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Respironics no leak; Resmed huge leak
#21
RE: Respironics no leak; Resmed huge leak
I don't think leaks have changed much, but the large leak threshold on the Resmed is clearly lower.  In spite of that, the flow rate chart remains well-defined and your tidal volume is roughly the same, accounting for the loss of pressure support.  I will compare these charts below.  With respironics, your unintended leak rate averaged 18 L/min which is just below the 24 L/min threshhold used for the Resmed. The total leak appears to average 60, and the 95% is at about 70 L/min.  If we= subtract the Resmed "allowed" leak of 24 L/min, you would be in large leak most of the night (60-24=36 L/min).  So I don't see these two charts as reporting significantly different results, however the charts are projected on very different scales.

I think you need some work on leaks, and I think these leaks are from your mouth rather than a mask leak.  You may need a chinstrap, cervical collar or full face mask to resolve this.  The leak is habitual and occurs all the time, so I think you need to start looking a FFM alternatives.  Both charts show good efficacy of treatment.  I don't think you needed a new sleep study at all, but I'm sure someone got to make a boat payment, so it all works out.  If you were more comfortable on bilevel, then setting your Autoset CPAP to 11.0 pressure with EPR at 3, I think you would be much more comfortable, and will continue to realize good results.  You could even use the Autoset mode, although your results are fine in CPAP.  Good luck with the leaks. I think you need a new full face mask or hybrid.

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Sleeprider
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#22
RE: Respironics no leak; Resmed huge leak
(11-13-2017, 10:19 AM)Walla Walla Wrote: TBX, Actually both machines track large leaks. On the respironics it's shown on the machine display as Mask fit. In the ResMed you get the famous frowny Face. The data that sleepyHead uses to show large leaks does come from the machines.

sc4922, Here's the problem with just going by Respironics total leaks. The machine may keep up with the leaks but if all the pressure is going out your mouth how effective is the treatment your receiving?

I myself go by the sleepyhead 24ml redline which is based on Resmed's measurement. I think the guideline given the SleepyHead Guide here is a good one. Try and keep leaks below 10% of the Redline.

Thanks again for the help.  My understanding is that the total leak number for Respironics includes mouth leaks--the machine measures all of the leaks from the system, including mouth leaks and intentional mask venting.  The Respironics engineers appear to have concluded that their machines can compensate for total leaks (whatever the source, including mouth leaks) of up to 70L/m, which is the large leak threshold and which I rarely exceed.  If the machine can compensate for mouth leaks and produce an accurate and low AHI number (which in my case is typically below 2 on the Respironics machines), then I don't care about mouth leaks so long as they don't wake me up, which they don't.  Up until a few days ago, I had no experience with Resmed machines, but it's hard for me to believe that the leak compensation features of the Respironics machines are so much better at dealing with leaks.
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#23
RE: Respironics no leak; Resmed huge leak
Well than your choices are either go back to your old machine or buy a DreamStation Auto.

Than you can live happily ever after with your mouth leaks. 

Big Grin
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#24
RE: Respironics no leak; Resmed huge leak
(11-13-2017, 01:04 PM)Walla Walla Wrote: Well than your choices are either go back to your old machine or buy a DreamStation Auto.

Than you can live happily ever after with your mouth leaks. 

Big Grin

Thanks again for your time and your patience.  I've lurked on this board and other apnea boards for years, and I can usually find the answers to my questions by searches, but this one stumped me.  Personally, I'm not as focused on having a really low leak rate so long as the leaks aren't materially affecting the therapy and aren't waking me up.   So long as the AHI is accurate and low, I'd rather have mouth leaks than use the options for preventing them.  I know others may have a different opinion.  And I may ultimately buy a DreamStation.
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#25
RE: Respironics no leak; Resmed huge leak
(11-13-2017, 10:49 AM)Sleeprider Wrote: I don't think leaks have changed much, but the large leak threshold on the Resmed is clearly lower.  In spite of that, the flow rate chart remains well-defined and your tidal volume is roughly the same, accounting for the loss of pressure support.  I will compare these charts below.  With respironics, your unintended leak rate averaged 18 L/min which is just below the 24 L/min threshhold used for the Resmed. The total leak appears to average 60, and the 95% is at about 70 L/min.  If we= subtract the Resmed "allowed" leak of 24 L/min, you would be in large leak most of the night (60-24=36 L/min).  So I don't see these two charts as reporting significantly different results, however the charts are projected on very different scales.

