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Determining leak with a "nonsupported" mask?
#1
Determining leak with a "nonsupported" mask?
Hi! I'm brand new here.

My son (age 6) is the patient and has been on CPAP for a week. I am just trying to understand the numbers and everything.  He is on the dreamstation auto cpap and using the resmed pediatric pixi mask. I'm assuming because of the brand difference, dreammapper won't let me choose the pixi type mask. Am I understanding correctly that this will impact how much leak is expected/reported? Is there anything I can do to make the data more accurate?  Is there a way for me to know the expected leak of the pixi?

I do have OSCAR and I am looking at the charts and just trying to make heads and tails of it.

Anyone have any thoughts, advice, or input for me? Let me know if I've left out any key info.
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#2
RE: Determining leak with a "nonsupported" mask?
Additional info: dreammapper reported 100% mask fit, but oscar displayed  leak of of 0-32 liters (mostly 15 liters)vand total leak of 16-65 liters (mostly 32 liters). When it was on the higher end of those numbers,  the mask was pretty loud, but my son was sleeping fine. I wasn't sure if I should fix it or what. Mostly this time was early this morning, so I eventually just turned it off. Once I saw that it was 100% fit on dreammapper, I wondered if this was the wrong move and maybe I should have left well enough alone since he was sleeping?
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#3
RE: Determining leak with a "nonsupported" mask?
Welcome to Apnea Board.

Dreammapper is more basic, and doesn't take intentional, vent leaks into the equation. OSCAR does show that and is going to be more accurate overall. Respironics devices typically show 2 lines on OSCAR's leak graph, the higher of the 2 represents both intentional/vent leaks and unintentional combined. Dreammapper isn't intended to be a diagnostic tool, but for giving basic user info as I see it.
Dave

OSCAR
Standard OSCAR Chart Order
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INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEBSITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#4
RE: Determining leak with a "nonsupported" mask?
Dave, I get all that, but what I don't know is how OSCAR or Dreammapper would know the real intentional leak since it doesn't allow me to select the correct (other brand) mask?
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#5
RE: Determining leak with a "nonsupported" mask?
It's not the software that is determining the leak, it's your CPAP that is reporting it.
Crimson Nape
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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.
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#6
RE: Determining leak with a "nonsupported" mask?
I still need more help. How do I know if his leak is too much? What do I need to do for him? 

His AHI is 2x as high as it was untreated.  Something is wrong.


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#7
RE: Determining leak with a "nonsupported" mask?
Others can help you better, but what I see are the grey bands where the machine is flagging that it cannot deliver effective therapy. I also see a BND black zone where it appears that breathing is not detected. The BND could be where the mask is no longer on the face. In the grey zones I see a lot of events. The mask appears to be leaking. You either need to adjust the mask better, or you need a different mask that is a better fit.
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#8
RE: Determining leak with a "nonsupported" mask?
@happydreams
If it is the ResMed Pediatric Pixi Mask then it looks like it is a nasal mask.  I'm not familiar with the Philips machines but see if it has a mask setting for "nasal".

If I'm reading the specifications for the ResMed Pixi show at 7cmH2O it has an intentional leak of 28 L/min

   

I'm not sure how that comes into play on the OSCAR charts though.

Another thing to consider is that when using a nasal mask, if your child is opening their mouth during sleep then the effectiveness of xPAP may be reduced.  All the pressure from the machine will be going straight out their mouth.

It may be worth giving your Dr a call and asking if their is a different pediatric mask you can try.
Using a 13" MacBook Air (2017), MacOS Catalina (10.15.7), OSCAR v1.2.0
In a VM: Win10 1909 (18363.1139)

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Attaching images and files for the forum
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#9
RE: Determining leak with a "nonsupported" mask?
Respironics has an "X number" I'm thinking 1-5 and Off, for masks made by Respironics. It's not the same setting as Full Face, Nasal, Pillows on the ResMed.

OK if this is as I'm seeing it, Pixi is a ResMed pediatric nasal mask, and you're using it on a Respironics machine. Find the resistance setting and set it to 0 or Off. The X resistance settings on Respironics is only good for their own mask brand. This does not mean the Pixi cannot be used with Respironics machines, it just means they say to set resistance to Off or 0 whichever is on there being equal to off. Respironics doesn't have resistance values nor have they tested other branded masks, so that is the explanation for Off resistance.

As for what leak is too much on Respironics, what was shown is probably a bit high, something over 50 or so on the upper line on OSCAR is where I mean. Check again the mask connections, for proper fit that isn't too tight or painful, and where minimal air is leaking out around the mask cushion.

Hope that helps more, as I could finally use the PC to look at this as internet was down until a few minutes ago.
Dave

OSCAR
Standard OSCAR Chart Order
Mask Primer
Dealing With A DME
Soft Cervical Collar Wiki
INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEBSITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#10
RE: Determining leak with a "nonsupported" mask?
Personally, I think the Respironics recommendation of X0 for any other company’s mask is utter nonsense. I don’t think any mask should be set lower than X1.

That said, what it really determines is how the machine compensates for pressure drop in the mask that is proportional to airflow, and for a child the airflow will presumably be lower anyway.
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