S9 Autoset Leak Question

[mark-n-miro]

I have another question. Despite the fact that I am a physician, I do not know everything. I have a ResMed S9 Autoset, previous to this I had a Respironics PR System One Autoset (older version), thus the post about if the new PR System One Auto is quieter than the ResMed S9 Autoset. I notice that on the Resmed S9 Autoset there is information given about leaks every night. I have spoken to a couple of RT's and ResMed themselves but am getting conflicting info especially when I read things on here i.e "There should be no leaks or get rid of the leaks".

When running in Auto mode (S9) between 6cm and 12 cm I have no leaks at all. If I set the machine to straight CPAP at my titrated level of 11CM I have a leak of 2.4 l/min. I keep reading on here that there should be no leaks at all. The RT's and ResMed said this is a negligable leak and nothing to cause concern.

I am not sure who to believe and how to if necessary get rid of the darn leak if I am running on CPAP @ 11CM

So which came first the chicken or the egg? Is there a right or wrong answer to this or just a shade of grey. I really love the S9, but there is this leak/depression problem.

I must say I really like my Auto S9, but it is different than being on my PR System One Auto, on the S9 leaks or no leaks I often wake up tired and I must say a bit depressed.I first notice it after using the machine for about 3 months. I at first thought this was really just circumstance I then for awhile switched back to the PR System One Auto and within a couple of days use I wake up most times feeling not tired and ready to tackle the day, with no feelings of depression. The other reason why I was asking about noise as I was thinking of buying another PR System One Auto (new version 2.XX), I really love the S9 quiet as can be, and I would hate to waste the money.

Could this really be or is it all in my head. That is how I ended up on CPAP as I was having horrible anxiety with depressive moments, and at the advice of a Psychiatrist friend of mind who told me to go have a sleep study done found out that I have OSA.

Sorry for rambling, thanks for all your help in advance.

[Pugsy]

The RT's and ResMed said this is a negligable leak and nothing to cause concern.

leak of 2.4 l/min.

I vote with the RT's and ResMed. It is an unrealistic expectation to expect a flat 0.0 leak rate. Some people attain it but it is not critical. ResMed actually says that the machine will adequately compensate for leaks up to 24 L/min.
You have a lot of room before the leak impairs therapy. I wouldn't give it a second thought.

Now if a minor leak is disrupting your sleep in some fashion then that is of course unwanted.

[apneawho]

Everything I have read says leak under 24 on ResMed machine is acceptable. What is your AHI in these different scenarios? And of course, you have to go based on how you feel. Some nights I have zero leak with my S9. I run constant cpap mode pressure of 14. I do not have an auto. You know the leaks are more a result of your mask fit and whether you are opening mouth if not using full face mask. Zero leak is not a usual phenomenon for me with AHI consistently <1.

[mark-n-miro]

Everything I have read says leak under 24 on ResMed machine is acceptable. What is your AHI in these different scenarios? And of course, you have to go based on how you feel. Some nights I have zero leak with my S9. I run constant cpap mode pressure of 14. I do not have an auto. You know the leaks are more a result of your mask fit and whether you are opening mouth if not using full face mask. Zero leak is not a usual phenomenon for me with AHI consistently <1.

OK as I said leak is running at 2.4l/min @ a pressure of 10.5 my AHI on all of this is 0.2. Like I said for the first 2 months I seemed fine, then the blues started creeping up on me again. I switched back to the System One Auto and 2 days later I had more energy and the blues were gone. Perhaps it is a placebo effect, as I get worse numbers on the System One AHI of 1.0 with a leak of 5.3l/min. OR as usual I am driving myself mad, Dr's make the worse patients!

[Pugsy]

Dr's make the worse patients!

They do don't they? I worked with doctors and have several as personal friends. Yes, most often not good patients.

You know you might be one of the people that actually feels the difference in the way one machine works over the other. You wouldn't be the first one. A few people have had the opportunity to use both brands and have noticed a preference. The algorithms and how they deliver therapy are different. Exhale relief is also addressed differently.
It may not be placebo effect. Sometimes the least little difference or change makes a huge difference in how we feel.

[robysue]

I have another question. Despite the fact that I am a physician, I do not know everything.

What a refreshing attitude!

