Leaking, weight and pressure

[Anny Middon]

Hi, all. I'm new to this forum. Been using my Resmed Elite S9 machine since I was diagnosed with OAD in March of this year.

About 3 months ago I started getting the red "frowny face" for leaks. Changing out the pillow on the Mirage nasal mask I was using then didn't help. I switched to a Phillips Wisp nasal mask, but am still having problems with leak.

The pressure on my machine is set (based on my titration sleep study) at 15. My doctor suggested that since I have lost weight (more than 60 lbs since I started with the CPAP), the leak problem may be due to the pressure being set too high. She's my primary care physician and she doesn't seem to be too knowledgeable about CPAP operation. She thinks maybe I should have another sleep study. I'd like to avoid that if possible.

A technician from my insurance company (well, sort of -- don't get me started on CPAP-related issues I've had with insurance) mentioned as an aside that with the Resmed S9 I don't need a sleep study to determine the best pressure for my machine.

Any ideas on whether my weight loss might be causing the pressure to be too high and thefore causing my problems with leak? If so, how do I set my machine to determine the best pressure?

The manual provided with my machine is frankly worthless -- it didn't even document how to get my detailed numbers.

Thanks in advance.

Anny

[robysue]

If you had the S9 AutoSet, then you could switch it to Auto and use a somewhat wide range to find out what pressure you need. But the Elite is a fixed pressure machine and so it cannot really be used to autotitrate---in other words, it cannot be set to figure out how much pressure you need by responding to your events as they happen.

Your doctor could ask the DME to set you up with a Loaner S9 AutoSet for a week or two to see what your 95% pressure level is as a way of avoiding another in lab sleep test.

Alternatively, you could work with your doctor to slowly lower the pressure setting on the Elite by 1-2 cm and leave it there for a week or two and then look at the AHI and leak data. If the leaks get better and the AHI stays below 5, then you'll have your answer.

[trish6hundred]

Hi Anny, WELCOME! to the forum.!
What robysue said.
Hang in there for more responses to your post and best of luck to you.

[zonk]

Hi Anny Middon, welcome to the forum
Your machine (S9 Elite) is fixed pressure machine, does not auto-titrate just deliver a constant pressure all night long. On the other hand S9 AutoSet can be set on fixed pressure like your machine or range of pressure and the machine adjust the pressure within the range. But with any machine, the data is useless with red "frowny face" showing up on the sleep report, you want happy "green face" and leaks below 24 L/m

Edit: Congrats on the weight loss, just checked 60 pounds = 27.2 kg ... I would go along with the doctor suggestion

[Tez62]

Welcome Anny Middon, I agree with the others suggestion, seeing you are not using software to look at your results, have a look on the screen each morning and see what your AHI is, you want it to be as low as possible but always below 5. As robysue suggested you can then start lowering your pressures as long as your AHI stays similar. Do you know what your AHI was at your sleep study, it will be on your results if you have a copy, is may also be called RDI. There is free software called Sleeyhead you can use to view and track your nightly results, you can then either make some decisions either yourself or after consulting your doctor. Let us know if you want or need a hand downloading and using this software.

[Anny Middon]

Thank you, thank you, thank you, all!

I just looked at my machine and it IS the S9 Autoset. Sorry I didn't realize before that's what I have -- this CPAP business is still pretty new to me and I'm lost with some of the acronyms, machine types and lingo.

So how do I set my machine to Auto? Once I do so, what should I look out for to be sure I'm getting effective therapy?

Although I really want to avoid another sleep study if possible (I had two earlier this year -- one to diagnose and another [because I didn't fall asleep soon enough for the first one] to titrate the machine), I'm a bit scared to willy-nilly make changes on my machine. I was diagnosed first with Pulmonary Hypertension and was very glad to find out it is secondary to apnea. Treating the apnea treats the PH which if untreated can be fatal. But if my machine is designed to set levels automatically, why wouldn't I want to let it do so?

I can read data from my machine -- not only the quick screen that gives the smiley face and AHI, but also the more detailed, somewhat hidden screen that gives more details. My machine has a memory card, but I had to send that in only once -- my DME provider sent me a modem for the machine. I don't know what happens with that data -- the 3rd party retained by my insurance company to manage patients with certain conditions told me they hadn't gotten a report since June. My doc got a later report, but only after they called and requested one. I have never seen a report.

Can I get data myself off the card? Will the Sleepyhead software read the card directly?

Again, sorry for being so clueless about this.

[danzig]

I know you switched masks but I trick I have used if I am alone and
Think I have a leak is to record the sound of me sleeping. The pillows don't tend to like high pressure so you can hear the difference. on the machine it will show as a leak at the time. Just something to try the other thing that works is the wife's elbow in the ribs followed by your masks leaking fix it .. I like the recording better.
P.s. I use an old walkman but you can use anything with a mic computer laptop ipad etc

[skyler]

Congratulations on the weight loss. Your pressure at 15 may well be too high since you've lost weight.. I don't see why that would cause leaking, though. The contours of your face have undoubtedly changed a great deal and you may need a different style/size mask. I have mixed results with my wisp- usually no leaks, but sometimes it leaks very badly. The clinicians manual for your machine is available on this site and will detail how to check your numbers. The problem is if you're having bad leaks the ahi may not be accurate.
Can your GP refer you to a sleep medicine specialist? With your PH it's imperative that you get good therapy. If I had that diagnosis I would be leery of making changes myself without solid data to back up the changes. In fact, I would not trust my health to my own experimentation at all. For many of us a little experimentation is fun- for you it's much more serious because of the pulmonary hypertension. My sleep medicine doc is a pulmonologist which for you would be ideal.

I found SleepyHead to be easy to use. I installed the program and when I inserted my sd card into the computer the program found the data with no problem. What kind of numbers are you getting from the detailed info screen?

Don't apologize for being clueless, you aren't for one thing and in any case we all started here.

Be very careful- few of us have the PH diagnosis- it's nothing top fool around with.
Good luck,
keep us posted.

[trish6hundred]

Hi Anny,
CONGRATULATIONS! to you on your weight loss.