My Rem Star Auto M  although nice and quiet seems to have a problem. Or I do:O)
It leaks from somewhere?? I use a full face mask and the pressure is set at 9 cm
As my user name implies "ancient" I am that. I have been using CPAP regularly every night now for around 17 years. I do OK with the treatment and seldom fall asleep during the day as I used to.  Nor do I  when I drive :O)
Since I got the Remstar Auto I have been manually pencil charting the AHI per hour every day. I think the "averaging" is for the birds and makes little sense to me. I am only interested in the performance of the prior night.
Since I got the new machine it has continually shown an average leak rate of  40+- I was concerned about this and checked with the RT She checked the mask fit and it is good. I am not aware of any huge leakage at least while I am awake. The new machine was great otherwise  as it registered the AHI as around 4 per hour. My concern is that this has now climbed steadily over the past few weeks to over 7 and I have had the odd nod during the day. This of course could just be my age. :O)
 If the AHI keeps climbing I will have to make an appointment to see about it. but would appreciate any comments.

What make/model of full face mask do you have?  40 l/m may or may not be excessive for your particular mask at pressure 9.  

A general rule of thumb is to find out the expected leak (the port exhaust rate) for your mask at your pressure, pad it with 10% of that rate, and that is the maximum 'allowable' leak for your mask.  (Some doctors use 15%.)

You can find leak rates in the spec sheets online at the manufacturer's website, for your particular mask.  If the mask spec is in liters per second, be sure to convert to liters per minute before using the numbers.  (Respironics M series report leak in liters per minute, Resmed in liters per second, not sure about other brands.  Take care to use a common unit of measure.)

For example, my mask (Hans Rudolph full face mask) has an expected port exhaust rate of 23 l/m at your pressure of 9.  if you were using my mask, 23 + 2.3 = 25.3 l/m maximum allowable leak rate.  40 l/m would be VERY excessive leaking for this mask at pressure 9.

If you use a Resmed Quattro FFM, the expected leak is about 34 l/m at pressure 9.  34 + 3.4 = 37.4 maximum allowable, so again 40 liters per minute is excessive.  

Any time leak is excessive it is quite likely the cause of higher AHI due to loss of therapy pressure.  Higher AHI = more sleep disruptions therefore poorer quality sleep and more fatigue during the day.

Blessings,
--pseudonym

Thank you Pseudonym for your prompt answer.
 I am using an  Res Med Ultra Mirage full face mask and use a chin strap.
I did as you suggested and tried to find out the expected port exhaust rate at the Res med site. I couldn't find it. I called the telephone  number on their site and talked to a nice young lady in California. She said that since I was using (a Remstar Auto M) she couldn't give me the answer.? I tried to explain that it was the mask I was asking about . However, I will look further, or perhaps you could help? My  AHI dropped to 7 last night. Avg leak rate about 38.  I don't know much about that either as I ran for years not knowing what was happening with a  noisy Remstar Choice. It didn't record data. :O) I am deaf now and so is my wife :O)
 Thanks John

This may help.

http://www.internetage.com/cpapinfo/leak-rates-1.html

OK, I am a little confused here.  My smart card shows my leak rate is 35-40%.  My sleep practitioner stated that a normal leak rate is <60%?!  I need some clarification, as I do not fully understand.  Lantern4life

Thanks Violet I printed that out for a reference, if that is the expected rate of leaks to venting it explans a bit. My HP didn't know this? John

To Lanternlife,
I don't have the program to read the smart card. I wish Rem Star would give us this program as the machine costs enough already. It is all a big money game as evident by the cost of  all of the little parts you have to buy if they break (and they do if you move while you sleep). I just bought a flat screen monitor for less  than the cost of a piece of molded plastic  .??
As I said in my first post, I am really only interested in the reading of the previous  Apnea Incidences to see how "I did" :O) The rest of the averaging is "gobbledegook" I don't think there is much there of value to a practitioner either, unless they sleep with you :O) 60% seems to be a high rate of leaks, (Read Pseudonym's post) but then your practitioner should know ???
 John

For those of you w/a new mask, SAVE your mask literature. You will find the Flow Chart listing the allowed vent rate for your mask at specific pressures in your mask literature. If you've had your mask for awhile but saved the literature that came w/it, dig out the literature and find that chart to check what the allowed leak/vent/flow rate is.


_________________
Some people are like Slinkies... Not really good for anything, but they still bring a smile to your face when you push them down a flight of stairs.
Resmed VPAP Auto. Humidaire 3i, Simplicity & Micro masks, ResScan 3.4, S8 ResLink, Embla oximeter.

OK, I went to the site with all the numbers:

Innomed Hybrid F/F + N/P  43.9  45.0  46.1  47.2  48

....and found that at a pressure of 10.0, the corresponding number is 48.

What does that mean?

 


_________________
As a Christian, you may be the only bible someone ever reads.

I assume that at a pressure of 10 cms a reported leak rate of 48 L/M is expected, allow for 10 L/M as the most compensation your xPAP can provide for would mean that any reported leak over 58 L/M is way too much leak.


_________________
Some people are like Slinkies... Not really good for anything, but they still bring a smile to your face when you push them down a flight of stairs.
Resmed VPAP Auto. Humidaire 3i, Simplicity & Micro masks, ResScan 3.4, S8 ResLink, Embla oximeter.

CrohnieToo wrote:

I assume that at a pressure of 10 cms a reported leak rate of 48 L/M is expected, allow for 10 L/M as the most compensation your xPAP can provide for would mean that any reported leak over 58 L/M is way too much leak.

