Can Data Tell If I Have a Mask Problem?

[Char1ieJ]

I just received my BiPAP machine 5 days ago. I goofed up and slept in my recliner one night, so I have only 4 nights data. However, it seems a lot of the night, I have "large leaks" -- according to Encore Basic 2.

10/3
Min. in large leak = 224
% = 55.1
Avg. leak = 92.3

10/5
Min. in large leak = 147
% = 40.1
Avg. leak = 83

10/7
Min. in large leak = 121
% = 82.3
Avg. leak = 103

10/8
Min. in large leak = 6
% = 2.2
Avg. leak = 66

As you can see from my equipment list, I have the ResMed Mirage Quattro FFM. I am going to add a DIY mask liner tonight, and then order a Padacheek IF it helps. But, I'm wondering... does the data give you any hints as to whether I have the wrong mask, don't have it "strapped on" properly or what? I'm curious. The mask doesn't irk me, but I do notice a pinhole leak around my left eye some nights (esp last night). And, sometimes I feel/hear air moving around the lower right "corner" of my beard. BTW, I shaved my beard to a different shape in anticipation of the mask fitting like the one I used for the titration study -- a Respironics Comfortgel FFM. The MQ fits across my beard, just below my lower lip -- and maybe that's where it's leaking. If I need to shave my beard off completely, I can do that, too.

Unfortunately, I'm normally so out of it when I awake with a leak that I can't coherently determine the problem. I adjust here and there, reseat the mask and fall back asleep. One night, I did take it off between 4:45am and 6am -- but I don't recall doing that.

I'm adjusting, but would like some guidance on this issue before the time frame for changing masks runs out -- IF it's needed.

[Char1ieJ]

No replies... Maybe I didn't ask the right question.
Is there ANYTHING useful that can be gleaned from this data?
Smart alec answers are also welcome.

[Suzjohnson]

Hi Charlie! Well, it's obvious you have been having leak issues but I see it is improving. YEAH!! I'm sure a mask liner will help. I don't believe that data can pinpoint what exactly is causing the leaks but at least you are headed in the right direction. Sometimes a mask simply won't conform to our face shape. It took me about a week to reach that conclusion because nothing I tried helped. I loosened the headgear, tightened it, re-cleaned the cushion, adjusted it to my face this way and that, checked that the cushion was properly seated, and so on. Finally discovered, with my FFM, that if I let my mouth drop open and cheeks fill up with air, it fit great, but I was left with a funny sensation that something about this picture just wasn't right! Hang in there and let us know how the mask liner worked out for you.

Suz

[woodworkerjunkie]

I don't have any experience with this mask, but here is a link that may help with the leaks! Hope it can help you.

http://maskarrayed.wordpress.com/taming ... e-quattro/

[Xney]

If you can load your data and look at the leak graphs, you can tell a bit more about it. Maybe you can post them?

[Pugsy]

I was waiting for my crystal ball to get back from the repair shop. Alas, it is still broken so I got out my magic 8 ball.

It says "maybe" You know how those darned old 8 balls like to sit on the fence.

Your most recent night with average leak of 66 L/min is better. So you are heading in the right direction.
Can we tell by this data if the mask is "right" for you...."maybe" says the magic 8 ball.
The fact that you can sleep through the leaks is a big plus. If you weren't getting any sleep due to the leaks then for sure the mask is a real trouble maker. Is there a better (as in much less leaky) mask? Magic 8 ball says "maybe" again.

Vent rate....http://www.resmed.com/us/assets/documen ... sa_eng.pdf
Somewhere between 41 and 48 L/min for your mask.

Look at your leak line on your software report instead of the overall average...how much time was spent above say 70 L/min?
Did you have any large leak segments show up in last night's report? If so...how many and about how long did they last?
If minimal to none....and you sleep well...I wouldn't panic.
When it comes to the numbers as averages I really can't "see" the whole picture. I prefer to look at the leak line and see how much time was spent in large leak territory and if only 5 or 10 minutes and I slept well...then I don't get all worked up over a little bit of leak.
It sounds like the mask is getting better and you are getting the leaks under better control. If you like the mask, it is comfortable and all that...then keep trying to work on the leaks a little each night with different stuff like the mask liner.

If your last night's leak average was as bad as your first night then I would be more prone to suggest a different mask but you are improving on the numbers.

So what did the leak line look like for that 66 L/min average?

