123 L/min median leak.

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robysue
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Re: 123 L/min median leak.

Post by robysue » Wed Dec 29, 2010 2:40 pm

ohammersmith wrote: Which brings me to my next question... if the mask is supposed to be leaking 40 L/min then why are there times when I'm seeing 0 L/min leakage?

Maybe that graph is the "above expected" leak rate... but then where do I set the expected leak rate? Maybe I just have that set wrong somewhere. I don't think it makes the numbers look good, but maybe fixing a setting like that would make it appear less catastrophic.
Yes, In ResScan, the expected leak rate is indeed subtracted off the actual leak rate. So the plot you're seeing is the difference between the two. And I'm glad that you figured out how to change the scale in the y-axis on your own as shown in your second plot.

As for what's going on at night: Did you change position in bed around 3:30 from some position that is marginally working with this mask to a position that's pushing the mask all around and triggering the massive leaks? For instance, are you rolling onto your stomach perhaps?

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ohammersmith
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Re: 123 L/min median leak.

Post by ohammersmith » Wed Dec 29, 2010 2:51 pm

How does Rescan know what the expected leak rate is supposed to be?

Is it something set on the machine or something set in the software? I can't find it in either place. If it's the software, I'm sure it's not set right, if it's the machine I'm 80% sure it's not set right.

I may have rolled to my left or right, but definitely not far and definitely not on my stomach. My wife says my bottom lip falls out of the mask and it happened last night, so that's probably what it is. It doesn't happen most of the time, so it should be a reasonably easy hack to fix it... I'm debating taping my mouth half open tonight and seeing how that does.

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Re: 123 L/min median leak.

Post by robysue » Wed Dec 29, 2010 3:28 pm

ohammersmith wrote:How does Rescan know what the expected leak rate is supposed to be?
The mask setting. It's on the setup menu and it should be accessible from the PATIENT's version of the set up menu. Check that out NOW. Maybe (knock on wood) you're chasing a phantom leak?
Is it something set on the machine or something set in the software? I can't find it in either place. If it's the software, I'm sure it's not set right, if it's the machine I'm 80% sure it's not set right.
Yep, I think maybe you are chasing a phantom leak. The setup menu is the one that looks like a pair of gears. Under that menu, there should be an item called "Mask." That's where you select types of mask. Each choice gives the software a standard "average" expected intentional flow rate for the mask type at various pressures, which the S9 then subtracts off the leak rate. Read the Patient's user guide (and the Clinician's guide if you have it) to try to figure out what the correct setting should be. If all else fails, try posting here under a new thread with the title, "Mask setting for S9 when using MASK ***" where *** is the mask in question.

Hope that helps!

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Re: 123 L/min median leak.

Post by xenablue » Wed Dec 29, 2010 3:30 pm

I use the same mask as you, and found a PapCap works great for keeping my mouth shut. The chin strap is comfy, but I really like the 'cap' because it spreads the load of the chin strap pressure as well as stopping my unruly hair from getting tangled in the mask headgear and velcro.

Maybe just a regular chin strap would work too - I just can't even think about taping my mouth.

Cheers,
xena

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Re: 123 L/min median leak.

Post by ohammersmith » Wed Dec 29, 2010 3:34 pm

I'll double check when I get home, but I'm reasonably certain it's set to full face mask, which if I do my googling right is correct for this mask on this pressure.

Even so, how much could it be "off"? A 120+ L/min leak isn't going away because the setting was wrong. At best it might only be a 70-80 L/min leak. Still crappy and still well correlated with my feeling like crap.

xena, will check out the PapCap... I bet that helps. I'm considering the tape thing, not completely taping my mouth shut, but taping it "open but not slack jawed".

The mask fits just fine and covers my mouth most of the time.

Might also try a tweaked set of headgear or something.

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Re: 123 L/min median leak.

Post by ohammersmith » Wed Dec 29, 2010 3:45 pm

Couldn't wait, had my wife check.

It is, in fact, on the correct "full face" setting. No phantom leak here.

Which, honestly is a good thing. There's this hyooge leak thing going on that is a pretty concrete problem to attack. If it just didn't exist, then I'd have to figure out what other random thing is making me still tired.

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Re: 123 L/min median leak.

Post by Muse-Inc » Wed Dec 29, 2010 7:37 pm

ohammersmith wrote: Image
The red line (and above) on the graphs is where the machine can no longer provide the pressure you need to stent open your airway. You really need to get those leaks under control.

