General Leak and Apnea Advice

General Discussion on any topic relating to CPAP and/or Sleep Apnea.
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chris.donovan
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General Leak and Apnea Advice

Post by chris.donovan » Tue Nov 16, 2021 11:48 pm

Hi All,

I'm chasing some general advice regarding my treatment.

I've been analysing my data using Oscar as I have not felt like I've been getting great therapy at night. The AHI's are relatively low - this particular scenario attached is 1.60 however I still feel like absolute rubbish during the day so there must be something wrong.

I do notice a squeeling/hissing noise coming from the machine/hose connection lately but wiggling the hose connection to the machine and reinserting the water tub clears this more times than not.

Any general observations based on what you can see would be greatly appreciated. The leak rate looks atrocious to me.

Specifics;
AirSense ResMed 10 AutoSet
Philipps AirFit N20
Pressure Settings; Min:6 Max:20
EPR ON, Level 2.
Humidifier On
Attachments
cpap.JPG
cpap.JPG (454.49 KiB) Viewed 304 times
Last edited by chris.donovan on Wed Nov 17, 2021 12:11 am, edited 1 time in total.

GrumpyHere
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Re: General Leak and Apnea Advice

Post by GrumpyHere » Tue Nov 16, 2021 11:58 pm

chris.donovan wrote:
Tue Nov 16, 2021 11:48 pm
Any general observations based on what you can see would be greatly appreciated.
We need to see flow limitations graph and other info missing from your screenshot.

FLs can cause disturbed sleep.

Leaks below 24 L per min are actually ok for your machine.


Please format OSCAR screenshots in the specific preferred format.

The resident experts also ask that questions specific to your therapy stay in one single thread - this one. So that they don't hunt down other threads to know your history. Or have to answer in multiple threads.

The easy way to set the OSCAR (v1.2) graphs in the preferred order and format:

1. Go to View menu - Reset Graphs - Standard

2. In View menu, turn on Sidebar

3. Again in View Menu turn off Daily Calendar and Pie Chart

4. Set Graph Height in File Menu -> Preferences -> Appearance Tab

At 192, the 5 graphs (flags, flow rate, pressure, leak, flow limit) are nicely spaced out.

At 160 I also get snores as the bottom graph.
ResMed S9 VPAP Adapt, p10 mask

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chris.donovan
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Re: General Leak and Apnea Advice

Post by chris.donovan » Wed Nov 17, 2021 12:13 am

GrumpyHere wrote:
Tue Nov 16, 2021 11:58 pm
chris.donovan wrote:
Tue Nov 16, 2021 11:48 pm
Any general observations based on what you can see would be greatly appreciated.
We need to see flow limitations graph and other info missing from your screenshot.
Thanks Grumpy, apologies. I have updated to the latest version (doh!) and resubmitted a compliant screenshot.

Interesting, the data shows my minimum as 10 cmH2O (not 6) and EPR as OFF...

Regardless, screenshot has been updated.
GrumpyHere wrote:
Tue Nov 16, 2021 11:58 pm
chris.donovan wrote:
Tue Nov 16, 2021 11:48 pm
Any general observations based on what you can see would be greatly appreciated.
Leaks below 24 L per min are actually ok for your machine.
Bugga!

GrumpyHere
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Re: General Leak and Apnea Advice

Post by GrumpyHere » Wed Nov 17, 2021 12:28 am

chris.donovan wrote:
Wed Nov 17, 2021 12:13 am
Interesting, the data shows my minimum as 10 cmH2O (not 6) and EPR as OFF...
That's the old settings.
Oscar did not manage to pickup the current settings as noted by the red notice.

EPR is on, as noted by the red and green pressure lines.

