2 Weeks-in Need Help With Increasing Leaks

Hello all:

I have been lurking for the past month. 35 y/o male. Was diagnosed after a home sleep study and in lab titration with an AHI of 68. DR prescribed Auto CPAP. Started with my machine two weeks ago (DreamStation Auto). DME set the machine pressure at 4-20. Thanks to information on this site, I went ahead and moved the minimum up to 8 and recently 8.5.

I started with, and have only slept with, the AirTouch F20 FFM. I had a deviated septum from birth which was corrected about 10 years ago. I tried the nasal pillow mask at the DME, but sadly I am a mouth breather through and through.

I had instant success. I felt better immediately and am still seeing incremental improvements. However, I have had increasing problems with leaks. At first the leaks were associated with ramps in pressure in response to events. More recently, I have been having problems with leaks at lower pressures. I have no idea what is happening. I have been experimenting with how tightly I secure the mask...but it seems I have lost the mojo! I have downloaded two screenshots. The first is from my second night with the machine. The second is from last night. Last night was the first time I had the sleepyhead report tell me that the machine failed to detect breathing.

Please help!

http://imgur.com/a/3HgM2 (June 15, 2017, 2nd night with machine)
http://imgur.com/a/A0LS9 (June 28, 2017, 15th night with machine)

Thank you in advance...

First of all let's fix the statistic "time over leak redline" so that it more accurately reflects your machine.
SleepyHead's default for figuring "time over leak red line" is for a ResMed machine and it uses 24 L/min excess leak as its threshold.
Respironics machines don't use that number. In fact they never really give us a number because it can vary with pressure used as well as mask used.
So go to Preferences/CPAP tab and change the 24 L/min to something more in line with your machine....60 L/min would be a really conservative number. Or just turn that statistic off by removing the check mark.
Large leaks will show up on the events graph (as you learned) and usually a person can eyeball it and figure out if leaks are a problem.

Obviously something happened last night. I suspect the mask moved significantly and you slept through it. We can sleep through some really big leaks....been there and done that myself.

Is last night the only night it has been this bad?
You say progressively getting worse...are you using that red line leak % statistic or eyeballing it to determine it is getting worse?
What is your cleaning routine for the mask?
At what pressure are you fitting the mask at the beginning of the night? If it is the minimum pressure you might want to use the mask fit feature on your machine and fit it at the higher pressure to anticipate the increase which could blow the seal.

Thank you Pugsy for chiming in! I really appreciate this forum...

I actually changed the Time Over Leak Redline last week after finding a few old threads about the Resp. machines. I set it to 75. I have been eyeballing the bottom line to see how the days have been going.

Last night was the worst. But things have been getting worse over the past week. It began with my reading about proper tension of mask straps on the forum. "Mask should float on your face." I realized that the memory foam was collapsing "into" the mask and the plastic was creasing as I laid down (assumed mask was too tight). I tried letting the mask float...and got these results:

http://imgur.com/a/tzlRj (Monday)

A little tighter on Tuesday, but still leaving some space on top...and got these results:

http://imgur.com/a/83skg (Tuesday)

So things have been getting worse over the last week.

I clean every morning with a CPAP wipe. The memory foam can't be washed, so I just wipe it down in the AM with the wipe. I wash my face before bed each night.

The mask fitting in the evening is just "turn on the machine." I hadn't thought of setting the seal at a higher pressure. I assume that is a function on the machine that I will have to enable? I will go back to the manual and see if I can figure that out. Thanks!

well .. basically what pugsy said ... except one little thing:

SleepyHead (SH) takes the leakrate reported by your machine (the upper curve) and substracts whatever you set in the preferences as the intentional leakrate for your mask.
the resulting value is used as the "real" leak-rate or unintentional leak - the lower curve! The calculations with "time over leak redline" are based on that very curve / values.
If you set that the threshold to sth like 60 it is very unlikely you will ever hit that - as the machine can't compensate that much. (a very good BIPAP or ASV maybe could)

the default values for the intentional leak in SH are set to a nasal / pillow mask. You can find them in the manual of you mask. These values can be changed in the settings under the CPAP-Tab. Changing that may require to rebuild the CPAP-Data.

there is one pitfall: SH uses linear regression between the 2 values you provide (if you have no clue: draw a line between 4 and 20 cmH2O in the chart inthe manual ... whatever is above that line will show up as "leak" - whatever is under simply vanishes ... but that isn't really a problem you get used to the fact that the leaks increase a little bit if the pressure raises.)

