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Big Leaks, and new machine issues - Printable Version

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Big Leaks, and new machine issues - BrickBreaker - 04-10-2021

So, thanks to some empirical observation and the use of OSCAR I realized a couple weeks ago that my ResMed9 was faulty and turning off periodically through the night. I got my ResMed10 just over a week ago, but am experiencing some issues (apparently!) due to leakage. (see attached image)

I also was set to a fixed pressure of 14.6 but the new machine is set to 12.6. Not sure how that's affecting my quality of sleep, but I know that I require a fairly high pressure, though I wonder if that was due to limitations with the machine (the ResMed9) when I got it? The sleep docs seemed to try with dynamic pressure a couple times, then just gave up and put me at the high static pressure when it seemed difficult to resolve.

So, what steps can I take to manage these huge leaks?

Is there a way for me to perhaps find a more suitable pressure for my machine?

Thanks in advance for all your advice!

RE: Big Leaks, and new machine issues - Sleeprider - 04-10-2021

I really don't see a good reason for your machine to be set to a fixed pressure of 12.6. With the Autoset, a range of pressures can be used to target your changing needs through the night. In addition, you have some pretty high flow limitations and you should consider using EPR to help with that. To learn more about flow limitation and how EPR helps, see this wiki http://www.apneaboard.com/wiki/index.php/Flow_limitation

Now, the elephant in the room is the high leak rate. You are in the market for a new mask or different size or model. That level of leaks precludes good therapy. In fact, if you were using Auto-Start the machine might shut down with leaks that large, and that may have been the problem with the S9. Check out the entire circuit, humidifier, tube and mask, and verify everything is intact, but it appears you need something different. What mask are you using?

Once you have leaks sorted out, get into the settings and set the machine to Autoset mode, minimum pressure 12.0, Maximum pressure 18.0 with EPR on Full Time at 3. That will give you more comfortable (for most) bilevel pressure with lower pressure on exhale. Here is a quick tutorial on settings: https://www.apneaboard.com/resmed-airsense-10-aircurve-10-setup-info

RE: Big Leaks, and new machine issues - BrickBreaker - 04-10-2021

Thank you so much for your advice and reply! I'll make those setting changes before bed tonight!

The mask I have is just the one the NHS gave me, I believe it's called Simplus. Also, I might need to tighten it slightly, and I have a short beard so that could be a contributor to the leaks, right?

Thank you so very much for your help!

RE: Big Leaks, and new machine issues - SarcasticDave94 - 04-10-2021

The Simplus, a full face mask made by Fisher and Paykel. I have this one and the newer Vitera as well.

Try this on strap adjustment:

  1. Lie back on the bed with mask held to your face but not strapped on just yet
  2. Holding mask in place turn on the PAP, regular sleep setting not the mask fit
  3. Add loose straps then start with bottom set, get them just tight enough to take up slack
  4. Top set next, same as before just take up slack
  5. The top of head strap needs loosened to allow you the next few steps...
  6. Lightly and straight up, pull mask slightly off your face and settle it further down your face, closer to your chin
  7. Check the nasal bridge area to minimize leaks, this seems to be the area you must check most
  8. Lock your top of head strap
  9. Edit tension on lower and top sets to minimize leaking, LOOSE fit is lots better, overtightened will never work out

Try this and see if it works better.

RE: Big Leaks, and new machine issues - Sleeprider - 04-10-2021

How old is your mask? The mask, cushion and headgear are all perishable and need periodic replacement

RE: Big Leaks, and new machine issues - BrickBreaker - 04-10-2021

I think it's about 5 months old, they replace them when they wear out

RE: Big Leaks, and new machine issues - BrickBreaker - 04-11-2021

Thanks to the adjustments suggested by you and SarcasticDave94 I managed to get notably better results, leak-wise, last night. From 60-90% leak time over the last week, to 26.6% last night. Thank you both very mugh.

Still experiencing apnoeas through the night, but also more clear airway events than ever before, so it seems like it was a winner.

Any advice on next steps, or should I just carry on like this?

Thanks again!

RE: Big Leaks, and new machine issues - SarcasticDave94 - 04-11-2021

The slight uptick in CA isn't much of an issue, certainly not worth changing therapy settings. I'm seeing it as an indicator your breathing is increasing efficiency and giving the little blip on CA as CO2 is flushed out a bit more than your past.

Keep working at the leaks, but don't sweat over it too much. It's notably better so you've gained something good. If you're feeling better for it, just keep at it. Try building a positive trend, and note down any issues you may have and mention them here so we can help out.

RE: Big Leaks, and new machine issues - BrickBreaker - 04-11-2021

Brilliant, thanks so much for all your help! I will be contacting the sleep medicine folks to get a mask replacement soon, so that might make a difference as well.

I really appreciate that this forum exists - without it I never would have managed to figure out there was something wrong with my old machine in the first place!

RE: Big Leaks, and new machine issues - SarcasticDave94 - 04-11-2021

You're welcome and congrats on the success.