I have a ResMed S9 Autoset, previous to this I had a Respironics PR System One Autoset (older version), thus the post about if the new PR System One Auto is quieter than the ResMed S9 Autoset. I notice that on the Resmed S9 Autoset there is information given about leaks every night. I have spoken to a couple of RT's and ResMed themselves but am getting conflicting info especially when I read things on here i.e "There should be no leaks or get rid of the leaks".

When running in Auto mode (S9) between 6cm and 12 cm I have no leaks at all. If I set the machine to straight CPAP at my titrated level of 11CM I have a leak of 2.4 l/min. I keep reading on here that there should be no leaks at all. The RT's and ResMed said this is a negligable leak and nothing to cause concern.

Is that 2.4 L/min coming directly off the S9's LCD? If so, it's your 95% unintentional leak rate. In other words, you're leaking AT or ABOVE 2.4 L/min above the mask's intentional leak rate for a mere 5% of the night.

I vote with the Resmed folks and the RTs: As long as you're not waking up because that small leak is somehow irritating the daylights out of you by blowing directly in your eye or chapping your lips, you shouldn't lose any sleep worrying about it. (On the other hand, if you're waking up all the time with a small, but irritating leak then you probably ought to deal with the leak so that it doesn't continue to wake you up.)

I must say I really like my Auto S9, but it is different than being on my PR System One Auto, on the S9 leaks or no leaks I often wake up tired and I must say a bit depressed.I first notice it after using the machine for about 3 months. I at first thought this was really just circumstance I then for awhile switched back to the PR System One Auto and within a couple of days use I wake up most times feeling not tired and ready to tackle the day, with no feelings of depression.

Now that IS a issue to be concerned about. If you're waking up feeling WORSE with the S9 and your 95% leak rate is only 2.4 L/min, then the problem ain't leaking. And it's not noise as you point out later on and in the other thread. So what could it be?

Are your overnight AHI numbers roughly the same on both machines?

Do you use EPR on the S9? If so, what is it set at? Do you use Flex on the System One? What is it set at? The two systems for exhale relief do work differently. And some folks are sensitive to the differences. And some folks find that if they turn EPR on when using the S9, they have to bump the pressure setting up accordingly. Unlike Flex, which increases the pressure back to the full setting by the time you start inhaling, EPR on the S9 waits pretty much until you start inhaling to increase the pressure. For a few folks, that difference of when the pressure is increased matters a great deal in how they feel in the morning.

So---you could try turning EPR down or off entirely and seeing if you wake up feeling more rested, less depressed, and more ready to face the day.

[apneawho]

as I said leak is running at 2.4l/min @ a pressure of 10.5 my AHI on all of this is 0.2. Like I said for the first 2 months I seemed fine, then the blues started creeping up on me again. I switched back to the System One Auto and 2 days later I had more energy and the blues were gone. Perhaps it is a placebo effect, as I get worse numbers on the System One AHI of 1.0 with a leak of 5.3l/min. OR as usual I am driving myself mad, Dr's make the worse patients!

AHI of 1.0 on System One is nothing to sneeze at. I would not consider that worse at all. If you feel better on that machine then I don't think there is any question, use it! Don't drive yourself mad about it. I am a nurse, so I am the wrong person to ask about doctors making the worst patients. Nurses aren't much better. Best wishes.

[chunkyfrog]

Apnea, like other ailments, does not always exist in a vacuum.
Other problems may exist as well.
Insomnia is not uncommon, as are many other conditions.
Once your apnea has been addressed, other professionals may be able to address other problems that may have previously been overlooked.
Do not give up; thinking this is as good as it gets. Persistence.
Sleep well, doc.

[mark-n-miro]

I must say I really like my Auto S9, but it is different than being on my PR System One Auto, on the S9 leaks or no leaks I often wake up tired and I must say a bit depressed.I first notice it after using the machine for about 3 months. I at first thought this was really just circumstance I then for awhile switched back to the PR System One Auto and within a couple of days use I wake up most times feeling not tired and ready to tackle the day, with no feelings of depression.

Now that IS a issue to be concerned about. If you're waking up feeling WORSE with the S9 and your 95% leak rate is only 2.4 L/min, then the problem ain't leaking. And it's not noise as you point out later on and in the other thread. So what could it be?

