ejbpesca

It is now a curiosity for me as to why the auto start of the AirSense 10 ceases to function with the machine set to Pillows. The auto-off still works. If I cover the exhaust ports on the mask and blow air through it forcefully, this will sometimes trigger auto-on to function.

I think I have been fretting over high AHI scores needlessly for years due to my often Large Leak cluster of events. It has always been a wonder as to why many times I may feel better with a 7.30 AHI than a 2.75 AHI and a frustration that for 18 years I could never get an AHI below 1.75 yet I see other's OSCAR reports showing frequent < 1.00 and even 0.00 scores. I am concluding that if you Large Leak for more than a few seconds your AHI is not accurate. Take out the OAs, CAs, and UAs of a Large Leak cluster then calculate the AHI for a more accurate score especially if the events are within a tight cluster of an event every minute (AHI 60.00) which seems like more suffocation, not apneas. Why average in a short time period of AHI 60.00 with hours of AHI < 2.00? Does this not skew the AHI?

The possibility that my AirSense 10 is false flagging of events during a Large Leak gray area is part of my issue with a possibly skewed AHI. I can have 20 events within a 20-minute cluster within a gray area. The large amount of compacted events raises the AHI giving a false indication of the quality of therapy over a total sleep session. In other words, pull out the Large Leak time and its cluster of events from X hours of sleep and the AHI score will drop dramatically. Why be concerned over a 7.00+ AHI when it was a 20-30 minute cluster of events within a Large Leak gray area that caused the score? The AHI would be < 1.00 with the cluster excluded. Even if the events are accurate, they skew AHI's meaning toward the overall sleep session with over 90% of the sleep time in an AHI of <.50.

If a cluster of events is seen on a report even though over a gray Large Leak area the interpretation includes, "positional," and "chin tucking." The advice will be to use a low pillow and a soft cervical collar and may give suggestions on how not to roll to the back during sleep. Some CPAP users strap their chins, tape their mouths, collar their necks, and put nostril-opening spring strips to their noses when another mask could be all that is needed to get AHI down by reducing Large Leaks.

I don't expect perfection from anyone or a machine, but I would like those concerned with CPAP therapy to take a closer look at apnea clusters within Large Leak gray areas and give more consideration to the possibility that these event clusters may not be caused only by sleeping positions that restrict airflow. They could be false flagged events due to a Large Leak. How can the machine flag events and measure airflow limitation if the air pressure is lost in the mask by air freely flowing out its perimeter? Does the rate of 75 events an hour make sense inside a Large Leak gray area? Could not the cluster of events be eliminated by fixing the leak problem as opposed to wearing a soft collar, mouth tape, or a chin strap? I do understand that it is jaw-dropping that may cause the Large Leak, but is it worth disturbing sleep with a collar if one or two event clusters in a gray Large Leak area are showing nonexistent events? Would not a mask that functions with a jaw drop be better advice than a collar or at least give it as an alternative try before a collar?

Thank you very much. ejbpesca

The reason I asked this question is that no setting is offered by Fisher Paykel for their Evora hybrid. ResMed says to use the nasal setting for their hybrid. The two masks look much alike and both send air to the nostrils. Fisher Paykel has no answer and ResMed cannot be contacted by consumers. My healthcare provider does not know anything about CPAP and my DME is sales only.

I think I have the AHI concept correct:

The AHI (Apnea Hypopnea Index)score is measured and produced by most CPAP machines. AHI comes from the machine sensing apneas and hypopneas occurring per hour during a sleep session. A score of 5 and under is considered okay. The machine senses that breathing has stopped and if the stoppage lasts for enough seconds (I think 10) it is recorded as either CA (central apnea), OA (obstructive apnea), UA (unidentified apnea, or H (hypopnea). If my score is 5 or under a green smiley face will appear under Sleep Report on my ResMed AirSense. Over 5 and a red frown face appears.

To see the AHI numerical score I must remove the SD card from the CPAP machine, insert it into my laptop, launch the program OSCAR, and import data from the SD card. Daily reports will then be available for AHI scores and a large amount of other data concerning sleep sessions like machine settings, date, hours of sleep, air leaks, and number of apnea events.

Some feel AHI scores can be off due to the machine's falsely identifying apneas. My high AHI scores occur when a cluster of apneas are recorded during a 30-minute to hour period of large mask leaking. This happens when I roll from side to back during sleep. This action knocks the mask off its seal, therapy is not being delivered. How apneas can be registered when the mask has no seal, is something I do not understand. I eventually wake, adjust the mask, and therapy resumes. I feel that the large leak periods of lost mask seal skew the AHI. I would rather see an AHI of only the time I'm getting therapy, excluding the time spent with the mask seal lost.

Some may think my cluster of apneas that produce a >5 AHI score likely comes from my chin going towards my chest which causes restricted air flow, resulting in OAs. I think it is the mask losing its seal that causes these clusters to appear which can be 75 OAs registered in less than an hour. That's over 1 apnea per minute! Not breathing 10+ seconds out of every minute does not sound like an accurate sensing, but maybe it is possible.

Are there any opinions of the AHI being skewed by large leaks?

On its last year of use, year 4, my last AirSense 10 started blowing too much air. The mask was blowing out air at its sides. Turns out the water tank had lost its seal. I removed and installed the tank several times, made sure it was snug into the machine and the problem was solved. The water tank's lack of a seal to the water tank was causing the AutoSet to run up to 20 cm and stay there.

I have had my AirSense 10 auto on/off function fail intermittently, but once manually on it keeps pumping air.

I have experienced dents at the bridge of my nose for years from my full face masks. I have to strap them exceedingly tight to manage large leaks but with little success. Six months ago (after 17 years of CPAP) I got an Evora Full Face which is a hybrid nasal mask of sorts. It does not cover the top of the nose. It is an improvement for me. My AHI score is getting better and large leaks are more under control than ever even though I do not have to adjust the straps nearly as tight. My next mask to try will be a ResMed hybrid the AirFit 30.

I've had tinnitus since childhood starting about 64 years ago. It started when I had what was called, "the mumps." I have been on CPAP therapy for the last 17 years. My five CPAP machines have not caused an increase in the ringing. I have 3-4 fans running continuously to help get my mind off the ringing. Funny, when I read the title of your post, I heard the ringing. Think about it and there it is.

My experience with an increase in CAs came with increasing my minimum pressure from 8 to 10 over a few months. After a month at minium 10cm the CAs have gone back down. I was told a pressure increase can trigger CAs and EPR can raise CAs. I have EPR at 2 full time. My AHI is up and down continuously though so it is hard to figure out what settings are best. Of late I've been getting some pretty good AHI scores. About time after 17 years of CPAP therapy.