If you've tried all the fixes that Rooster posted and searched for Liberty fixes and pillow fixes, then maybe the Liberty will not seal properly on your face. As I shared before, the Liberty contantly leaks, a lot, but the Hybrid doesn't...might be time to try the Hybrid.
viewtopic.php?t=14422&highlight=
ResMed S9 range 9.8-17, RespCare Hybrid FFM
Never, never, never, never say never.

ohammersmith
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Re: 123 L/min median leak.

Post by ohammersmith » Wed Dec 29, 2010 8:21 pm

Wait, what fixes Rooster posted? I don't think I've seen those. Searching now...

Just did some tests and I think the failure mode is my lip falling out. It's the only failure I was able to simulate that came even close to the kind of leak I'm seeing there... granted only in five minutes each position. The leaks when turned left or right just aren't big enough... they're barely perceptibly higher than when I've got it dead on and am lying on my back. Will post screen shots of that shortly, but basically < 5 L/min leak during those 5 minute each tests.

Even with the nose pillows out entirely the leak rate was under it's 24 L/min catastrophic level. Craziness.

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Re: 123 L/min median leak.

Post by ohammersmith » Wed Dec 29, 2010 8:57 pm

Ok, searched, but I didn't find anything I think would solve my problems.

Here's a screenshot from my 35 minute leak experiment. I switched positions every five minutes to get a good looking graph for each of the positions. They were:
  • On my back, mask well fit
  • On my back, mask fit well enough, head turned left which causes a small leak on the right side of my face where the mask pulls up a bit.
  • On my back, mask fit well enough, head turned right same as above, but opposite.
  • On my back, attempting to simulate "lip falling out the bottom of the mouthpiece" failure. This is really annoying, I really didn't think this failure could happen without waking me up.
  • On my back, nose pillows entirely out and just spewing air.
  • On my back, head tilted left, but hanging off the pillow... I have a tempurpedic pillow and my intent was to simulate a fancy CPAP pillow.
  • Mask completely off, I was hoping for a maximal possible leak, but the machine detected the lack of return flow and didn't register any of this time as a leak.
The divisions I've drawn are pretty rough, but close enough to see a trend, I think. I really wish I had access to the real data so I could make my own graphs, but I can't get Rescan to output any CSV or anything except for daily summary data. Gee thanks, Resmed.

Image

I think this is clear that the failure I'm seeing is the mask sliding up my face and half my mouth coming out. It was annoying as heck and I almost couldn't hold up the "simulation" but I guess if I were dead asleep I wouldn't necessarily notice right away.

I was surprised to see the leaks that happen when the mask separates from my face just don't seem to be all that big. I was starting to doze off, so maybe this is entirely inaccurate, but it's the best I have until I set up a camera to watch myself overnight.

I was really surprised to see the nose pillow failure just isn't anywhere near as catastrophic as you'd expect. I could plug those nose pillows up, put on a swimmers nose clips and call it a night and probably get a really great night's sleep.

I think a cpap pillow would help but a chin strap would probably help more. Gonna go see if I can hack something up for tonight.

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Re: 123 L/min median leak.

Post by jules » Wed Dec 29, 2010 9:02 pm


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Re: 123 L/min median leak.

Post by idamtnboy » Wed Dec 29, 2010 10:16 pm

ohammersmith wrote:Also is there a way to get the data out of this and do my own graph? Rescan only shows up to 40 L/min, which is bizarre because the expected leak rate of the on the Liberty at my pressure (12cm H2O) is supposed to be 40 L/min +/- 6 L/min, so I think the nominal leak is somewhere around 64 L/min.
Yes, actually fairly easily, providing you have the expertise to dissect files and manipulate data. Two approaches you can use, one with EDFBrowser.exe, and the other with edf2ascii.exe.

EDFBrowser is the easier way to look at the data. Google to download a copy. It's a freebie program w/ no adware or nag screens or any other such crap. The file you want to look at is xxxxxxxxxxxxx_PLD.edf. where xxxxxxxxxxxxxxx is the date and time the file was created. It's in the DATALOG directory of the card. When you open up the file with EDFBrowser you'll see a dialog that lists all the data signals in the file. Select Leak, click on add, then click the display button. Play around with the timescale and amplitude settings until you get a good readable graph. There's a crosshair option that will let you read out the exact values. Also, the raw data on the card is in L/sec so you'll have to multiply the reading by 60 to see L/min like Resscan shows. That conversion is not performed in EDFBrowser. The help file is reasonably good but the program is not the most user friendly. You can load more than one EDF file into one browser window. That way if you have multiple mask times during the night you can see them all on one timeline, just like in Resscan.

