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[CPAP] Need help trying to understand where the air leak is coming from.
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PaytonA Offline
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Posts: 3,013
Joined: Dec 2013

Machine: ResMed S9 VPAP Auto
Mask Type: Full face mask
Mask Make & Model: Resmed Mirage Quattro
Humidifier: H5i(distilled-top up)
CPAP Pressure: VAuto MinE14.0 MaxI 20.6 PS4.0
CPAP Software: ResScan SleepyHead

Other Comments:

Sex: Male
Location: Orange County,California

Post: #21
RE: Need help trying to understand where the air leak is coming from.
If you discover a leak in the system including the mask, correct it. If you can not find any leaks in the system, I would suspect mouth leaks. Try a chin strap. If the chin strap does not provide enough correction, my recommendation would be to try another nasal pillows mask like the P10 or go to a full face mask.

Best Regards,

PaytonA
02-13-2015 06:04 PM
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Sleeprider Online
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Posts: 3,363
Joined: Dec 2014

Machine: Resmed Aircurve 10 Vauto
Mask Type: Nasal pillows
Mask Make & Model: Resmed Airfit P10
Humidifier: Resmed Climateline
CPAP Pressure: Auto Bilevel 18/9, PS 3
CPAP Software: ResScan SleepyHead EncoreBasic

Other Comments:

Sex: Male
Location: Where they make Respironics

Post: #22
RE: Need help trying to understand where the air leak is coming from.
Great job posting the data. Next time, be sure to click on the Details tab instead of the events tab before taking the screenshot, and there is some important data for us there. The reason the daily data helps more than a summary in this case is we can see where the baseline leaks really are how leaks change through the night, and what effect pressure has on leaks.

First, you have ramp turned on. You can see on the pressure graph, you start at 4.0 pressure and gradually increase to a therapy pressure over 15 minutes. Then pressure goes up FAST! This is setting you up for failure, because you may not be aware of leaks until the machine reaches that treatment pressure. If you can handle it, turn off the ramp feature so you start the night aware of leaks in the equipment and mask, and fix them. Also, that low pressure often feels suffocating. Sound familiar? Turn off ramp, or make the minimum pressure for ramp 6.0 in the clinical settings. Your pressure is increasing that fast because I suspect you are ringing up flow limitations that your graphs are not showing. I'll explain below how to change that. But this is another indication that ramp is suffocating you, and as soon as it ends we see a rush of pressure and a cluster of not-real apneas and hypopnea.

It appears there is nearly 16 to 20 lpm of background leaks, but leaks increase into large leak category when you sleep more deeply. I think you have a hose leak and I suspect you are leaking through the mouth much of the night.

Lets make a change to your Sleepyhead settings first. Open Sleepyhead and click on File, Preferences and go to the Waveform tab. On the Leak Rate line are two settable values. Change the lower leak rate to 30. This will cause the graph to use your machine defaults for flagging large leaks rather than what Sleepyhead thinks is a leak. Also, on the Events preferences tab, check the boxes on both sides of Flow Limitations and Vibratory Snores so those features shows up on your event charts and statistics. Flow limitations are a key reason that pressures increase, and we need to see them.

Okay, lets see some more data before we make any changes to your machine. I think if you do the thinks in this post, your leaks will greatly improve, and I need to see the machine settings in the Details tab of the daily data.

______________________________________________
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(This post was last modified: 02-13-2015 09:06 PM by Sleeprider.)
02-13-2015 09:00 PM
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DeepBreathing Offline
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Posts: 2,296
Joined: Sep 2013

Machine: Resmed S9 VPAP Adapt
Mask Type: Full face mask
Mask Make & Model: F&P Simplus
Humidifier: Resmed H5i
CPAP Pressure: EPAP: 9 - 15 PS: 3 - 10
CPAP Software: ResScan SleepyHead

Other Comments:

Sex: Male
Location: Perth, Western Australia

Post: #23
RE: Need help trying to understand where the air leak is coming from.
(02-13-2015 09:00 PM)Sleeprider Wrote:  Lets make a change to your Sleepyhead settings first. Open Sleepyhead and click on File, Preferences and go to the Waveform tab. On the Leak Rate line are two settable values. Change the lower leak rate to 30. This will cause the graph to use your machine defaults for flagging large leaks rather than what Sleepyhead thinks is a leak.