[Slartybartfast]

Charlie, you've got some serious leaks to contend with. The numbers should be below 30, unless your machine isn't subtracting the leak rate built into the mask. But even then, you've got too much air blowing by your face. I've not heard of any mask that won't leak like a newborn if it has to seal against facial hair, so shaving might be your best course of action. Your last night's numbers are almost tolerable, but still too high.

[Pugsy]

The numbers should be below 30, unless your machine isn't subtracting the leak rate built into the mask.

Charlie has a PR S1 BiPap machine. Leak reported is Total leak so vent rate is included. His pressures are in the 15 range (I forget exact number) so the vent rate for his mask is going to be somewhere around 41 to 48.
He won't ever see below 30.

Need to see the leak line graph....maybe 75% of the night he was around 50 or so and maybe only spent brief amount of time in large leak territory or close to it. Leak number reported by PR S1 machine is an average. Averages sometimes look worse in numbers than they really might be if the whole picture is seen.

[Char1ieJ]

OK, I don't know what I'm doing, but here you are... I added in Sleep Therapy Flags, in case that would help at all.






I guess this is the night I took the mask off, without knowing it. My wife said it happened between 4:45am and 6:00am. Guess she was wrong, too.



I think these will give you what you were asking about. It looks like most of those graphs are above 70... well above the 48 norm. Yuck.


THANKS to all who have answered so far!

[robysue]

Charlie,

The numerical data points to a really big problem somewhere in the system. Here's the expected leak rate chart for the Mirage Quattro:

I don't know what your pressure settings are on your BiPAP. But it is very uncommon for people to require IPAP pressures of more than 20 cm unless their machine is an ASV type machine that is designed to treat central apneas by acting as a non-invasive vent.

So if we assume that your pressures are in the 20cm range, the expected leak is about 54 L/min. And except for last night, your average leak rate is well above that (sometimes twice a much). And the time spent in Large Leak is astonishing since the PR System Ones seem to be very, very reluctant to score Large Leaks until your total leak rate is about three times the expected leak rate. It would be illuminating to see what your leak line looks like on the daily detailed data.

The data from 10/8 may indicate that the leaks are beginning to come down. And that you're learning just how tight/loose the head gear needs to be so that your seal stands a good chance of holding up through the night. Or (based on the arithmetic) it could be that your leak numbers look better for this night only because you didn't wear the mask as long as you did on the first two nights.

And please understand that the "Time in Large leak" numbers indicate you do NOT seem to be using the machine all night, every night. Or perhaps, the leaks are so large on some nights, that the machine assumes that there is not a person breathing at the other end of the hose. (Any black bars on your daily details leak graphs?)

Here are my computations for your usage figures:

• 10/3
  Min. in large leak = 224
  % = 55.1
  Avg. leak = 92.3
  So on 10/3 you used the machine for about 406.6 minutes = 6.78 hours (which is GOOD)
  
  10/5
  Min. in large leak = 147
  % = 40.1
  Avg. leak = 83
  So on 10/5 you used the machine for about 366.6 minutes = 6.11 hours (which is GOOD)
  
  10/7
  Min. in large leak = 121
  % = 82.3
  Avg. leak = 103
  So on 10/7 you used the machine for about 147.02 minutes = 2.45 hours (which is NOT GOOD)
  
  10/8
  Min. in large leak = 6
  % = 2.2
  Avg. leak = 66
  So on 10/8 you used the machine for about 272.73 minutes = 4.55 hours (which is NOT SO GOOD)

So you've used the machine for more than 6 hours the first two nights. The third night you used the machine for less than 2.5 hours, and last night you used the machine for about 4.5 hours.

So----how much time in the last two nights did you spend sleeping without the mask on your nose? That improving leak line means nothing if you're just taking the mask off and then returning to sleep.

As for other things you ask about. You write:

But, I'm wondering... does the data give you any hints as to whether I have the wrong mask, don't have it "strapped on" properly or what? I'm curious. The mask doesn't irk me, but I do notice a pinhole leak around my left eye some nights (esp last night). And, sometimes I feel/hear air moving around the lower right "corner" of my beard. BTW, I shaved my beard to a different shape in anticipation of the mask fitting like the one I used for the titration study -- a Respironics Comfortgel FFM. The MQ fits across my beard, just below my lower lip -- and maybe that's where it's leaking. If I need to shave my beard off completely, I can do that, too.

The leak lines themselves would be more useful than just the summary data about how much time you spent in Large Leak territory.

Pertinent information that the detailed data's leak line can show include: Are you almost all of the night in near large leak territory? Or are there well defined periods where your leak line is where it is supposed to be and well defined periods where the leak is well above where it's supposed to be each night?

