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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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Permalink Reply by Dave on March 28, 2009 at 11:01am
In my sleep study, they claimed to have zeroed me out....we also switched to my resmed mirage quattro full face mask (i brought with me) somewhere in the study because I started mouth breathing.

Mike had posted the results of my study here:
http://www.sleepguide.com/forum/topics/central-sleep-apnea-vs?page=...

It seems in lab I responded well. I just want to replicate those results!

Could it be the pressure is wrong, which causes me to toss and turn, which causes me to cause more leaks, etc?
Permalink Reply by RockRpsgt on March 28, 2009 at 11:19am
What size mask are you wearing? Sometimes you can fix a leak by going to a smaller size. Also when you fit yourself with a full face mask, Fit it with you mouth in a relaxed open position to compensate for breathing through an open mouth. Also your face muscles relax when you are sleeping. I agree with Butch and Rock on the nasal. They are much better masks in the long run. Good luck.
Permalink Reply by Dave on March 28, 2009 at 11:23am
I have a large resmed mirage quattro. Seal always seems good prior to sleeping and when moving around head before sleeping. In terms of nasal masks, I have a lot of sinus issues - which I'm also trying to improve with an ENT/allergist. I know that full face masks are more likely to leak, but I have a question: Does opening your mouth change the pressure you might need for best treatment?
Permalink Reply by Banyon on March 28, 2009 at 11:30am
Reply by Rock Conner RRT 12 hours ago
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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Rock,

I disagree. Full face masks fill a critical need for many patients (maybe 40%) who either breathe or leak through their mouth for part or all of the night. While mouthbreathing, the pressure is often lost to the extent that the patient is still having apneas.

There are many full face masks in use, properly fitted and adjusted, and the patients are getting excellent results. I have been using one for 2.5 years and the leak line is very flat every night.

For a new patient, a nasal mask should be tried first. The patient should try to determine as soon as possible whether he is mouthbreathing/leaking. If he is, he should switch to a full face mask.

Effort needs to be undertaken to get the right fit and to make the correct headgear adjustments. Patients often have to try two or three masks before they find one suitable for themselves.

I would assume that the patient under discussion was prescribed a full face mask due to mouthbreathing/leaking during his titration study.

Regards,
Permalink Reply by James Moriarty on March 28, 2009 at 11:34am
Most of the responses are pertinent to the leak with blame on the mask. The headgear slips and causes the leaks.
Seen in not only ResMed but all types and styles of nasal and oro-nasal masks. As an RRT with 20 years experience, I had to go through many trials and am still working on improving the headgear interface. Here is a link with a photo of the headgear. http://www.strapparatus.com and click on "Full Face Mask Headgear" tab.
In addition, this product will be shown at the Focus Conference for Respiratory and Sleep Medicine in May 2009 at Disney World in Orlando, Florida. If anyone here is attending stop by and say hello.
Permalink Reply by Judy on March 28, 2009 at 12:26pm
Good point about the headgear, JamesMoriarty!!! That was the problem I had w/my beloved Simplicity simple nasal cushion. The headgear is WAY TOO BIG! However, I was easily able to solve the problem by grabbing the center of the center strap and placing a fold in it and holding the fold in place w/a velcro strip. It took a couple of adjustments to find just the right size fold (or pleat if you prefer). The velcro strip holds that fold great! When I was sure I had that center strap the right length for me I cut the fold out and put the two cut ends together w/the velcro strip. The upper and lower straps I just have to attach almost to the back of my head but since that works it didn't seem worth the effort to try the fold and velcro "fix".

If we find a mask we like that is comfortable but ... sometimes it pays to try a few "fixes" on your own if you are stuck w/it until you are due for insurance to purchase a new mask for you. RestedGal who usually hangs out at cpaptalk.com is the QUEEN of innovative mask and headgear "fixes".

Good luck w/your innovative headgear, James! And thank you for spending the time and energy to develop it!!
Permalink Reply by Dave D. on March 28, 2009 at 1:50pm
Don't worry about replicating results with a machine download. It won't happen, unless by luck. Certainly ranges need to be taken into consideration, but being anal about it won't do you anything except cause frustration and ultimate failure. Fix the air leak and I'll bet you're tossing and turning will be greatly alleviated. One, it will be more comfortable and less noise, leak on your face, etc that will help. But also, the pressures will not go wasted in a large air leak and you'll be treated more effectively. All of the above suggestions may help. Still a good CPAP clinic would help wonders.
Good luck,
Dave

Dave said:
In my sleep study, they claimed to have zeroed me out....we also switched to my resmed mirage quattro full face mask (i brought with me) somewhere in the study because I started mouth breathing.

Mike had posted the results of my study here:
http://www.sleepguide.com/forum/topics/central-sleep-apnea-vs?page=...

It seems in lab I responded well. I just want to replicate those results!

Could it be the pressure is wrong, which causes me to toss and turn, which causes me to cause more leaks, etc?
Permalink Reply by Melissa on March 28, 2009 at 4:12pm
The first problem is that there are too many leaks in the mas. The other problem may be that 14 is not a high enough pressure. It would be beneficial if you are still having sleep apnea symptoms despite cpap treatment, to have your doctor order an auto titrating cpap for 1 month to see what pressure you really need. Talk to your DME provider as well to assist with your mask issues.
Permalink Reply by Dave on March 28, 2009 at 5:27pm




I figured out how to look at detail by day. Here is an example day. Is everyone still so sure that it is all related to leak? To me it just looks like the therapy is not working.
Attachments:
Permalink Reply by Henning on March 28, 2009 at 6:13pm
This supports my theory that Resmed counts hypopneas although they are treated.
Permalink Reply by Dave on March 28, 2009 at 6:42pm
It looks like when there is any leak at all (even minor and with 'acceptable' range)...instantly I have problems.....what do i do? when i go to sleep, there is no leak. I'm ready to tear my hair out (and I don't have that much to begin with)
Permalink Reply by Henning on March 28, 2009 at 7:04pm
For me, it seems that all of your hypopneas is treated (although they counts)

On your profile page, I see that you have central apneas.

I don't know much about central apneas, but perhaps it could be your central apneas that are untreated?

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