Help with my settings and statistics

so true. Last night I tightened my mask super tight. same results more uncomfortable, and 110 leaks later. my pressure setting is at 22. I have the mask fit feature and use it, just when I think I have a good seal. I look at the results and still lots of leaks. My dme isn't much help. I live in a small town so only one choice. Should I consider driving to diff town
about an hour away.

Bennnyp wrote:so true. Last night I tightened my mask super tight. same results more uncomfortable, and 110 leaks later. my pressure setting is at 22. I have the mask fit feature and use it, just when I think I have a good seal. I look at the results and still lots of leaks.

Please read and follow JanKnitz's instructions for fitting the Quattro family of masks. You can find her blog entry on this at http://maskarrayed.wordpress.com/taming ... e-quattro/

Another thought: How old is this particular mask? How old is the mask cushion? Worn out cushions and worn out headgear can cause a lot of problems with leaks.

My dme isn't much help. I live in a small town so only one choice. Should I consider driving to diff town

It depends on whether the DMEs available in other nearby towns will be anymore helpful. You could try phoning some other DMEs and interviewing them to see if they appear to be more helpful.

ok so I spent yesterday working with my mask with my mask fit. Bought a cpap pillow. Slept last night for 6 hours, I feel very well rested. I looked at
my numbers. AHI of 11.9. obstructive 0 Central 1 and Unknown 9.2. Leak rate median 21.6 95th percentile 106.8. which number should I use for leak rate? Why so many unknowns? Also median IPAP 16 95th percentile 16.2 and max 16.4. median Epap 16 95th percentile 16.2 and max 16.5.
Normally my max range is 21.1 IPAP and EPAP is 17.1. why such a drop on the IPAP?

The 95% is what you look at, it should be at 24 or below 95% of the night. With a leak of 106 your machine can't figure out what activity you're having so it's marked as an unknown. Your data is meaningless with this leak rate. When was the last time you changed the mask cushion and headgear? Are you wearing the proper size and have you tried other masks?

The mask I have is only about 2 weeks old. Is it possible that the data is wrong. Last night it sure seemed like I had very few leaks compared to most
nights? why all of the sudden did my ipap drop to 16 from 21 for the first time in 2 months? I also felt awesome today. Just think how good I feel
with an AHI of 11.9. I can't imagine what I will feel like if I can get it under 5. I will continue dealing with the leak issue. I have read many posts
here and have done a lot of research on masks for people with high settings, and I have it narrowed down to 6 masks that might work.
They are. Resmed Quattro FX FFM, Fisher & Paykel Forma FFM, Decilbiss Easy Fill Gel FFM, Hans Rudolph 7600 V2, PMI Probasics ZZZ FFM, and the
Amara FFM W/Gel and Silicone. Oh and I currently am using Resmed Mirage Quattro. Any help or comments on these masks would be greatly appreciated.

http://maskarrayed.wordpress.com/taming ... e-quattro/

Bennnyp wrote:Leak rate median 21.6 95th percentile 106.8. which number should I use for leak rate?

You need to pay attention to both the median leak rate and the 95% percentile leak rate. You want that median leak rate well below the 24 L/min "Large Leak" line. Ideally you'd like the 95% leak rate below 24 L/min as well, but in your case you're battling some pretty serious leaks and the 95th percentile is less useful than the median.

How do I know you're leaks are significant? The median leak rate is already getting close to 24 L/min. That means that for at least 50% of the night, your leaks are really too high because for 50% of the time your leaks are AT or BELOW 21.6 L/min and for 50% of the time your leaks are AT or ABOVE 21.6 L/min. And your 95% leak rate is a whopping 106.8 L/min and that means that for 95% of the night your leak rate was AT or BELOW 106.8 L/min and for 5% of the night your leak rate was AT or ABOVE 106.8 L/min. And how long is 5% of the night? 5% of one hour is 3 minutes. You say you slept for 6 hours. So your leak rate was AT or ABOVE 106.8 L/min for at least 18 minutes. And so it is reasonable to assume that for a significant portion of 50% the night when your leak rate was AT or ABOVE 21.6 L/min, it was well above 21.6 L/min and, hence, well into the Large Leak territory.

You also write:

I looked at
my numbers. AHI of 11.9. obstructive 0 Central 1 and Unknown 9.2. Leak rate median 21.6 95th percentile 106.8. which number should I use for leak rate? Why so many unknowns?

The large number of Unknown Apneas is because the FOT algorithm for distinguishing between OAs and CAs is unreliable when the leak rate is close to or above 24 L/min on a Resmed. And your leak rate numbers indicate that you spent at least 50% of the night with Leak Rates that are high enough to make the FOT algorithm unreliable. In other words, because the leak rate is so high, the machine is unable to distinguish whether the apneas it is scoring are OAs or CAs.

You write:

ok so I spent yesterday working with my mask with my mask fit. Bought a cpap pillow. Slept last night for 6 hours, I feel very well rested.

and

The mask I have is only about 2 weeks old. Is it possible that the data is wrong. Last night it sure seemed like I had very few leaks compared to most
nights?

and

Oh and I currently am using Resmed Mirage Quattro. Any help or comments on these masks would be greatly appreciated.

The leak data is not likely to be wrong. But when the leaks are this high, the AHI data may be "off". When the leak rate is too high, the machine cannot always accurately determine the breathing pattern, and that can lead to problems with detecting apneas and hypopneas. The real AHI could be higher than the displayed AHI if the machine was unable to detect events because it could not properly track your breathing due to the high leak rate. Or the real AHI could be lower than the displayed AHI if the machine was misreading the breathing pattern it was detecting during the high leak rate periods.

You need to spend some more time trying to fit the mask at your full pressure. Please read and follow JanKnitz's instructions for fitting the Quattro family of masks. You can find her blog entry on this at http://maskarrayed.wordpress.com/taming ... e-quattro/ Until the leaks are under control, you really can't trust the rest of the data.

And you'll know the leaks are under really control when your median leak rate is no higher than 10-15 L/min and your 95% leak rate is no more than 25-30 L/min.

Finally you write:

Also median IPAP 16 95th percentile 16.2 and max 16.4. median Epap 16 95th percentile 16.2 and max 16.5.
Normally my max range is 21.1 IPAP and EPAP is 17.1. why such a drop on the IPAP?

and

why all of the sudden did my ipap drop to 16 from 21 for the first time in 2 months? I also felt awesome today. Just think how good I feel
with an AHI of 11.9.

There are a lot of things that go into determining when the Resmed is going to increase pressure. Some of it is events. But the S9 will also increase pressure for flow limitations and snoring as well. It could be that on this night there was less flow limited breathing and less snoring going on. So the machine didn't increase the pressure as much. It could be that the leaks were marginally better and that lead to the machine increasing pressure a bit less. Without seeing the actual flow rate, pressure, flow limitation, snore, and leak graphs all at the same time for this night and a typical night with the 95% IPAP = 21. 1, there's really no way to answer your question about why the 95% IPAP is down on this particular night.

The fact that you feel good today is encouraging. If you ever do get the leaks under control, my guess is that the AHI will drop simply because the machine will have an easier time providing enough pressure to splint your airway open all night and many fewer events will get through.

Thank you for the reply. Going to do my do diligence on my mask leaks and not worry about anything else right now.