The other approach is to get a copy of edf2ascii.exe. It's a little command line program that extracts all the data out of the EDF file and converts them into CSV files, which you can then open up with Excel or Lotus 123. You will have to look at the info from the signals file and header file to assemble a complete spreadsheet of the data with column headers. You'll also have to calculate the time from the raw data and create your own chart of the leak numbers. The plus of this approach is you have the real raw numbers in front of you in a very readable form. You can do the L/sec to L/min conversion in the spreadsheet and graph the L/min data. To see data from multiple mask times in one graph you'll have to process each EDF file separately and then combine them into one spreadsheet page.

Whichever approach you decide to go with, do what you can and if you have questions send me a PM. I'll try to help as much as I can. At this point I have no idea of your expertise level in doing such things, but you mention CSV so obviously you have some knowledge of files and data manipulation. How comfortable are you in pursuing either of the above approaches? I hope quite a lot, otherwise you're up the proverbial creek with a busted paddle for getting what you want to see.

Resscan really only does two things for us. One, it puts the data into a pretty format to look at with reasonably good display options. The other is it automatically assembles separate files from one 24 hour period into a single display. It is totally dumb as far as data massaging goes. It does absolutely nothing to the data.

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Re: 123 L/min median leak.

Post by idamtnboy » Wed Dec 29, 2010 10:33 pm

idamtnboy wrote:It is totally dumb as far as data massaging goes. It does absolutely nothing to the data.
Minor correction.

Resscan does offer some display conversion options such as what I mention above. It converts the L/sec raw data for leak rate into L/min for the graph. Some of those options can be changed in the Resscan.xml file, but I haven't mucked with them. But again, Resscan does not modify any data, at least none that I have found.

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ohammersmith
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Re: 123 L/min median leak.

Post by ohammersmith » Thu Dec 30, 2010 1:00 pm

idamtnboy wrote:
ohammersmith wrote:Also is there a way to get the data out of this and do my own graph? Rescan only shows up to 40 L/min, which is bizarre because the expected leak rate of the on the Liberty at my pressure (12cm H2O) is supposed to be 40 L/min +/- 6 L/min, so I think the nominal leak is somewhere around 64 L/min.
Yes, actually fairly easily, providing you have the expertise to dissect files and manipulate data. Two approaches you can use, one with EDFBrowser.exe, and the other with edf2ascii.exe.
"EDFBrowser is a free opensource multiplatform viewer[...]"

idamtnboy, you just made my day. Seriously. No more trucking the files over to my freakin' work machine because it has Windows and I didn't want to futz with VMware more than I had to.

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Re: 123 L/min median leak.

Post by ohammersmith » Thu Dec 30, 2010 1:08 pm

Ok so for lack of any better idea that I could hack up on zero notice, I just threw on a really thin cap over top my headgear last night. I got it a while back when I started buzz cutting my hair because it gets freakin' cold, sometimes. It's meant for working out so it's some kind of breathable synthetic material.

Anyway, I think it basically kept the headgear more in place than it normally is when I toss and turn a bit... which kept the mask in place. While it didn't solve the problem 100%, I think this kind of improvement indicates I'm on the right track.

Image

The first spike is my 30 minute tests.

I think this is basically 2+ hours last night of hardly any leakage, it got a bit bad then got a bit better for a while... all told, ran for 7h13m hours and still had some water left in the tank, which is unusual for such a long run, lately.

Summary was mean leak of 4.8 L/min, 95th percentile 132.0 L/min and a max of 171.6 L/min. Really low mean, which is a good sign, I think.

If I can come up with a better way to secure it, I should be good. Any tips? Basically if I can keep the headgear in place the mask seals just fine and works great for me. I might go ahead and order a PapCap, but I'm looking for something I can hack up tonight. It's frustrating to be so close to a perfect night's sleep.

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Re: 123 L/min median leak.

Post by jules » Thu Dec 30, 2010 1:13 pm

which mask now? quattro?