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[Merged thread]Have tried 4 different nasal and/or nasal pillow masks. All leak crazy.
#21
RE: Have tried 4 different nasal and/or nasal pillow masks. All leak crazy.
(10-22-2019, 08:36 PM)ChinaMan Wrote:
(10-22-2019, 02:30 PM)WillSleep Wrote:
(10-19-2019, 08:04 PM)ChinaMan Wrote: My pressure is 13-13.5. Have tried Dreamwear Nasal, Dreamwear Nasal Pillow, Wisp Nasal, and Bleep mask. They all leak.

Bleep mask is the most comfortable, but it also leak every night. Any suggestion for nasal mask that won't leak?

Hi ChinaMan, 

One of the best ways to lower leak problems is to lower pressure.  

I remember your screenshots showing those high pressures.  I know you have put a lot of pain, time and work to get the therapy right.  

I have been thinking about our chat.  Maybe the ResMed algorithims are a better fit for your needs. 

If your still not happy with the DreamStation and if you need high pressure to knock out the OAs cause the Dreamstation APAP will does raise pressure very fast in the face of a flow limitation then it might be worth it to try an Autoset or VAuto (given the higher pressures you have been running).  

I see [/url][url=http://www.apneaboard.com/forums/Thread-CPAP-Supplier-List]Supplier #2 and [/url][url=http://www.apneaboard.com/forums/Thread-CPAP-Supplier-List]Supplier #33 mentioned a lot.  Others may have more recommendations
http://www.apneaboard.com/forums/Thread-...plier-List  

I have seen ResMed Autosets and VAutos on Craigslist for $200-500.

WillSleep

I lowered the pressure by 1.5, and the leaks appeared to have stopped; but the Total Leaks gradually increased over the course of the whole night, so I am not sure whether there was leak or not. BTW, do you have any idea why my blood CO2 level was high: 31 mmol/L? Also I think I felt better with high pressure, but higher pressure came with leaks, so there is trade-off. With the lower pressure, there was less wakeups due to leaks but feel not refreshed when wake up in the morning.

"do you have any idea why my blood CO2 level was high: 31 mmol/L? "

Yes, a non-professional idea.  I think we might be able to see why in the screenshot you posted 5 hours ago.  

If you are an average sized male then your Minute Vent (6.3), Tidal Volume and Respiratory Rate looked pretty normal but your I:E Ratio looks high. 

Insp Rate / Exp Rate = I:E Ratio   
  2.44       /  1.43      = 1.88 

     

Regardless of your size your Inspiration / Expiration Ratio looks high to me.  In my non-professional opinion I think a Med school proctor might say "With an I:E Ratio of 1.88 his inspiration is significantly longer than his exhalation.  A median of his breaths have not had enough time to exhale so we would expect his CO2 levels to be high.  We would prefer to see an I:E Ratio in the range of .85-1.3" 

You have tried many settings.  I would scan previous settings to see if another collection of settings produces one of your better Inps:Exp ratios ~(.85-1.3) and also has one of your better AHI and "How you feel" experiences.   

If cannot find an example then I think you have all the proof you need to tell a Doc to prescribe a different machine for you.   I am pro both ResMed and Phillips Respironics (PR).  Since you already know some core PR algorithims shared across PR machines are not yet showing a great fit for I would specifically pursue an ResMed Autoset or ResMed VAuto as the next machine you try.     

If not through the Doc then via the Craigslist route above..  better therapy might pay for these machines in just a few days from better effectiveness.  

Any more Questions?  Thoughts?

WillSleep

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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#22
RE: Have tried 4 different nasal and/or nasal pillow masks. All leak crazy.
(10-22-2019, 09:13 PM)WillSleep Wrote:
(10-22-2019, 08:36 PM)ChinaMan Wrote:
(10-22-2019, 02:30 PM)WillSleep Wrote: Hi ChinaMan, 

One of the best ways to lower leak problems is to lower pressure.  

I remember your screenshots showing those high pressures.  I know you have put a lot of pain, time and work to get the therapy right.  

I have been thinking about our chat.  Maybe the ResMed algorithims are a better fit for your needs. 

If your still not happy with the DreamStation and if you need high pressure to knock out the OAs cause the Dreamstation APAP will does raise pressure very fast in the face of a flow limitation then it might be worth it to try an Autoset or VAuto (given the higher pressures you have been running).  

I see [/url][url=http://www.apneaboard.com/forums/Thread-CPAP-Supplier-List]Supplier #2 and [/url][url=http://www.apneaboard.com/forums/Thread-CPAP-Supplier-List]Supplier #33 mentioned a lot.  Others may have more recommendations
http://www.apneaboard.com/forums/Thread-...plier-List  

I have seen ResMed Autosets and VAutos on Craigslist for $200-500.