I should qualify what I said about the leaks.
Leaks under 24L per minute are ok for your machine UNLESS they are disturbing your sleep.
ResMed S9 VPAP Adapt, p10 mask

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chris.donovan
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Re: General Leak and Apnea Advice

Post by chris.donovan » Wed Nov 17, 2021 12:44 am

GrumpyHere wrote:
chris.donovan wrote:
Wed Nov 17, 2021 12:13 am
Interesting, the data shows my minimum as 10 cmH2O (not 6) and EPR as OFF...
I should qualify what I said about the leaks.
Leaks under 24L per minute are ok for your machine UNLESS they are disturbing your sleep.
Now the ten million dollar question - how to eliminate leaks so as not to disturb sleep? ImageImage


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Pugsy
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Re: General Leak and Apnea Advice

Post by Pugsy » Wed Nov 17, 2021 10:02 am

chris.donovan wrote:
Wed Nov 17, 2021 12:44 am
Now the ten million dollar question - how to eliminate leaks so as not to disturb sleep?
Indeed the ten million dollar question. To fix a problem we first have to identify the problem.
What concerns me about your leak line is the baseline leak...it's never really at the 0.0 mark. Makes me wonder why.
Seems to have a baseline of around 7 L/min and the it goes up from there...

Have you done any experiments to figure out if the leak (when it goes up from 7 L/min) is related to mask movement or mouth opening???
In other words have you ever tried taping your mouth shut?

Have you ever seen a report where the leak line went down to 0.0??? Even for part of the night?

Have you ever tried a different mask?
Mask: Bleep no headgear mask.. https://bleepsleep.com/
Machine: AirCurve 10 VAuto

I may have to RISE but I refuse to SHINE.

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ChicagoGranny
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Re: General Leak and Apnea Advice

Post by ChicagoGranny » Wed Nov 17, 2021 10:05 am

chris.donovan wrote:
Wed Nov 17, 2021 12:44 am
Now the ten million dollar question - how to eliminate leaks so as not to disturb sleep?
Here are some tips:
To reduce unintentional mask leak -

- Make sure the mask is fitted properly. (See mask manufacturer's video and other videos on youtube.)

- Make sure the headgear is adjusted properly (See mask manufacturer's video and other videos on youtube.)

- If you use a low ramp pressure or a low minimum pressure, you should fit and adjust your mask at the higher pressures it is operating at for most of the night. You would temporarily change the machine pressure settings while you do the fitting and adjusting. It's best to do this well before bedtime before you are tired and ready for sleep. Don't forget to change your settings back to the ones you prefer.

- Make sure to use good hose management - the hose should not pull on the mask. Notice how your hose is positioned between machine and mask. It should be positioned to minimize any pull on the mask. Hose management is an individual practice. How it is done depends on the mask, the position of the machine, your sleeping position and other factors specific to the individual.

- If you still have problems, learn from the forum what mask liners are available.

- Start a thread in cpaptalk asking for help. Subject: Need Help with Mask xxxxxx

- If your mask still has excessive leak, try other masks. Many people report trying several masks before they find one that works well for them.

Note: Links to just some of the mask manufacturers' instructional videos can be found on the forum host's website - https://www.cpap.com/cpap-masks.php and https://www.youtube.com/

- CG

Xjarhd
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Re: General Leak and Apnea Advice

Post by Xjarhd » Sun Nov 21, 2021 11:24 am

I have 2 lines on my leak rate graph, Why?
screenshot-20211121-112726.png
screenshot-20211121-112726.png (122.79 KiB) Viewed 194 times

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Pugsy
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Re: General Leak and Apnea Advice

Post by Pugsy » Sun Nov 21, 2021 11:29 am

Xjarhd wrote:
Sun Nov 21, 2021 11:24 am
I have 2 lines on my leak rate graph, Why?
Because your machine reports leaks differently.
Top line is the total leak which is the mask's expected vent rate plus any excess leak.
Bottom line is a close approximation of excess leak only without vent rate being included.

It's just the way Respironics reports leaks and OSCAR does the calculations.
Nothing abnormal about it.
Mask: Bleep no headgear mask.. https://bleepsleep.com/
Machine: AirCurve 10 VAuto

I may have to RISE but I refuse to SHINE.

clownbell
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Re: General Leak and Apnea Advice

Post by clownbell » Mon Nov 22, 2021 12:50 am

I'm confused.