I overlooked your post; thanks for the response.  I'm not following your math.  The Respironics Sleepyhead chart shows a median total leak of 51L/m.  To get the amount of the median unintended leak rate, you'd deduct the intended mask leak from the total leak of 51L/m.  On the night reflected in the chart, I was wearing a Resmed Activa nasal mask, which, according to the info that comes with the mask, has an intended leak of about 34L/m at a pressure of 11.  So the median unintended leak for that night was about 17L/M (i.e., 51L/m total leak - 34L/m intended leak), which is 7L/m less than the 24L/m redline for the Resmed machine.  But the Resmed Sleepyhead chart is showing a median unintended leak rate of 34.8L/m, which is more than double the median unintended leak rate of the Respironics machine.  That is the mystery.
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#26
RE: Respironics no leak; Resmed huge leak
full disclosure: I am a data-nerd AND leak-nazi. So it might be best to just ignore this.

First of all: you had different settings on the Philips and the ResMed. Bi-PAP 7-11 with PS 3(?) does not mean: take the vent rate from the upper range and substract it. The vent rate is highly pressure dependant. The best you could do would be: take the (real) average of the mask pressure and use that for the vent rate.
Next thing: a constant pressure all the time most likely results in different leaks as (real) Bi-PAP would cause.
and don't forget: leak rate determination is more like guessing than actual measuring.

As said - I am a leak nazi.
Your machines believe that your tidal volume is around 320-360 ml .... I somehow have my doubts believing that. (no, not doubts - I just looked at your flowrate at the beginning and the end - which where the only part with no leak besides some other very short parts - and guessed your (normal) tidal volume based on that^^)
I don't know anything about how philips regulates the pressure - but the EPAP-curve looks very odd to me.
If I look at the ResMed mask pressure chart - even given your resp. times - I also have a really hard time believing that this shows "normal operation" - that looks more like EPR 1.
Or in other words: your machines cannot even keep the pressure steady.

and as I have a FFM and no experience at all with mouth leaks and nasal masks: I really can't imagine how the pressure from the device should be in your airways? If such amounts of air can flow right out your mouth, I really see no way there is any pressure at all below your upper airways - or even in them. (the machines do measure the pressure right in the device - which means: that pressure builds up before your nose - which is the smallest passage in that system - after that it is: just 'open water')

That the AHI is low is no "wonder" - there simply is nothing to measure at all^^ although the hypopnea and RERA "detection" on the philips is quite funny - given the circumstances.
Given the very short time with no or not that much leak on the ResMed it flagged a lot of events^^ - (that must be around AHI of 6-12? ... you had maybe like 30 minutes with really acceptable leaks for accurate measurement)


@walla walla: I was talking only about the grey-areas - that is the large-leak flag. That does not come from the ResMed-Device - that is SH (according to whatever you set as the red-line)!
In contrast: my device does set that flag by itself. It does not matter what I set the red-line to. (but my device does not greet me in the morning with a smiley^^)
I don't have to guess at what point my machine is trying to tell me: "and from this point on you are on your own." - It tells me that very clear.
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#27
RE: Respironics no leak; Resmed huge leak
what mask

same here
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#28
RE: Respironics no leak; Resmed huge leak
TBMx,
           Your right about the shaded area in sleepyHead. But I don't concern myself with the shaded area I pay attention to the numbers in the statistics box. Those are from the machine.