Its truly amazing that a leak of 48 L/M is acceptable.

Some nasal masks have leaks of 15-20 on 8cm h20. No No, I understand its a different mask type and all. I just stating a worthless thought on the subject. Dont mind me!

Hey, your observations mean a lot, RAM. You certainly have more experience at this than we do. I've just been told several times that these newer CPAPs can compensate up to 10 L/M over the allowed vent rate. I have no way of knowing if that is gospel or not. And since I've never tried the Opus 360 and don't have the literature; all I had to go by are the figures that were presented to us. You are right tho, I should have said "as far as I know" or "as I understand it", rather than to have been so .....definite sounding.  Oh heck, I DID say "I assume" ....


_________________
Some people are like Slinkies... Not really good for anything, but they still bring a smile to your face when you push them down a flight of stairs.
Resmed VPAP Auto. Humidaire 3i, Simplicity & Micro masks, ResScan 3.4, S8 ResLink, Embla oximeter.

CrohnieToo wrote:

Hey, your observations mean a lot, RAM. You certainly have more experience at this than we do. I've just been told several times that these newer CPAPs can compensate up to 10 L/M over the allowed vent rate. I have no way of knowing if that is gospel or not. And since I've never tried the Opus 360 and don't have the literature; all I had to go by are the figures that were presented to us. You are right tho, I should have said "as far as I know" or "as I understand it", rather than to have been so .....definite sounding.  Oh heck, I DID say "I assume" ....

No, im sure that the literature is spot on. I am just saying that 50 L/M sounds like a heck of a lot, but in reality the machine is compensating for it.

Hard to believe, but true (according to the charts and booklets).

Also, I do not have any experience with wearing the masks. That is why I am here. I want to gather as much information as I can from the guys who know what the hell they are doing. If I can use you guys knowledge at work, then I can be a better technician/therapist.

I can strap a mask on someone with an incredibly small leak, but that doesnt mean that the patient is having the time of his'her life. Haha. Ultimately, im worried about the end result. I cant stand when patients are over titrated, but I bet that I see it on a weekly basis. Split night studies are hurting the field, but insurance companies do not want to pay for 2 nights, if they dont have to.

Ram, You are obviously someone who cares. You should do well as a therapist. I am sure that you are right about some people being set up with too high a pressure initially.( It could and can turn them away from this therapy). I had to persevere at first with an initial low 7cm
I have to go for a sleepover every two years to maintain my eligibilty for insurance.  Normally I sleep well at home and get  comfort from the CPAP. I don't get a great deal of sleep on these nights with all of the wires connected to my body and it isn't my own bed.
A friend of mine was set up at 15 cm and it was literally blowing the mask off his face as he tried to sleep.  i am sorry to say he doesn't use it at all now.
As you sit in a therapist's office with a mask on trial it is far different from when you lay down in bed at night.
I have found the venting leak rate discussion interesting and wonder why someone like the doctor or therapist doesn't tell you this.?
 They give you a new tool that tells you all?. I still maintain that most of the information is of of no use to me.  I guess that is why they blank out most of it.  When I leave the therapist's office I am sure they don't worry if I had an average of 7AHI over the past thirty days when infact I worry about the fact that I had a 12 AHI  over the past 8 hours. I already know because I didn't get a great deal of sleep that night. Sure , if you have the  flash card program you could do a print out. It is the patient who is the final judge and if he runs into  continuos problems he should see a doctor or therapist to check for major leaks or settings. You live or you die without it.
 Thanks John

Ah, RAM! IF ONLY MORE RTs and RPSGTs thought and felt as you do!!! IF ONLY there could be better communication between patient and RT, RPSGT and sleep doctors .... ah, if wishes were horses ....

I do have to admit tho, so many of the more involved in their own CPAP therapy forum members have had such bad experiences w/their sleep professionals they can get a bit tough on those sleep professionals such as yourself who take the time to visit these forums. Sometimes you have to be pretty thick-skinned to hang around. And, no, that does NOT speak well of those of us who get carried away at times and are unpleasant to the sleep professionals who do take the time to take part in these forums. Those of us who do need to learn to swallow some bitter apple on occasion and apologize or at least back off.

I was just live chatting w/an RPSGT last night who had never heard of using Mack's Silicone Ear Plugs for mask leaks and was very interested and wants me to send him the info from the forums on their use. He's been of great help to many in that forum but was just recently flamed and had posts deleted by one of our grumpier, not yet successful, CPAP users. Fortunately, he has a good sense of humor!!!

And, yes, WhiteBeard. One of my biggest gripes is that the local DME suppliers' RTs do NOT know how to fit a mask properly (with the patient laying down) or are not provided w/the facilities and equipment to do a proper mask fitting (cot or bed, CPAP at pressure). AND who either do not make use of the manufacturers' mask exchange in order to be as lenient as necessary to get their clients fitted w/a comfortable, correct mask.

Another of my biggest gripes is the sleep doctors who could care less and allow their patients to be provided w/a less than fully data capable CPAP (except in cases of no insurance and financial duress). I have no use for sleep "doctors" who have so little interest in their patients' therapy.


_________________
Some people are like Slinkies... Not really good for anything, but they still bring a smile to your face when you push them down a flight of stairs.
Resmed VPAP Auto. Humidaire 3i, Simplicity & Micro masks, ResScan 3.4, S8 ResLink, Embla oximeter.

Right on Chronie2!