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+--- Thread: [Diagnosis] Request observations on readings/Leaks (/Thread-Diagnosis-Request-observations-on-readings-Leaks)
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Request observations on readings/Leaks - Bob Cali - 07-16-2023
I have attached several random days and statistics for the past 17 days, since I have been using the ResMed AirCurve 10 ASV. The pressure seems to mess with my mask, a full mask F&P Evora. I am unable to usually get past 6 hours when I wake up and unable to get back to sleep. The air leaks appear to reflect AHI, I thought, but now not so sure. Why I am asking for any comments pertaining to the attached. Is there any readings etc. that reflect these days that are irregular or any pressures that could be changed to help with mask leaks yet keep AHI at a very low level. I am requesting assistance as I am getting a little frustrated with my mask and AHI levels, low I am told by Doctor, but seems inconsistent to me in total, although only 17 days , so far. I appreciate your time and thank you!
RE: Request observations on readings/Leaks - Sleeprider - 07-16-2023
You are using your Resmed ASVauto in fixed ASV mode with EPAP 10, PS 3 to 15. The maximum PS we can see in your charts only reaches 8-cm, so it appears you will respond to the ASV pressure support with spontaneous breathing. I assume, but would like to know if you discontinued your S-11 Autoset due to therapy induced CA events. Your history shows you had relatively high AHI using that device. My impression is your EPAP is too high on the ASV and we should try some titration using ASVauto mode using EPAP min 6.0, EPAP max 10.0, PS min 3.0 PS max 10.0. Mask fit issues seem to be improving, but a full-face is always challenging with ASV due to the changing pressure support which will cause the mask to expand and contract like it is bouncing. If you tolerate nasal therapy without mouth leaks, nasal pillows are far easier to live with.
RE: Request observations on readings/Leaks - Bob Cali - 07-16-2023
My tritation was originally misinterpreted so was treated for OA although from first night OA was zero, central was the problem. My Doctor now tells me I should of probably had ASV machine to start with, as occasionally when AHI was above 10, I had a little CSR, as well. With regard to mask, I am told a mouth breather so, for now, using a full mask, although I don't breathe out of my mouth during the day, no problems just breathing thru my nose. I have tried a nasal mask and doesn't work, too many leaks. Perhaps it would work if I eliminated my mouth breathing or simply mouth opening while I sleep??
RE: Request observations on readings/Leaks - Sleeprider - 07-16-2023
Bob, we can learn a lot more about your needs in ASV auto mode using the settings I suggested above which include pressures you are currently using in fixed mode. Give it a try and I think we can greatly improve your comfort and might give you some leak relief as well.
RE: Request observations on readings/Leaks - Rich66 - 07-16-2023
When I first started with PAP therapy, I was given a mask that caused a lot of leaks. It was a nose cushion -- and it was sized wrong for me. My first real success was getting a proper mask, and size. From there, it was a matter of adjusting the pressures. BUT, I did have some leaks out the mouth -- so I ended up taping the mouth shut. That turned out to be a big help. A number of people are having to do that. It is not as scary as it sounds. I even slept through a power outage for about 8 minutes. I notice it on the graphs the next morning -- that, and all my clocks were blinking.
RE: Request observations on readings/Leaks - Bob Cali - 07-16-2023
l will start today and report changes after a week and thanks very much for your time and expertise.
RE: Request observations on readings/Leaks - Sleeprider - 07-16-2023
I can pretty well interpret your machine results and your feedback after one-night. Up to you, but I want to see where obstruction ends and good therapy begins, so that is the rationale behind the big drop in starting EPAP.
RE: Request observations on readings/Leaks - Bob Cali - 07-16-2023
Understood...thanks...Will post results in a week.
Sorry, might have misunderstood, will post results and feedback tomorrow, then go from there.
RE: Request observations on readings/Leaks - Bob Cali - 07-17-2023
Changed settings as suggested, I have attached last nights report. I changed EPAP from 10 to 6 to 10, as suggested, I don't understand why it says min. EPAP 6 max IPAP 20 ?
Thanks again.
RE: Request observations on readings/Leaks - Sleeprider - 07-17-2023
What we can see from your chart is that your fixed EPAP pressure of 10 was over-titrated and resulted in pressure being much too high. Leaks are improved with lower pressure, but there is room for improvement. Efficacy in terms of AHI is relatively unchanged, but you are not having obstructive events. Your feedback on comfort is important in deciding how to proceed. It appears there may be room to reduce pressure even further, however with median EPAP at 6.6 and 95% EPAP at 8.2 it looks like we may currently be in the sweet spot for settings. My recommendation is to continue these settings for the week you previously mentioned, and focus on comfort improvements and leak improvement.
The summary description of your settings is correct. The EPAP 6 comes from the EPAP min setting, and max IPAP is EPAP max + PS max. As you can see from the summary statistics you briefly hit a max EPAP of 9.0 and 17.38 cm maximum pressure. If there was a reason to reduce that, we could, but I don't generally worry about the max pressures. With the previous settings your EPAP never went below 10 cm and you IPAP max hit 19.5. I mentioned before, the ASVauto range included the settings you were using under direction from your doctor, and this proves it is available when and if needed.