The average doctor visit lasts less than 20 minutes, so have your questions written down or on the top of your head. Unfortunately, you are on the clock.

When is all this "leaking" taking place?

I've never heard or noticed any leaking.


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As a Christian, you may be the only bible someone ever reads.

Yer lucky then, Ted. Most people on CPAP struggle to find a mask that is comfortable and fits well enough to keep leaks under reasonable control. Usually the leaks, even w/a good fitting mask at times, take place whilst you are sleeping; often when you change sleep position, often via the "lip flutters" when air tends to build up in your mouth and then gently escapes between your lips.


_________________
Some people are like Slinkies... Not really good for anything, but they still bring a smile to your face when you push them down a flight of stairs.
Resmed's new VPAP Auto. Humidaire 3i, Simplicity & Micro mask, ResScan 3.4 software, SPO 7500 oximeter.

Hello again,
 At the beginning of this post I said I was keeping a daily pencil graph of my average API occurrences.  My concern was how it related to the high (leak rate) I was seeing around 40 ever since I got this replacement machine. According to the charts and comments posted here, it would seem that it is normal and is attributable to port venting for a Resmed Full Face Ultra Mirage mask.
I have noticed however, that although the mask is comfortable and there are no noticeable leaks around my face,  the API on my graph  in the past thirty days has climbed from being a steady 2-3  of the previous  30 day time period  to 9.5 in 8 hrs. This concerns me as this happened before and they changed the machine a Remstar Auto M. I seem to sleep OK but do have a few nod offs while reading or watching TV. I did also say that this could just be age :O) I am working too hard in the garden :O) Any comments?
I don't use a humidifier in summer and I have no nostril plugging as it is humid enough here.

John

Hi John!  (Loved your poems in the other thread BTW!!!)

Something is not right here.  I believe it would be prudent to see your doctor.  If he/she can read your machine's smart card (or have the DME do it) there may be some good clues there.

Your AHI (apnea/hypopnea index) is what is climbing, yes?  Typical goal of CPAP therapy in adults -- even ancient ones -- is to reduce the AHI below 5.  Many people with mild SA (AHI 5-15), and even some with AHI below 5 (especially if on the high side), experience enough disruptions during their sleep to cause residual daytime sleepiness and wakefulness during the night.  

Your AHI getting above 5 during the night, regardless of the reason, means your SA is not under control.  I think it is time to go back to the doctor on this one.  Perhaps the auto's pressure ranges need adjusted, perhaps the mask is having a BIG leak at a single point during the night, the devil may be in the details.  Please get it checked out, and let us know?

Blessings,
--pseudonym

Thank you for your comments Pseudonym.
 As they tell you, "A man who is his own lawyer has a fool for a client". Probably the same applies to  Apnea treatment :O)  I am the one on the receiving end of me, :O) and the only one who cares, although I appreciate this forum and caring people like you, as we are all in the same boat.
To get an appointment with the doctor who last sent me for a "sleep over" is easier said than done. There is a long wait time and I am still waiting on the list.
 I cheated a bit and when I got this new machine . They mistakenly left the provider's setting instructions in one of the pockets of the fancy case. I will probably go to jail for this :O) I am fairly handy :O)  so I used them last night and upped the pressure from 9cm to 10cm.  I never changed anything else, however, I also turned on the humidifier. I seem to have slept a bit better and the 8 hour figure  dropped to 8AHI  My graph is now moving downwards. From a high of 9.5  I hope it continues. It is strange that the sleep therapists don't set a goal like zero AHI when they fit the mask and supply the equipment. I was on 7cm for 15 years and I was never measured in all of that time The Remstar Choice machine was like the Timex it kept on ticking.:O) All I knew was that my sleep definitely improved from pre- CPAP. I keep a close watch on myself. :O) I even played better golf today.:O)
John

Hello Pseudonym, If you are still there?,
 I talked to my Therapist today. She is a really nice caring person and we talked for a while. She said that 8AHI is considered by some doctors as only "mild apnea" she says that some don't even consider therapy at 5AHI. My 7 day average is now reading 8.5 so considering that I had a couple of 9's and 9.5's in there  this week I think I am on the way back down.

Just think if they hadn't put the readable data in there I wouldn't be at all bothered by it :O) (As long as I slept well.) At 9.5AHI I definitely felt wasn't sleeping well.

Thanks for your comments
John

AA: I also find it odd that anyone is satisfied with getting your AHI to the "MILD" classification. You are using a device that can get you back to within the "Normal" range, yet the therapist suggests that you are doing well and that its only mild. That isn't acceptable, in my opinion.

Some do NOT require/advise treatment at an AHI of 5 because 5 is borderline normal. What is her point in bringing that up?

