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Un-happy face sleep report
Experience: 18 years with CPAP at 15 cmH2O setting after Uvulopalatopharyngopalsty (UP3) surgery, full face mask with 10 foot hose and three clinical sleep studies. I use my machine every night and average more than eight (8) hours per sleep session.

I replaced my second machine, a ResMed S8, with a new ResMed Aircurve 10 Vauto last week and I was looking for some way to get rid of the un-happy face displayed on the sleep report for the mask seal. Since I started using the Bi-PAP with the lower pressure on exhale, I have not had a major mask leak (blowout). I have long suspected the added pressure of exhaling plus the constant pressure of 15 cmH2O from the CPAP was blowing the soft edges of the face mask seal outward, causing a leak and a lot of noise. The new machine came to me configured and set by the DME to 8 ccH2O minimum and 13 cmH2O maximum, as per my latest 2014 sleep study. The face to face with the new DME was with me using my 10 foot hose, since they did not have one in stock when I picked up the machine. These new pressures seemed to me to be too much pressure on inhaling and too little pressure on exhaling, compared to the ResMed S8's constant pressure. My sleep study doctor reported that I could not tolerate pressures greater than 13 cmH2O, even though I clearly have been at 15 cmH2O on two different CPAP machines for the past 16 years. I also noticed I was snoring a little (while still awake) on exhaling. I prefer a long hose, having pulled my machine off the bed side table more than once with the six foot hose, so I use the ten foot hose. The DME knew this because I told her and it is listed on the paperwork; “patient requests 10 foot hose”. I decided to check the hose type setting in the secret menu and found it was indeed set to slim line hose (6 feet), the wrong type hose. The slim line hose with its smaller diameter has a much smaller volume compared to the standard size 6 foot tubing, then add 33 percent increase for the 10 feet length. After I changed the setting to the correct hose setting, the resulting pressures are much more pleasant. I could not believe the difference. I am pretty sure the data for the first five days may very well be skewed because the machine was calibrated for the wrong hose. I had tried a new Bi-PAP two years ago but gave up after 72 hours because of these new wild pressures. I found my self hyperventilating, and waking up with my heart pounding. So after trying to work the S9 problem with the DME, I was told the technician required an appointment and the closest was two more weeks out. I returned the ResMed S9 and paid the month's rent, went back to my ResMed Escape S8; that is, until the S8's motor froze up on December 18th , 2016. The wild pressures on the new ResMed Aircurve 10 were the same as the pressures I experienced on that ResMed S9 back in 2014 before I changed the hose type configuration; but I had no choice, I was determined to use the new Bi-PAP machine and force myself to acclimate to the new pressures. I had been using my old Respironics Solo LX for the last forty-nine days and thankful it still works. Thank goodness that DME is no longer my provider. That company was bought out by another national DME provider back in December 2016. But when I requested a Medicare compliance report from my S8's memory chip from them, they told me they could not touch my machine until my AHP records were transferred and that I would have to wait. So guess what; I am not using them either since my Medicare advantage insurance company allowed me to use someone else. After all, it is my machine and my data, not theirs. The Aircurve 10 uses a standard memory card that I can read and upload via the card reader in my Dell computer and with the ResMed software link found on this site, I am up and running with my own reports. Love it!

I am still getting the red un-happy face for mask seal, and I am using a new hose and mask. But with my 18 years experience, I am sure the mask is fine and only leaking a little around the hose swivel connection and valve assembly, as always. Is there a mask seal threshold setting in the secret menu? Before I changed the setting, the only way I could get a happy face when running the mask fit adjust test was to disconnect the hose from the mask and completely close off the hose with my hand. Any ideas will be welcome. Joe
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could you please clarify machine settings?
Mode (fixed or auto)
PS (pressure support):

Be sure to download the free software SleepyHead which will give you much better feedback than MyAir or your machine.
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Forgot to mention, you can get a clinician manual by following the instructions here: http://www.apneaboard.com/adjust-cpap-pr...tup-manual

The "secret menu" is access by pressing the control knob and home button at the same time. You can set the mask type, but I don't think the leak threshold can be set there, but is settable in the software. For nasal pillows I know it is 24 L/min, and for full face I think about 30 L/min, but the allowable leak curves vary by pressure.

Let us know the mask brand/model you have. Check that the anti-asphixiaton valve is in place, and the mask has the proper connector, that is leak-free. The fact you can't get a fit seems like something is wrong.
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I already downloaded and installed the ResMed software and have it running with my data. I also downloaded the sleepyhead but have not installed it yet. The Sleep report on the machine display is a joke in my option. It literally tells you nothing but the total time of the sleep period. MyAir is not much better. I don't understand your reference to changing the mask leak via software. Will the ResMed software allow changing the clinical configuration? Or does it just figure out that the mask leak is bogus or dosen't display it in the reports.  Joe
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I downloaded the manual and for both the clinical and software. Still reading them. I am using the Quattro full face mask and yes the valve is in place. I would have no problem with a connector without the valve as I am confident I could remove the mask if the air stopped. These swivel connections have always leaked a little, some more than others. but with the bi-level pressures the exhaling pressure makes a great difference in leaks and noise. This is the best face mask I have ever used and have been using this model for two years. The DME has ordered a new version without the top connection to the headgear so I will try it out when it arrives.
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(02-02-2017, 04:00 PM)Joe Fox Wrote: These swivel connections have always leaked a little, some more than others. but with the bi-level pressures the exhaling pressure makes a great difference in leaks and noise.

I thought my swivel connector was leaking, then I realized there is a circle of tiny holes in the mask where the connector attaches where the exhaust (expiration) air apparently comes out.
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are you using fixed bilevel pressure of 13/8.0 over PS 5? That is a pretty big pressure support and can make you feel hyperventilated. You have a Vauto, so you can set a minimum, maximum and a pressure support, then let the machine sort things out.

In Sleepyhead, you can set the large leak threshold manually. I have not tried to do that in Resscan. I think you will find the SH software a lot more user-friendly and revealing since you can really zoom in on events.
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Interesting. I will go have a closer look at mine. I can feel the air escaping around the swivel, as it has on every mask I have ever tried. I would think this would be compensated for since it is a ResMed mask and ResMed machine. I can feel no air escaping from around the edges of the mask. With older masks I would have a hard time getting a seal and I would get a lot of leakage near the eyes, causing dryness.
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"...fixed bilevel pressure of 13/8.0 over PS 5? "  Not sure what PS 5 means but I am fairly sure the minimum pressure is 8 and max pressure is 13. I wanted the DME to set it higher as the machine is supposed to auto adjust up to the max but you know how it is. They will not set it outside the doctor's orders. Before I start changing things myself, I need to learn a lot more about the settings and what they do. Also learn how to and what to interpret from the reports. I plan to measure the pressure [at the mask] with the 10 foot hose and the hose selection on slim line to see exactly what it is. I believe the pressure was higher than 15 and the lower pressure was lower than 8 with the wrong hose selected. The hyperventilation was breathing in the higher pressure without controlling my breathing. I plan to talk to the DME about measuring it.
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If you can load your data in to SleepyHead and organize it as shown in the first link in my signature, then post it as described in the second link, I can give you all your answers.
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