This is not necessary with Resmed machines which report unintentional leaks only. Leaks over 24 L/min are regarded as large leaks by Resmed and this is mirrored in Sleepyhead. Note that Resmed and PR handle leak reporting quite differently from each other.

DeepBreathing
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INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
02-13-2015 09:53 PM
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AnonAgent Offline

Members

Posts: 14
Joined: Feb 2015

Machine: ResMed S9
Mask Type: Nasal mask
Mask Make & Model: ResMed Mirage™ FX Nasal
Humidifier: none
CPAP Pressure: unsure
CPAP Software: ResScan SleepyHead

Other Comments:

Sex: Male
Location: Singapore

Post: #24
RE: Need help trying to understand where the air leak is coming from.
Thank you for all your replies and suggestions & my apologies for the late reply.

sgearhart, I've been making purchases online & that's the only place i can get the stuffs i need. Prices in my area are quite costly approx marked up x2.5.

PaytonA & Sleeprider, I've checked the whole system for leak, the host, the connectors and the mask. On low pressure there's no signs of leakage but when i turn it up to 10 the mask started leaking air. So i think that might be the reason.

Anyway, these are the results from yesterday,
[Image: yP1q9eMl.png]
[Image: BXO5p4Fl.png]
[Image: tQBpaVcl.png]
[Image: 5h7rsI8l.png]

For now I've changed the min pressure and start pressure to 6.0 now and it feels much better compared to being at 4.0. Also I've tighten my mask to ensure that there's no leakage when the pressure is at 15. I'll update the results after trying out the new settings.
02-14-2015 04:42 AM
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DeepBreathing Offline
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Moderators

Posts: 2,296
Joined: Sep 2013

Machine: Resmed S9 VPAP Adapt
Mask Type: Full face mask
Mask Make & Model: F&P Simplus
Humidifier: Resmed H5i
CPAP Pressure: EPAP: 9 - 15 PS: 3 - 10
CPAP Software: ResScan SleepyHead

Other Comments:

Sex: Male
Location: Perth, Western Australia

Post: #25
RE: Need help trying to understand where the air leak is coming from.
AnonAgent, have you tried using the mask fit facility on your machine? Put your mask on then push and hold the push dial for three seconds. The machine will crank up to maximum pressure which will rapidly identify leaks. While you're doing this open your mouth so you and your partner can hear what a mouth leak sounds like, and maybe identify one if it happens in your sleep.

DeepBreathing
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www.ApneaBoard.com


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INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
02-14-2015 05:09 AM
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AnonAgent Offline

Members

Posts: 14
Joined: Feb 2015

Machine: ResMed S9
Mask Type: Nasal mask
Mask Make & Model: ResMed Mirage™ FX Nasal
Humidifier: none
CPAP Pressure: unsure
CPAP Software: ResScan SleepyHead

Other Comments:

Sex: Male
Location: Singapore

Post: #26
RE: Need help trying to understand where the air leak is coming from.
DeepBreathing, yup, I used that to test for leakage just now & we also did the mouth opening thing earlier so she can identify if it's leaking from the mask or the mouth. She did mention that i don't sleep with my mouth open whenever she wakes up halfway in the night.
02-14-2015 06:23 AM
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Sleeprider Online
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Posts: 3,363
Joined: Dec 2014

Machine: Resmed Aircurve 10 Vauto
Mask Type: Nasal pillows
Mask Make & Model: Resmed Airfit P10
Humidifier: Resmed Climateline
CPAP Pressure: Auto Bilevel 18/9, PS 3
CPAP Software: ResScan SleepyHead EncoreBasic

Other Comments:

Sex: Male
Location: Where they make Respironics

Post: #27
RE: Need help trying to understand where the air leak is coming from.
The leaks are a real mess, and I'd suggest a new mask and possibly trying a full face to see if it helps. If you get a new mask, buy from a company like Supplier #1 or a DME that provides a 30 day return policy. Also, for a nasal mask, the Airfit P10 has been a real solid performer for me and cut leaks in half from my former mask, the Swift FX.

