OPUS USERS WHO TAPE: QUESTION!!!!

I am wondering what kind of typical leak rate you Opus users get. I have been using an Opus for almost two years and wondered if you other folks who tape get results similar to mine. My leak rates are usually very low but I think maybe too low since I find that when they are very low I feel groggy and almost dizzy. SO-please give me some data from some actual users that I can compare to mine. My pressure on the APAP is 9.4-12.0 with a typical nights pressure of 10.0. I know what the Opus brochure says is a typical leak rate for my pressure but I want to see what others are getting. Thanks-GG

My leak rate on the Opus 360 (that's a 9 month old model )is always higher than my leak rate for the Headrest.

O.

What is the mask setting on your machine?

As you may know, ResMed machines use the mask setting to figure the intention leak rate of the mask, and subtract it from the total leak, displaying only the unintentional leak.

Since there are no settings on the machines for non-ResMed masks, you have two choices. Either set the machine to Swift ( I checked and the vent rate data for the Opus 360 is close to that for the Swift LT) or set it to Standard. Standard subtracts a constant 24 liters/minute from the total leak, leaving you to correct for the balance of the mask vent rate.

jdm2857 wrote:Standard subtracts a constant 24 liters/minute from the total leak, leaving you to correct for the balance of the mask vent rate.

Velbor has posted on this topic previously and has said he can find no evidence to this effect ... other than some consistently restating this questionable information here on cpaptalk. Personally I'd like to know the source of this "24 liters/min reduction." Perhaps this belief has come about due to the "red line" at 24L/min in ResScan charts showing the machine's inability to compensate for leaks beyond that point.

As I use non-ResMed masks, I have my machine set to the "Standard" mask type (also called "Modular" in the patient profile section in ResScan 3.7). Consequently I've done some research so I can determine whether or not leaks are under control for me.

Velbor posted a "flow rate" chart showing various mask types from the S7 manuals. Here it is again:


Further, ResMed states users of the Mirage Vista mask should set their machines to the "Standard" mask type. http://www.resmed.com/us/assets/html/ma ... c=patients

Here's the flow rate curve from the Vista user manual:


Subtracting a flat 24L/min might make calculations easier for those of us using ResMed masks, but if ResMed's intent is to simplify leak calculation for their own masks, why not create a setting specific to the Vista mask rather than using "Standard" -- unless "Standard" is indeed a curve rather than a flat line? Frankly I wish ResMed machines just reported the actual flow rates per session to avoid confusion when using non-ResMed masks!

In my own data at a range of pressures, I do not see "leaks" rising sharply (as one would expect if ResMed machines did indeed deduct a flat 24L/min across the pressure range. I see a subtle rise that pretty much conforms to the Standard and Vista curves above. Further, this curve is very similar to the curve shown for my main mask, the FlexiFit 406.

Of course I have only my own anecdotal evidence, as I've been "eyeballing" the data rather than systematically testing and recording results in a spreadsheet. Still, it might be nice to have a bit of conversation on this topic. (I guess I should start another thread!)

Edit: Here's the new thread: viewtopic/t44802/ResMed-Machines-quotSt ... Rates.html

I have my mask setting on Swift since I can see it is the only setting that closely resembles an Opus mask. My leak rates are typically 0.06 or lower, even 0.0. I personally think that is WAY too low and I may be rebreathing which is often causing headaches, dizziness and grogginess. I was wondering what I can do to actually increase this leak rate somewhat to maybe counteract these side effects. If I don't tape then the mouth breathing totally screws the therapy all together. My luck with a FFM is nil. I have a recessed chin which keeps the mouth area from fitting properly and the masks just are not comfortable around the back of the neck where I have some issues with pinched nerves. SO, I feel there are few solutions to my problem other than trying to raise the leak rate some with the Opus in order to feel better. I love the comfort of the Opus but just cannot seem to find a way to raise the leak rate. Any suggestions would be GREATLY appreciated!!! I know this sounds like a ridiculous problem but I just want a good nights rest and the chance to feel human again. Thanks-GG

You don't need to raise your leak! ResMed machines deduct the expected vent rate for a given mask, so leaks 0.0L/s and above indicate the actual leak beyond the expected vent rate. With the dead air space in pillows masks being so small, the likelihood of you rebreathing much CO2 is very small.

If you're going to tape anyway, you could try a nasal mask. But if you like the Opus and tape, I'd stick with it. Perhaps there are other reason(s) why you're feeling light-headed and groggy.

TwoKat --

I, indeed, am repeated information (about the standard mask setting)that I have read on this site several times.

I did not realize that the information was questionable. I think that starting a discussion on this topic would be a great idea.

I also wish that ResMed had a setting that displayed the measured leak unaltered.

Edit: I see the discussion has already started.

Grumpygirl -

I use the Opus 360 with the new pillow design. I have an M-Series Auto 9-13, with average pressure around 11. My usual average leak is 35 - but that is due to a couple of bigger leaks each night (trying to figure out what, when and how). BUt looking at the graph, for much of the night the leak is stable around 25.

I hope that answers your question.

THANK YOU 2flamingos!!! Yes, that does help me-I think your leak rates are what the chart(included with the Opus package)indicate as fairly normal. I still think my leak rates are too low and I am determined to find a way to normalize it. Thanks again-GG

twokatmew wrote:You don't need to raise your leak! ResMed machines deduct the expected vent rate for a given mask, so leaks 0.0L/s and above indicate the actual leak beyond the expected vent rate. With the dead air space in pillows masks being so small, the likelihood of you rebreathing much CO2 is very small.

I agree, the Opus is so compact there is very little dead space in it.

GG, the older Opus was redesigned, twice I believe.

