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Do I have a leak??
#1
Do I have a leak??
I use my AirSense 10 autoset APAP and have been plagued by annoying inspiration noise coming from the airvent of my F10 FFM.  Besides being driven nearly batty by it I did a lot of experimenting.  I found that the valve on the mask elbow was leaking and the swivel part of the elbow may also have been leaky.  Since all my mask hardware was old, I got a complete new F10 FFM (with a new elbow) and also a new heated air tube although my old slimline did not appear to have any leaks.  The mask inspiration noise problem went away but there was little or no change to the sleepyhead leak plot.  After replacing everything this is what SleepyHead shows:
https://imgur.com/a/pD1TU 
The 2nd picture (zoomed in) shows a leak rate of 2.4 when the pressure is about 13cm.  Is this normal or is there a leak somewhere else like maybe inside the machine?  I'm trying to figure out if I can relax or still need to do some leak fixing!
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#2
RE: Do I have a leak??
Your leak rate is fine. I don't know why but the ResMed's sometimes can be off a couple of points. It's not enough to matter though. Your treatment isn't affected.
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#3
RE: Do I have a leak??
You can have a sweet dream and you'll smile and get a leak!

There's supposed to be an exhale valve. It's there to keep you from suffocating.
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#4
RE: Do I have a leak??
Thanks folks, glad to hear this. It took me a long time to track down the source of the Dearth Vader mask noise so mostly I wanted to verify that the problem is not lingering somewhere beneath my radar. Anyway the Dearth Vader noises seem to have moved from my cpap back to the big screen which is the way I want it!
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#5
RE: Do I have a leak??
To start with, to try and get the cpap working a bit better, I would have the min on 16 and see if that stabilises it a bit. I would also reduce the ramp time to what you need to fall asleep.
Assuming you haven't turned off the flags, and I would double check. Do you always have AHI 0.00 nights? Unplugging the machine for half an hour can help reset it too.

you could also put up zoomed in charts of the area to see if anything is obvious, there are some very good people who can help.

If the advice you will receive doesn't fix things, I would go back to the doctor and talk about a bpap/bilevel titration sleep study.
Your AHI is good but the stats on the left hand side are a bit out, also assuming the machine is counting correctly.
These are the things I would talk about.
Med/median tidal volume is down, breath rate per minute is up, minute vent is ok.
you are breathing in longer than you are breathing out.
you are using over 15cm of pressure.
mask fit http://www.apneaboard.com/wiki/index.php...ask_Primer
For auto-cpap, from machine data or software. You can set the min pressure 1 or 2cm below 95%. Or clinicians commonly use the maximum or 95% pressure for fixed pressure CPAP, this can also be used for min pressure.
https://aasm.org/resources/practiceparam...rating.pdf
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#6
RE: Do I have a leak??
(11-19-2017, 11:20 PM)ajack Wrote: To start with, to try and get the cpap working a bit better, I would have the min on 16 and see if that stabilises it a bit. I would also reduce the ramp time to what you need to fall asleep.
Assuming you haven't turned off the flags, and I would double check. Do you always have AHI 0.00 nights? Unplugging the machine for half an hour can help reset it too.

you could also put up zoomed in charts of the area to see if anything is obvious, there are some very good people who can help.

If the advice you will receive doesn't fix things,  I would go back to the doctor and talk about a bpap/bilevel titration sleep study.
Your AHI is good but the stats on the left hand side are a bit out, also assuming the machine is counting correctly.
These are the things I would talk about.
Med/median tidal volume is down, breath rate per minute is up, minute vent is ok.
you are breathing in longer than you are breathing out.
you are using over 15cm of pressure.
Thanks, ajack for chiming in. 
It’s atypical for me to have zero AHI night though it has happened.  Typically I see low AHIs though like 1 or so are not uncommon.  The last two nights were both zero AHI so I did power cycle machine today just in case.  We’ll see what happens tonight.  The only thing that changed for the last two night’s besides having 0.0 AHI is that I now use a heated air tube instead of the slimline tube. 
On Sunday, last night that is, I had zero AHI but on reviewing the Flow Rate graph I see some regions that look suspiciously like they should have been flagged as hypopneas.  You can find these examples at the link below.  I’d like to see if a good set of eyes sees what I’ve flagged as an event or not:
https://imgur.com/a/QNKgg
I’m already planning to get the suspicious waveform seen in my prior thread http://www.apneaboard.com/forums/Thread-Why-High-AHI-using-DreamStation-vs-AirSense-10  before the doctor to see what he thinks.  Its likely to be a little while before I get to that. 
One thing I’d like a little guidance on is that I really don’t know what healthy limits are for the things you mentioned like Med/median tidal volume or minute volume.  My thinking is that minute volume is more indicative of breathing health then tidal volume which can vary with breath rate.
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#7
RE: Do I have a leak??
Ok, I remember that thread, I still think to use more pressure, to see if these events can be better controlled. Re the other thread, the high breath rate for 11 minutes wasn't good, but not the worst thing on your chart. The machine can miscount if there is a pulse in the breath, the machine sees it as two breaths. You need to zoom in and count the real exhales
mask fit http://www.apneaboard.com/wiki/index.php...ask_Primer
For auto-cpap, from machine data or software. You can set the min pressure 1 or 2cm below 95%. Or clinicians commonly use the maximum or 95% pressure for fixed pressure CPAP, this can also be used for min pressure.
https://aasm.org/resources/practiceparam...rating.pdf
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