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ResMed Tech Support and DME, Good Grief
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Marnid2014 Offline

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Posts: 187
Joined: Mar 2014

Machine: ResMed S9 Elite
Mask Type: Nasal pillows
Mask Make & Model: P10 & Circadience Advance Cloth Mask
Humidifier: H5i
CPAP Pressure: 4
CPAP Software: ResScan SleepyHead

Other Comments:

Sex: Female
Location: Florida

Post: #11
RE: ResMed Tech Support and DME, Good Grief
(04-01-2014 12:32 PM)becker44a Wrote:  
(04-01-2014 12:05 PM)Marnid2014 Wrote:  What really got to me was the fact that the ResMed people were so upset that I even have the software and the DME did not like it as well.

I had a similar experience with a Respiratory Tech at my DME. She started to lecture me about changing pressure . . . "You'r not even supposed to know how to do that." Started acting like the pressure settings were handed down on stone tablets. This was ludicrous, because she was the one who had earlier requested my Doctor (GP not Sleep Sp) for an increase, and he just changed it from 10 - 14, up to 10 - 20. And then she put in the change.

This is just a turf war, and they want you to be ignorant, because then you are easier to control.

By the way, you may want to complete your profile, so people can help you better (currently indicates you'r not using software).

Good luck and stand your ground.


I just added it, thanks. I use both Sleepyhead and ResScan. I am trying to figure out how to open the additional charts that are in ResScan?????
04-01-2014 01:29 PM
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robysue Offline
Wiki Editor
Advisory Members

Posts: 1,245
Joined: Oct 2013

Machine: PR Dreamstation BiPAP Auto
Mask Type: Nasal pillows
Mask Make & Model: Swift FX
Humidifier: PR Dreamstation humidfier
CPAP Pressure: min EPAP = 4; max IPAP = 9;
CPAP Software: SleepyHead EncoreBasic EncorePro

Other Comments: Papping since September 2010

Sex: Female
Location: Buffalo, NY

Post: #12
RE: ResMed Tech Support and DME, Good Grief
(04-01-2014 12:05 PM)Marnid2014 Wrote:  I have a very small face so these masks are very hard to fit me. The nano is coming up to my eyes and almost to my lips, so I am not sure that this will work.
What size cushion did they give you? The nano is really one of the smallest nasal mask interfaces on the market.


Quote:I think the point was that my first mask was giving me the scores that were within range of even below normal leaks, like 7 and raising that pressure did make those leaks MUCH worse. I just think I am going to have to go back to that pressure and see if I can see it go back down. If that happens, then I have the right mask and pressure as long as my AHI is low as well.
I'm a bit confused.

What is your titrated pressure---the pressure that the doc (and DME) WANTS you to use?

Almost any mask can be made to work at almost any pressure, but the way you fit a mask at higher pressures is NOT the same as the way you fit it at lower pressures.

Are you fitting the mask at the beginning of a ramp period at the beginning ramp pressure? And then the leaks start once the pressure increases up to where it's suppose to be? The answer to that problem is to figure out a way of fitting the mask at full pressure.

It helps to fit the mask when you are lying down in your sleeping position AND with your full pressure coming from the machine.
04-01-2014 01:34 PM
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robysue Offline
Wiki Editor
Advisory Members

Posts: 1,245
Joined: Oct 2013

Machine: PR Dreamstation BiPAP Auto
Mask Type: Nasal pillows
Mask Make & Model: Swift FX
Humidifier: PR Dreamstation humidfier
CPAP Pressure: min EPAP = 4; max IPAP = 9;
CPAP Software: SleepyHead EncoreBasic EncorePro

Other Comments: Papping since September 2010

Sex: Female
Location: Buffalo, NY

Post: #13
RE: ResMed Tech Support and DME, Good Grief
(04-01-2014 01:29 PM)Marnid2014 Wrote:  I just added it, thanks. I use both Sleepyhead and ResScan. I am trying to figure out how to open the additional charts that are in ResScan?????
There are no additional charts in ResScan that are NOT easily available in SleepyHead. Indeed, the default charts shown in SH include some charts that are hidden from the standard user in ResScan.
04-01-2014 01:35 PM
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Marnid2014 Offline

Preferred Members-2

Posts: 187
Joined: Mar 2014

Machine: ResMed S9 Elite
Mask Type: Nasal pillows
Mask Make & Model: P10 & Circadience Advance Cloth Mask
Humidifier: H5i
CPAP Pressure: 4
CPAP Software: ResScan SleepyHead

Other Comments:

Sex: Female
Location: Florida

Post: #14
RE: ResMed Tech Support and DME, Good Grief
(04-01-2014 01:29 PM)robysue Wrote:  Marnid,

First things first: Let's talk about those leaks of yours. I think that you may be making a mountain out of a mole hill.