      If I just used the shaded area in the event charts to track large leaks I could fix that problem quickly. I'd just turn off the Large Leak flag. Voila no more leaks.      Laugh-a-lot
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Membership in the Advisory Members group does not imply medical expertise or qualification for advising Sleep Apnea patients concerning their treatment.



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#29
RE: Respironics no leak; Resmed huge leak
(11-14-2017, 09:05 AM)Walla Walla Wrote: But I don't concern myself with the shaded area I pay attention to the numbers in the statistics box. Those are from the machine.

I have to admit that leak is one value where I am unable to make anything out of the statistical data. I tend to wake up very soon to leaks - although not very small ones - totally annoying.
Having an average or median leak of 1 liter per minute tells me exactly nothing for an 8 hour sleep. That can be some quite long time with very minimal leak (which does not concern me at all) or some very large but short leaks (which do not concern me either) or some medium leaks (which are the ones that actually do concern me).
Minimum and maximum are meaningless for me - in most nights there is at least one moment where I take of the hose for coughing or I put away the mask and forget to turn off the machine.

But maybe I am just reading those values the wrong way.

I simply put the red line to my personal pain barrier and look at everything above that.
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#30
RE: Respironics no leak; Resmed huge leak
(11-14-2017, 05:55 AM)TBM Wrote: and as I have a FFM and no experience at all with mouth leaks and nasal masks: I really can't imagine how the pressure from the device should be in your airways? If such amounts of air can flow right out your mouth, I really see no way there is any pressure at all below your upper airways - or even in them. (the machines do measure the pressure right in the device - which means: that pressure builds up before your nose - which is the smallest passage in that system - after that it is: just 'open water')

Thanks for the detailed response.  I've lurked for years in the forums, and I know that there is a disagreement on leak management among the people who populate the apnea forums.  Some believe that you should strive to get leaks as low as possible; others believe that leaks are acceptable so long as they don't cross the line into large leak territory as calculated by the machine and don't wake you up or cause other adverse consequences. I fall into the later category.  Unlike many people, mouth leaks don't wake me up or cause excessive dry mouth or congestion.

As I understand it, CPAP machines function like a closed, pressurized system.  A leak anywhere in the system will cause the pressure in the system to go down, and the machine software simply detects these leaks but cannot distinguish among them--a leak is a leak is a leak regardless of whether the leak results from mouth breathing, an unintentional leak at the mask, or intentional mask venting.  Up to a certain level (which is different among the different brands of machines), CPAPs can compensate for these leaks by increasing the pressure to keep the airway open.  So, like any other leak, if you have air leaking out of your mouth, the machine can compensate for that depending upon the volume of the leak; the volume of mouth leaks can vary and if the mouth leak is so large that the pressure in the system is greatly reduced, the machine would detect that as a very large leak.  If the mouth leaks significantly exceed the machine's threshold for large leaks, therapy would be impacted and the machine's AHI numbers might be inaccurate.  

So why are there such significant differences between my Respironics machine (which shows no large leaks) and my Resmed Autoset (which shows massive large leaks)?  I finally found an answer to that question.  The Respironics machine is just much better at compensating for leaks and can maintain adequate therapeutic pressure even in the presence of total leaks of up to 70-80L/m (which appears to be the large leak threshold for my Respironics machine) or more.  On the other hand, the Resmed machine evidently can't deal with unintentional leaks that exceed 24-35L/m.  I wish I'd know that before I bought the Autoset, which has proved to be an expensive mistake.

The results of my recent sleep study seem to confirm that mouth leaks aren't a big problem for me.  I was successfully titrated with a nasal mask, and neither the technician nor the sleep doc mentioned anything about excessive mouth leaks. 

So from now on, I will just use a Respironics machine and won't worry about large leaks unless the machine flags them or they cause other adverse consequences.   

Thanks again for taking so much time to respond to me.
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