Last nights data; need help analyzing

[drjsparker]

Greetings: Below are last nights results... good news/bad news... good news is it looks like my snoring is in good shape (not keeping my wife up); bad news is now all of the leaking is keeping her up.

Some questions:
-What do 'Median' and '95th percentile' mean with respect to Leaks?
-Is an AHI of 1 considered normal or do I need to keep tweaking until I get to 0?
-In the 'Events' Section, what do the numbers (10, 11, 12, etc...) at each event represent?
-Most importantly, what in the world can I do to prevent these leaks?!? [Very Frustrating]

Any thoughts and/or additional observations would be GREATLY appreciated. Thank You

[Pugsy]

Is an AHI of 1 considered normal or do I need to keep tweaking until I get to 0?

AHI 1.0 is considered to be quite acceptable. Don't dwell on the 0.0 AHI. Some do attain it and some do not. I have seen it only once in 2 years and that was with only 4 hours of sleep.

-In the 'Events' Section, what do the numbers (10, 11, 12, etc...) at each event represent?

Number of seconds that each obstructive apnea lasted. The don't measure amount of time for hyponeas.

-Most importantly, what in the world can I do to prevent these leaks?!? [Very Frustrating]

Over the nose mask leaving mouth uncovered? Any chance some of the large leaks from mouth opening and therapy pressure exiting the mouth? Dry mouth? Sore throat?
For leaks obviously from mask itself (hissing sounds or whatever) maybe someone who uses your type of mask can offers some hints. I have no experience with those masks.

-What do 'Median' and '95th percentile' mean with respect to Leaks?

95 percentile means that you spent 95 % of the time at OR below that number.
Median is just a median number. 50 % of the time your were above that number and 50 % of the time you were below.
ResMed already subtracts the mask vent/intentional leak rate before reporting leaks and they say that 24 L/min is where they draw the line when therapy and scoring of events can be impaired so you want to stay away from that red line as much as possible. On this report you spent quite a lot of time near that red line. It needs to be straighter and much closer to zero line. With those large spikes I suspect some mouth breathing issues as work. Chin strap, tape or full face mask should be considered if you suspect the open mouth being a large part of the leak line.

Did you consider nasal pillow mask? Less surface area to mess with in regards to sealing.

[Wulfman...]

I see a recipe (configuration) for disaster.

Did they prescribe a fixed pressure for you in the titration portion of your sleep study?
If so, I'd suggest setting your machine in CPAP mode at that pressure.
If they didn't prescribe a fixed pressure, I'd recommend a pressure of 11 cm. (based on the report you've posted here)

Your minimum pressure is WAY too low.
Your Flow Limitations are driving your pressures upwards.
As your pressure increases, so do your leaks.
Your mask is probably not sufficiently snug to prevent leakage as the pressures increase.
A fixed pressure will be much better to help you control the leaks.
If some of the leaks are coming from your mouth, tape your mouth shut or get a full face mask.


Den

[máirtín]

Any thoughts and/or additional observations would be GREATLY appreciated.

Use the numbers as a guide for tweaking the mask or machine but use how you feel for judging efficacy of treatment.
How do you feel?

[drjsparker]

With those large spikes I suspect some mouth breathing issues as work. Chin strap, tape or full face mask should be considered if you suspect the open mouth being a large part of the leak line.

Did you consider nasal pillow mask? Less surface area to mess with in regards to sealing.

I believe you are correct as far as leaking from my mouth. I have a swift FX (I believe it is) that I alternate back and forth with. I'll get a chin strap and see what kind of changes occur.... my only concern is in the past I've been woken up with my cheeks expanding like a fish... If I strap my mouth shut, where is that air going to go?

Thanks again

[avi123]

I don't see anything wrong with the graphs. As to raising the pressure why do it if the Autoset has not raised it even up to 14 cm for the first 4 obstructive apneas. But I would raise the min pressure to 8 or 9 cm and set the APR on 2. This would minimize the effects of the changes in pressures on the smoothness of the respiration. Assuming that you can exhale into it with no problems.

The fact that the Autoset has not dropped the pressure in time toward the 10 sec Central apnea (black) and the hypopnea in front of it, is what annoys me about this machine.

BTW, note that the flags are usually shown at the end of the apneas.

Overall, I don't see why is this poster regarded as having OSA with such good values. Reminding you that all those 10 sec event durations did not really had to be scored.

As to "Most importantly, what in the world can I do to prevent these leaks?!? [Very Frustrating]". IMO, the leaks are OK as long as they are confined inside the red line which they except one.


p.s. isn't the flow limitation graph up- side- down?

[AMUW]

Below are last nights results... good news/bad news... questions...

