Un-happy face sleep report

[Joe Fox]

OK. It will be a while before I can do that. Maybe tomorrow. Thanks. Joe

[trish6hundred]

Hi Joe Fox,
WELCOME! to the forum.!
Good luck to you as you continue your CPAP therapy and getting your new machine fine-tuned to meet your needs.

[Joe Fox]

http://imgur.com/a/VWHBw 

I hope I did this correctly. there are two screen shots per day, Thursday, Feb 2, 2017 after changing the hose selection and the second day is Saturday, January 28, 2017. I have 6 days of data, the last two days are after the hose configuration change. Joe

[Sleeprider]

Hi Joe.  The two charts that are most useful are these:





Your leak rate is close to 40 L/min and the machine does seem to be flagging leaks less than that.  The charts you posted confirm the machine is set to full-face. Also, if you want to clean up the charts, you can go to the Sleepyhead menu File/Preferences/CPAP and change the value on the right half of the page next to Flag Values Greater than xx.   Take note of the default value before making changes.  As long as you are in the menus, go to the Appearance tab and uncheck the Show Pie Chart.

With that out of the way, let's talk about machine settings. Your machine is set to fixed bilevel (VPAP-S).  You have a lot of obstructive events, and some hypopnea occurring, so I think you would benefit from a change to Vauto.  This gives the machine the capability to increase EPAP pressure when needed to resolve obstructive apnea.  You have no CA (central) events, so your pressure support is not a problem at this point.  Pressure Support (PS) is simply the arithmetic difference between inhale pressure (IPAP) and exhale pressure (EPAP).  So IPAP 13.0 -EPAP 8.0 = 5.0 PS.  Oddly, your settings (in the lower pane of Machine Setings) indicate that your EPAP is 8.00, IPAP 13.00 and PS 4.0.  Makes me wonder if the person that set up the machine made a mistake, because since you are on VPAP S, the PS of 4.0 is over-ridden.  A PS of 5.0 is on the high side, and I think you will be more comfortable with lower PS of 4.0, especially if you sometimes feel over-ventilated. 

Recommendations:
For leaks, you should carefully inspect the machine and components from the humidifier, to the outlet, hose, mask connections and mask.  Your leak line never reaches zero, and your machine is calculating an estimated excess leak, not whole leak.  There is something wrong here because you never reach the baseline of zero leak.  I am attaching a screenshot of my own to show how my machine is setup and how the leak line should look.  If you cannot find a problem, and continue to see improper leak rates, you should take the machine mask and whole setup to your DME for troubleshooting.

For settings, you should enter clinical settings (press control knob an home button at the same time). Now change the mode to Vauto, Min IPAP 8.00, Max EPAP 15.00, PS 4.0, then exit.  These settings will be similar to your current settings, but reduce the PS by 1, and allow the machine to increase EPAP from 8.0 to 11.0 to try to address the OA and H events.   Note on my chart, my settings are 9.0 to 180 over PS 3.0, but I never reach the IPAP pressure of 18. The machine only goes as high as necessary to address events. You should consider also setting your IPAP max to a higher value like 18, just in case it is needed. You have a lot of OA, so while I have conservatively recommended a max IPAP of 15 to be closer to your prescription, I think you could benefit from a higher setting there. Keep in mind, OA events are treated by EPAP, and H events are treated by IPAP or PS.

[Joe Fox]

Thanks Sleeprider, for looking at the charts I posted and your comments. I inspected every inch of the new tubing and mask again last night looking for tares and holes and found none. I still think the mask fit is fine. I will look more closely at the humidifier and it's cavity. Maybe a missing or damaged seal. I have only used the humidifier once so far, trying to solve the leak problem first. I do have the circle of small holes around the swivel connector like RichardVT mentioned, but I really don't think that is the problem. From the data I am seeing, I am thinking the leak would be very noticeable; but what do I know. As a 30 year retiree from IBM servicing typewriters, dictation equip, copiers, keypunches, mainframe computers , tape drives, line printers, ect., you would think something this simple would be easy.

[RichardVT]

Can you hear or feel any air leakage around the machine while it is in use?
Any leakage felt around the humidifier while in use?

[Joe Fox]

FM: Richardvt, "Can you hear or feel any air leakage around the machine while it is in use?

Any leakage felt around the humidifier while in use?"

No. I also removed the humidifier container and examined the seals inside the machine and preformed a pressure test on the container for leaks too. Last night I installed a 6 foot hose and set the hose selection accordingly. No change. I am even getting computer generated messages from the DME that the mask is leaking. Both emails and an automated phone call  [from myair] yesterday.    I woke up last night tangled in the 6 foot hose and this morning the Aircurve 10 was half off the table. Going back to the 10 foot tonight. A new mask and hose should be here Tuesday so if that doesn't work, I think a face to face with the DNE is on order. A little more studying the data and configuration terms and I will start playing; thanks to Sleeprider. Joe

[RichardVT]

I wonder if it could be something with the machine possibly giving erroneous numbers on the leak rate. I wonder if another machine with the same hose and mask you are using would give the same leak rate.

[Sleeprider]

Good point Richard. It sure would be interesting to take a quick mask fit test on a different machine.

[Joe Fox]

Thanks,guys. Just what I was thinking.

So here is a recap. The original post mentions a un-happy face displayed on the ResMed Aircurve 10 Vauto's display screen at the end of an overnight sleep period, indicating a mask seal leak. Sleepyhead graphs and displayed machine data indicate a large leak of as much as 60 percent. Myair and DME email and DME phone calls tell me there is a large mask leak and to check my mask fit. While a hose type configuration selection fixed one problem, it did not fix the leak problem. Sleeprider examined two different days of Sleepyhead data and offered several suggestions, and a comment that the leak graph never goes to zero.

1. “Your leak rate is close to 40 L/min and the machine does seem to be flagging leaks less than that”.
   
2. “Your leak line never reaches zero, and your machine is calculating an estimated excess leak, not whole leak.” ”There is something wrong here because you never reach the baseline of zero leak”.
   

I concur with his observation. I have checked and double checked the machine, hose, and mask assemblies and can not find a significant leak. The only leaks I detect are around the circle of little holes where the hose swivel/valve assembly connects and at the holes where the valve that allows the patient to breath when machine stops delivering air. I have tried two masks and both 6 foot and 10 foot hoses, each showing the same problem.

The only way I can get a happy face (Green) in the display is when I disconnect the mask, run the mask fit adjust routine from the main patient menu, and seal the end of the hose. When the hose is sealed at the end (6 foot or 10 foot hose) I can not find air leaking from the hose, machine, or the humidifier. So I decided to expand this test to the following.
1. Open the end of the tube and wait for the face to go Red.
2. Close the end of the tube and count the seconds until the face goes Green.
3. Open the tube until it goes Red again, waiting two seconds. Then repeating steps 1 and 2, until the test times out and the machine resumes normal operation.


The mask fit adjust routine is a menu function of the machine and should not damage the machine if this test is run. This is the results of my second run of this test. Similar to the first time I did it.
2 (seconds), 5,2,2,4,2,4,4,5,4,7,3,7,2,8,8,8,10, 10 seconds, then the mask fit adjust routine terminates and the machine resumed to normal machine operation. This to me seems to be all over the place. I expected the times to be more equal.

So, if any of you have the ResMed Aircurve 10 Vauto and have a couple of minutes to preform this same test. I would be interested to see if my results are normal for this model ResMed or if I have a machine problem.
In advance, Thanks. Joe