Very High Leak Rate

[Sleeprider]

Please ask her for the Resmed Aircurve 10 VAuto. An Auto bilevel machine is really what you want. It will do S treatment, but the Auto will let you enjoy a lower pressure for much of the night, and can automatically detect oncoming apnea and increase pressure to prevent it. With your very high pressure settings, an auto bilevel like the Aircurve 10 (the one I use), can let you set a lower range to the pressure, and still get good, if not better treatment.

Please feel free to show your supplier this post. You will benefit from an Aircurve 10 VAuto tremendously, because the pressure can be set to an IPAP max of 23 as your currently have, but the EPAP minimum can be set to 15 or lower with pressure support (PS) at 4.0. this will fully comply with your prescription, but provide a lot of relief from high pressure when you don't need it. The VAuto with these settings can deliver 19/15 to 23/19 automatically. It is the same billing code as the VPAP S. Please emphasize that you want the auto to give you some additional comfort! I'm sure your DME will agree it is appropriate and will arrange it. It's great that your DME provided the VPAP ST in order to get you faster treatment. If they will now get you the VAuto, you will have a much more comfortable and effective experience.

Good luck!

Tom

[trish6hundred]

Hi Grmato10,
Good luck to you in getting the machine Sleeprider suggested above.

[Grmato10]

Thanks so much for the explanation! I printed to be able to take with me Monday to talk to her!
I'm hoping for a good night tonight with adding the neck collar!!

[Grmato10]

Well, this shows the data from last night - the change I made was to wear a neck collar (actually an anti-snore collar until my neck collar comes)
http://imgur.com/GNtgMk5
I would really like to know your comments.
I just really don't think the 0 AHI is accurate?
How could it be with so much leakage.
I felt like I kept waking up a fair amount at the beginning of the night, and then from 4 on.

---

Oh, and the provider offered me a cloth liner for my mask to help stop leaks.
Shouldn't I want a better fitting mask instead?

[Sleeprider]

I think the results are as accurate as can be measured given the leaks. The machine will still detect apnea with the leaks, but can potentially miss hypopnea which is just a volume reduction. I still think we could try lower pressure. Much better continuity of treatment here. You might want to try switching back to your last mask cushion and see if that resolves some leaks.

[Grmato10]

I used the medium last night (which is what I used the first 5 nights on the machine); and then switched to small until last night.
Maybe I should try the small tonight.
How do I lower the pressure?
Thanks for looking at my data. I really think the neck collar helped alot - my order for the actual cervical collar should arrive Monday.

[Sleeprider]

We're not suggesting a medical cervical collar. A soft foam collar that holds your head in a good sleep position comfortably, and prevents the airway from closing is all that's needed. OpalRose knows about these. May be she can chime in.

Good luck getting the Vauto. I think that might be the best solution of all to let you sleep at lower pressure.

[Grmato10]

Well, I haven't posted anything for a few days. Here is last night's data:
http://i.imgur.com/EkhZaL4.png
Last night I did the "mask fitting" setting to begin with, so thats why there is no ramping up at the beginning of the night.
I also lowered the pressure to 20 for the higher number and 16 for the lower (for 3 nights now)
I have the "OTC soft foam cervical collar" which I've worn for 2 nights now. Its made a big difference in my mouth breathing. I don't wake up during the night with horrible dry mouth, so its really helped me to keep breathing through my nose. That alone is a big help.
I still have terrible leakage. One night I tried a liner made of soft cotton, it didn't change the leak rate, just made it quieter!
I haven't been able to talk to my equipment provider as she is out with the flu.
I talked to someone with the sleep doctor's office and told her my leakage rates. She was going to talk to the dr. and tech and see what suggestions they had.
I did find out that at my sleep study I had 104.9 events per hour. That seems hard to manage.
I will try to get a copy of my sleep study later this week to read it for myself.
Any suggestions on the next thing to try?

[Sleeprider]

I think it's time to try a different mask altogether. The F10 just isn't working for you. Events still look good, and the pressure reduction did not hurt anything. If you're sleeping better, you might continue to move the pressures down slowly until you see unacceptable level of events appear. Glad you found the OTC collar beneficial, even if it didn't resolve the leak. Do you think you might be able to use nasal pillows without the mouth leak? Sure would be easier to fit.

[Grmato10]

Thanks kinda what I was wondering - could I get away from the full face mask if the collar is helping the mouth breathing.
As soon as the equipment provider is back from the flu, I want to address that with her (There is only 1 person there, small town )
Thanks for your advice. The lower pressure is much more comfortable than 23!
Do you think the event count of 0 is accurate with such a high rate of leakage?
I seem to be awake longer before I fall asleep, but I've gotten way more sleep since I got on the machine than I have for years, so I may be getting caught up and not needing so much.