You write:
(04-01-2014 10:00 AM)Marnid2014 Wrote:  I found out that my leak rate has been pretty high. I called ResMed and told them that the ResMed software was showing the following:

Pressure 8
Median 8.4
95th % 28.8
Maximum 33.6
AHI 0.5

Night before

Median 10.8
95% 34.8
Maximum 38.4
AHI 0.2
and
Quote:IF I did not have it I wouldn't know about these leaks in the first place, I would merrily go along thinking that when I look at the machine in the morning and it has a happy face and say's AHI less than 5 I am good to go. She replies, "I get your point" and your leak rate is high, because for 95% of the night you were at 28% which skews the AHI. It is a false reading.
and
Quote:I am claustrophobic so I hear about the the new P10 mask and they bring it to me. It's wonderful, low profile, and I am in heaven HOWEVER my leak rate is up above the red line again for 95% above 30 or so.
You and the people at Resmed and the DME who are trying to help you all have some serious misconceptions about the leak numbers gathered by your machine and it's time to work on setting that straight.

First: The leak rate is measured in liters per minute, not %'s of anything. The Resmed machines report only the excess, unexpected leaks, and so an "ideal" leak rate would be 0.0 L/min all night long. Resmed also defines an official Large Leak as any leak that is AT or ABOVE 24 L/min. But there's more to evaluating how bad a Large Leak is than just its size---the length of time you spend above the red line at 24 L/min is also important. A few short lived Large Leaks here and there are usually nothing to worry about; long periods of time where the leak rate is AT or ABOVE 24 L/min are what you need to worry about.

It's also important to understand that most people don't have ideal leak graphs, and, quite frankly once your leaks are "good enough" there's little point in trying to eliminate the last little bit of leaking if the leaks are not waking you up.

Next: The median and 95% leak rate numbers are statistical numbers with very specific meanings. For a lot more detail on the statistical meaning of these numbers and how they're calculated, see my blog entry Average, Median, 95% numbers: A guide to those who don't remember their introductory stats.

Recall that on one night's data, the leak rates in Resmed were reported as:
Quote:Median 8.4
95th % 28.8
Maximum 33.6
A median leak rate of 8.4 L/min means that for 50% of the night your leak rate was AT or BELOW 8.4 L/min. And for 50% of the night your leak rate was AT or ABOVE 8.4 L/min. Since 8.4 is well less than the RedLine at 24 L/min, we can conclude that for at least half of the night, your leaks were small enough for the machine to compensate for.

A 95% leak rate of 28.8 L/min means that for 95% of the night your leak rate was AT or BELOW 28.8 L/min. And for 5% of the night your leak rate was AT or ABOVE 28.8 L/min. The 95% of the night your leaks were AT or BELOW 28.8 L/min includes the 50% of the night that your leak rate was AT or BELOW 8.4 L/min. So we now know this:
  • For 50% of the night your leaks were AT or BELOW 8.4 L/min.
  • For 45% of the night your leaks were possibly above 8.4, but they were also AT or BELOW 28.8 L/min.
  • For 5% of the night your leaks were AT or ABOVE 28.8 L/min.

