help heart pounding

General Discussion on any topic relating to CPAP and/or Sleep Apnea.
xstien
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help heart pounding

Post by xstien » Mon Apr 16, 2018 12:01 pm

so both my resmed s9 autoset last night info shows no major mask leaks and sleepyhead an ahi of 0.00 but I don't understand how to read sleepyhead's average leak rate and all that. everywhere I read said some number then an L something but sleepyhead just says
average leak rate: 0.77
90% leak rate: 1.20
% of time above leak rate threshold: 0.40%
so what does that mean? I have cognitive problems which is why I'm having a hard time figuring this out. i have my s9 on all the right settings and if my mask isn't leaking more then normal for the airfit f10 why am I waking up about every half hour all night with my heart pounding? I've never experienced this until the last 3 nights. it scares me. and the sleep center I'm with works with a totally different company than where I got my s9 in 2016 and they said they can't give me a new machine until 5 years so the brand new respironics dreamstation has to be returned and only until after they receive everything can they try to help me. but that won't be for like another week or so. I'm finally getting some cbd oil today to help with my pain and anxiety and it might help with my sleep (i take both 10mg Ambien and 300mg seroquel to sleep but with all this apnea business it's not helping). any help and insight is greatly appreciated. to add I'm also on lamotrogine 400mg which gives me horrible dry mouth so my humidifier and heated hose are both on max but it's not enough because of the meds. I see my psych next week to start tapering off of it so I won't see improvement in dry mouth for maybe a month. oh and my recommended cpap pressure is 7 also tried 8 then auto and sleepyhead shows it going from a min 7.20 to max 9.72 and 90% pressure 8.92 average epap 7.76 min epap 7.20 max epap 9.72

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Machine: S9 AutoSet™ CPAP Machine
Mask: AirFit™ F10 For Her Full Face Mask with Headgear
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Additional Comments: I'm trying to figure things out so I don't consistently use the same masks etc so bare with me

HoseCrusher
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Re: help heart pounding

Post by HoseCrusher » Mon Apr 16, 2018 3:36 pm

Leaks are measured by the volume of the leak. The measurement being used is the Liter. A liter is about a quart.

The allowable leak depends upon the mask being used but it doesn't look like you need to worry about leaks. My mask has an acceptable leak rate of 24 liters per minute. Your leak rate is much lower than that. That is a good thing.

As far as your pressure goes, it looks like your maximum is being hit. Consider a pressure range of something like 7 minimum to 11 maximum.

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Mask: Brevida™ Nasal Pillow CPAP Mask with Headgear
Humidifier: HumidAire H4i™ Heated Humidifier
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Machine is an AirSense 10 AutoSet For Her with Heated Humidifier. SpO2 96+% and holding...

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palerider
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Re: help heart pounding

Post by palerider » Mon Apr 16, 2018 6:14 pm

xstien wrote:
Mon Apr 16, 2018 12:01 pm
I don't understand how to read sleepyhead's average leak rate and all that.
The higher the worser.

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palerider
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Re: help heart pounding

Post by palerider » Mon Apr 16, 2018 6:15 pm

HoseCrusher wrote:
Mon Apr 16, 2018 3:36 pm
The allowable leak depends upon the mask being used
No, the allowable leak depends on the brand of machine being used, not the mask.

Resmed doesn't care what kind mask you have, the machines's allowable excess leak limit is 24lpm

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Machine: S9 VPAP™ Auto BiLevel Machine
Mask: AirFit™ P10 Nasal Pillow CPAP Mask with Headgear
Additional Comments: S9 Vpap Auto
Last edited by palerider on Mon Apr 16, 2018 10:36 pm, edited 1 time in total.

TedVPAP
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Re: help heart pounding

Post by TedVPAP » Mon Apr 16, 2018 6:46 pm

Welcome to the forum.
Your leak rate is low so don't worry about that.
Your heart pounding could be due to having an apnea event, or maybe something unrelated.
I recommend that you keep a written log and document every morning your AHI and how you think you slept, and how many times you woke up with your heart pounding. Share the results with your health provider and with this forum if you would like.