WillSleep

I lowered the pressure by 1.5, and the leaks appeared to have stopped; but the Total Leaks gradually increased over the course of the whole night, so I am not sure whether there was leak or not. BTW, do you have any idea why my blood CO2 level was high: 31 mmol/L? Also I think I felt better with high pressure, but higher pressure came with leaks, so there is trade-off. With the lower pressure, there was less wakeups due to leaks but feel not refreshed when wake up in the morning.

"do you have any idea why my blood CO2 level was high: 31 mmol/L? "

Yes, a non-professional idea.  I think we might be able to see why in the screenshot you posted 5 hours ago.  

If you are an average sized male then your Minute Vent (6.3), Tidal Volume and Respiratory Rate looked pretty normal but your I:E Ratio looks high. 

Insp Rate / Exp Rate = I:E Ratio   
  2.44       /  1.43      = 1.88 

 

Regardless of your size your Inspiration / Expiration Ratio looks high to me.  In my non-professional opinion I think a Med school proctor might say "With an I:E Ratio of 1.88 his inspiration is significantly longer than his exhalation.  A median of his breaths have not had enough time to exhale so we would expect his CO2 levels to be high.  We would prefer to see an I:E Ratio in the range of .85-1.3" 

You have tried many settings.  I would scan previous settings to see if another collection of settings produces one of your better Inps:Exp ratios ~(.85-1.3) and also has one of your better AHI and "How you feel" experiences.   

If cannot find an example then I think you have all the proof you need to tell a Doc to prescribe a different machine for you.   I am pro both ResMed and Phillips Respironics (PR).  Since you already know some core PR algorithims shared across PR machines are not yet showing a great fit for I would specifically pursue an ResMed Autoset or ResMed VAuto as the next machine you try.     

If not through the Doc then via the Craigslist route above..  better therapy might pay for these machines in just a few days from better effectiveness.  

Any more Questions?  Thoughts?

WillSleep

My Aflex is set at 2, would increase Alex to 3 help my CO2? But I also have many CAs; if my CO2 is high, then why so many CAs?
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#23
RE: Have tried 4 different nasal and/or nasal pillow masks. All leak crazy.
(10-22-2019, 09:51 PM)ChinaMan Wrote: My Aflex is set at 2, would increase Alex to 3 help my CO2? But I also have many CAs; if my CO2 is high, then why so many CAs?

I think it is time for you migrate to ResMed but ..  

If this is one of your best setting configurations and you have not yet tried A-Flex 3 with it then YES.

Also, with Pressure Min-Max set so tight you are really using the machine as a CPAP rather than an APAP.  So you should also for a few nights switch the machine to CPAP mode at Pressures 11 to 13 and try C-Flex+ at 2 and 3.  

C-Flex+ has received better reviews than A-Flex.

WillSleep

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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#24
RE: Have tried 4 different nasal and/or nasal pillow masks. All leak crazy.
(10-22-2019, 10:02 PM)WillSleep Wrote:
(10-22-2019, 09:51 PM)ChinaMan Wrote: My Aflex is set at 2, would increase Alex to 3 help my CO2? But I also have many CAs; if my CO2 is high, then why so many CAs?

I think it is time for you migrate to ResMed but ..  

If this is one of your best setting configurations and you have not yet tried A-Flex 3 with it then YES.

Also, with Pressure Min-Max set so tight you are really using the machine as a CPAP rather than an APAP.  So you should also for a few nights switch the machine to CPAP mode at Pressures 11 to 13 and try C-Flex+ at 2 and 3.  

C-Flex+ has received better reviews than A-Flex.

WillSleep

So the sleep doctors just care about AHI/RDI, and don't care about anything else like blood CO2 level, esp./insp time, tidal volume, etc.

Also, the blood CO2 level was for day time; does that mean I have some kind of lung disease or daytime breathing disorder?
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#25
RE: Have tried 4 different nasal and/or nasal pillow masks. All leak crazy.
(10-22-2019, 10:17 PM)ChinaMan Wrote: So the sleep doctors just care about AHI/RDI, and don't care about anything else like blood CO2 level, esp./insp time, tidal volume, etc.

Well I think they care a lot about all of it.   It is just very uncommon to find patients that have the kind of detail we use here or knows that his/her CO2 level was low today.  

The AASM & Medicare protocols they were trained and continually reinforced to follow point the very dull instrument of AHI of 5.0 represents a "Treated Patient, unless they keep complaining and failing the ESS, etc."  
https://aasm.org/clinical-resources/prac...uidelines/  


AHI is the simple common reference / the 'handle' the doctors, DME, Medicare and private insurance can all grab onto to talk about treatment.  

Even the default overnight sleep study prescription is horrifically soft for someone with mostly health lungs  (~Titrate until you reach AHI of 5.0 and SpO2 of at least 90%).    

I think they care alot.  What we are seeing is just in-efficiencies in the health care ecosystem. 

WillSleep

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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