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ResMed Data Report -- interpretation request
My friend was titrated at straight CPAP of 14, and has been dutifully using his ResMed S8ii machine at that pressure setting, along with his ResMed Quattro Full Face Mask. Problem is, he's still having AHIs >10. Here's the latest report; can anyone help shed some light on what his problem is and what he might try to fix it?
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Replies to This Discussion
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Permalink Reply by Duane McDade on
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His Mask is too loose! He needs to adjust it to not leak. I try to keep it under 15LPM.
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Permalink Reply by Judy on
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He wants to get and keep his Leak rate UNDER the red line in the bar graph. First off make sure the Mask Selection is set correctly for the Quattro. Then check he has the right size Quattro for him.
He might want to try using a Mack's Silicone Ear Plug, rolling it in the palms of his hands to form a thin tape or rope and laying that on the Quattro's outer cushion cover along the line where it lays on his face to help form a better seal and to protect the tender skin at the bridge of his nose.
With the Quattro especially, due to that thin outer cushion cover, it is important to not have the mask fitted too tight. The cushion cover needs to fill w/air so it can "float" on his face and seal against leaks. Generally, you want the top straps looser than the bottom straps. Leaks around the eyes are generally corrected better w/the bottom straps than the top straps. Running your fingertip along the seam line between mask and skin also helps to turn the edges under and seal better.
Has he watched the CD/DVD that came w/his Quattro so that he puts it on and fits it correctly? One should ALWAYS lay down when fitting their mask; then lay the mask on the face SLIGHTLY lower on the nose than where it should ultimately go, turn the CPAP on at the set (not Ramp) pressure and then adjust the straps, lift the mask SLIGHTLY away from the face for it to fill w/air again and then move it SLIGHTLY up into position on the nose. That turns the thin cushion cover edges UNDER so that they don't cut into the tender skin at the bridge of the nose. It also helps to either clip the hose to the PJs to prevent "hose drag" during the night or hang the hose above the head to prevent "hose drag" downwards which can really contribute to bridge of nose discomfort.
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Permalink Reply by Mike on
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guys-- i'm confused about the leak with this ResMed report (i'm more familiar with my own Respironics reports) -- i checked the manufacturer's guidelines and the maximum acceptable leak for the Quattro at his level of pressure of 14 is up to 44 --- now you're saying that it can't be above the red line, which is around 24. i'd really like to understand this FULLY. what's going on?
Judy said:He wants to get and keep his Leak rate UNDER the red line in the bar graph. First off make sure the Mask Selection is set correctly for the Quattro. Then check he has the right size Quattro for him.
He might want to try using a Mack's Silicone Ear Plug, rolling it in the palms of his hands to form a thin tape or rope and laying that on the Quattro's outer cushion cover along the line where it lays on his face to help form a better seal and to protect the tender skin at the bridge of his nose.
With the Quattro especially, due to that thin outer cushion cover, it is important to not have the mask fitted too tight. The cushion cover needs to fill w/air so it can "float" on his face and seal against leaks. Generally, you want the top straps looser than the bottom straps. Leaks around the eyes are generally corrected better w/the bottom straps than the top straps. Running your fingertip along the seam line between mask and skin also helps to turn the edges under and seal better.
Has he watched the CD/DVD that came w/his Quattro so that he puts it on and fits it correctly? One should ALWAYS lay down when fitting their mask; then lay the mask on the face SLIGHTLY lower on the nose than where it should ultimately go, turn the CPAP on at the set (not Ramp) pressure and then adjust the straps, lift the mask SLIGHTLY away from the face for it to fill w/air again and then move it SLIGHTLY up into position on the nose. That turns the thin cushion cover edges UNDER so that they don't cut into the tender skin at the bridge of the nose. It also helps to either clip the hose to the PJs to prevent "hose drag" during the night or hang the hose above the head to prevent "hose drag" downwards which can really contribute to bridge of nose discomfort.
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Mike, unlike the Respironics where you must subtract your allowed vent rate at your set pressure from the reported pressure, the Resmeds have a Mask Selection feature. You set the Mask Selection to the Resmed mask you are using and the xPAP automatically deducts the allowed vent rate from the reported Leak rate. On the other hand, if you use other than a Resmed mask, you do have to do your own math.
With other than a Resmed mask you always use the Standard mask selection. Using the Standard mask selection the Resmed xPAPs automatically deduct 0.4 L/s (24 L/M) from the reported Leak rate and you have to do the math from there.
So assuming the Mask Selection has been correctly set for the Quattro the Resmed xPAP has done the math for him in already having deducted the allowed vent rate for the Quattro at his pressure when reporting his Leak rate.
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interesting, Judy. so the red line shows what the ResMed machine calculated as his maximum allowable leak given the mask that he programmed into the machine?
Judy said:Mike, unlike the Respironics where you must subtract your allowed vent rate at your set pressure from the reported pressure, the Resmeds have a Mask Selection feature. You set the Mask Selection to the Resmed mask you are using and the xPAP automatically deducts the allowed vent rate from the reported Leak rate. On the other hand, if you use other than a Resmed mask, you do have to do your own math.
With other than a Resmed mask you always use the Standard mask selection. Using the Standard mask selection the Resmed xPAPs automatically deduct 0.4 L/s (24 L/M) from the reported Leak rate and you have to do the math from there.
So assuming the Mask Selection has been correctly set for the Quattro the Resmed xPAP has done the math for him in already having deducted the allowed vent rate for the Quattro at his pressure when reporting his Leak rate.
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The Resmeds can compensate for a Leak rate up to 24L/M above the allowed vent rate, above that the AHI data, etc. might be distorted and is not reliable. That red line is the 24 L/M limit. Assuming the correct Mask Selection for a Resmed mask if one had no Leaks the reported Leak rate would be 0.0 L/M.
