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Leak issues - worst in AirSense10 than Dreamstation
#1
Leak issues - worst in AirSense10 than Dreamstation
Hi!  Smile

I have started my CPAP treatment in 20/feb with a Philips Auto Dreamstation trial and Wisp nasal mask.
After initial adaptation things seemed to be working well (IAH constantly below 5).

In March 22nd I started another one month trial with Resmed AirSense10 - still using the Wisp nasal mask (nasal mask configuration).
Contrary to the previous Dreamstation trial, I am not adapting well to the AirSense10.

From what I could observe:
- Apparent sudden increases in pressure, causing discomfort - up to the point of 'puffing' my mouth open if I deliberatly close it;
- Much noisier than the Dreamstation had been (corroborated by my wife);
- Frowny red face indicating Mask Fit issues shows up frequently;

I followed instructions from the forum threads and downloaded SleepyHead.
Overview stats and two representative daily stats for each machine are attached.
I have changed the mask intentional leakage values in SleepyHead to reproduce the Wisp manual vent rate curve.

From all I read in previous threads, leak rate was already somewhat high with the Dreamstation machine, but it has skyrocket with the AirSense10 together with 'high pressure' discomfort.
I can't understand exactly why, since it is the same mask.
I have always been a mouth breather, but my sleep therapist indicated a nasal mask initially. 
The plateau-like leaks are indicative of mouth breading?
I haven't tried chin straps yet. Will probably give it a go.
Was just wondering why the Dreamstation seemed to work fine - without any discomfort and with much less leakage.  Dont-know

Thanks!


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#2
RE: Leak issues - worst in AirSense10 than Dreamstation
Some comments:

Leak Issues

If your mouth opens up and you use a nasal mask, air is going to leak out your mouth. It is independent of the machine and is a problem between you and the mask. I have a AirFit P10 and am having similar issues. Your pressures are quite low, so you may or may not get away with it. Your numbers are not real bad, and some are quite good.

I am not sure that the leak rate scale of numbers in SleepyHead can be compared from one brand of CPAP to another. My experience is all with the ResMed S9 and A10.

Last, I don't believe there is a mask type setting in the Dreamstation, but there is in the A10. Sometimes the mask manufacturer in their user manual will recommend what setting to use with the various machines. Alternately you could just try the different settings on the A10 to see if it helps.

Setup

I would suggest your pressures need some adjusting. I don't think it is ever a good idea to leave the default minimum at the 4 cm. Often that is not enough air either to get started or in the middle of the night when the machine decides to ramp down to minimum. You can wake up feeling short of air. Based on the Dreamstation charts your maximum is a bit too low and appears to be creating events.

My suggestion for a revised setup would be as follows:

Min Pressure: 6 cm
Max Pressure: 12 cm (you may be able to go lower after you see where the machine goes under auto)
Ramp: Set to Auto (it works well on the A10)
Ramp Start (Pressure): 5 cm

This will start you out a bit higher at 5 cm pressure and it will stay there until you fall asleep. Then it will ramp to 6 cm over one minute and then go on auto pressure control. 

This is a pretty subtle change using the auto ramp, but you have the features and your comfort is suffering, so you may as well use what is there. 

Moving the minimum up should reduce the pressure fluctuations you are experiencing, and probably improve your AHI too.
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#3
RE: Leak issues - worst in AirSense10 than Dreamstation
The DreamStation does have a mask setting. The Wisp cushion says x1 or x2 on it, and that's what the DreamStation should be set to.
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#4
RE: Leak issues - worst in AirSense10 than Dreamstation
Hi Ron, thanks for the help

There is also a "Mask Type" setting in dreamstation - based on resistance of the mask model (x1 - x4)
As for the leak rate scale, from what I read, I guess Sleepy head takes Dreamstation "Total leak" and simply subtracts the intentional leak that is set for your mask (informed in preferences - I corrected it for Wisp vent rate curve). 
So the leak rate overview data should be approximately in the same scale.
Probably both machines have different criteria as to what would be a large leak and compromise treatment.

I'll change the mask setting in AirSense10 tonight.
Last night I tried the EPR full time with level 3.
There was apparently less discomfort, but didn't solved the leaks (attached daily data).

And for the increased pressure configuration, I'll give it a go after fiddling with the mask setting and EPR - just to 'isolate variables'.

Cheers!


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#5
RE: Leak issues - worst in AirSense10 than Dreamstation
(04-09-2018, 07:09 AM)Danielcff Wrote: I'll change the mask setting in AirSense10 tonight.
Last night I tried the EPR full time with level 3.
There was apparently less discomfort, but didn't solved the leaks (attached daily data).
And for the increased pressure configuration, I'll give it a go after fiddling with the mask setting and EPR - just to 'isolate variables'.

That SleepyHead chart does indicate major leaks. Mouth breathing is not really a problem, it is when you open your mouth and let air out that is a problem. The A10 sees it as a leak, and responds, which in turn may cause other problems. I think it also causes apnea events because the air/pressure is diverted. I have temporarily solved my mouth leaks by using a chin strap and have even paper medical tape shut my mouth. All of those grey areas go away, and leaks will stay under 20 or so. 

As for minimum pressure, that chart confirms it should be increased to 6 cm. The max may be slightly low too. Suggest increasing to 9, and it might stop an event or two.
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#6
RE: Leak issues - worst in AirSense10 than Dreamstation
The bottom pressure is what needs to be raised. If your going to use a EPR 3 I Set the minimum pressure at 8cm. If your going to use an EPR of 2 I'd set the minimum pressure at 7cm. A maximum of 9cm should be more than enough since you were only hitting 8cm briefly.

Also turnoff the ramp. 1cm isn't going to matter and it's one less thing to worry about.
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