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New to Bipap, 4 years on Cpap
#11
(01-31-2017, 05:00 PM)Sleeprider Wrote: Leaks are pretty bad.  The fact you say the Simplus or Amara masks could not stay connected to the hose has me wondering if you have left a plastic connector in the hose-end.  When you remove the mask from the hose, the end of the hose should have a 22 mm soft rubber connector.  If there is a hard plastic piece there, remove it.  That would be a mask connector, and it would explain the inability to remain connected or high leaks.

The DME examined the heated hose, and tried another heated hose and it too was real loose with both the Simplus and Amara, you could stretch the end of the hose with your fingers. So she gave me an unheated hose which I am using with the Mirage Quattro. It has stayed put. 

The leaks unfortunately continued. I lowered the pressure from 25 to 20 to 19. The pressure will pretty much stay at 19 or 20 most of the night, same pressure the sleep study came up with.
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#12
Here is what I see. AHI is low, but the machine is not going to be able to detect events over about 50% of the session due to extreme leaks.  You have a Vauto machine setup in VPAP Fixed mode at 16/19.  With the leaks being so severe,  I would change the machine to Vauto mode and specify Min EPAP at 12 Max IPAP at 20 and PS 3.  This will allow the machine to lower pressure when it's not needed, and you will see an increase when it is appropriate.   I see no reason at all for you to be at fixed pressure.

The biggest problem here is you have the wrong mask.  I have never heard of a hose not properly fitting multiple masks.  The fittings are standard...get a replacement heated hose because you were issued one that was defective.  You need to continue working to find where the mask leaks are occurring.  It's not like they only occur when you sleep, they start within a few minutes of starting therapy; however between 130 and 4:30 they are within reason in this graph.  Whatever happened there, you need to do more of it.  Mask liners can help some people but this looks like fit, or open mouth issues to me.

[Image: nZY4PRl.png]
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#13
Thank you Sleeprider!!!! DH was just wondering if the AHI could be right with leaks so high.

The sleep study recorded over 500 limb movements, so I think that activity level contributed to the hose sliding off. The material the heated hose was made of is different from the nonheated hose. The heated hose material is much softer and pliable, and the side load was too high for it to stay put. They did issue another heated hose, but it was just as soft. The mask tube that goes into the hose was also shorter on the Simplus and Amara Gel masks than on the ResMed masks, so the hose didn’t have far to slide before it was off.

I just went into settings and the machine is set on VAUTO, ramp shows on and the pressure settings are 18.8 and 14. Why would it be different on the SH data? Or is there another place to adjust the settings?
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#14
Sleepyhead does show you in Vauto mode, but pressure 16-19. You should enter the clinician menu and verify settings on the machine. Just push the control knob and home button at the same time, then enter settings.

Do a search for mask liners for your mask. They can help with comfort and fit. Since you do a lot of moving, look at ways to suspend the hose so that it moves with you and does not drag on the bedding. I simply hook mine to the headboard using a lanyard, but a "CPAP hose holder" or "Sleep buddy" may work better for you. I see the holder sells for $15 at Walgreens. Finally, a CPAP hose cover, can really add to comfort and will help prevent condensation since you're not using a heated hose. I recently bought one at Supplier #1 for about $12 plus shipping.

Good luck with all of this. Your main challenge is to deal with leaks and comfort. If AHI becomes more apparent once leaks are under control, we'll be glad to advise.
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#15
OK, thank you. I verified the VAUTO mode on the machine and will lower pressures. Will search for these items you recommend. I wonder if I am sleeping on the hose somehow that causes it to pull the mask away from my face, thus causing the leaks. I’m trying to remember to change position when the leaks wake me up enough that I am aware of them. I guess most anything is possible with all these variables.
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#16
Just back from a mask fitting with the sleep doc’s sleep tech. She took careful measurements and had me put on the DME issued small Mirage Quattro. I laid down and at just a pressure of 12, the leaking noises started and I was laying still. 

She then put the medium Amara View (where the DME started three weeks ago) back on me and had me lay down again while she gradually cranked up the pressure to 20/15. There were some leaks so she took another look at the mask and decided to try a large Amara View. Felt like all my nose was getting air in this one and the leaks were fewer. And her strap adjustments were way looser than mine would have been. 

She gradually cranked it up to 19 on a CPAP setting, which I guess meant a constant pressure of 19. She’s going to recommend to the sleep doc that he change the pressure to 19 CPAP. 

The difference in fitting from the DME was remarkable: careful measurements for various masks, tips on putting on the mask (like putting a coffee cup to your lip and tilting it back, as opposed to first placing the mask against the bridge of the nose then tilting it down to the chin as I had just done. She also noticed that the way I positioned myself on the pillow was causing the lower strap on one side to pull. She suggested I try to remember to pull the straps back down after I settle in. 

So tonight I’ll be trying the large Amara View. Somehow the steady pressure of 19 on a spiffy new Bipap machine seems a waste. However, as little as I presently know I guess I’m willing to try it. I wrote down the various measurements, which varied mask to mask, as a reference if I decide to try another mask down the road.

In the meantime, I will try your settings tonight Sleeprider. I do thank you again for your help. I’ll keep the board advised on how this goes. And I’m going to look for the hose strap.
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#17
One month since I started BPAP. Still battling leaks! The large Amara View that the sleep tech measured me for on 2-1-17, had loads of leaks. I went back to the Quattro Air for several nightstand  with somewhat fewer leaks. I gave the large Amara View with a liner and mouthguard, another go but same level of large leaks as 2-1-17. 

Mixed in was several nights with the medium Amara View.

Still no feedback from sleep doc on machine settings, especially the pressures. Finally just made an appointment, but that’s another week away.

Right now it is a toss up between Quattro Air and medium Amara View masks, but either is capable of large leaks, just fewer. I have been keeping the IPAP right around 20, AHI ranging from 1. 14 to 3.88. 

Tonight, I’m going back to my old CPAP brick pressure of 8-13. Just a test. I’m not getting much, if any, benefit from this BPAP therapy. I felt better with the brick, nasal mask and mouth breathing! Go figure! Will load a chart later today, but you can pretty much go with the last chart, there’s very little difference.

Should I just go with the medium Amara View or Quattro Air and figure the leaks will slowly improve? (The Quattro Air does run quieter than the Amara.) Try yet another mask, if so, recs? 

Here’s a link to the data from 2/8/2017, which was the large Amara View mask. http://imgur.com/a/LX5kk

As always, thank you.
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#18
Fabby, is your machine also recording the same AHI with these unclassified apnea? The leaks are better since your last visit. As far as duplicating what your old machine did for therapy, why not set minimum EPAP to 8 and Maximum IPAP to 13 and set PS to 0? It will be a little different than your old machine, but pretty close.
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#19
(02-10-2017, 04:00 PM)Sleeprider Wrote: Fabby, is your machine also recording the same AHI with these unclassified apnea?  The leaks are better since your last visit.  As far as duplicating what your old machine did for therapy, why not set minimum EPAP to 8 and Maximum IPAP to 13 and set PS to 0?  It will be a little different than your old machine, but pretty close.

Hey Sleeprider  - yes, the unclassified apneas are calculated into the AHI. I have the machine set for 8-13 tonight, PS 0. Going back to the medium Amara View mask. 

We were reviewing the last month’s data and I noticed how well the small Amara View did on minimal leaks the first four nights. So tonight I will try the medium AV I have on hand.

Thank you, I will report back on the night’s results tomorrow.
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#20
Nothing wrong with CPAP pressure, or auto CPAP. Bilevel is NOT for everyone.
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