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Need help with Aerophagia
#61
RE: Need help with Aerophagia
(06-01-2019, 06:45 PM)KallyA Wrote: Thank you for your response, Sleeprider.

Yes, using the cervical collar definitely reduces the large leaks with the Amara mask, where LL is defined as anything over 50 L/min. It seems like the machine responds well with leaks under this level. 

About the last charts posted, I was framing what appeared to be drops in pressure during high leakage from 22:25-23:15.  I was wondering if the ASV might be missing events during those times. There are no events shown at all during the times the pressure drops there. Here I will post the full night again, and then zoom into some two minute windows where the leaks are particularly high. Here is the full night:
 
The next two are from 22:48-22:50. I am not sure whether the ASV is showing accurate wave pattern here because we have fairly low pressure/high leakage/high respiration rate. What do you think? This is my main concern .. can you tell (or do you suspect) the ASV is unable to show events at this leakage rate? Is this what it would look like if it were missing events?

The ASV is showing approximately your median respiration rate and volumes in this segment and there are no gaps or pressure increases that would go with events.  This looks fine.

Quote:The next two are from 22:51:15-22:53:15 with an event. Though the leak rate is high, pressure is high/variable and the respiration rate has declined.  Here the ASV appears to be able to see the event in spite of the large leakage. This looks like a normal response from the ASV. Do you agree?

The ASV appears to be responding as expected here.  The zoom is not close enough to see the flow rate clearly. 
I have more to learn about breath rate, tidal volume, minute volume. In particular, I don't know what constitutes shallow breathing vs. normal. I see the breath much more constricted during A&H. I see a lot of breathing around 20 bpm in my charts. What does shallow and fast breathing represent?

Thanks ahead for your response. You've been very informative.[/quote]
Sleeprider
Apnea Board Moderator
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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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#62
RE: Need help with Aerophagia
Thanks for the info, Sleeprider
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#63
RE: Need help with Aerophagia
It looks like this thread has petered out, but I want to add a followup for those who may have followed it, or find it later.
I managed to get my leak level out of the 60 L/min range using the cervical collar. I highly recommend it!

As for the level of leakage that would affect the Aircurve 10 ASV's ability to respond appropriately, I called ResMed with my questions and was told nobody there knows the answers. They suggest I do whatever my doctor tells me (which was to let it leak). So I poured back through the literature looking for anything more about Vsync. Here is a little clip showing how Vsync works:
   
Upon close examination, you can see that when the leak starts, the pressure changes to compensate with a little bump up. The shape of the wave will change over the next few breaths as it "normalizes" that level of pressure. Wave forms in conjunction with your leak graph can tell you when this is happening.
Here is a pretty good illustration in my own data, where the mask pressure shows the bumps and these bumps are in sync with the leak increases.
   
All these leaks are above the 24 L/min range. Vsync seems to kick in at about that level, which may be why ResMed sets 24 L/min leak as the limit of what is acceptable. Below 24 L/min you are not dealing with Vsync. But it is there, it does kick in, and it does fine in this range. As long as you can see the Vsync bumps in your mask pressure chart, the machine has calculated the leak and compensated. 
Here is an example of what I see on my chart when the machine can't keep up ...
   
This is NOT me removing the mask or adjusting it. All graphs are blank for a bit before the machine kicks back in.
There may be other indications below this massive leak level that indicate the machine is not working well, as noted by other contributors previously.
Hope this helps others with a ResMed AirCurve 10 ASV and questions about leak.
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#64
RE: Need help with Aerophagia
Wow! I didn't see that coming. I think I'll bookmark this for possible wiki inclusion.
Sleeprider
Apnea Board Moderator
www.ApneaBoard.com

____________________________________________
Download OSCAR Software
Soft Cervical Collar
Optimizing Therapy
Organize your OSCAR Charts
Attaching Files
Mask Primer
How To Deal With Equipment Supplier


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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#65
RE: Need help with Aerophagia
Here is a related study I found helpful. It gives more info about how my ASV works as well as other machines. Some info I have not seen elsewhere. It is titled "Treatment of sleep-disordered breathing with positive airway pressure devices:technology update." from 2015. It includes ResMed and Respironics comparisons.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4629962/
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#66
RE: Need help with Aerophagia
There was no other advice I could give. You were doing the best you could and as I said. The doctor has the history and is treating you as a whole, just not a SD card. I think you will find that Vsync works up to 24 l/m of unintended leak. After 24 l/m the algorithm isn't able to accurately monitor and adjust to the unintended leak. If Vsync effectively controlled unintended leak above 24 l/m, they wouldn't have "EXCESSIVE LEAK. Leak is greater than 24 L/min. Adjust or change mask until leak fixed"
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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