Since your 95% leak rate is not much above the RedLine at 24 L/min, it is reasonable to conclude that for most of the night your leaks were actually below 24 L/min. We then add in the fact that you report seeing Mr. Green Smiley Face in the morning. Mr. Smiley Face shows up when your so-called 70% leak rate is BELOW 24 L/min. (In other words, the Resmed engineers are only concerned about Large Leaks being long enough to adversely affect therapy if the Large Leaks last 30% or more of the night.) Since Mr. Green Smiley Face showed up, we know that for 70% of the night your leaks were AT or BELOW 24 L/min and this includes the 50% of the night when your leaks were AT or BELOW 8.4 L/min. So we now know:
  • For 50% of the night your leaks were AT or BELOW 8.4 L/min.
  • For 20% of the night your leaks were possibly above 8.4, but they were also BELOW 24 L/min since Mr. Green Smiley showed up.
  • for 25% of the night your leaks were possibly above 24 L/min, but they were also AT or BELOW 28.8 L/min
  • For 5% of the night your leaks were AT or ABOVE 28.8 L/min.
So we know for sure that your leaks were LOW enough to not be official Large Leaks for at least 70% of the night, and again, because the 95% leak rate is only 28.8 L/min, it's quite possible that official Large Leaks made up much less than 30% of the night.

In other words, the upshot of all this is: Your leak rate numbers are not as bad as you think they are. That's not to say you don't have some problems, but they are in the "Something Must Be Done NOW!!!!!!" category either.

Consider: The sleepyhead data you post shows a long term median leak rate of 4.04 L/min. So for 50% of the entire time you've run your machine, the leaks have been AT or BELOW 4.04 L/min. That's pretty good for a long term median leak rate.

Consider: The sleepyhead data you post shows a long term 95% leak rate of 23.11 L/min. That means that for 95% of the entire time you've run your machine, the leaks have been AT or BELOW 23.11 L/min. Which also means that long term, your official LARGE LEAKS make up no more than 5% of the time you have used the machine. That's not great, but it's also not a disaster. Long term, your leak rate numbers are acceptable and 95% of your AHI data can be regarded as "reliable".

So how much should you worry about the leaks and what should you consider a "good enough" leak line?

Here's my definition of a "good enough" leak line for Resmed data: The median leak rate is no higher than about 5 or 6 L/min night after night. Mr. Green Smiley Face ALWAYS shows up in the morning. And the 95% leak rate is no more than 15 L/min on many nights and is SELDOM above 24 L/min. If it's above 24 L/min here and there, but Mr Green Smiley Face is showing up, prudent watching of the leak line might be in order, but you don't have to suddenly start working hard on "fixing the leaks" if the 95% leak rate is above 24 L/min now and then. (An increase in leak rates can indicate that your mask cushion might need to be replaced however.)

Now let's consider your mask issue. You write:
Quote:I am claustrophobic so I hear about the the new P10 mask and they bring it to me. It's wonderful, low profile, and I am in heaven HOWEVER my leak rate is up above the red line again for 95% above 30 or so.
Your 95% leak rate for the P10 mask is 30 L/min. That means that for 95% of the night your leak rate was AT or BELOW 30 L/min. The important question is this: How much of the night was the leak rate BELOW 24 L/min? If Mr. Green Smiley Face shows up, we know that for 70% of the night, your leaks are AT or BELOW 24 L/min.

It seems to me that your 95% leak rate with the P10 mask indicates that it is well worth the time and effort to figure out a way to make this mask work for you. To see how much work you have to do and what kind of work might need to be done, we need to see what the leak graph itself looks like---not just the leak numbers. Both SleepyHead and ResScan will display a leak graph in the detailed daily data if you download the data at least once a week. Can you post a leak graph for us to see?

With nasal pillows masks, leaks can be caused by a number of things. Sometimes it's as simple to fix as gently pulling the pillows away from your nose and allowing them to resettle against your nostrils. (For the P10 with its double cones, it's important that the pillows be fully inflated for the double cone seal to work correctly.) Sometimes playing with the headgear helps. While the headgear of the P10 is not directly adjustable, moving the straps apart or together will affect how tight the mask is at the nose. So play with that.

You also write about your leaks:
Quote:All this time, I am taping my mouth shut, so I know it is not mouth breathing.
Even with taping, air can leak out through the corners of the mouth. So sometimes the leak problem is mouth breathing/leaking even if you are taping. If that's the issue then you have to evaluate just how bad the mouth leaking is. If it's just a few minutes here and there a few times a night, that's one thing. If it's really large (above 24 L/min) for 2+ hours every single night, that's another thing. But the thing is: The median and 95% leak rate numbers are NOT enough to tell minor mouth breathing from major mouth breathing. You have to look at the leak line itself.


