HELP needed for 13-yr CPAP user!

[JoyD.]

Ozij wrote:

I was reminded of something I saw on page 27 of the AS10 clinical manual:
https://www.respshop.com/manuals/ResMed ... %20her.pdf

Pay attention to images 4, 5, and 6. The part where you insert the hose can be released and taken out.

Yes I saw that on a youtube video - you can remove that part to clean it. But the other day I tried to disconnect it, and couldn't. (Tried that AFTER all these Large Leaks started, so I didn't disconnect anything.) -- And THANKS for the link for the Clinical Manual which I did not have!

I wonder if whatever cracked the older water chamber has anything to do with that internal disconnect -- leading to those massive leaks.
I know - the leaks are intermittent, and you'd expect a more stable leak from a disconnect.
But on the other hand, you'd also expect an experienced user of 13 year not to run into such massive leaks all of a sudden.... They seem to happen immediately when the pressure goes up, they're never low or intermediate, they're never gradual.
Did the machine fall and possibly knock that hose inlet out of place?

I probably cracked the water chamber while washing it which I did about every week or so. No, my AirSense never fell.

Thanks for putting out some new ideas to consider, Ozij.

[JoyD.]

Lynninnj wrote:

Actually I was wondering if you have a backup machine?

Can you test out the masks that way?

If a backup gives better results then perhaps it’s a question of settings or something on your primary machine being amiss? Maybe a warranty issue?

I wonder about your settings as well and if you have a backup, take note of whether the last used backup settings are different?

Lynn, wow, I hate to drag out that old thing . . . and, anyway, the card is one of those old large things & I no longer have the old card reader. I guess if worse comes to worse, I may have to see if I still have the old card for it (or find one to buy), then buy yet another card reader accommodating that size card (if those things are still made). UGH. I think I'll put that in "last resort" place.

[JoyD.]

Lynninnj wrote:

You said nothing has changed in 6 m. revisiting this my sinuses really started to act up a few weeks ago. I believe it is a combination of leaves, falling and being moldy from moisture and the heat has been on a few times, potentially drying me up.

I look at all of the flow limit stuff on your chart and it looks an awful lot like the stuffy nose from hell. I am not sure where you live, but I wonder if this could be a possibility?

I don’t have the a S 10 but I do have the a S 11 and there is a removable portion next to the chamber. I think that is a good thing to pursue as well.

1. Actually, Lynn, so far I haven't had a stuffy nose; my nose-stuffiness usually happens during the Winter, and then I use Flonase.
2. What removable portion next to the chamber are you referring to? And what are you suggesting I pursue??

[JoyD.]

Pale Rider responded:

JoyD. wrote: ↑Wed Nov 09, 2022 3:49 pm
1. I only use EPR during ramp because I thought that using EPR "all the time" can increase Centrals (?).
"can" in about 1 in 7 people.
"Will"? not necessarily, even in those 1 in 7
JoyD. wrote: ↑Wed Nov 09, 2022 3:49 pm
Also, I just don't feel pressure when I breathe out, so didn't think I needed EPR.
Not unless you want it.

I'm not real clear on when I might benefit from EPR. My understanding was that it was there to use if you were uncomfortable with the pressure against your exhale. So far, I haven't been aware of that bothering me. So . . . I've played around with it, turning it to 1, 2, or off - and haven't noticed a difference. I'd welcome any other insight into EPR.

[ChicagoGranny]

I'd welcome any education someone might wish to share. with me.

I would get the leak issue resolved before worrying about changes to EPR.

And what are you suggesting I pursue??

lynn generally recommends everyone pursue everything. She has an open-cylinder shotgun and enjoys shooting it.

[lynninnj]

Lynninnj wrote:

You said nothing has changed in 6 m. revisiting this my sinuses really started to act up a few weeks ago. I believe it is a combination of leaves, falling and being moldy from moisture and the heat has been on a few times, potentially drying me up.

I look at all of the flow limit stuff on your chart and it looks an awful lot like the stuffy nose from hell. I am not sure where you live, but I wonder if this could be a possibility?

I don’t have the a S 10 but I do have the a S 11 and there is a removable portion next to the chamber. I think that is a good thing to pursue as well.

1. Actually, Lynn, so far I haven't had a stuffy nose; my nose-stuffiness usually happens during the Winter, and then I use Flonase.
2. What removable portion next to the chamber are you referring to? And what are you suggesting I pursue??

See the diagrams a few pages in? (7 of 119 pdf)

#5 outlet connector

https://document.resmed.com/documents/p ... er_mul.pdf

Do you have one on yours?

pg 18 of 119 pdf instructions to disassemble. image 5 and 6.

hth

Edit: I just looked here https://document.resmed.com/documents/p ... er_eng.pdf

You have an outlet but it doesn’t say it’s removable like the as11 so maybe that’s not the issue?

sorry but maybe just look closely for signs of wear or damage?

[ozij]

4. Re: the Tape, tonight I'm going to do a BETTER JOB of taping; I have been leaving the corners free & thought that was sufficient to keep my mouth closed . . . but someone pointed out to me that air can still escape in the corners and I need to be taping beyond my lips on the sides.

I need my mouth shut up firmly by the tape. No corner no slit open to let air out, and not that X shaped tape that works so well for some.

My recent favorite technique is a combination of two tapes:
The first, available from Amazon, is Medvance Soft Silicone Tape with Perforation for Easy Cut Size - 1" Width. When bought in 3 roll packs it's much cheaper per pack. Some people need a 2" width.

