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Very High Leak Rate
#1
Hello, I've had my machine just over 2 weeks; the first few days were great - I slept really well, with good AHI but had leakage in my mask.  I switched to size small AirFit 10 and thought that would help the leaking. Leaking still in the 70's.  Now the last few days sleepyhead shows many "sessions" per night, leakage in the 70's , I'm rarely at pressure according to the graph; AHI is 0 but I'm sure that is not accurate.  I've tried all the mask adjusting hints I've read on here.  
What should I do?  The machine obviously isn't doing me any good at these readings.
Can someone tell me how to copy in my sleepyhead data?
Thanks!
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#2
This is where we would like to see your SleepyHead charts. You don't have 4 posts yet so just break up your imgur.com url and post that way. See my signature. Include your leak rate chart.

My first guess is you are mouth breathing.

Why are you saying mask leakage
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#3
You have a bilevel Resmed S9 VPAP-S at 23/19, which is pretty impressive pressure. Mask fit is going to be important for you to get right at that pressure. How did you end up with such high pressure settings? Do you think the fit could be improved if you stabilized your head position some? Do you know if leaks are coming from a specific part of your mask or if your mouth opens below the mask?
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#4
My sleep study was very bad. I haven't been able to get ahold of the actual results; but they were concerned enough that they had the dr read it immediately and I picked up a machine that very day. (small town - usually results are read, then sent to family dr to get the machine prescribed, usually running a week or more before machine can be picked up)
I most definitely mouth breath; seems like most of the leakage comes from around the lower perimeter of the mask.

the first few nights with the medium mask, it made like burping noises around the lower mask; after I changed to the small mask, its like air is blowing out all around between my face and the lower part of the mask. I figure because of the high pressure; cause it seems to be okay while it is ramping up.
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#5
Grmat10, I have a suggestion for you to try. Get a soft cervical collar at your local Walmart or drugstore. These are not the ones you see used by paramedics, but are soft cloth covered foam collars 2-3/4 or 3-inches tall that wrap loosely around the neck. They are also available online, and many cost less than $10. I think this may do two things for you. First, it will help to keep your chin from tucking toward your chest which is a leading cause of having your airway obstructed, and probably why your pressure is so high. It also applies soft pressure to your jaw to help keep your mouth closed, and can greatly reduce leaks. I hope you will try it.

I have a question about your machine. The S9 series was replaced by the Aircurve 10 nearly 2-years ago. Did your DME give you a used or left-over machine? Not a surprise, just curious if you're aware. Also, do download SleepyHead. Once we get the leaks and head position under control, I think you might be able to tolerate some lower pressures, and we're going to want to see the data.
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#6
I will find a collar on amazon and get it ordered (we live far from "stores").
I have a "dr dakota stop snoring" collar I bought a few years ago, I will try it until the new one gets here.
My machine says VPAP ST on the top, the DME said it was a new machine.
Do you think its not the newest version?
Also, I downloaded sleepyhead and imported my data yesterday. I don't know how to get the info on here, and what info would you want?
Thanks for your suggestions.
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#7
Okay, I think I attached 2 screen shots of different views in sleepyhead.
I am assuming the days of no AHI were because of the extreme leakage.
Thanks for any comments, or if you need a different view, let me know.


Attached Files Thumbnail(s)
       
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#8
Thanks for your follow-up and the data.  Very helpful.  The fact you have a VPAP ST is important information.  That should be included in your profile.  As I guessed, your machine is running in VPAP-S mode. Let me explain.  The VPAP ST is a specialized and expensive machine normally prescribed for individuals with obstructive sleep apnea and usually restrictive pulmonary conditions or hypoventilation.  This macine in ST mode provides for both spontaneous breathing and automatic spontaneous and timed breathing.  This ST mode is for patients that may have central apnea or do not take breaths "spontaneously".  In VPAP-S mode, this machine works just like a regular bilevel machine and does not provide timed breaths.  Basically you have a machine that costs upwards of $5000 and are using the features of a $1600 machine....go figure.  Dont-know  All I can say is you would be a lot more comfortable with an auto-bilevel like the Aircurve 10 VAuto than this expensive ST.  The S9 VPAP ST was recently replaced by the Aircurve 10 ST, so your machine is not exactly outdated, but the replacement has been around a while.  And I'll just say the machine selection makes no sense at all.

You have a high leak rate, and we'd like to get that fixed, meanwhile you have no events whatsoever, and other than leaks, your respiratory results look outstanding.  Your settings are 23/19 over PS 4.0 meaning your inhale pressure (IPAP 23.0), minus exhale pressure (EPAP 19.0) equals the pressure support (PS 4.0).  If you are interested in sleeping better, and lowering leaks, we can try lower pressures and see where events like apnea become a factor.  We would simply start reducing the pressures and watch the results in Sleepyhead.  In other words, we can manually do what an auto bilevel machine would have done for you. Since March 1, your sleep has been very fragmented, and whatever changed at that time was really disruptive.

I'd love to hear your doctor's rationale for prescribing a VPAP-ST.   Is that actually on the prescription, or was that the DME's idea? If you don't have it, ask your doctor's office to send you a written copy of the prescription. I could be very wrong, but something doesn't look right.
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#9
(03-10-2017, 10:19 AM)Grmato10 Wrote: I will find a collar on amazon and get it ordered (we live far from "stores").
I have a "dr dakota stop snoring" collar I bought a few years ago, I will try it until the new one gets here.
My machine says VPAP ST on the top, the DME said it was a new machine.  
Do you think its not the newest version?  It is NOT the newest version. The newest version is the ResMed Airsense S10 Auto. (I missed the ST)
Also, I downloaded sleepyhead and imported my data yesterday.  I don't know how to get the info on here, and what info would you want?
Thanks for your suggestions.
  Nice job on the SleepyHead data,  but let's tweak some details.  
Attachments are limited on the forum for use IMGUR.COM and open an account there.  
Drag your screenprints to your IMGUR page then
click on the image and select Large Thumbprint and click the "copy" button for "linked BBC code" and Paste that in your post.
Look at the "Organization" link for the data because as you guessed, all data is not the same.  

Please read the Mask Primer (see my Signature) since the first problem to solve is your mask.

At the bottom of the Mask Primer are fitting guides,  download the one for your mask and see if you have the right size.  Size definitely makes a difference.
Any chance the mask is too tight?  It is common to over-tighten a mask.
New to Apnea? Helpful tips to ensure success
Including Understanding Sleep Apnea, New to Sleep Apnea-the process, Rx, Machine Choices, Optimizing Therapy, SleepyHead, posting charts, more

Mask Primer
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#10
This is the current model for VPAP ST http://www.resmed.com/us/en/consumer/pro...10-st.html

This is what I think you should be using http://www.resmed.com/us/en/commercial-p...vauto.html
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