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Machine: DreamStation Auto CPAP Machine
Mask: AirFit™ P10 Nasal Pillow CPAP Mask with Headgear
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Use data to optimize your xPAP treatment:
how to see your data https://sleep.tnet.com/resources/sleepyhead
how to present your data https://sleep.tnet.com/resources/sleepyhead/shorganize
how to post your data https://sleep.tnet.com/reference/tips/imgur

HoseCrusher
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Re: help heart pounding

Post by HoseCrusher » Mon Apr 16, 2018 8:39 pm

palerider wrote:
Mon Apr 16, 2018 6:15 pm
HoseCrusher wrote:
Mon Apr 16, 2018 3:36 pm
The allowable leak depends upon the mask being used
No, the allowable leak depends on the brand of machine being used, not the mask.

Resmed doesn't care what kind mask you have, the machines's allowable excess leak limit is 24lpm
Phillips seems to offer different leak rates for different masks at different pressures...

https://www.continuedcare.com/wp-conten ... -ports.pdf

If you look at the ResMed Swift LT mask, the vent flow rate at a pressure of 12 is 37 l/min

https://www.resmed.com/us/dam/documents ... er_eng.pdf

Looking at the ResMed Quattro mask the vent flow rate at a pressure of 12 is 41 l/min.

https://www.resmed.com/us/dam/documents ... er_eng.pdf

This seems to indicate that the mask design has an influence on the acceptable leak rate along with the pressure the mask is being used at.

_________________
Mask: Brevida™ Nasal Pillow CPAP Mask with Headgear
Humidifier: HumidAire H4i™ Heated Humidifier
Additional Comments: Retired my Swift FX
Last edited by HoseCrusher on Mon Apr 16, 2018 9:06 pm, edited 1 time in total.
Machine is an AirSense 10 AutoSet For Her with Heated Humidifier. SpO2 96+% and holding...

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palerider
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Re: help heart pounding

Post by palerider » Mon Apr 16, 2018 8:48 pm

HoseCrusher wrote:
Mon Apr 16, 2018 8:39 pm
palerider wrote:
Mon Apr 16, 2018 6:15 pm
HoseCrusher wrote:
Mon Apr 16, 2018 3:36 pm
The allowable leak depends upon the mask being used
No, the allowable leak depends on the brand of machine being used, not the mask.

Resmed doesn't care what kind mask you have, the machines's allowable excess leak limit is 24lpm
Phillips seems to offer different leak rates for different masks at different pressures...

https://www.continuedcare.com/wp-conten ... -ports.pdf
That has nothing at all to do with the allowable leak rates.

Yes, the *intentional* leak rates vary by pressure, since the vent opening is fixed, the more pressure, the more vent. And while there are *minor* differences between different masks, they all vent something around 20lpm at 4cm pressure up to around 40-50lpm at 20cm pressure..

But, again, that has *nothing at all* to do with the acceptable leak rates, which are something the machine itself determines... because the acceptable leak rate is 1) a flow level that the machine can sustain, and 2) a flow level that the machine can still differentiate reliably between centrals and obstructives.

Has nothing to do with the mask.

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HoseCrusher
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Re: help heart pounding

Post by HoseCrusher » Mon Apr 16, 2018 9:29 pm

So the suggestion is that if I need a pressure of 12 and want to use the Quattro mask that has a vent rate of 41 l/min at that pressure I will not get the best performance from the ResMed AirSense 10 machine because while it is capable of producing around 136 l/min at a pressure of 12 it is only accurate to 24 l/min...?

_________________
Mask: Brevida™ Nasal Pillow CPAP Mask with Headgear
Humidifier: HumidAire H4i™ Heated Humidifier
Additional Comments: Retired my Swift FX
Machine is an AirSense 10 AutoSet For Her with Heated Humidifier. SpO2 96+% and holding...

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palerider
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Re: help heart pounding

Post by palerider » Mon Apr 16, 2018 10:35 pm

HoseCrusher wrote:
Mon Apr 16, 2018 9:29 pm
So the suggestion is that if I need a pressure of 12 and want to use the Quattro mask that has a vent rate of 41 l/min at that pressure I will not get the best performance from the ResMed AirSense 10 machine because while it is capable of producing around 136 l/min at a pressure of 12 it is only accurate to 24 l/min...?
Are you being deliberately obtuse, or do you simply not understand the concept?

