No intention to slight ANYONE and if my hasty remarks were taken as such I apologize. My point was simply that regardless of blower, regardless of mask, there is a "baseline" from which we must work. The baseline for 'leaks' takes into consideration the vent flow rate based on pressure presented to the mask. As an example, on the Mirage Quattro full face mask, at 16 cmH2O pressure presented, one would expect a baseline 'leak' rate due to the mask vent, of approximately 48 L/Min. While this is, in fact, 'leak', it must be accounted for in calculating the overall and correct leak rate of the system. So, we would deduct 48L/Min from the flow in order to arrive at the "net flow rate" and determine what, if any, the leak rate is. My comment was simply to suggest that the very first objective suggested in most all of the patient literature is simply to get the undesired leakage down as close to zero as possible.... from which point, the other empirical data becomes more valid and useful. If one's system is leaking like a busted balloon much of the data is made less relevant as continuous positive airway pressure is absolutely compromised. I think that you would have to agree with this, no? So my comment, again, was simply to state that one must have a solid starting point from which to work and that once accomplished, there are going to be all sorts of OTHER compromising factors one will need to consider if one is titrating their own pressures, etc. For instance, one reached a point of 'no leakage' (taking into account the designed leakage of the system vent(s), etc.) and the titrated the pressure upwards from, say, 10 to 14 cmH2O. The result of which was an increase in designed vent flow (or leakage) or perhaps the mask seal being lost several times while in use during the night. All of these factors need to be taken into consideration when attemptingto achieve optimal performance, as I am sure you will agree. All I can tell you is that it was like trying to juggle multiple rubber balls, even after reaching a net zero leakage rate. And even then, the determination of centrals versus OSA events is difficult at best, even in a sleep lab supervised by a qualified physician. Some of us get lucky, some don't. I think a lot of it is a matter of perserverence and how much you are willing to do and endure in order to resolve the problem. In MY case, I was quite fortunate. Starting from this baseline where my leakage was close to zero most of the time (extranious factors considered and accounted for) it took some time for me to get all of my ducks lined up. And I did so with the input and help of many members of this board whom I don't seem to see around any more.
Again, if I offended, I apologize. We cannot afford to be offending one another. Nor is anyone on the board really able to hand out a solution on a silver platter if you think about it. My resolution, as I say, took some time experimenting (tsk. tsk. Not supposed to do that, right?) I had an issue, just as a matter of interest, shared by several members of the forum, whereby when I approached and entered REM sleep my breathing became so shallow that my SpO2 or more appropriately my CO2 caused me to arouse in order to bring my blood oxygen up. One of the members of our little group designed and built a device that read SpO2 from a pulse oximeter and opened or closed a valve from an oxygen concentrator until SpO2 was up around 93-94%'ish. Fortunately, in my case, I kept turning down the flow rate from my oxygen concentrator and am now OFF oxygen at night (am about to sell the Everflo Q-5 I think). At the time it was unheard of but by sharing thoughts and experiences we helped one another through the situation.
Anyway, nuff said here. Sorry I was not clear in my first post and sorry if I offended. We need to speak freely and help one another. This is NOT a popularity contest but a mixing pot of knowledge from which we should all feel free to dip.... but once dipping, need to validate information, digest information and make an informed decision. THIS IS WHAT makes this forum such an amazing place - and never a place to speak in harsh terms in while angry.
From one hose head to another. Be well.
Pugsy wrote:torontoCPAPguy wrote:With all due respect, LEAKS are the #1 issue and make no mistake about it. When I refer to leaks I include things like mouth breathing. Anything that does not fit into the bill of "CONTINUOUS POSITIVE AIRWAY PRESSURE". Everything else is secondary but requires addressing as well. If you have a mask leak you are not getting a constant positive airway pressure and the gear is not NOT doing its job.
Fix that leak issue to start with. You need to be seeing an almost immediate response bringing your AHI below 5 before you begin to make the minor changes to aim for zero.....
With all due respect you need to understand that different machines report leaks differently and the OP here has a machine that reports leaks differently than your machine.
Perhaps you should understand the differences before you go telling someone to fix a leak that can't be fixed and telling them that the leak is the cause of the high AHI because in this case....it isn't.
Your S9 machine reports excess leak only.....the Respironics machines report total leak which is the mask's vent rate plus any excess leak. It's impossible to have 0.0 total leak number from a Respironics machine.
So maybe you need to understand what you are talking about a little better instead of blasting me...huh???
Fall colours. One of God's gifts. Life is fragile and short, savour every moment no matter what your problems may be. These stunning fall colours from my first outing after surviving a month on life support due to H1N1.