Sorry about the resolution. It's my first time posting a screenshot here. I did use that website, but possibly not correctly.
His previous setting was 16 - 20 on auto-pap. The doctor was the one who recommended 20 straight as a new setting.
He has been waking up with headaches again. He never really feels rested and/or energetic.
The mask is Res Med Quattro Air Full Face Mask.
The machine is a REF 550P.
The mask was replaced January 25th, that includes the valve. I'm not familiar with how the valve should work. I have a nasal mask myself.
I put a new hose on today. That was MUCH older.
I updated my profile to his information.
The gasket in the top of the humidifier looks a little questionable. I'm going to clean it and see if it makes a difference tonight.
I have some experience with such large leak curves with a Quattro Air. For me, I would do the mask fit check on my PRS1 60 series Auto with the Quattro air and go to sleep. A couple of nights, I had such large leaks. One of them woke me up and turns out the mask was leaking near the nose area.
Since the anchor of Quattro Air is on the forehead, sometimes during the night, if your forehead swells up or your front sinus get drained or multiple other reasons, the Quattro Air may lose its seal. This is compounded in this particular case by very high pressure so there is not much tolerance in the system to resist small changes to facial topography.
You can try a Resmed Airfit F10. Its top anchor has moved down to the nose and cheek area from the forehead. This makes it less prone to leaking due to changes in facial topography during the night. I have that mask too and I have generally found it to be more forgiving than the Quattro Air. And both these masks share the same cushion and mask elbow SO you can try it for cheap by buying the headgear and the frame on eBay.
Started APAP 4-20, Closed range to 7.5-14, then straight 8.0 w/ Aflex 3
RDI always below 1. But sleep much much better at straight pressure.
Started on F10, Tried Quattro Air successfully. Finally settled on P10.
02-28-2015, 10:59 AM
(This post was last modified: 02-28-2015, 11:08 AM by jms722.)
I cannot for the life of me figure out how to add the attachment of the screenshot!! Says I've reached my attachment quota.
I /we wish every night could look as good as last night!
To answer your questions... before changing to 20cm his 14 day AHI was 2.45 with large leaks on many, but not every night. One night he had a leak of 108 minutes, then things returned to normal. Since changing to 20 cm, excluding some days with faulty readings due to a card issue, his AHI is 4.02. That being said, he also has had no RERA since the increase in pressure.
Today we will go through the mask fitting video and do that. I think that may be an issue. Every time I tell him his mask is leaking (buzzing) he tells me he has it as tight as he can get it. Now I understand that is not the answer to the leaks.
I also understand, thanks to the experience of the members here, that when he is having these leaks the machine cannot read properly.
However I'm still not convinced that his lying on his back and not breathing (normally) isn't causing the machine to think it is having large leaks. If one stops breathing or breathes very shallowly, the air has to go somewhere, right?
BTW, last night he had just 5 hypopnea, 6 obstructive for an AHI of 1.71. No large leaks or anything else!!
That leak is so large that you should be able to hear it. Is his machine set so that it shuts off automatically when the mask is removed? Because my guess is that he's removing the mask while asleep and has no recollection of it. Unfortunately the only rememdy for this is extra homemade straps and bobby pins!
It seems that if the leak were a gasket or something like that it would be continuous. Instead we see it going up and staying there for an hour or so, then going back down. Perhaps his mask is ajar, but again you should be able to hear the resulting leak.
As others have noted, with a leak that large the machine can't report reliable flow rates or AHI. It's also rendering the therapy ineffective, which would lead to the symptoms you mentioned.
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