Quote:So end result is he gives me yet ANOTHER mask to try, this one being the nano, self sealing. So I am going to try it tonight on pressure 8 and then call them tomorrow after looking at my stats in the morning and then make them come out AGAIN and put the pressure down to 6, put on the p10 and see if that works with less pressure. The nano, I can tell is going to drive me nuts with my clostrophobia, but I will give it a shot.
If the problem is mouth leaks, the nano will have the same kind of leak problems the P10 has. If the problem is the nonadjustable headgear on the P10, you should try the Resmed Swift FX nasal pillows mask. It uses the same headgear as the nano, but the pillows are very similar to the P10's pillows.

Quote: He say's that I cannot change my own pressure that it is illegal to do so and Medicare will take my machine away.
The CPAP police won't come take your machine away if you are using it. But if you are adjusting your pressures without knowing what you are doing, you are likely to cause problems with the efficacy of your therapy. A great seal at a pressure that is too low to actually manage your OSA is really of no use to you. You will (eventually) have to find a way to maintain a decent enough seal on a mask you can tolerate at a pressure that is high enough to keep your AHI under 5.0.

Quote: Also, can anyone tell me how to get the graphs to display in the RedMed, I can only get overviews.
It's been a long time since I've used ResMed. But you do have to check a box that says to download all the data.

In SleepyHead, it's much easiser: Just switch to the Daily view for the data instead of the Overview or Statistics view. On a Windows machine, you should be able to make this choice in the RIGHT sidebar OR by going to the View menu at the top of the window.



YOU ARE BRILLIANT !!!!! How in the world do you know all this? I am speechless, they need you at ResMed really badly. Thank you so much. I am going to e-mail you my report in a zip file if you don't mind? I will send it to your inbox in a pm. I am not sure what all you need. THANKS so much. With all my drama recently with having the Afib diagnoses and a pacemaker, it's greatly appreciated. I find myself going to sleep worrying about leaks and with your information, I feel so much better. Hugs
04-01-2014 01:55 PM
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Marnid2014 Offline

Preferred Members-2

Posts: 187
Joined: Mar 2014

Machine: ResMed S9 Elite
Mask Type: Nasal pillows
Mask Make & Model: P10 & Circadience Advance Cloth Mask
Humidifier: H5i
CPAP Pressure: 4
CPAP Software: ResScan SleepyHead

Other Comments:

Sex: Female
Location: Florida

Post: #15
RE: ResMed Tech Support and DME, Good Grief
OOPS, forgot there is no way to upload a file in the pm window. if you would not mind sending me your e-mail I will send it to you. I thank you so much in advance.
04-01-2014 01:58 PM
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zonk Offline

Advisory Members

Posts: 7,908
Joined: Feb 2012

Machine: A10 AutoSet
Mask Type: Nasal mask
Mask Make & Model: Activa LT
Humidifier: Integrated /ClimateLineAir
CPAP Pressure: 9/13
CPAP Software: ResScan

Other Comments: CPAP since Nov 2010

Sex: Male
Location: Australia

Post: #16
RE: ResMed Tech Support and DME, Good Grief
Happy face indicate good mask fit, 70the percentile leak is less than 24 L/m. No problem as far as the machine goes but any leaks big or small that disturb your sleep is a problem need fixing. Number don,t always tell whats going on, need to see a single night chart
S9 score "unknown apnea" (shown in yellow color symbol) during high leak, cannot determine whether the apnea is obstructive or central

Personally I,m not bothered by leaks as long as not disturbing my sleep or comes near my eyes
04-01-2014 02:22 PM
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zonk Offline

Advisory Members

Posts: 7,908
Joined: Feb 2012

Machine: A10 AutoSet
Mask Type: Nasal mask
Mask Make & Model: Activa LT
Humidifier: Integrated /ClimateLineAir
CPAP Pressure: 9/13
CPAP Software: ResScan

Other Comments: CPAP since Nov 2010

Sex: Male
Location: Australia

Post: #17
RE: Questions from a new user
(04-01-2014 11:21 AM)Jchris Wrote:  1. Although my AHI levels are usually <5, my hypopnea events are always greater than my apnea events. Is this normal ? (I have complex sleep apnea and use Sleepyhead software)
AHI below 5 is normal while on PAP
What S9 are you using to treat complex sleep apnea
If you,re concerned about SO2 levels, you can get an oximeter
Post a new thread, many folks uses oximeter, they can recommend which one to buy and supported by SleepyHead
04-01-2014 02:38 PM
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ImaSurvivor Offline