If your leak line is NEVER near the expected leak rate for your mask and pressure, then that's probably pretty good evidence that something major is wrong. It may be the mask simply doesn't fit your face at all. Or it could be that you've adjusted the headgear way too tight. (Or too loose.) It may be that you've got a small hole somewhere in the hose that is partially blocked by where you've routed it on some nights. It could be the leaks you can feel and hear are much larger than you think they are.

If your leak line is SOMETIMES near the expected leak rate for your mask and pressure, then the mask can be fitted to your face. It still may not be the best mask for you, but if you're comfortable with it, then there's hope that you can make the mask work----possibly with a mask liner, or a chin strap, or an anti-leak strap, or even shaving the beard. Because if the leaks are intermittent (even if they're also long), then the problem may be that you are "springing" a serious leak sometime during the night well after you've first fallen asleep. It could be that your facial muscles relax enough that your mouth starts to hang further open than when you first went to bed and that your chin drops further as well. And the combination of the additional laxity in facial muscles with the wider open jaw and lower chin causes the mask to spring a leak somewhere near the bottom of the mask.

I'm adjusting, but would like some guidance on this issue before the time frame for changing masks runs out -- IF it's needed.

I'd report the problem to the DME now. In your shoes, I'd tell them I'm not ready to declare the current mask a failure (yet), but that I'm already wondering if it can be made to work. See if they give you any advice. A few DMEs are kind enough to not demand a mask back when you need to swap the original one out for a new one because the original is not working good enough.

[Char1ieJ]

Charlie,
So you've used the machine for more than 6 hours the first two nights. The third night you used the machine for less than 2.5 hours, and last night you used the machine for about 4.5 hours.
So----how much time in the last two nights did you spend sleeping without the mask on your nose? That improving leak line means nothing if you're just taking the mask off and then returning to sleep.

WOW, thanks for the comprehensive review. I'll call the DME after I answer these questions. My IPAP is 17; while EPAP is 14. The machine is set to AUTO mode, so it adjusts itself.

The 2.5 hour night I fell asleep in my recliner; woke and went to bed around 3am (I think). My wife says I took the mask off between 4:45am (when she got up to let the dog out) and 6:00am when she got up for the morning. Last night (4.5 hours), I also feel asleep in the recliner. I awoke around 1:30am and went to bed. Put the mask on and slept the rest of the night. Got up around 6:15am this morning. Both of those nights, the sleep meds got the best of me and I just fell asleep in the living room, while in the recliner.

I'm not out of compliance those nights on purpose. Believe me, I want this to work! And I know I have to use the BiPAP for it to work.

The leak lines themselves would be more useful than just the summary data about how much time you spent in Large Leak territory.

If you can load your data and look at the leak graphs, you can tell a bit more about it. Maybe you can post them?

I went back and uploaded graphs from all four days, if that helps. THANKS again!

I don't have any experience with this mask, but here is a link that may help with the leaks! Hope it can help you.
http://maskarrayed.wordpress.com/taming ... e-quattro/

THANKS! I printed this page out... forgot about the link when Pugsy sent it to me. I'll try the tips tonight.

[robysue]

Char1ieJ,

First things first:

The 2.5 hour night I fell asleep in my recliner; woke and went to bed around 3am (I think). My wife says I took the mask off between 4:45am (when she got up to let the dog out) and 6:00am when she got up for the morning. Last night (4.5 hours), I also feel asleep in the recliner. I awoke around 1:30am and went to bed. Put the mask on and slept the rest of the night. Got up around 6:15am this morning. Both of those nights, the sleep meds got the best of me and I just fell asleep in the living room, while in the recliner.

Sleeping medication usually includes the instructions to "take right before bed and go directly to bed." At least the instructions on my Ambien and Sonata say something along those lines.

So---if you're going to take a sleeping pill, no stopping by the recliner before going to the bedroom.

(Melatonin is different; but it is a sleep "trigger" or "regulator" and NOT something that puts you to sleep shortly after you take it.)

Now, let's look at those leak lines, shall we?

Your pressures are: (max) IPAP = 17; (min) EPAP = 14, and you're running in Auto Mode, with a PS = 3 most likely. Meaning that your IPAP ranges from 16 to 17 and your EPAP ranges from 14 to 15. Which in turn means that your expected leak rate is around 45-50 L/min.