Im sorry. I shouldn't be criticizing your care. If you are satisfied, then so be it. I hope that you get your AHI down to within normal range. Heck, I hope that you can get it under 1.5  

 

Thank you Ram
I am afraid we have wandered a bit off the Leak rate subject although that was my initial concern. The leak rate I am still seeing is  averaging around 38 which according to the charts for the Res Med Mirage Full face is "normal". That I accept now at least.
My AHI is back on a downward slope on my daily graph to 7.5 AHI. I didn't sleep well at all last night ?? I guess we all have to accept bad nights. I have a clear conscience :O) If I can't sleep I  just get up and play the piano (with earphones:O)) Perhaps my brain becomes drugged with the strange sound of the blues played badly :O)
I too would like to see no Apneas /Hypo Apneas registered.
My golf game was terrible today. Now that really concerns me :O) :O)
Thanks for caring
John

Ancient Apnean wrote:

Thank you Ram
I am afraid we have wandered a bit off the Leak rate subject although that was my initial concern. The leak rate I am still seeing is  averaging around 38 which according to the charts for the Res Med Mirage Full face is "normal". That I accept now at least.
My AHI is back on a downward slope on my daily graph to 7.5 AHI. I didn't sleep well at all last night ?? I guess we all have to accept bad nights. I have a clear conscience :O) If I can't sleep I  just get up and play the piano (with earphones:O)) Perhaps my brain becomes drugged with the strange sound of the blues played badly :O)
I too would like to see no Apneas /Hypo Apneas registered.
My golf game was terrible today. Now that really concerns me :O) :O)
Thanks for caring
John

Question: Have you been diagnosed with PLMD?

Also, try to work on that leak rate. Maybe leaks are causing onset events, which is dragging that AHI upward?

Hey, whilst hypopneas can tire you out as well, it is worth noting if it is the HI that is high and the AI 0.0 or at least less than 1.0.

RAM, I thought that AncientApnean said that according to his mask's literature his leak rate was in line w/the allowed vent rate at his set pressure. Maybe I have him mixed up w/someone else.


_________________
Some people are like Slinkies... Not really good for anything, but they still bring a smile to your face when you push them down a flight of stairs.
Resmed's new VPAP Auto. Humidaire 3i, Simplicity & Micro mask, ResScan 3.4 software, SPO 7500 oximeter.

CrohnieToo wrote:

Hey, whilst hypopneas can tire you out as well, it is worth noting if it is the HI that is high and the AI 0.0 or at least less than 1.0.

RAM, I thought that AncientApnean said that according to his mask's literature his leak rate was in line w/the allowed vent rate at his set pressure. Maybe I have him mixed up w/someone else.

I think you are right, but an acceptable leak is just that. Its not necessarily great, but rather it is acceptable. It can't hurt to try to get it lower, so long as it can be done "comfortably".

Hello again,
 In an earlier post Violet gave  an address:  
http://www.internetage.com/cpapinfo/leak-rates-1.html
The acceptable leak rates are charted here for various masks. I thought this was great information and it really answered my initial question. It would seem there is a lot of air going out the vent with all of the masks listed. The higher the pressure setting the more air is vented??

 Ram S, I don't know what PLMD is and I hope I don't have it :O) It sounds too serious for me. I have difficulty with all of the AHI, API. (I think I made that one up:O)  
Chronie what is a Hypoapnea anyway? I thought I just had the "straight stopping breathing when I snore kind apnea" :O) The Remstar Auto reads AHI which I took to be Apnea / Hypoapnea  Incidences. I don't see anywhere where I can seperate the two readings. I must sound pretty dumb to you guys :O)
 Thanks for your concern I am fine again and happy that figures are coming back below what some doctors consider to be  "mild" It is OK for them to say :O) :O)
I wonder if there was ever a poll on this site to find out what is the averagel AHI of patients? It would be too big a post I think to do this However you may find some that are really in trouble and can help them.
 John

AncientApnean, PLMD is Periodic Limb Movement Disorder. Not quite the same as RLS which is Restless Leg Syndrome. Supposedly PLMD only occurs during sleep and RLS only when awake but ....

Hypopneas are best described as "apnea wannabees". Actually, they are a partial closing of the airway w/resulting lowering but not cutting off of air.

The built-in or allowed leak rates for these mask is to allow the escape of stale air full of C02 we exhale to make room for fresh air on inhale.

AHI is the combination of apneas and hypopneas experienced PER HOUR
AI is the number of apneas experienced per hour
HI is the number of hypopneas experienced per hour

Add the AI and the HI to get the AHI or
Subtract the AI from the AHI to get the HI or
Subtract the HI from the AHI to get the AI

Nope, you don't sound at all dumb, AA. What? You think the rest of us were born knowing all this stuff? Ha! Suprise! 'T'ain't so. We learned and are learning by asking questions the same as you are. You know the old cliche: the only dumb question is the one that doesn't get asked.


_________________
Some people are like Slinkies... Not really good for anything, but they still bring a smile to your face when you push them down a flight of stairs.
Resmed's new VPAP Auto. Humidaire 3i, Simplicity & Micro mask, ResScan 3.4 software, SPO 7500 oximeter.

Well now, I didn't mean this thread to be about me. However, I am glad to see that there is a lot of good information coming from you for all to read.
As a matter of fact I do have that PMLD thingy:O). I guess I was diagnosed with it at that first sleep clinic I had years ago  I didn't know what it was called. No one said. :O) They perhaps didn't have letters for it then:O) THey just said my legs jumped while I slept.
 I was prescribed and take a lo dose Clonazepam every night, it seems to work.
I was very athletic in my sleep. :O)
It used to feel as if I was playing soccer all night. Before I  had CPAP I used to swim under water and it felt as if I would never reach the other side of the lake. I would wake up and even then feel as if I couldn't start breathing again. It was a pretty awful feeling.   This is why strongly I encourage its use to those who need it. Some discard it after a few weeks?
I still get the sore leg feeling occasionally in the morning dependent on what I do the day before. But have never had a recurrence of the breath holding thing in the time I have been on CPAP. I am sure it saved my life (for what that's worth :O)

I thank you all, John