Help in adjusting Resmed Autoset II min & max pressures!

[cycloman2005]

Hi and Happy New Year to All!
I've been using the Resmed Autoset II since July 2009, I think I'm not getting to most effective therapy with this machine. I previously used an Respironics Remstar Auto, and it seemed that I woke up more refreshed with this machine. My Autoset II is now set at 7cm - 18cm and a EPR setting of 3. I was titrated in October 2008 at the sleep lab for 16cm. I used an Respironics Sleep Easy CPAP machine for about 3-4 months. I was then prescribed an Auto (Remstar) 6cm-18cm, the sleep doctor said my apneas are worse when I sleep on my back. My sleep lab results: RDI is 55/hr and min SpO2 was 64%.
I mostly sleep on my side and occasionally I wake up and realize that I'm sleeping on my back. I have lost 20 lbs since my sleep study, I called the sleep lab and they said I don't need to go again for a new sleep study if I lost over 50 lbs. I was diagnosed suffering from OSA, they say that weight loss improves breathing issues with sleep apnea.

My avg for the Autoset II is:
pressure/wk. - 10.0
pressure/month - 9.4
leak/wk - 0.56
leak/month - 0.50
AHI/wk - 8.2
AHI/month - 4.4
AI/wk - 0.6
AI/month - 0.3

(No numbers for 6 months yet because I did not have the machine that long!)
Are the pressure numbers with the EPR setting or is it the actual pressure?
Do my numbers fall in the normal range?

What would be a good range to set for min and max pressures to control my apneas?
I do occasionally have bouts of bloating due to swallowing air, and reflux.
I have elevated the head of my bed at least 5" of the floor, this has cut down my bouts of reflux.
I will be going for an endoscopy in the new year, to check to see if I have GERD.
I find that the EPR helps the bloating and reflux when it is set for 3, I have tried 2, 1 and no EPR, it felt a lot worse.
I'm wondering if my CPAP therapy has uncovered another medical issue that I may have...could it be GERD? I've read that many other sleep apnea sufferers also suffer from GERD.
Any input or suggestions would be greatly appreciated!
Thank you!

[scrapper]

Congrats on your weight loss.......

You mention your average pressures........do you have the software? Are you interested in obtaining the software and a card reader to optimize your therapy? Do you have the clinician's manual?

Working off of the average numbers is difficult. Having the 95th percentile numbers with lows and highs would be better.

Your therapy can be optimized by a smalled range of pressure, based upon your numbers. Based upon what you've written I'd proabably decrease the range to 7-12 for 7-10 days and then review again. I suspect a range of 8-11 might even be better. Utilizing the software or getting a readout of your therapy from a dme would make these decisions much easier.

Make one change at a time though, and keep track of your numbers and how you feel. Allow at least a full week between changes--my body often doesn't consistently respond for 10 days to changes.

Keep in touch--you're in the right place to learn and ask questions.......and receive more advice than you've ever wanted.

[cycloman2005]

Thanks scrapper,
I do not have the Resmed software, I will have to call my DME in the near future to purchase the software, however I do have the card reader. I do have the clinician manual in PDF format.
Thanks for your quick reply!

[scrapper]

Please send me a private message by clicking on the PM button......I cannot access yours

[ozij]

Your leaks are way beyond what the machine can handle. You're probably not getting the therapeutic pressure you need - you absolutely must get those leaks down.

They could be the result of a mask whose shape is wrong for you
They could be the result of a mask whose size is wrong for you
They could be the result of a mask that is simply not set up properly for use
They could be the result of a mask that is slipping on your face because of facial oils
They could be the result of a worn out seal on an otherwise perfect mask.
They could be the result of the hose tangling and pulling the mask from its original good seal

Whatever the reason -- those leak have to be better controlled.

[rested gal]

I agree with what ozij said:

Your leaks are way beyond what the machine can handle. You're probably not getting the therapeutic pressure you need - you absolutely must get those leaks down.

They could be the result of a mask whose shape is wrong for you
They could be the result of a mask whose size is wrong for you
They could be the result of a mask that is simply not set up properly for use
They could be the result of a mask that is slipping on your face because of facial oils
They could be the result of a worn out seal on an otherwise perfect mask.
They could be the result of the hose tangling and pulling the mask from its original good seal

Whatever the reason -- those leak have to be better controlled.

leak/wk - 0.56
leak/month - 0.50

Any brand of autopap that is trying to deal with excessive leaks generally cannot provide therapy that would be as good as when leaks are well controlled.