I am looking at your curves, and am quite envious of your low AHIs. I see no reason to be concerned about a few apneas ... unless you have complaints about other measures of your sleep quality.
If you insist on interpreting one night's data, and the results are repeating over several nights, than it would be nice to also see detail zoomed in to say a 5 or 10 minute scale.
Comparing with my own experiences on the sequence of events, may I paraphrase some of the advice provided by the other forum members ... for a possible interpretation:
- when you had your titration study, what pressure values were recommended in the report for this mask and for various sleep positions? it doesn't look like the lower limit of 6 cm H2O is doing much for you.
- first the flow limitations appear ... maybe due to a REM sleep stage
- then the ResMed S9 Auto starts compensating by raising the pressure; at 12 cm H2O it looks like it suppresses all but a few insignificant obstructive apneas
- you have an increased airway resistance at this point, so the pumped air has to go somewhere: either the mask starts leaking around the seals (if too loose) or you mouth-breathe (your minute ventilation and flow amplitude decreased to maybe 50%); in this eventuality the ResMed S9 Auto algorithm doesn't quite know what to do, so it pushes the pressure up to max ... until the arousals and flow limitations stop (REM stage over or you maybe changed body position)
- looks like the first such sequence woke you up; the second resolved with continued sleep; you're not showing how far down the pressure went

Any chance that you're wearing your nasal mask very loose? In my case going to the nasal pillows was a solution.

[Judy in CA]

10 years on CPAP but I've never had a print out
Now that I'm in CA with new provider and Dr having nothing but TROUBLE
new masks, new machines, so many questions.
what machines give you a print out
I had a ResMed Escape 8 and never had any problems with it or the masks.
can't you tell me what machines give a print out and why people need them and do Dr's make this kind of CPAP harder to get.
Thanks Judy

[Pugsy]

Overall, I don't see why is this poster regarded as having OSA with such good values. Reminding you that all those 10 sec event durations did not really had to be scored.

Huh? You get the diagnosis from the sleep study. We have no idea how many apnea events he had during the sleep study.
The fact that the AHI is seemingly controlled now doesn't alter the initial diagnosis. Geez. My AHI is routinely less than 1 now but I had AHI of 53 at sleep study. Does my low AHI now mean I don't need the machine? I don't think so. It just means that the machine is doing its job.

my only concern is in the past I've been woken up with my cheeks expanding like a fish... If I strap my mouth shut, where is that air going to go?

Hopefully the air will go down the airway and not try to exit out the mouth which puffs us up with chipmunk cheeks.
As the air goes in the nose and down the airway it tries to exit through the mouth. Practice holding your tongue against the roof of you mouth and it will act like a door and block the air from entering the mouth. Do it enough and it becomes second nature. I never get chipmunk cheeks. Now some people will use a chin strap to help keep the mouth close as well as providing gentle pressure on the cheeks to help prevent chipmunk cheeks.

If you can normally breathe just fine through your nose during the day and aren't a die hard mouth breather it is possible to learn to keep the mouth shut. Sort of break that habit. I taped for about 2 months and then sort of got lazy and found out that I no longer open my mouth during sleep. I think it was just a habit from gasping for breath with the events.

Also when using APAP and you have a large leak like that the machine will try to "fix" the leak and increase the pressure and that in turns can even create more leak. Nasty little circle.
I don't know your history or how long you have been doing the cpap thing or who came up with your APAP range so I won't go suggesting any changes that might mess you up with doctor or DME but watch that pressure line and the same time frame for leaks. They kinda go together. If you make sure that the mouth remains closed and you still have wide pressure ranges and more leaks than you want, you may want to consider straight cpap mode or tighter APAP range just in case that pressure increase is simply from the machine trying to fix the leaks.

[avi123]

del

[Lizistired]

Another perspective...
Have you looked at those apneas in a 1 or5 minute frame?
You may be blocking your airway to fix a leak, which might be caused my your mouth coming open or just relaxing in really deep sleep.
I would bet only 1 or 2 of those are not preceded by an increase in flow. The arousals are not good, but your O2 probably isn't dropping.

[Pugsy]

So why have you not inquired why the poster is using XPAP in the first place before giving advice on the quality of treatment? Many XPAP users have underlying medical conditions. Do you know what and if the poster suffers from other comorbids besides OSA, and most likely it's not going to be your condition?

OP wanted opinion on his data. I gave opinion on data. He wanted to understand the data.
He didn't ask me if I thought he had a diagnosis of OSA. I figure he already accepted that fact or he wouldn't be using the machine.. It is not for me to question him or his doctor on his diagnosis.
I gave opinion on the data as presented. I see no need for people to post their entire medical history each time they ask a simple question or are simply wanting to understand what the numbers mean.

If you go doubting OSA diagnosis based on low AHI numbers while using the cpap machine, you are doubting the diagnosis on a good majority of the members here on this forum. Do we all have something else besides OSA? OMG why are we here then?

To suggest that a person with a perfectly acceptable AHI while using the cpap machine might not have OSA because of the low numbers while using the machine, is faulty logic.

Geezzz, KISS Keep it Simple ......
Worry about the what ifs when or if they come up. Don't go confusing newbies with your logic. When you do, you will be challenged.

[Lizistired]

logic?

[Pugsy]

logic?

Yeah.. I couldn't think of a better term that wouldn't get me in trouble for my unladylike language.
Funny, I thought Avi had me on his Foe list.. Oh well..I guess not.

[avi123]

Most importantly, what in the world can I do to prevent these leaks?!? [Very Frustrating]

Any thoughts and/or additional observations would be GREATLY appreciated. Thank You


I agree with Den saying: "if some of the leaks are coming from your mouth, { not this: tape your mouth shut or} but this: get a full face mask."

You're using a nasal mask and you are probably a mouth leaker. This drives the APAP crazy.