Resmeds are good for up to 24lpm of *excess* leak, above and beyond whatever the masks built in vent rate is.

Respironics machines have no published maximum leak amounts, because they are not smart enough to calculate the mask leak levels, so they just flag "large leak" whenever your leak amount exceeds whatever the machine feels is it's limit at whatever pressure.

Once again, *it has nothing to do with the mask, and everything to do with the machine.*

Perhaps you just missed the word "excess* in the post above.

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HoseCrusher
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Re: help heart pounding

Post by HoseCrusher » Tue Apr 17, 2018 5:45 pm

OK, let me see if I understand...

From a design perspective, ResMed simply adds 24 l/min to the mask selected and any leak above that is excess leak.

From a users perspective I need to select the proper mask in order for this to work properly.

If I select full face mask and am using nasal pillows the excess leak number will be off. This means that the results are dependent upon mask selection even though the design is to simply add 24 l/min to whatever mask is selected.

Am I close...?

By the way Respironics seems to measure intentional leak at the start of the session and then uses double that leak rate to flag excessive leaks. I believe the algorithm is somewhat dynamic.

_________________
Mask: Brevida™ Nasal Pillow CPAP Mask with Headgear
Humidifier: HumidAire H4i™ Heated Humidifier
Additional Comments: Retired my Swift FX
Machine is an AirSense 10 AutoSet For Her with Heated Humidifier. SpO2 96+% and holding...

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palerider
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Re: help heart pounding

Post by palerider » Tue Apr 17, 2018 6:10 pm

HoseCrusher wrote:
Tue Apr 17, 2018 5:45 pm
OK, let me see if I understand...

From a design perspective, ResMed simply adds 24 l/min to the mask selected and any leak above that is excess leak.
No.
HoseCrusher wrote:
Tue Apr 17, 2018 5:45 pm
From a users perspective I need to select the proper mask in order for this to work properly.
No.

HoseCrusher wrote:
Tue Apr 17, 2018 5:45 pm
If I select full face mask and am using nasal pillows the excess leak number will be off. This means that the results are dependent upon mask selection even though the design is to simply add 24 l/min to whatever mask is selected.
No.

HoseCrusher wrote:
Tue Apr 17, 2018 5:45 pm
Am I close...?
Not really.

HoseCrusher wrote:
Tue Apr 17, 2018 5:45 pm
By the way Respironics seems to measure intentional leak at the start of the session and then uses double that leak rate to flag excessive leaks. I believe the algorithm is somewhat dynamic.
No, they don't. Where are you getting this impression?

Respironics doesn't do *anything* with excess leak... all it cares about it the total leak, and some undocumented behavior in their machines. They have a mask *resistance* setting on the newer machines that's documented as being used to fine tune pressure delivery at the mask, by compensating for mask airflow resistance.

Resmed is *totally different*. Their machines *calculate* baseline leak by examining the flow waveform and doing complicated math. They then show you *excess* leak.

Resmed primarily uses the mask settings to adjust the pressure at the machine to give more accurate pressure at the mask (respironics copied that in their 60 series).

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HoseCrusher
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Re: help heart pounding

Post by HoseCrusher » Tue Apr 17, 2018 8:31 pm

OK, now I am totally confused...

How does ResMed define excessive leaks?

If the mask selection doesn't matter why offer a selection to choose from?

Perhaps you can offer what you think in reference to how this works...?

In particular I am looking for acceptable leaks with my regular nasal pillows and comparing them to the use of a full face mask.

I am sorry you haven't done research on Respironics algorithms. All therapy involves addressing leak issues and I think the Respironics approach is a valid approach.

_________________
Mask: Brevida™ Nasal Pillow CPAP Mask with Headgear
Humidifier: HumidAire H4i™ Heated Humidifier
Additional Comments: Retired my Swift FX
Machine is an AirSense 10 AutoSet For Her with Heated Humidifier. SpO2 96+% and holding...

