Confused Again

grumpygirl · Post by **grumpygirl** » Sun Jul 20, 2008 11:29 am

I guess I am always somewhat confused when it comes to getting things right on my new APAP. However, I have noticed lately that my leak rates are VERY low- like .02, .00 for the last two nights. When this happens I seem to be very depressed the next day and find that I am also more tired than usual. What is happening here. What do I need to do to get these leak rates back to a normal level? I know some folks would kill for very low leak rates but it seems to impact me in a negative way. ALso, I tape my mouth since I am a horrible mouth breather(hate FF masks) and lately my tape has been wet during the night and when I wake up. I have lowered my humidifier from 3 to 2 and that doesn't seem to have helped any. I guess I'll try lowering it to 1 tonight and see if that helps any. I surely don't want to wake up with my tongue sticking to the roof of my mouth because it is too dry. Maybe I am not taping correctly and my mouth is still opening during the night just enough to let saliva out. Will I ever get this thing right???

ozij · Post by **ozij** » Sun Jul 20, 2008 11:53 am

First of all, if the mask setting on your machine is not "Standard" then move it to Standard.

Second, search in your Opus 360 manual for the expected leak rate (vent flow rate) of the mask at the average pressure you're using. Your leak rate at night, with the machine set at standard should not be lower than the mask's vent flow rate.

The Opus™360 Nasal Pillows Mask has an air exhaust system that vents the
expelled CO2 through a group of fine holes in the front of the Elbow.
It is important that these holes are not blocked by any object. This controlled leak
ensures exhaled CO2 is expelled from the mask.
Code: Select all
Pressure (cmH2O) 3  5  7  9  11 13 15 17 19 21 23 25
Flow     (L/min) 17 22 26 30 33 36 39 42 45 48 50 52
Resistance to Flow Medium
Pressure drop through mask @ 50 l/min 1.2 cmH2O
Pressure drop through mask @ 100 l/min 5.4 cmH2O
Mask Dead Space
22cc

A 0 leak rate on your machine, with the wrong mask setting may indicated you're obstructing the vent - and not flushing out enough CO2.

A 0 leak rate on a Resmed machine with a non-Resdmed mask makes sense only if you know your mask's vent flow is equal to the Resmed mask you set it up for.

O.

grumpygirl · Post by **grumpygirl** » Sun Jul 20, 2008 12:09 pm

Thanks Ozij- My ResMed APAP is not set on Standard. I will try that tonight. Also, my pressure is set at 7.8-12.0. So my leak rate should be somewhere around 26-33 ? Is that correct, if my machine is set on Standard? My machine is set on Swift- my DME said that setting was the closet to the Opus. Any other suggestions??? I am not aware that I am blocking the exhaust system in any way.

Slinky · Post by **Slinky** » Sun Jul 20, 2008 12:18 pm

At the Standard mask setting the "allowed leak rate" is 24 L/M or .4 L/s

RiverDave · Post by **RiverDave** » Sun Jul 20, 2008 2:01 pm

Grumpygirl,
below is a comparison of the Opus leak rate, as well as the measurements made for the "Activa" and "Standard" settings on the S8

press Opus Activa Standard
4.0 20 19 21
6.0 24 24 25
8.0 28 27 30
10.0 31 31 33
12.0 35 34 36
14.0 38 38 40
16.0 41 40 42
18.0 44 43 46
20.0 46 45 48

Leak rates for the Opus came from the F&P website (I put a best fit line to get to the same pressure readings). The rates for the different S8 mask settings came from someone on the forum (don't remember who, I came across it in a post).

BTW the swift settings are more similar to the "standard" than the Activa.

ozij · Post by **ozij** » Sun Jul 20, 2008 10:31 pm

GG, I would expect the average reported leak rate to be in the vicinity of the average pressure. I would expect something like a min. of 28 to a max of 34 depending on the average.

Slinky, I assume that number is only relevant for doing a mask fit check - and a Resmed will not give you "good fit" on "Standard" if you exceed that. I doubt very much that Resmed will subtract 24 L/M from therapy reported leak rates regardless of pressure for any mask at "Standard". That would be misleading and irresponsible.

GG - to tape properly: put chapstick on your lips, purse them in, and then put on the tape, so you're actually taping your mouth's perimeter. Done like that, your lips stay taped together even when your jaw drops (like "polite yawning").

O.

grumpygirl · Post by **grumpygirl** » Mon Jul 21, 2008 5:59 am

Well, I changed my mask setting last night to Standard. My leak rate was 0.00 this morning. My AHI was 2.6, AI:0.2, HI: 2.4. So what's up now?? I checked to see if the exhaust was being covered etc. and could find no problems there. So now what?? I think I will maybe try to not use so much tape tonight and see if that helps. I have taped the same way since I started using a nasal interface and did not have these problems. I have to "double" tape since I am a heavy mouth breather, I'll give less tape a try tonight and see.

ozij · Post by **ozij** » Mon Jul 21, 2008 6:29 am

What do you call "double taping"?

O.

grumpygirl · Post by **grumpygirl** » Mon Jul 21, 2008 6:55 am

Double taping is when I use two strips going horizontally, and three strips going vertically and then one more on top of that going horizontally to keep it all in place. Man, that does sound like overkill but before that I would often wake up with huge leaks since my mouth would fall open during the night. Now I notice that the tape is damp, sometimes even wet during the night-with my humidifier set on 3-lowered it to two last night and it was a little better. I know I should be using a FF mask but I just cannot sleep with one of those things and I LOVE my Opus. It is so much more comfortable than anything and does not put pressure on a sensitive place at the back of my neck like most FF mask straps do.

bap40 · Post by **bap40** » Mon Jul 21, 2008 7:35 am

The only reason my tape is ever wet in the morning is from drool, not humidification.

DreamStalker · Post by **DreamStalker** » Mon Jul 21, 2008 7:47 am

grumpygirl wrote:Double taping is when I use two strips going horizontally, and three strips going vertically and then one more on top of that going horizontally to keep it all in place. Man, that does sound like overkill but before that I would often wake up with huge leaks since my mouth would fall open during the night. Now I notice that the tape is damp, sometimes even wet during the night-with my humidifier set on 3-lowered it to two last night and it was a little better. I know I should be using a FF mask but I just cannot sleep with one of those things and I LOVE my Opus. It is so much more comfortable than anything and does not put pressure on a sensitive place at the back of my neck like most FF mask straps do.

Nah ... now if you end up looking something like this in the morning, that might be a little "overkill" -