At least this is my understanding of the matter. I use a non-Resmed mask so it can get tricky for me to figure out.
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Permalink Reply by Dave on
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I am Mike's friend who is using the AutoSet ii. I'm dealing with a lot right now, so mike has been a good help. I'm also starting to be gluten-intolerant...and may be celiac (although, not very likely)...I blame it all on sleep apnea...but that's another story...please help me understand the report!
I have some questions:
1) I have a constant pressure of 14 set, with an EPR of 3 and an inhalation level set to medium (fast was only other option). I also use humidifier at either highest or second highest (most moisture) settings. Why does the pressure chart look like there are 2 pressures? The sleep study doctor wasn't sure if they used EPR or not during the titration, but presumed so and told me to set this up.
2) While I see some days I leak a lot, the days I don't leak more are seem to be no better than the days I do. I usually go to sleep with a fantastic seal, however, I toss and turn. I suspect the tossing/turning and subsequent leaking is due to the fact the pressure is not ideal, hence, my body tosses/turns/awakens slightly and then weird things happen as I toss and turn. I often wake up with the mask off with no recollection of what happened. Is there a way I can break down the night hour-by-hour using the rescan software to support this hypothesis? Anyone have any thoughts on this?
Note: I do have the mask type set appropriately to: 'MIR FULL'
Note: I had ramp in the above as well (although, I will drop that soon and see if that has impact, since I can handle pressure no problem falling asleep...)
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Okay, understand that my experience has been w/the S8 AutoSet Vantage (that was over a year ago) and yuo have the newer S8 AutoSet II and there are some minor differences. I've also been using the S8 ResLink w/my Resmed VPAP Auto for so long that I'm not sure whether the AutoSet provides the Detailed Data in ResScan or not. The Summary Data charts will show a break in mask on usage but the Detailed Data gives even better indications of mask off periods. In the Detailed Data graphs you have the option of stretching them out to various time periods from 1 minute down to 24 hours.
The fluctuation is caused by the use of EPR. You inhale half the night and exhalate half the night. So, given a decent Leak rate your pressure actually can fluctuate from 11 cms to 14 cms. (14 cms pressure - EPR of 3 cms = 11 cms of pressure on exhalation). Ramp can also reduce the overall reported pressure as you start out at a lower pressure gradually building up to your set pressure each time you hit the Ramp button. In addition, your xPAP can compensate for Leaks by as much as 1 cm.
If you are having stomach/intestinal problems THAT can make you restless during your sleep. I have Crohn's disease so I speak from personal experience. Heck, ANY pain or discomfort can make you restless during sleep.
You can help to reduce "hose drag" on your mask by either clipping your hose to your PJs or by hanging your hose above your head.
If you give me your e-mail addy I can send you the Clinicians Manual for the S8 AutoSet II in pdf format. Spell your addy out, don't present it in the usual format as trolls could pick it up and bombard you w/spam.
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Permalink Reply by Rock Conner RRT on
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Get outta that full face mask. They are leak monsters to be used only after all else fails. Try the Resmed Activa LT, the Swift LT, or the Piritan Bennett Breeze.
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Permalink Reply by Butch Hernandez on
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I couldn't agree more. The new Activa LT, Swift LT and even their Micro's are awesome masks! I love the breeze too provided the pt knows how to get it back to "0". 0 being where the mask was set just right. A lil adjustment goes a looong way with the breeze!
Rock Conner RRT said:Get outta that full face mask. They are leak monsters to be used only after all else fails. Try the Resmed Activa LT, the Swift LT, or the Piritan Bennett Breeze.
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Permalink Reply by James Bacher on
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I have one question. Does he have a mask leak problem, or is he just still having the events indicated in the report?
I only read through the reply's listed below so if there is more dialog which indicated there was a leak problem pardon me. But if he is simply having apnea and/or hypopnea events that is not unusual. Perhaps the events are the result of central apnea episodes in which case standard CPAP, BiPAP, or AutoSet therapy will not solve the problem.
Good luck figuring it out. I would start by reviewing the reports from the sleep study(s) to determine what the type of problem being treated is.
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Permalink Reply by Dave D. on
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Leak is definitely the main issue that needs to be addressed first. All of the suggestions above are good to pursue. Keep in mind that the FFM will be needed if you are unable to breathe only through your nose. Chin straps can help "closet mouth breathers", but will have little to no effect on one that prefers to breathe with their mouth, or have significant nasal problems. It's weird, but probably more than 1/2 of our patients prefer the FFM over a variety of all others.
Just messing with the mask may not provide a resolution to the issue, thus it is important to have a sleep lab that has a good CPAP clinic that you can go to with your equipment, hook it up, put it on at pressure as you would normally do, lay down and try different positions all with an experienced tech watching and identifying problems in real time. We have caught many problems this way, from the patient placing the mask upside down (really) to small leaks in the hose.
Once the air leak issue is solved, then you can pay attention to the AHI. This may never resolve completely, especially with a ResMed system, as their algorithm (although superior in my experience) has a tendency to report "non-obstructive hypopneas". These are events that it chooses not to treat (auto) but still notes them and records them. We've tried to get ResMed to consider changing this "too much information" download (if its not treated, why report it?), but it doesn't appear that will be coming any time soon. In short, these are inconsequential. Pay more attention to the AI alone. Also, compare it to your titration study records. Did you have any increased centrals with positive pressure? If so, then these could be some centrals that are giving you trouble, as someone mentioned. If not, then I wouldn't worry about it. In either case, the leak needs to get much better before you can even consider the event reporting accurate.
So air leak first, then watch for events. Get a lab that has a good CPAP clinic that can help if need be.
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