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Pugsy
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Re: help heart pounding

Post by Pugsy » Tue Apr 17, 2018 8:47 pm

ResMed subtracts a generic vent rate prior to reporting excess leak.
They never tell us what it is or exactly how they come up with it but it's based somewhat on the mask pressure selection in the setup menu and partly on the pressures used because obviously pressure impacts vent rate.

ResMed is the only brand that reports only excess leak....why...beats me...they just decided to do it.

So about the best you can do is make the correct mask selection and trust the machine that the generic vent rate it subtracts is close and if you don't get a large leak flag...you are good to go.

FWIW...my personal opinion is the 24 L/min that ResMed came up with is an ultra conservative number and the machine can really handle quite a bit more excess leak than 24 L/min...meaning sense, report and respond.
It just gets iffy the higher above 24 L/min excess leak you have...I don't really give it much thought until I hit 35 L/min and then only if it's very prolonged. I don't get in a panic over 5 or 10 minutes of I don't care how big the leak is.
HoseCrusher wrote:
Tue Apr 17, 2018 8:31 pm
In particular I am looking for acceptable leaks with my regular nasal pillows and comparing them to the use of a full face mask.
You can't really do much about it...ResMed never tells us exactly how they come up with the excess leak only numbers.
Trust your machine and if it isn't saying "large leak" then I wouldn't worry about it.
You have zero way of figuring out total leak with a ResMed machine with any certainty because we don't know what generic vent rate they use.
I may have to RISE but I refuse to SHINE.

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palerider
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Re: help heart pounding

Post by palerider » Tue Apr 17, 2018 10:48 pm

HoseCrusher wrote:
Tue Apr 17, 2018 8:31 pm
How does ResMed define excessive leaks?
I ANSWERED THIS
"Their machines *calculate* baseline leak by examining the flow waveform and using math. They then show you *excess* leak."
HoseCrusher wrote:
Tue Apr 17, 2018 8:31 pm
If the mask selection doesn't matter why offer a selection to choose from?
I ANSWERED THIS
"Resmed primarily uses the mask settings to adjust the pressure at the machine to give more accurate pressure at the mask"
HoseCrusher wrote:
Tue Apr 17, 2018 8:31 pm
Perhaps you can offer what you think in reference to how this works...?
I ANSWERED THIS
"Their machines *calculate* baseline leak by examining the flow waveform and doing complicated math. They then show you *excess* leak."
HoseCrusher wrote:
Tue Apr 17, 2018 8:31 pm
In particular I am looking for acceptable leaks with my regular nasal pillows and comparing them to the use of a full face mask.
24lpm or less.
HoseCrusher wrote:
Tue Apr 17, 2018 8:31 pm
I am sorry you haven't done research on Respironics algorithms. All therapy involves addressing leak issues and I think the Respironics approach is a valid approach.
Which part are you not understanding?

Respironics doesn't do *anything* with leaks, they report the total amount of outflow, without any calculations, which leaves you to guesstimate what the excess is, at whatever pressure you have, based on the ball park (not precise) numbers in the back of the mask manuals.

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Machine: S9 VPAP™ Auto BiLevel Machine
Mask: AirFit™ P10 Nasal Pillow CPAP Mask with Headgear
Additional Comments: S9 Vpap Auto
Last edited by palerider on Tue Apr 17, 2018 11:10 pm, edited 1 time in total.

HoseCrusher
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Re: help heart pounding

Post by HoseCrusher » Wed Apr 18, 2018 9:58 pm

OK, I think I get it, or part of it...

The Respironics information I was reviewing was related to their ventilators. I don't know if they use a similar approach in the CPAP and BiPAP machines. All I could find for those machines was a mask fit function that gave you a go - no go indication if the leaks exceed the ability of the machine to flag problems.

Just for fun... Since the idea that mask selection doesn't matter I am going to try a couple of nights selecting full face while using my nasal pillows to see if I can notice differences in the leaks or any other differences.

_________________
Mask: Brevida™ Nasal Pillow CPAP Mask with Headgear
Humidifier: HumidAire H4i™ Heated Humidifier
Additional Comments: Retired my Swift FX
Machine is an AirSense 10 AutoSet For Her with Heated Humidifier. SpO2 96+% and holding...