Preferred Members-2

Posts: 322
Joined: Nov 2013

Machine: ResMed S9 Auto
Mask Type: Nasal pillows
Mask Make & Model: Swift FX
Humidifier: H5i Heated Humidifier, ClimateLine Tubing
CPAP Pressure: 10
CPAP Software: SleepyHead

Other Comments: Moderate Sleep Apnea, Began using CPAP 11/27/2013

Sex: Female
Location: New York State

Post: #18
RE: ResMed Tech Support and DME, Good Grief
Welcome to the forum Marnid2014. You mentioned your head is small and have trouble fitting masks. There are kids sized masks you might look into as well. Others have done that. Just a thought! robysue is VERY Brilliant! She is a mathematics professor at a university. She is very experienced with CPAP and a great deal of help.
04-01-2014 02:55 PM
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RonWessels Offline

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Posts: 465
Joined: Jun 2013

Machine: REMstar Auto AFlex DS560TS
Mask Type: Nasal mask
Mask Make & Model: ComfortGel Blue
Humidifier: REMstar Heated Tube DS6T
CPAP Pressure: 11 - 20
CPAP Software: SleepyHead

Other Comments: CMS50F Pulse Oximeter

Sex: Male
Location: Ontario, Canada

Post: #19
RE: Questions from a new user
(04-01-2014 11:21 AM)Jchris Wrote:  Hi All !

I have a few questions that I hope you will be able to help me answer.
Hi Jchris, and welcome to the Apnea Board Forum.

(04-01-2014 11:21 AM)Jchris Wrote:  1. Although my AHI levels are usually <5, my hypopnea events are always greater than my apnea events. Is this normal ? (I have complex sleep apnea and use Sleepyhead software)
2. Are there any risks when there are only hypopnea events ?
3. Is there a direct relationship between the number of hypopneas and SO2 levels ?
4. What immediate risks should be addressed as seen on the reports ?

1. An Apnea Event is the reduction of airflow by 80% or more. A Hypopnea Event is the reduction of airflow by 50% to 80%. So you can see that more hypopnea's than apnea's is certainly better than the other way around.

2. Even though a Hypopnea Event is only partial obstruction of the airway, it can still be a problem. However, with an AHI level (which includes Hypopnea Events) less than 5, you are considered sufficiently treated that there should be no issue.

3. Hypopnea Events, and to a greater extent Apnea Events, will reduce airflow to the lungs. Depending on the severity of the reduction, this will tend to reduce one's SpO2 levels. When I had my sleep study, they woke me up after an hour with an AHI reading over 100 and SpO2 levels down to around 80%. My treated AHI is consistently 1.0 or lower, and my SpO2 levels now always remain above 90%.

4. Based on an AHI value less than 5, there should be no immediate risks. In fact, you are considered fully treated. Depending on your personality, it would not be uncommon for you to tweak your treatment to get your AHI even lower, but as far as doctors are concerned, there's no point.
04-01-2014 03:31 PM
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herbm Offline

Preferred Members-2

Posts: 852
Joined: Jan 2014

Machine: ResMed AutoSet S9
Mask Type: Oral
Mask Make & Model: ResMed Airfit P10 Nasal Pillow
Humidifier: ResMed H5i
CPAP Pressure: 11-16
CPAP Software: ResScan SleepyHead

Other Comments: Backup Mask: Innomed Hybrid FFM -- Oral+Nasal Pillows

Sex: Male
Location: Austin, TX

Post: #20
RE: ResMed Tech Support and DME, Good Grief
Also consider the LENGTH of the events (most easily seen in SleepyHead).

If they are (almost) all at (or very near) 10 seconds that is way better than a bunch of 20-40 second events.

If they are isolated instead of being clustered then that is usually better also.

Practically everyone can hold their breath OCCASIONALLY for 10-20 seconds with no ill effects.

Sweet Dreams,

HerbM
Sleep study AHI: 49 RDI: 60 -- APAP 10-11 w/AHI: 1.5 avg for 7-days (up due likely to hip replacement recovery)

"We can all breathe together or we will all suffocate alone."
04-01-2014 03:40 PM
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