Finally got switched to auto - new data

I was still struggling with mask problems (and still am), but I got the DME to get me switched over to auto instead of fixed at 13, which wasn't working. So last night was my first night with true auto and I wanted to get your take on the data. The pressure is definitely higher and I'm having a heck of a time keeping the mask on without leaks. My wife kept waking up and nudging me because the leaks sound like you're deflating a balloon. Wwweeeeeeeee... So, I need to press the DME to get another mask coming. I see the leakage was all over the place, but the AHI was under 10 for the first time. Could this actually be working?

Sorry, she set the machine to 20/4.

To my untrained eye it looks like if the flow rate is steady and the mask inst leaking I don't have apneas. Correct? So hypothetically if I can get a mask that works for me I should be golden, right?

FreeIndeed wrote:Sorry, she set the machine to 20/4.

To my untrained eye it looks like if the flow rate is steady and the mask inst leaking I don't have apneas. Correct? So hypothetically if I can get a mask that works for me I should be golden, right?

The mask is leaking and you do have apneas. To me it looks like your pressure is hitting the max (20) often. You may need a different machine if you really need that high pressure.

Sorry, I meant that when the mask wasn't leaking things seemed to work right. When the mask leaks, the flow rate is all over and there are events. I think you can set the s9 higher than 20 right?

FreeIndeed wrote:Sorry, I meant that when the mask wasn't leaking things seemed to work right. When the mask leaks, the flow rate is all over and there are events. I think you can set the s9 higher than 20 right?

you can't set the autoset higher than 20.

vpap models (bi-level resmed s9 units) go to 25, and one, the vpap ST-A goes to 30, but that's for pretty specialized needs).

I'd suggest raising your minimum pressure, maybe to 12 for a start, instead of being far far too low, and, also, consider turning down epr, because that's limiting your base pressure (epap) to 17, with the way you've got things set now.

FreeIndeed wrote: I see the leakage was all over the place, but the AHI was under 10 for the first time. Could this actually be working?

the leaks weren't good, but they weren't as horrible as you've had in the past

so, yeah, great signs of progress... how do you feel today?

20 cm is the highest the S9 AutoSet can go. You may need a bilevel pressure machine as they can go to 25 cm.
In the meantime I second Palerider's suggestion to increase the minimum...4 is way too low but I think you are going to need at least 14 cm minimum...maybe 15 cm if you want to keep EPR at 3.

I have a sneaking suspicion that you are going to need pressures above 20 cm and I am basing that thought on the 4 AM pressure line. Leaks were not horribly above 24 L/min and you pretty much maxed out the pressure for 30 minutes or so.
You may need to try to reduce or turn off EPR which could be uncomfortable at those upper teen pressures and that's why I mention bilevel because it allows for higher pressures and pressure support which would likely be more comfortable.

When you see leaks above 30 L/min and no events...we have to wonder if the machine just couldn't sense any events or you didn't have them but we have no way to know for sure.

Hopefully I am wrong and you can get by without having to go to the bilevel machine because getting DME and insurance to spring for one of those machines could be a bit difficult.

Pugsy wrote:20 cm is the highest the S9 AutoSet can go. You may need a bilevel pressure machine as they can go to 25 cm.
In the meantime I second Palerider's suggestion to increase the minimum...4 is way too low but I think you are going to need at least 14 cm minimum...maybe 15 cm if you want to keep EPR at 3.

I'd have said higher too, but I keep trying to go slower than my first impulse tells me

I've been on auto for a couple nights now. For some reason it didn't record any data for Wednesday night, but it does show last night. I'm still having problems getting the @#$%$ mask to seal off and I'm basically fighting the DME to get something else. At the higher pressures I just can't get the mask to seal. So I KNOW (despite the reluctance of the DME) I need to get another mask. It says my AHI is under 10, but honestly, I don't know if that's right because of the high leakage. Maybe you guys will see something i don't. I still have dry mouth, but that's the least of m,y problems right now. Oh and I think I farted for 32 minutes straight when I woke up this morning, so I bet I'm swallowing a lot of air

Forgot to add - I followed your advice and changed the minimum to 13 instead of 4. I'll tell the DME it was an accident

Helps if I attach the pic huh?

The SD card must be in the S9 all night (and inserted correctly... I mention that because Mon and Tues of this week mine was in but not far enough) or else SleepyHead can read the data as SH says I didn't use the machine but I did.
If you had ResScan it would still show some data for that blank night...just not the details. SleepyHead needs all the files to do any calculations.

Your leaks were horrible until 3 AM. So horrible that we can't trust the machine's not reporting much of any events during that time frame.

3:15 to 4:15 where you turned the machine off is under the red line and pressure line is nice and stable.

Your mask is not working for you. If you can't get it to seal better than this you need to try something else.
Mouth breathing leaks with nasal pillows don't look this bad.

Keep the pressures the same for now and figure out something to do about the mask/leaks. That's your primary problem at the moment.

Thanks Pugsy.

You have my vote for the ugly leak graph of the week...

HoseCrusher wrote:You have my vote for the ugly leak graph of the week...

In another thread he got my vote for "ugliest leak graph I have ever seen"... I have seen bad but never that bad for that long.

Freeindeed.....all that pressure activity during the really ugly leaks...that's just the machine not having a clue what to do. It was struggling because it was clueless as to what it needed to do to fix the situation. It's sensors were all messed up. Unfortunately those pressure increases likely just made the leaks worse which in turn made things even harder on the sensors.