Your obstructive apnea and hypopnea events are correlating with times when your machine pressure is dropping to the minimum. I think you need to increase your minimum pressure to 6.0. You may want to be more conservative and only increase by increments of 1.0. The graph is pretty clear where the problems are happening. Please turn on the flow limitations and snores in the graphs. File/Preferences/Events, then check the left and right hand boxes for those events.

______________________________________________
Organize your SleepyHead Data
Post your SleepyHead Data from Imgur
Robysue's Beginner's Guide to Sleepyhead
02-14-2015 09:53 AM
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AnonAgent Offline

Members

Posts: 14
Joined: Feb 2015

Machine: ResMed S9
Mask Type: Nasal mask
Mask Make & Model: ResMed Mirage™ FX Nasal
Humidifier: none
CPAP Pressure: unsure
CPAP Software: ResScan SleepyHead

Other Comments:

Sex: Male
Location: Singapore

Post: #28
RE: Need help trying to understand where the air leak is coming from.
Thanks for the recommendation, will take a look at those company that you've mentioned.

By checking the left and right hand boxes, you mean this?
[Image: HnmDp6I.png]

Cause i don't see any differences when i check those boxes.
02-14-2015 12:09 PM
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quiescence at last Offline

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Posts: 753
Joined: Nov 2014

Machine: REMstar System One with Autoflex
Mask Type: Full face mask
Mask Make & Model: Quattro AirFit F10
Humidifier: yes typical setting = 4
CPAP Pressure: 5-13 Autotritrating CPAP
CPAP Software: SleepyHead EncoreBasic

Other Comments: CMS-50F Plus oximeter /w SPO2 Assistant software. Avowed mouth-breather switching to nose-breathing

Sex: Male
Location: US

Post: #29
RE: Need help trying to understand where the air leak is coming from.
it has been noted before in various places that -

excessive leakage causes the machine to be less able to detect and properly characterize (score) the events.
your chart is a classic example of this

you'll note in grey bands there are precious few events scored.

once the leaks are reduced you may find your AHI score for the night is increased some - or alot.

good luck - have you tried any chin support/strap ideas?

QAL

Dedicated to QALity sleep.
You'll note I am listed as an Advisory Member. I am honored to be listed as such. See the fine print - Advisory Members as a group provide advice and suggestions to Apnea Board administrators and staff concerning Apnea Board operation and administrative policies. Membership in the Advisory Member group should not be understood as in any way implying medical expertise or qualification for advising Sleep Apnea patients concerning their treatment.
02-14-2015 12:15 PM
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quiescence at last Offline

Advisory Members

Posts: 753
Joined: Nov 2014

Machine: REMstar System One with Autoflex
Mask Type: Full face mask
Mask Make & Model: Quattro AirFit F10
Humidifier: yes typical setting = 4
CPAP Pressure: 5-13 Autotritrating CPAP
CPAP Software: SleepyHead EncoreBasic

Other Comments: CMS-50F Plus oximeter /w SPO2 Assistant software. Avowed mouth-breather switching to nose-breathing

Sex: Male
Location: US

Post: #30
RE: Need help trying to understand where the air leak is coming from.
to view flow limitations, you might try - on the daily tab (main screen) lower right corner - clicking the down arrow where it says event flags. see if flow limitations is listed, and if is shows as red (off), select it to change to green (on).
(This post was last modified: 02-14-2015 12:23 PM by quiescence at last.)
02-14-2015 12:21 PM
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