Help Wanted- Sleepyhead leak setting and graph reading

General Discussion on any topic relating to CPAP and/or Sleep Apnea.
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coolbranch
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Help Wanted- Sleepyhead leak setting and graph reading

Post by coolbranch » Mon Mar 30, 2015 2:27 pm

First, my SH preferences with AirSense 10 Autoset using Quattro Air mask. Does this Sleepyhead setup look correct? ResMed Quattro Air mask chart shows pressure at 10cm with approximately 37 L/min intentional leak rate.

Image

Second, does the leak graph show leaks within range or is my mask continuously leaking over the intentional leak rate? Looks like the mask leak is causing events while causing the machine to rev up pressure. Maybe this mask can't take the higher pressure.

Image

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palerider
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Re: Help Wanted- Sleepyhead leak setting and graph reading

Post by palerider » Mon Mar 30, 2015 2:32 pm

coolbranch wrote:Second, does the leak graph show leaks within range or is my mask continuously leaking over the intentional leak rate? Looks like the mask leak is causing events while causing the machine to rev up pressure. Maybe this mask can't take the higher pressure.
your settings look fine.
the quattro air can take much higher pressures.
the machine *never* *ever* "revs up pressure" due to a leak. the turbine spins faster when there's a leak, but that's because it has to pump more air to *maintain* pressure when there's more leak than when there's less.

zoom in, you'll likely see that there's an event of some sort (flow limit, snore) then pressure goes up, then there's more leak because of higher pressure)

and, anytime the leak trace in SH is above zero, your mask is leaking more than the intended amount.

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coolbranch
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Re: Help Wanted- Sleepyhead leak setting and graph reading

Post by coolbranch » Mon Mar 30, 2015 2:49 pm

A-HA! That makes a lot of sense (increase RPM to maintain pressure). I learned something. Also PR, thanks for the leak graph read. I must be burying my mask in the pillow and/or I have noticed that I may be pulling the hose off the machine slightly. The dreams and nightmares have been vivid lately. I seem to be flipping and flopping during REM.

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palerider
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Re: Help Wanted- Sleepyhead leak setting and graph reading

Post by palerider » Mon Mar 30, 2015 3:04 pm

coolbranch wrote:A-HA! That makes a lot of sense (increase RPM to maintain pressure). I learned something. Also PR, thanks for the leak graph read. I must be burying my mask in the pillow and/or I have noticed that I may be pulling the hose off the machine slightly. The dreams and nightmares have been vivid lately. I seem to be flipping and flopping during REM.
if you remember your dreams, then you're getting waked up a bit during them... otherwise they fade away quickly.

as to the way leaks show, you have to remember that resmeds show *excess* leak, while respirs show *total* leak on the graphs.

so any leaks showing on your graph is an amount that the machine has calculated is above the baseline.

I've seen (first in some posts from Robysue, and then in some traces I've seen myself), where machines will *reduce* pressure if the leaks are too bad, to try and get the mask to seal back up

if your leaks are under 24lpm, AND they're not bothering you, then they're ok... if they're bothering you (waking you up, etc) then work on them.

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coolbranch
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Re: Help Wanted- Sleepyhead leak setting and graph reading

Post by coolbranch » Mon Mar 30, 2015 3:35 pm

I can't recall the content of dreams but only that I do.

Another point I wish you could help me clear up about the excess leak rate. This is a math problem. If the standard SH setting for ResMed is 24 L/min, I then can assume anything over the 24 L/min will be excess (unintentional) leaks. If the intentional leak rate for the mask is 37 L/min for my mask at 10 cm (last nights medium pressure was 11cm) how do I account for the difference between 37 L/min and 24 L/min? The difference between the preference setting and the actual mask intentional leak rate is 13 L/min. That is kinda what I am seeing in the leak rate graph, but you and others say no. If the AirSense "feels out" mask pressure then reports excess leaks, then the SH setting is meaningless. It's bugging me.

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Re: Help Wanted- Sleepyhead leak setting and graph reading

Post by Pugsy » Mon Mar 30, 2015 3:48 pm

Your machine reports ONLY excess leak.
Prior to figuring out what to report for excess leak it takes into account the pressure you are using and the mask type you are using and I think it sort of takes a baseline rate when you first start the machine and we expect a good seal...and it takes all those figures into account before it ever reports the excess leak that is reported.
So in a way it subtracts that 37 L/min vent rate prior to reporting anything. Now of course it doesn't know exactly which mask you are using and thus it might not subtract exactly 37 L/min from the calculations but it is going to be really close.

This is the way ResMed reports leak...so all of what you see is excess but ResMed says that they can compensate for excess leaks up to 24 L/min. Above that it starts getting iffy and the farther above 24 L/min you go the iffier it gets.

Now if you were using a Respironics machine we would be talking about that 37 L/min in more detail but for you ...you have to sort of put it out of your mind.

And PR has it correct about the machine not responding to leaks with more pressure. A long time ago it seemed like they did but these newer machines (PR S1 and the ResMed S9 and the newest AirSense/AirCurve models) do not try to fix a leak with more pressure which used to create some ugly leak monsters years ago.

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Re: Help Wanted- Sleepyhead leak setting and graph reading

Post by palerider » Mon Mar 30, 2015 4:23 pm

what pugsy said *points up there*.

if you look at a lot of mask vent charts (I prefer to call the intentional leak 'vent' to differentiate it from what's blowing out around the mask seal that's unintentional...) they're all in the neighborhood of being the same, give or take a few lpm... they most all start around 20lpm@4cm and go to somewhere around 50ish lpm@20cm. so the machine probably makes the assumption to get itself in the ballpark.

then it watches the flow as you inhale, and exhale, and it can mathematically calculate a baseline of leak from that, then when there's more leak, it says "aha!" and reports excess leak.

on the vpaps, you can actually see it figuring out where the baseline is over the first few breaths.

https://www.youtube.com/watch?v=1eeDtO-k47c

the leak in the middle was caused by opening one of the oxygen ports on the mask, creating right at 10lpm excess leak.

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coolbranch
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Re: Help Wanted- Sleepyhead leak setting and graph reading

Post by coolbranch » Mon Mar 30, 2015 4:56 pm

Great explanation Pugsy and palerider! Somehow I knew you both as well as the AirSense 10 Autoset are most intelligent in these matters. I can now move on. Thanks again.

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Re: Help Wanted- Sleepyhead leak setting and graph reading

Post by coolbranch » Mon Mar 30, 2015 5:11 pm

I viewed the youtube video link you posted PR. The VPAP in the video...well...smarter than fresh paint!

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Re: Help Wanted- Sleepyhead leak setting and graph reading

Post by coolbranch » Wed Apr 01, 2015 11:16 am

Large leaks look to be pressure induced, not to mention apparent leaking of mask all night. Time for equipment check.

Image

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