Switched to ResMed and....frowny face

So I got an AirSense 10 recently. I am now getting a LOT of large leaks, like half the night. This is with the same headgear as before. I am looking at the data in Oscar for my PR System 1 and then the Airsense (two different profiles) and it's quite dramatic how much worse I'm doing since I started the Airsense.

Has anyone else had this experience? I thought I might get woken up by the more aggressive ResMed algorithm, but instead I'm apparently sleeping through a lot of really bad leaks. Tried getting new pillows, then a new mask altogether (same model, Airfit P30i) but still terrible large leaks. Last night was 39.8% large leak. Feeling very sleep deprived!

Be sure tank is firmly and evenly seated and that hose connections at both ends are secure.
What machine were you using before?
It is possible you are finally seeing the leaks you were having all along.
If you do not have essentials set to plus, you are missing the whole picture.
The frowny face is sometimes full of crap.

Thanks for your reply, but I do not understand all of it. What do you mean by "essentials set to plus" ? You mean on the machine? It shows me the large leak and AHI etc not just the faces.

But I am not just looking at that, I am looking at the nightly data in Oscar. I can see the times and durations of large leaks. They are much worse than the same data is for my Philips Respironics System 1, my previous machine, which showed some large leak periods but not nearly as many or as long in Oscar.

So show us the Oscar--the frowny tells us/you nothing of consequence.

Here is last night with Airsense. Note I had a hard time getting to sleep, and then woke up around 7:15 and tried to get back to sleep unsuccessfully. Here is one of my worse nights with the PR System 1. Many nights have zero large leak

Here's the deal with Respironics large leak territory boundaries vs ResMed large leak territory boundaries.
Respironics simply has a more generous boundary line and ResMed has a really conservative large leak boundary line.
So while Respironics might not care...ResMed does.

When I used to use a Respironics machine I never got a large leak flag but with a ResMed machine I would. It's simply a difference in reporting.

ResMed flags only excess leak...what is sort of like the bottom line on the Respironics leak report...and the line in the sand is 24 L/min.
Respironics never gives us a definitive line in the sand for their large leak territory because it varies as the pressure varies.
The top leak line on the Respironics report is the total leak line which is the mask's expected vent rate plus any excess leak.
ResMed doesn't show the expected vent rate.

So either the mask is moving a lot or you are mouth breathing a lot.

Your difference in leak numbers....2 different nights for one thing and different leaks plus the difference in the way each machine reports large leak along with the line in the sand for large leak territory.

While I do think that the 24 L/min line in the sand is a bit conservative....I don't worry about ResMed excess leaks until I hit 35 L/min because I have found that once I get up around 35 L/min or more the machine started flagged unknown apneas which means it was having trouble figuring out what kind of apnea I might be having and once I went above 40 L/min I saw no flags...which makes me wonder was the no flags because I didn't have any apneas or the machine wasn't flagging them because the leak was so bad it simply missed them. That's why we worry about large leaks....is the leak so bad that it's missing flagging stuff.

Your leaks are deep into large leak territory and could potentially be affecting the machine's ability to sense and record and respond to events. I would suggest trying to figure out if the leaks are mouth opening leaks vs mask movement leaks and then work on fixing them.

There likely has not been a new "significant leak" developed since you changed machines.

The three likely differences (possibly all) in triggering the large leaks are:

• Different pressures being used. Respironics (compared to ResMeds) are notorious for not adjusting the pressure soon or high enough. It's possible that the ResMed is using higher pressures for more of the time, and leak volume increased.
• The two machines report leaks differently, and have a different threshold over what is considered a large leak. ResMed machines normalize the leak rates by removing the estimate of what is vented, attempting to measure what is true leaks. Respironics display leak + venting. The two can't be compared.
• Ensure your mask type is set properly in the clinical menu.

Both graphs show a leaking problem, and the difference can be explained by the difference in reporting, and potential pressure differences.

This is why it's valuable seeing all the graphs that are asked for.

Assuming both devices are supplying the same amount of pressure, one doesn't blow different to cause greater leaks.

Thanks for the comments.

Here is pressure, in case it makes any difference. I partially tape my mouth, but I have tried fully taping it when I first noticed these leaks and it didn't affect the outcome, so I am pretty sure they are leaks at the nasal pillows. That is why I switched to a new set of pillows, and then the next night (after another frowny face) switched to an entirely new mask (same type, just brand new) and I do use Lansinoh on my nares.

Airsense pressure
PR System 1 pressure

Last night managed 0.02% large leak by tightening the mask. Hopefully that will solve the problem from now on.

The machine panel still said Large Leak 44l/min but looking at Oscar data that appears to just be when I first put it on and then removed it for a few seconds to allow what felt like water in the pillows to blow out. Once again Oscar is indispensable for diagnosing the actual situation!

The ResMed display may not be showing your one day summary, it defaults to 30 days.

Over the past month, large leaks have been getting worse and worse, up to 50% a night many nights. Mouth taped, Lansinoh etc. Mask test fit is good.

I think I will switch back to the Aloha and see how that is. Seems like the Airfit P30i gets very leaky within a few weeks.

tisket wrote: ↑

Fri Jan 22, 2021 6:11 am

Over the past month, large leaks have been getting worse and worse, up to 50% a night many nights. Mouth taped, Lansinoh etc. Mask test fit is good.

I think I will switch back to the Aloha and see how that is. Seems like the Airfit P30i gets very leaky within a few weeks.

If your mouth is taped securely and the tape is still secure in the mornings and mask fit test check is good...then the only thing left is mask movement. I would suspect maybe the frame size with the P30i. Maybe it needs to be smaller size (if possible).
I had similar issues with the DreamWear mask that is similar to the P30i in that it has that frame that air goes through and the hose attaches at the top. It came with the medium frame but I needed the small size and even that wasn't quite snug enough for my head size.

Yeah the Airfit standard frame seems pretty hopeless.

I have been using my old Aloha and some nights get less than 1%, but others, 14%, 22% or last night, 29%. Last night was using a new nasal pillow also and it was so snug my nose was a bit sore. Using Lansinoh. Mouth tape was still in place this morning. For awhile last year I thought CBD was making me sleep too deeply, but I haven't used it in weeks and last night was pretty bad, so it's not CBD causing it.

It just seems so weird that my leaks with the System 1 and Aloha were almost always low, and with the Airsense I have so many bad nights. I wonder if my pillow could have something to do with it. Using a CPAPMax 2.0 pillow.