[Diagnosis] At wits end with new machine and leak rates

[eok361]

        Hi,  
I just got a resmed airsense 10 a couple weeks ago, and having a real difficult time with leak rates. 

I've done all the standard attempts to alleviate it. Mouth taping, new ff mask (bust), 2 different mouthguards, v-com and last night, a soft cervical collar with a mouthpiece and the v-com. 

I am posting last night's results. A full night shot, and a zoomed in section of the worst of the leaking. 

I have a mask I have used for years (mirage micro) that my prior machine never flagged as problematic leaking. Now I got an n20, and the airfit 20 (the bust ff mask).

every one of them, including the mirage micro register major leaking, according to the as10 and oscar. 

does anyone have any clues? i'm beginning to think the resmed leak tolerances are way more sensitive than my last philips machine (560P system one). 

Any help would be greatly appreciated. 

Here are the screenshots.

[srlevine1]

I am curious...
Why are you in CPAP mode and not using the machine's auto-titrating capabilities?
Is the mask sized correctly?
Are your leaks around the bridge of your nose or lower?

[eok361]

I am on CPAP mode because after looking at Oscar I realized that my best sleep was right around 11 in the pressure setting. When I had it at 8-16 I was registering many more leaks, and what appeared to be bad machine markers (CA,H,OA, etc).

This is last night's data. I tried to really tighten up my lips before taping, and these were the results.

This section  was with the N20, v-com (at machine, not at the mask), and a soft collar. 

Interestingly, the card didn't register the first hour of the night, where I was wearing the FF mask. It was miserable. I was snoring enough to wake up my partner a couple of times. She said I was snoring really loudly. I don't know why the card missed it. I'm sure those numbers would have been awful.

If the minor adjustment I made in taping can keep the numbers like this, I'll be quite happy with them.

Thanks for asking.

[Sleeprider]

One more question, have you tried the EPR feature on your machine? It helps with flow limits and improves comfort for most people. I would recommend turning EPR on full time and experimenting with settings 1-3 to see what works and feels best to you.

[eok361]

I have not turned on the EPR. I don't know if having that on--in conjunction with the V-Com--would be counterintuitive. Plus, both of the CPAP youtube guys say it's a meaningless setting. 

I'm quite happy with last night's results. If the minor adjustment to taping is going to yield results like this, then I'll just keep the machine setup as it is.

Thanks for the reply.

[Sleeprider]

Well of course, no one is wrong on YouTube. Don't let the fact it makes your Airsense 10 a bilevel machine with limited 3-cm pressure support, or that it directly and quantitatively treats and improves flow limitations, hypopnea and RERA and dramatically changes the effectiveness of treatment for many users (but not all), get in the way of your internet confidence.

[Expat31]

Concerning the taping, make sure the tap is long enough to cover the corners of your mouth, that I have found is the weak point.

If that doesn't work, add another section on the tape on top of the first, just to see if it works..

I would suggest a 10cm wide tape to be on the safe side.

[eok361]

thanks.

[raylock1]

I have found a chin strap to be better than taping in my case.  I started out by using tape (wide) and then added a chin strap when that didn't work fully.  Later I removed the tape and just use a chin strap.  I use the ResMed type strap since it is thin, comfortable and holds well. The chin strap holds my jaw in place.

[Gideon]

The overall prevailing thought on the internet and many medical teams is that if it might, not will, cause central apneas, then don't use it. By this thinking please put your CPAP away because the simple use of a CPAP may, not will, cause an increase in central apnea. The same goes for any pressure increase, and it's by the same mechanism that may, not will, cause central apneas if EPR is utilized. Do realize that much of this same group feels EPR is safe during the ramp because they never see central apnea there. Care to guess why? Well the manufacturers do not report any events during the ramp simply because you are not at therapeutic pressure, and if it isn't reported, it doesn't exist right.

Here I agree with Sleeprider, the AutoSet with it's implementation of EPR is effectively a BiLevel that is limited to a max PS of 3 and typically is the best treatment for flow limits RERAS, hypopneas that you can possibly get short of a BiLevel and has enabled thousands of users to comfortably resolve their obstructive events without the need for a more expensive BiLevel machine. It is extremely effective.