Let's look at those leak lines with some important horizontal lines drawn for reference at 50 L/min, 80 L/min, and 100 L/min. Any leaks at or below 50 L/min we can consider in the expected range for your mask and pressures. Any leaks above 80 L/min are leaks that clearly exceed 30 L/min and are on the largish side; some of them (the ones close to 100 L/min) even appear to be large enough to be flagged as Large Leaks by Encore. Any leaks above 100 L/min are at least twice your expected leak rate and they seem to be formally flagged Large Leaks in Encore for the most part. And they've got to be considered pretty close to the Large Leak territory if they're not formally flagged.

Here are the marked up graphs:

On 10/3 large leaks seem to be flagged most of the time your leak line is close to the 100 L/min. Almost no time is spent with a leak rate around what your expected leak rates are on this night. Any way you cut it, this night indicates some serious problems.


On 10/4 the large leaks seem to be flagged by Encore only if they're near 100 L/min or above 100 L/min. Notably the last 45 minutes of the night your leak line is right down where we want to see it---hugging or just below the 50 L/min for the most part. But the rest of the night? Large leaks and largish leaks (around or above 80 L/min) are happening pretty much the rest of the night. If you were using a Resmed, Mr. Red Frowny Face would have definitely have paid you a visit.


On 10/6 your leak line is everything we DON'T want to see in a leak line: Short usage time AND sky high leaks. Your average leak is at least twice what it should be; you are leaking at or close to 100 L/min for virtually the entire time you used the machine. No wonder you took the mask off in your sleep on this night----it must have felt like you were trying to sleep in a wind tunnel set to "hurricane."


On 10/7 the leaks during the first half hour and the last 1.5 hours are acceptable. (Do you use a 30 minute ramp by chance?) The leaks from t=0.5 to t=2.2 are unacceptably high---they are just below the range that has been flagged as "Large Leak" on the other nights and they're skirting 100 L/min. From t=2.2 to t=3.0 the leaks get a bit better. They're still kind of large, but they're no longer flirting with Large Leak territory. After t=3.0 the leak line looks good enough.

In looking at your leaks as a whole, I notice a steady increase in total leak at the beginning of all four nights. And that raises the question: Are you using the Ramp feature? And if so, what is your initial ramp pressure? Because it looks to me as if you are fitting the mask (probably well) at a low initial pressure, but as the pressure creeps up to your set pressures of 17/14, the seal just doesn't hold and you develop some serious leaks.

So: I suspect that if you are using the ramp, that may be the culprit: You simply cannot seal the mask at low pressures (such as 6/4, which is the default starting ramp pressures on your machine) and expect the seal to hold once the pressures reach 17/14. You need to fit the mask at full pressure it looks like to me.

And yes, there is hope that you can make this mask work: That leak line after t=3.0 on the night of 10/7 indicates that you can indeed get a decent quality seal with this particular mask.

[Xney]

Anything I would say, robysue has already said!

[Pugsy]

Well....I was hoping for more time down around the 60ish range...not the 80ish range.
Totally agree with everything Robysue has said so won't duplicate those comments.

Your machine has a mask fit choice does it not? So that you can fit the mask to your pressures even if you are using ramp?
The new machines have that option and our old machines don't.

You might want to remind the forum members here that your DME is not nearly so open for mask trials and exchanges and is really pretty limited with your options and your insurance coverage is less than ideal.
While the mask manufacturers all pretty much offer a 30 day swapping thing....a lot of DMEs have set up their own "in house" rules and your DME kinda has some pretty sucky in house rules. Worse than usual bad.

You know I am not the most patient of people and I sit here wondering what I would do in your situation...knowing your situation with your sucky DME in house rules....I think I would maybe try a couple more nights with this mask because you are improving with the leak. Do try the mask liner for sure though. Homemade will give you an idea if it is going to help or not.
If no real improvement by Thursday...get a different mask from your DME so you can try a different one over the weekend.
If you had not shown some improvement last night I would have suggested contact the DME today for a different mask but you did improve and compared to your first couple of nights...pretty significantly.

Oh, did you ever tell me if your DME actually measured you for fitting of this mask? Or did they eyeball your size?

Oh....when leaks are hitting that 90 and above mark (especially the 100) the auto part of the pressure adjustment won't work properly. At those high of leaks the machine will instead work like straight bilevel and not adjust like it is supposed to.
Your pressure lines will likely show minimal to none variances.

[KEQ5]

Just as a counterpoint, I have a full beard, but didn't have much issues with leaks with either the QFX or the Mirage Quattro masks.

In fairness, my beard is a bit thin along the sides of the mouth and under the lips, so there's not as much hair there. And I keep that part of my beard trimmed up a bit but it's still 1/2 to 1" long.