There was a point in the first model where the pillows collapsed -- I wonder if this is the source of your headaches. Are you using the new Opus 360 pillows?

See this for the first redesign: viewtopic.php?p=264642#p264642 and there was another one, in December.

I don't know if the newest version pillows fits in the older version mask --

O.

I guess I have the older version of the Opus mask, however, the new pillows seem to fit fine. I am trying the Liberty mask tonight that my DME let me borrow. I have my doubts that it will stay on all night since the straps behind the head will probably irritate the sensitive place in my neck. I do tie my Opus nasal pillows together with a little dental floss in order to keep them from having very large leaks. I would like to think that I could use the pillows without having to tie them in hopes that maybe that might give me better results(no headaches, fatique etc.,etc.) but they seem to leak too much if I try to do that.
Will the new Opus coming out in Dec. have a different design? Would be curious to see one. I do like my Opus generally since I just have never tolerated a FFM but lately I feel so frustrated. I used to look forward to going to bed but NOT anymore because I know I will have trouble getting comfortable and I will probably feel like crap in the morning.
Enough with the complaining-Wishing you all a good nights' sleep and a bright tomorrow!! GG

grumpygirl wrote:I am wondering what kind of typical leak rate you Opus users get. I have been using an Opus for almost two years and wondered if you other folks who tape get results similar to mine. My leak rates are usually very low but I think maybe too low since I find that when they are very low I feel groggy and almost dizzy. SO-please give me some data from some actual users that I can compare to mine. My pressure on the APAP is 9.4-12.0 with a typical nights pressure of 10.0. I know what the Opus brochure says is a typical leak rate for my pressure but I want to see what others are getting. Thanks-GG

Before getting into a technical discussion of reporting of leak rates, I think you should consider something else.

grumpygirl wrote:....... and wondered if you other folks who tape get results similar to mine. My leak rates are usually very low but I think maybe too low since I find that when they are very low I feel groggy and almost dizzy. ........

1)With this nasal mask, you are taping presumably because you mouthbreathe or mouthleak when you don't tape. 2)Some nights you feel groggy and dizzy.

You may not be getting enough air through the nasal airway which causes your mouth to open reflexively to take in more air. Now you tape. thereby preventing the mouth from taking in air. Not enough air causes grogginess and dizziness.

I think it is a good idea to make a long trial with the full face mask (Liberty). Get it to working properly and see if the symptoms don't go away.

Rooster, I think I understand what you are saying- I'm not getting enough air through the nasal pillows themselves. Correct? Even though I have a very small face if I try to use the small pillows I feel like I am suffocating- so I use the med. ones. I'm still not getting enough air? If I can't use the Liberty or other FFM do you have any suggestions on how to get more air-use the large ones and tie them together with dental floss-thats' what I have to do to get the med. pillows not to leak horribly. Do you think that by tying them together I may be limiting my air flow? I don't know how to get them not to leak if I don't pull them closer together by tying them.
The trial with the Liberty last night did not last long. Couldn't get the pillow to stop leaking and the part that covers the mouth was painful-it was too much pressure on my upper lip. I tried not to have the straps too tight but it still felt like it would ultimately rub a sore spot over my mouth. I'll try again.
I did notice that I did not feel bad this morning(used the Opus) and my leak rate was .16 with 0.0 AI and a AHI 2.2 the 95% pressure for the night was 10.4. So I don't know what to make of those stats but I do feel pretty good this morning.
When the leak rates are really low I feel horrible. Any thoughts?? Thanks-GG

grumpygirl wrote:Rooster, I think I understand what you are saying- I'm not getting enough air through the nasal pillows themselves. Correct? ……

No. That is not what I meant. Unless you are wearing the pillows so that they are “crunched up” or something like that, there should be enough pressure from the pillows. The system is designed to give enough pressure even from the small pillows.

What I am talking about is not enough air flowing through the nasal airway and I will give a couple of examples. In my case, if I am slightly congested at night, I will reflexively (body does it automatically with no conscious effort) mouthbreathe in my sleep because the congestion is not allowing enough air to flow through my nasal airway. As another example, think about exerting yourself by walking up a long flight of stairs. You may be breathing with your mouth closed when you start. After you climb for some time, your mouth may open reflexively because you need greather airflow. Usually we are not even aware that the body has started breathing in a different way. Some people have deviated septums, enlarged turbinates or other physical problems that cause them to mouthbreathe often.

So I am suggesting that it is very common to have a need for mouthbreathing at times while asleep. Of course with your mouth taped, you can’t mouthbreathe. You say you feel like you are not getting enough air so you may have the need to mouthbreathe.

grumpygirl wrote: ……. ………..
The trial with the Liberty last night did not last long. Couldn't get the pillow to stop leaking and the part that covers the mouth was painful-it was too much pressure on my upper lip. I tried not to have the straps too tight but it still felt like it would ultimately rub a sore spot over my mouth. I'll try again. ………

As a former nasal pillow/mouth taper, who converted to a full face mask and saw a big improvement in therapy, I can only encourage you to work on making a FFM work for you. It can take determination and perseverance plus trials with different masks to be successful. The Liberty mask is similar (but not identical) to the Hybrid mask. Here are some of my suggestions to adjusting and using the Hybrid mask - viewtopic.php?t=14422&highlight= . Have a look at the comments about using the ladies’ tights fix to prevent nasal pillow leaks on the Hybrid.

Finally, do you know whether you have positional sleep apnea?

Rooster I only know that my sleep doc indicated that my apnea was much worse in the supine postion. As I have stated before I HAVE to sleep on my back because of bursitis problems and aerophagia. The wedge pillow helps some. I'm not sure how to solve the problem. Thanks-GG