It's very soft, easily removeable, leaves no residue on your skin - perfect for using on that sensitive skin. Also reusable, but I rarely reused it.
I make sure to fold in a tab on a least one side and also make sure to cut a length that is sure to cover the corners of my mouth and a bit more. If I don't, the minor leaks I get from the corners (fixed pressure of 8.4) leave me with a terribly dried out mouth - literally terrible as in causing pain and bother for some hours later. And the leaks don't ever look bad on the graph.

Then I add another layer of 3M micropore, which I have left over from when I used to use it for mouth taping. This one is shorter, on top of the Medvance, and is there to protect it from the humidity caused by my breathing. I do that because the Medvance tape can be loosened by the humidity coming from my breath - especially if I use the Bleep. No longer use the Micropore directly on my skin.

[JoyD.]

Lynn wrote:

I just looked here https://document.resmed.com/documents/p ... er_eng.pdf
You have an outlet but it doesn’t say it’s removable like the as11 so maybe that’s not the issue?

Yes, Lynn, it IS removable, but I have never removed it as some people do to clean it.

[JoyD.]

FINALLY . . . LAST NIGHT'S "PROPER" & AGGRESSIVE TAPING SOLVED THE HORRID LARGE LEAK PROBLEM I'VE BEEN HAVING!!!! IN OSCARS Statistics, last night's 95% Leak rate was 8.40 . . . compared with the Last Week's 40.80 -- So, I've learned that I've become a "big-time" mouth-breather who needs to continue taping aggressively! I take it that the 8.40 is coming from occasional mask leaks which is probably pretty much unavoidable for an active side-sleeper. At that level, I won't worry about it. (I still hope to try the BLEEP.)

Now, for the Screen Shots of my OSCAR charts: a CONFESSION is in order. I was a bad girl last night. I was reading in the Clinical Manual the modifications in "AutoSet for Her" compared with the regular "AutoSet" Mode . . . although mostly the same, the algorithm modifications for the "AutoSet for Her" are these:
1. Reduced rate of pressure increments designed to help prevent arousals.
2. Slower pressure decays.
3. TREATS APNEAS UP TO 12 CM H2O & continues to respond to flow limitation and snore up to 20 cm H2O.

Since my Pressure has been hovering just over 11 since I've had the machine, I thought perhaps I should go to the regular "AutoSet" mode. I REALLY should have consulted with the "experts" on this Forum, like Pugsy and Ozij. But impatience & curiosity got the better of me so before I went to bed I changed the "AutoSet for Her" Mode to regular "AutoSet".. . . and about half-way through the night I changed it back to "AutoSet for Her" setting which I've used these past 3 years since I've had the machine (w/o using software I might add). -- I'm not sure if this told me anything at all! SO, experts . . . should I stay with the "for Her" setting . . . or continue experimenting in some way (maybe a week at a time for each setting)? Feel free to PM me on this.

Here are my last night's results, for what they're worth (DEFINITELY worth the Leak Scores):
STATISTICS: https://imgur.com/a/sXGCTJf
GRAPHS: https://imgur.com/GQ96J4X

JoyD.

PS - Having solved the Large Leak problem, now I need to get the AHI down. I thought it was interesting that last night's graph (above) shows a considerable number of OAs (during both "Modes", both halves of the night). Yet, the preceding nights I've posted there were few or no OAs, rather mostly hypopneas. (My original sleep study showed an overwhelming majority of events being hypopneas also. I can post this chart if it could be helpful.) - Anyway, I was surprised with the number of OAs last night. Could it be that the former nights with few or no OAs were just INVALID because of the Large Leaks I had then??)

[ozij]

Something's wrong with the "Graphs" link.
I get a 404 error.

As for the leaks, the most impressive improvement - is in the "% of time above Leak Rate threshold". It was 0.03% of the time last night

[Pugsy]

You aren't going to believe this but I was going to suggest changing modes as the very next thing you did.
Almost typed it out last night but I wanted to first see what happened with aggressive mouth taping and a better looking leak graph.

I also cannot see your "graphs" link....I get a 404 error also.

You might want to redo the image link....something got broken.

[JoyD.]

Pugsy wrote:

I also cannot see your "graphs" link....I get a 404 error also. You might want to redo the image link....something got broken.

Thanks . . . fixed it. The new link works:
https://imgur.com/GQ96J4X

You aren't going to believe this but I was going to suggest changing modes as the very next thing you did.
Almost typed it out last night but I wanted to first see what happened with aggressive mouth taping and a better looking leak graph.

Well, maybe I'm not as stupid as I think! NOW . . . I need help with a PLAN . . . bring it on!

[JoyD.]

OZIJ wrote:

Something's wrong with the "Graphs" link. I get a 404 error.

As for the leaks, the most impressive improvement - is in the "% of time above Leak Rate threshold". It was 0.03% of the time last night

Fixed the Link, thanks. This one works: https://imgur.com/GQ96J4X

Wow, didn't notice the 0.03% percent of time about Leak Rate threshold. FINALLY.

Now hoping you and Pugsy can help me get my SETTINGS right!

[ozij]

I'd say you were making too many changes at once since the beginning of November.
Your best results are with EPR off (or ramp only).
The only change I'd make at this point is not use EPR for a week and see what it does.

[Pugsy]

Lots of changes recently so it's really hard to have any idea which change might have done what.

Pick something and plan to stick with it. If you like how EPR feels...use it but I suspect you will need a little more minimum if you want to use EPR and even if you don't use EPR there's a chance you might need a little more minimum.

I would really like to see a full night in regular auto adjusting mode though....with whatever settings you like, feel good with and promote sleep. Gotta start somewhere.

Do you ever sleep on your back? The clustering of the flagged events makes me think of REM or supine sleeping or maybe a combination of both. I don't think it is solely REM related though. First REM doesn't normally last all that long.