The screenshot of November 16 reflects and AirSense 10 AutoSet. Large leak rate is 0.01%

The Screenshot of November 18 reflects Philips Respironics Dream Station . Large leak rate is 0.00%

Why two different machines?

In either case, the large leak rate seems low, not worth worrying about. As previously pointed out, any leak that disturbs sleep is a problem, though. But not a case of large leaks here.
ResMed AirSense 10 Autoset with built in humidifier
F&P Brevida pillow mask

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Pugsy
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Re: General Leak and Apnea Advice

Post by Pugsy » Mon Nov 22, 2021 1:06 am

clownbell wrote:
Mon Nov 22, 2021 12:50 am
I'm confused.

The screenshot of November 16 reflects and AirSense 10 AutoSet. Large leak rate is 0.01%

The Screenshot of November 18 reflects Philips Respironics Dream Station . Large leak rate is 0.00%

Why two different machines?
2 different people and 2 different machines.
Nov 18 report is from someone who sort of hijacked the OP's thread with his own question about his report from a different machine.
Mask: Bleep no headgear mask.. https://bleepsleep.com/
Machine: AirCurve 10 VAuto

I may have to RISE but I refuse to SHINE.

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chris.donovan
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Re: General Leak and Apnea Advice

Post by chris.donovan » Tue Nov 23, 2021 4:29 am

Apologies I have been MIA. Been rather tied up...
Pugsy wrote:
Wed Nov 17, 2021 10:02 am
chris.donovan wrote:
Wed Nov 17, 2021 12:44 am
Now the ten million dollar question - how to eliminate leaks so as not to disturb sleep?
Indeed the ten million dollar question. To fix a problem we first have to identify the problem.
What concerns me about your leak line is the baseline leak...it's never really at the 0.0 mark. Makes me wonder why.
Seems to have a baseline of around 7 L/min and the it goes up from there...
Agreed. It's been concerning me for a while now - but due to my extra curricular commitments I've been pretty predisposed and unable to really give it the attention it deserves.... until now.
Pugsy wrote:
Wed Nov 17, 2021 10:02 am
chris.donovan wrote:
Wed Nov 17, 2021 12:44 am
Now the ten million dollar question - how to eliminate leaks so as not to disturb sleep?
Have you done any experiments to figure out if the leak (when it goes up from 7 L/min) is related to mask movement or mouth opening???
In other words have you ever tried taping your mouth shut?
I have used a chin strap for at least the last almost 3 years as the new girlfriend was not prone to the slight noises made during the night and it one of a myriad of desperate attempts to quieten things down in the early days.
Pugsy wrote:
Wed Nov 17, 2021 10:02 am
chris.donovan wrote:
Wed Nov 17, 2021 12:44 am
Now the ten million dollar question - how to eliminate leaks so as not to disturb sleep?
Have you ever seen a report where the leak line went down to 0.0??? Even for part of the night?

Have you ever tried a different mask?
I have seen the leak like lower - and i'll come back to this at the end of my post. I have a working theory... haha.
I haven't tried different masks, other than a full face which was a monumental failure.
ChicagoGranny wrote:
Wed Nov 17, 2021 10:05 am
chris.donovan wrote:
Wed Nov 17, 2021 12:44 am
Now the ten million dollar question - how to eliminate leaks so as not to disturb sleep?
Here are some tips:
Thank you, these have been noted, especially;
ChicagoGranny wrote:
Wed Nov 17, 2021 10:05 am
chris.donovan wrote:
Wed Nov 17, 2021 12:44 am
Now the ten million dollar question - how to eliminate leaks so as not to disturb sleep?
Here are some tips:
- If you use a low ramp pressure or a low minimum pressure, you should fit and adjust your mask at the higher pressures it is operating at for most of the night. You would temporarily change the machine pressure settings while you do the fitting and adjusting. It's best to do this well before bedtime before you are tired and ready for sleep. Don't forget to change your settings back to the ones you prefer.
This I will refer to at the end of the post also.

clownbell wrote:
Mon Nov 22, 2021 12:50 am
I'm confused.

