"High" pressure means more mask leaks?

stoveman · Post by **stoveman** » Wed Jul 06, 2005 3:58 pm

It seems like a no-brainer: Higher pressure settings mean more mask leaks. Please correct me if I’m mistaken.

The next question is: What is high? My friend says “Everyone he knows has a setting of 9 or below.” I have seen one post where the person referenced a setting of 19!

My prescription says 13 but the leaks on my F&P Flexfit 431 are so bad I had to (illegally) decrease the setting to 11. I honestly don’t know if 11 is enough pressure to keep the airways open; I do know that when the mask is lying on the floor, the pressure in my lungs is 0.

Next question: If some one needs a high setting, what type of masks work best?

Stoveman

chrisp · Post by **chrisp** » Wed Jul 06, 2005 4:18 pm

Yup, higher pressure means more leaks, Larger seal area = more leaks. Good mask = fewer leaks. good mask = Active, Ultra mirage, Aura, Breeze, Swift

Bad mask = HC 431,

IMHO

Tom1410 · Post by **Tom1410** » Wed Jul 06, 2005 8:51 pm

I have a HC 431 also and it leaks too unless I strap in on pretty tight (with a setting of 8.6). I also have an ultra mirage and it seals a lot better. I like the 431 because it comes down below my chin and helps to keep my mouth closed, but it leaves terrible red marks on the bridge of my nose and so I don't use it too often, mostly because of that.

rested gal · Post by **rested gal** » Wed Jul 06, 2005 9:27 pm

stoveman, if you can convince your doctor to prescribe an autopap for you, the autopap can find the varying pressures you need throughout the night.

Some people need one steady pressure all night, but many don't need the single high pressure all night long. An autopap might allow you to sleep most of the night at lower pressures, going up only when actually needed.

If it turns out that you do better on a single pressure, the autopap can always be run in "cpap mode".

GTOJim · Post by **GTOJim** » Wed Jul 06, 2005 11:57 pm

C-Flex might help with the leaks. If your using a straight CPAP and your pressure is 13 when you exhale the pressure inside of your mask could rise even higher.

You might want to discuss this with your doctor and see if you can switch to a C-Flex.
C-Flex drops the pressure when you exhale, and can help with mask leaks.
An Auto CPAP as Rested Gal suggested will also help, as you might be able to spend most of the night below your titrated pressure.

The best of both worlds is an Auto C-Flex. It can be used as a straight CPAP or as a CPAP with C-Flex , Auto with C-Flex ,or Auto CPAP.

I have an Auto C-Flex and it has helped with my mask leaks. Good luck.

jdacal · Post by **jdacal** » Thu Jul 07, 2005 12:22 am

I use the ResMed full face mask and find that at pressures above 15 the leaks become a problem for me.

I'm still experimenting with the proper settings for my APAP, but for the moment have settled with sleeping good with pressures set from 8 to 15 on APAP, as opposed to sleeping bad and frequent wakings from noisy and extreme leaks at higher settings. Though my AHI is slightly higher I get more quality sleep without the high pressure leaks causing frequent awakening.

I've found that a good face washing and washing the seal on the mask every night, really reduces leaks. The silicon seal seems to grab your skin much better with no oil residue on it, or your face. Even a little oil seems to allow the pressure to push the seal out and start blowing away.

ahujudybear · Post by **ahujudybear** » Thu Jul 07, 2005 7:01 am

Well, maybe it depends....

I have noticed that with a higher pressure (from 10 up to 12) that I actually have FEWER leaks with the Swift. It seems the slight increase in pressure presses the nasal pillows tighter against my nostrils?

Unfortunately the change in settings has done little or nothing about the whooshing noise of air being forced out through the vent holes.

And I don't know if my face is maybe beginning to conform to the 407 nasal mask? But that thing is now sealing so tight that the forehead cushions are no longer touching my face by morning and my upper lip is sucked up to the very edge of the mask. And the straps are not terribly tight when I put it on. Snug, but not tight at all. With the tracking wire across the front I am able to turn my head, allowing the headgear to move but not affect the position of the mask. Very feature!

WillSucceed · Post by **WillSucceed** » Thu Jul 07, 2005 7:33 am

Rested Gal wrote:

stoveman, if you can convince your doctor to prescribe an autopap for you, the autopap can find the varying pressures you need throughout the night

This is REALLY worth listening to. I was prescribed a pressure of 15 which, with all the air swallowing, damn near did me in. I complained at the Dr. until he wrote a script for autopap (which got me off his back) and then I started battling with the insurance company. I complained until they relented and am now using a 420E autopap. What a difference. The software shows that I spend the majority of the night around 8 with a few short periods that go as high as 12.

No more chest pain from swallowing air, essentially no leak (Breeze, Swift, Comfort-Lite) sleeping for 8 hours and feeling well rested during the day.

Push for the autopap -->even if you don't like the auto capability, you can change the programming so that it runs as a straight CPAP and it will still collect data for you.

LadyLarke · Post by **LadyLarke** » Thu Jul 07, 2005 1:34 pm

I am going to ask about the autopap thing. Canadian health care covered most of the cpap machine cost, but I don't know about changing or upgrading at this point. Worth asking though.

I am not feeling rested enough but I still sleep 6-8 hours a day plus an afternoon naps most days. So I do suspect a leak issue. The machine always says there was a leak every morning. But for how long or at what point. When I go to sleep there surely isn't. And I do clean the mask and my face every other day.