The foam cushion for the F20 is very new. I don't know of any special tricks to help it stayed sealed.
You might try the mask fitting at the higher pressure (I think it is explained in the manual) and if that doesn't work maybe consider trying the regular cushion for the F20. They are interchangeable on your frame so you only need the cushion.
And also check with your DME about any mask swapping policy they offer. Usually its 30 days and I would suggest that you make use of it while you can and it won't cost you anything. You can always go back to the original mask.

Mask liners...you can buy them or make your own out of an old T shirt...I don't know how well they might work with the foam but it's worth a try. I would cut up an old T shirt if it were me and see if it remotely helped before spending money on one.

Also..you might look at some sort of hose management system and see if the hose tugging on the mask is maybe making things worse.
viewtopic.php?t=10640
Some hints and ideas in the above thread.

Thank you again. I'll give these ideas a try and report back.

I know masks are entirely personal. The Amara View didn't work - the nose hole was too large and I couldn't get a seal at all. I had wanted a mask that did not have a forehead support. Perhaps I will need to try that to achieve a proper seal.

It might be something as simple as switching to the F20 silicone cushion. I know some forum members who were using the regular F20 cushion and tried the foam and had leak problems and went back to the silicone.

Don't blame you for not wanting the forehead thing...that would be a deal breaker for me.
Fortunately there are several full face masks out there that people use quite successfully that don't have that forehead thing.

Next Day Update:

Activated and used the "Check Mask Fitting" function. It was definitely a higher pressure than the minimum...there wasn't a reading on the screen but Sleepyhead seems to indicate it was up around 15. Thought I had a good seal and went to bed.

Also picked up the silicone cushion for the F20. I started the night with the memory foam using the Check Mask Fitting. Thought I had a pretty good seal. Woke up at 2:45am and could feel the usual leak around my chin. Switched to the silicone cushion. As you can see...the proof is in the pudding. I will try tonight with only the silicone cushion and see if this was the root cause of the leak problems.

http://imgur.com/a/Robh3 (Last night - 1st Half Memory Foam, 2nd Half Silicone)

My wife and I have both tried the new cushions. My pressure is on the high side (20 cm H2O), and I could not get a good seal with the foam lined cushion. It worked well for my wife until I raised her pressure to 16 cm H2O. After that, she started getting massive leaks and went back to the regular F20 cushion. The foam cushions are very comfortable, but the leaks bothered us too much.

jduluoz92 wrote:Leaks

Make sure to use good hose management - the hose should not pull on the mask. Notice how your hose is positioned between machine and mask. It should be positioned to minimize any pull on the mask. Hose management is an individual practice. How it is done depends on the mask, the position of the machine, your sleeping position and other factors specific to the individual.

Due to the way we route our hoses, my wife and I both had problems with the hose pulling our mask to the side and causing leaks. I purchased two of the circadiance sleepweaver feather weight hoses for us to use, and have no more problems with leaks.

https://www.cpap.com/productpage/circad ... -tube.html

Okie bipap wrote:Due to the way we route our hoses, my wife and I both had problems with the hose pulling our mask to the side and causing leaks. I purchased two of the circadiance sleepweaver feather weight hoses for us to use, and have no more problems with leaks.

https://www.cpap.com/productpage/circad ... -tube.html

That sounds like a good idea for people who have trouble with the hose pulling on the mask.

Is your 6-foot CPAP hose standard size or slimline?

We use the climateline hose, and have hose covers on both hoses. We have not had any problem with rain out using this set up.

I'm wondering how things are going how for the OP.
I'm only a week in, but I have that same memory foam mask (AirTouch F20) and am bothered by leaks every hour or so during the night. I am thinking of trying the silicone. I've seen several people now saying they get too many leaks with the memory foam.