The screenshot of November 16 reflects and AirSense 10 AutoSet. Large leak rate is 0.01%

The Screenshot of November 18 reflects Philips Respironics Dream Station . Large leak rate is 0.00%

Why two different machines?

In either case, the large leak rate seems low, not worth worrying about. As previously pointed out, any leak that disturbs sleep is a problem, though. But not a case of large leaks here.
Alas, as Pugsy has identified - a thread hijacker indeed!

Now, this leads me to my final result - and UNFORTUNATELY my SD card reader is not working, and my work laptop with inbuilt SD card reader is at the office this week as that's where I am also.... so I don't have any data to support my claim (Oscar screenshots etc) but I do have the daily energy and effects.
Off the back of ChicagoGranny's recommendation I quoted above that if I use a low ramp pressure of a low minimum pressure I had the idea to increase my minimums to the average nightly number. I have done this because when I inhale lately there is a louder than normal hissing, sometimes whistle coming from the hose connection/water container area. I definitely feel starved for oxygen to a degree. As well as this I find I struggle for air and can't settle or get into a rhythm. It's purely an exhaustion that puts me to sleep. Self perpetuated by lack of sleep.... and around and around we go.

I'm unable to clearly identify exactly where the noise is coming from but removing and reinserting the water container does nothing, adjusting the hose connection to the machine does nothing.

Increasing the minimum pressure the machine can operate at after the initial ramp period (5 minutes) seems to allow me to breathe more air in, resulting in my settling easier and calmer, and then providing that continued flow as required during the night. It also possibly caters for any machine leaks that I may be experiencing which would explain the high leak rate. I'm confident it's not coming from the mask. I do not feel anything before falling to sleep, and my girlfriend who is sensitive to the noises at night also does not report anything. I don't wake with dry eyes from the draft either.

I'm obviously no doctor, or professional in this area, and I've only had half a nights exposure to this so far (I did it last night mid way through the night) - but interested to know others thoughts in this practice?

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ChicagoGranny
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Re: General Leak and Apnea Advice

Post by ChicagoGranny » Tue Nov 23, 2021 10:14 am

chris.donovan wrote:
Tue Nov 23, 2021 4:29 am
Increasing the minimum pressure the machine can operate at after the initial ramp period (5 minutes) seems to allow me to breathe more air in, resulting in my settling easier and calmer, and then providing that continued flow as required during the night.
At any pressure below 7.0, I feel "starved for air". 8.0 is OK, but 10.0 is even better.
chris.donovan wrote:
Tue Nov 23, 2021 4:29 am
It also possibly caters for any machine leaks that I may be experiencing which would explain the high leak rate.
If you mean it is harder to control mask leaks at higher pressures - yes. But it can be done, even at 24.0 cm.

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chunkyfrog
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Re: General Leak and Apnea Advice

Post by chunkyfrog » Tue Nov 23, 2021 1:46 pm

If your sleep is being disturbed by the noise of air squeaking out from under
the nasal cushion, then a mask liner should silence the noise.
Trying to stop all leaks is a lost cause--but muffling the noise is doable.
Padacheek.com, (forum member Karen), makes these liners--and more.
Resmed Airsense 10 Autoset FOR HER, p10 mask

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chris.donovan
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General Leak and Apnea Advice

Post by chris.donovan » Tue Nov 23, 2021 1:48 pm

ChicagoGranny wrote:
chris.donovan wrote:
Tue Nov 23, 2021 4:29 am
chris.donovan wrote:
Tue Nov 23, 2021 4:29 am
It also possibly caters for any machine leaks that I may be experiencing which would explain the high leak rate.
If you mean it is harder to control mask leaks at higher pressures - yes. But it can be done, even at 24.0 cm.
chunkyfrog wrote:If your sleep is being disturbed by the noise of air squeaking out from under
the nasal cushion, then a mask liner should silence the noise.
Trying to stop all leaks is a list cause--but muffling the noise is doable.
Padacheek.com, (forum member Karen), makes these liners--and more.
The leaks are not coming from the mask. It is coming from the machine at the connection between the hose and the machine itself.


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