Excerpt from page 26 of the Provider Manual for the ResMed S8 AutoSet II:

Leak is derived by analyzing inspiratory and expiratory airflows (via the flow
sensor located in the device). Theoretically, inspiratory and expiratory volumes
should be equal. A net airflow greater than the expected mask vent flow is equal
to the leak. Generally, a leak rate of more than 0.4 L/s (24 L/min) is associated
with patient discomfort, disturbed sleep, and reduced efficacy of treatment.
Added emphasis mine.

[cycloman2005]

Thanks for your input ozij,
I recently replaced my old Quattro mask with a new one, but I do not like it very much, it hurts the bridge of my nose!
It is a Large size, I have a large nose, maybe switching to a shallow mask instead of a narrow one.
I will have to look into a better mask with lower leak rates, I have used a Mirage Liberty mask previously, but had too much nasal congestion using it!
I suspect that my hose is tangling while I sleep, I will have to install it overhead with a hook in the wall.
I do sweat and the facial oils could be contributing to the leaks.
I guess it is not a pressure-related problem, I do sometimes feels like I'm suffocating with the mask on my face.
I thought my min. pressure was too low causing the suffocation and discomfort, would raising the min pressure help?
I've read that some do not like the Quattro because of the high leak rates!
Time for me to try some different solutions to reduce or lower the leak rates...

[ozij]

Rasing the min would help - but those leak are way way out of sight.

Don't confuse the mask's built in vent rate (or leak rate) with the leakage you're getting when its in use.
Find a mask that fits you well - study it's fitting instructions and fiddle with everything - its your face, and you have to feel it fits comfortably.
I've never uses a Quattro, and I know it hurts some people on the bridge of their nose -- but there are also many adjustments possible to that mask -- try them all patiently when you're wide awake, not when you're just dying to fall asleep at night.
O.

[Muse-Inc]

I 'third' the leak rate is excessive: too much leak makes your numbers suspect. Do you have your mask properly defined in your AutoSet? See this chart http://www.resmed.com/us/assets/documen ... sa_eng.pdf

PS I wear the RespCare Hybrid FFM and really like it, no covering the nose or touching the forehead but with the comfort of pillows.

[cycloman2005]

Hi muse,
I do have my mask selection to MIRFULL for the Quattro on the Autoset II, I felt no leaks when doing the mask fit and the mask fit on my machine said it was an Excellent fit, it is a new mask, my new hose has no leaks!
It's very strange I had a high leak rate last night, about 77l/min, my mask fit was snug & tight on my face!
That is way to high for the Quattro! The chart says it should be around 54 l/s @ 20cm.
I was only a pressure of 9cm!
Odd!
Pressure: 8.8 cm
Leak: 1.28 L/s
AHI - 5.1
AI - 0.0
HI - 5.1
EPR - 0.0

The AHI & HI numbers was 5.1 which fall in the normal range.
I also felt bloated and uncomfortable, I do suffer from asthma and GERD, I wonder if this is contributing to the leak rates?
I also switched my Resmed headgear to Large from my previous mask, the Medium size from my new mask, feels too tight around my head!
I'm also thinking of trying a nasal mask similar to the Swift, to see if I get lower leak rates?
To my surprise I do feel well this morning despite the high leak rate because my AHI & HI was 5.1 within normal range.
I will increase my EPR setting to 1, to see if my numbers change and if I get a lower leak rate?
How would I know if my Autoset II was not functioning properly and is there a calibration test for the Autoset II?
There are no error codes displayed on my machine.
Ah...the ups & downs of CPAP therapy!

[cycloman2005]

I've been reading the following posts regarding the Quattro mask: Love or Hate relationship regarding the Quattro mask.
It looks like I'll be shopping for another FFM , lots of complaints on how much the Quattro leaks and has poor sealing!
viewtopic/t47916/Love-or-hate-the-quattro.html

[Muse-Inc]

With your mask properly defined in the ResMed xPAP, the reported leak is actual leak...not the vent rate of the mask plus leak -- the xPAP substracts the mask's vent rate from the detected leak and reports the excess leak. Re-read this from RestedGal's post above "Generally, a leak rate of more than 0.4 L/s (24 L/min) is associated
with patient discomfort, disturbed sleep, and reduced efficacy of of treatment." You are reporting leak >0.4.