't seeing any gray flagged areas in the LL line then you aren't having any large leaks despite what the software might be reporting.

Since you are reporting a lot of awake time with mask and machine on there is a good chance that a lot of the flagged events you are seeing aren't real asleep flagged events. These machines don't have any way to measure if you are asleep or not. They can only measure air flow and our awake breathing is much more irregular than asleep breathing and the machine can and will think those tossing and turning awake breathing irregularities are some sort of apnea event breathing irregularity.
We can't really telly how much is real and how much is asleep flagging at this level of examination of the flow rate.
You have to do some zooming in to really get an idea and even then it's not easy.
Watch the videos here. While mainly talking about central/clear airway apneas....false positives aren't limited to just centrals. It can be any flagged event.

http://freecpapadvice.com/sleepyhead-free-software

Your report is very ugly but we don't know if it's ugly because a lot of the flagged stuff is asleep flagged stuff or if it is just crappy sleep quality flagged stuff.
You know you aren't sleeping so great and doing a lot of tossing and turning and probably sighing as well. All of which will cause false positive flagging.

First order of business is to get a handle on the sleep quality so that you can best then look at the results the software is showing you.
I do know that is easier said than done. What is it that is keeping you from being able to fall asleep? Can you put your finger on it?

When they did the titration study and came up with the 11 cm pressure recommendation....did you sleep mainly on your back during that sleep study or were you on your side for most of it? Did you even sleep decently during the titration sleep study?
It is common to need more pressure when we are on our backs than we might need when on our side.
If they did the titration study with you mainly on your side then it is possible that the 11 cm recommendation is too low for back sleeping.

[Miss Emerita]

gwfl, do you breathe through your mouth during the day? If not, do you want to try out a nasal mask or a nasal pillow mask? For the sore spot, you might try a mask liner.

[gwfl]

Yes, I'm pretty much a mouth breather...maybe 80/20 mouth/nose breathing. I sleep best on my either side but most often fall asleep on my back. I used a nasal pillow during my sleep lab study and it was ok. Either a nasal pillow or the Amara View masks are possibilities.
I have always slept well and generally fall asleep quickly but with all this crap on my face it's been terrible. I know I'll work it out eventually.

[Pugsy]

One thought....you used a nasal pillow mask during the titration sleep study but are using a full face mask at home.
It is quite common for people to need more pressure when using a full face mask than when using a nasal mask.
So it's very possible that the 11 cm that worked fine with your nasal mask isn't quite enough to do a good job with the full face mask.

I think that the lower strap needed by most of the full face masks tend to alter the airway position a little bit and thus often cause the need to use a little more pressure. I know of people who have a 2 or 3 cm difference in pressure needs between full face and nasal masks.

[gwfl]

I'm trying to get appointment with Respiratory Therapist that set up equipment to discuss mask and pressure. She gave me the full mask because the others she had had magnet clips and I have a pacemaker...she was leary of having magnets close to it. I have since had an appointment with my electo-cardiologist and he says no problem...just don't put it on top of the pacemaker. I've also read the 2" or more is safe. This is a new pacemaker that I can go through MRIs with.