Are your overnight AHI numbers roughly the same on both machines?

Do you use EPR on the S9? If so, what is it set at? Do you use Flex on the System One? What is it set at? The two systems for exhale relief do work differently. And some folks are sensitive to the differences. And some folks find that if they turn EPR on when using the S9, they have to bump the pressure setting up accordingly. Unlike Flex, which increases the pressure back to the full setting by the time you start inhaling, EPR on the S9 waits pretty much until you start inhaling to increase the pressure. For a few folks, that difference of when the pressure is increased matters a great deal in how they feel in the morning.

OK first of all thanks for all the information. To answer the questions.

Yes I do use the EPR on the S9 it was first set at 3 then 2 then 1 tried all the settings. Yes my 95% leak rate every night read right off of the LCD screen is 2.4l/min. I have the same leak rate if I am on the PR One Autoset which is set to C-Flex + 1 according to my reports from Encore.

How much would I have to bump the pressure up? I was also thinking maybe it has something to do with the tubing the S9 runs with 15mm tubing the PR One with 22mm tubing.

I just do not want to have to go and get another machine if I do not have to. The PR System One I have now is the older version and it is noisy, it is also having problems that the screen freezes while scrolling and machine hours are not clocking correctly. I have been going back and forth with Respironics on this one for a replacement, but they are reluctant, as the machine was already replaced once (motor died and at that point and time the PR One was new on the market and they didn't do repairs they just swapped defective for new, now they have the parts for repair).

Not to sound stupid, but sometimes running the ER is easier than dealing with the darn CPAP.

[robysue]

Are your overnight AHI numbers roughly the same on both machines?

Do you use EPR on the S9? If so, what is it set at? Do you use Flex on the System One? What is it set at? The two systems for exhale relief do work differently. And some folks are sensitive to the differences. And some folks find that if they turn EPR on when using the S9, they have to bump the pressure setting up accordingly. Unlike Flex, which increases the pressure back to the full setting by the time you start inhaling, EPR on the S9 waits pretty much until you start inhaling to increase the pressure. For a few folks, that difference of when the pressure is increased matters a great deal in how they feel in the morning.

OK first of all thanks for all the information. To answer the questions.

Yes I do use the EPR on the S9 it was first set at 3 then 2 then 1 tried all the settings. Yes my 95% leak rate every night read right off of the LCD screen is 2.4l/min. I have the same leak rate if I am on the PR One Autoset which is set to C-Flex + 1 according to my reports from Encore.

How much would I have to bump the pressure up? I was also thinking maybe it has something to do with the tubing the S9 runs with 15mm tubing the PR One with 22mm tubing.

Since EPR lowers the pressure by a fixed amount for the entire exhale, you might try upping the pressure setting by the same amount as the EPR setting: If EPR = 3, increase the pressure by 3cm; if EPR = 2, try increasing the pressure by 2cm; if EPR = 1, try increasing the pressure by 1cm. It could also be that somehow the PR System One better matches your breathing pattern than the S9 does.

The hose is another intriguing idea. You can use that fatter hose with the S9 if you want. You just need to make sure the hose setting is set to STANDARD instead of SLIMLINE. It ought to be on the patient's set up menu. If it's not, you'll need to get into the clinical menu and change the hose setting.

I'd also say that if your 95% leak is running 2.4 L/min, you should quit worrying about the leaks. They just aren't that significant unless they are actually waking you up or physically keeping you awake instead of just keeping you awake through worrying about them.

I just do not want to have to go and get another machine if I do not have to. The PR System One I have now is the older version and it is noisy, it is also having problems that the screen freezes while scrolling and machine hours are not clocking correctly. I have been going back and forth with Respironics on this one for a replacement, but they are reluctant, as the machine was already replaced once (motor died and at that point and time the PR One was new on the market and they didn't do repairs they just swapped defective for new, now they have the parts for repair).

This is a bummer. But it seems to me that if you can prove the machine hours are not clocking correctly, then it ought to be a warranty issue if the machine is less than 2 years old.

Not to sound stupid, but sometimes running the ER is easier than dealing with the darn CPAP.

As many problems as I've had this past year making this crazy therapy work, I can really sympathize: CPAP is clearly the hardest thing I've ever done in my life. By a long shot.