SnoreNoMore2005 · Post by **SnoreNoMore2005** » Sat Jul 09, 2005 10:35 am

I tried a new ResMed Mirage Full Face mask last night. I'm having trouble breathing through my nose at 14cm with the ResMed Mirage Full Face mask, but I did not have a nasal mask leak problem.

However, with the full face mask, the leaks are so bad at 14cm that I sound like I'm burbing and passing wind all night long.

Try explaining that to your wife in the morning.

Is it possible to use a full-face mask at 14cm? What am I doing wrong? It seems to fit properly, but the leaks are ghastly. I've read all the ResMed instructions. They say don't make the mask too tight which makes the leaks even worse.

The higher humidity did seem to help. I had no trouble breathing through my nose as long as I had my mouth to pick up the slack.

SnoreNoMore2005

lindas88 · Post by **lindas88** » Sat Jul 09, 2005 12:57 pm

I had trouble with leaking with the full face mask and switched to a Mirage Activa Nasal Mask and what a difference. I have almost no leaking now and have slept much better since trying that 5 days ago. You put this mask on quite lose too so you don't get that thightness and soreness from the other masks. When you turn the cpap machine on the mask closes over your nose and no matter which way you move it seems to move with you...I have has super luck with this mask. Lindas88

Cameo Ann · Post by **Cameo Ann** » Sat Jul 09, 2005 6:58 pm

I use a BiPap set at 17/13. I have found that regular nasal masks and full face masks usually leak a lot at those pressures. (But of course, I have not tried them all, so I can't say for sure that all do.) I also found that the Aura would not work at those pressures without a considerable amount of remodeling.

For me, the Breeze is the answer for the time being anyway. There is little leakage and it is reasonably quiet. I also tried a Swift and a Snark but have not found them to be any better, or as good as the Breeze is. I not sure about their leakage, but they are neither as comfortable nor as quiet as the Breeze is for me. But as we all learn, what works for one, might not for another.

Ann

rested gal · Post by **rested gal** » Sat Jul 09, 2005 11:59 pm

Like Ann, I've used the Breeze at very high pressures...all the way up to 20 cm H2O. Experimentally! And not for long! heheh. It sealed well up there, and I did try it with a lot of side to side rolling to see if the pressure would dislodge it. Stayed sealed so well. The Breeze remains one of my favorites, very close second to my almost-every-night favorite...my deconstructed Aura.

By the way, Ann, I've started using a simpler modification to keep the nasal pillows part of the Aura in place. Instead of homemade straps pulling at the bottom corners of the nasal part, I took those off and now just use one long panty leg (yeah, still doing "that"!! lol) to cover the nasal part - not tied to it at all - going around my head as if putting a sweatband around it. The ends of the panty leg are tied behind my head in that very flat "double start knot" as usual. Doesn't have to be tight at all to give it that little bit of "fingertip type hold" to keep the pillows in place at high pressure - works for me, anyway.

Cameo Ann · Post by **Cameo Ann** » Sun Jul 10, 2005 9:08 am

RG-

Thanks for the tip about the Aura. I will have to try it out, assuming I can locate my Aura among all of my other stuff! When I do sort through the clutter, I will save my old panty hose-- they seem to come in handy, to which RG can testify! (RG, you could write a best seller entitled "Panty Hose Band Aids 101 and Duct Tape.")

Ann

fstanmyre · Post by **fstanmyre** » Sun Jul 10, 2005 2:35 pm

Re mask leaks, the way this works is that the pressure behind the mask wants to push it off your face. The straps hold it on yur face. If properly set, the pressure difference between inside the mask and room pressure tends to push the thin rubber membrane that all these masks have, against your face, thus creating the seal. Therefore the most important thing in fitting the mask is to have lots of contact between the thin membrane and your skin. The straps should be adjusted so that the thicker, harder rubber membrane (just inside or under the thin membrane seal) makes reasonably firm contact on your face. I'm theorizing now but I would expect greasy skin or beards will definitely lessen that contact and result in leaks at a lower pressure. If this is true, then it follows that guys using FF masks should shave, not just wash, before going to bed. Also seems to me that big complicated shaped masks like the Mirage FF Ultra which I sometimes use, makes the thin membrane contact a lot more problematic than say a nasal mask like an Aptiva. I have both and while the Ultra FF tends to develop leaks, particularly around the top of the nose, the Activa doesn't seem to have this problem. Trouble with all these "thin membrane" type masks is that at least for me, they are very sensitive to movement which particularly at higher pressures or too loose straps, causes the thin membrane to lose contact. The second this happens it most likely will not seal again, you're going to create a windstorm, and you're gonna be heading to the kitchen for a snack wondering what the heck happened.

In my opinion, if you can breath thru your nose, there is no substitute for a pillows type mask, ie Breeze, Swift, which I use or the Aura which I have not tried. The same sealing principles apply but it is a lot easier to seal a nasal pillow than the big long thin membrane on the face masks. I only use the Ultra FF mask when I have nasal congestion. The Ultra FF is a great mask but for me anyway, it's Encore average leak is double the nasal pillow masks and so is the AHI.

Final comment on CFLEX. If you peruse the Respironics website, there are a number of papers covering patient testing that clearly show the benefit of CFLEX in terms of greater compliance and longer sleep periods.

"High" pressure means more mask leaks?

"High" pressure means more mask leaks?

Full Face Mask Leaks

Mask pressures and function