leakage

General Discussion on any topic relating to CPAP and/or Sleep Apnea.
MaryGordon
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Joined: Fri Mar 28, 2014 5:00 am
Location: Scotland

leakage

Post by MaryGordon » Sat Apr 19, 2014 5:25 am

I'm having a lot of trouble with leakage even though my machine says I have a good mask fit. Please could anyone explain to me how this happens and what can be done about it? I use a nasal cushion mask and a chin strap. I tried mouth taping but after one night I am not willing to try that again without major need.
I'm a new user of just over a month, fairly ignorant still and not yet fully sorted with equipment it seemso.
Many thanks for any help.

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Pugsy
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Re: leakage

Post by Pugsy » Sat Apr 19, 2014 6:01 am

You are using a nasal pillow mask. They are easy to get and keep a good seal.
When people have large excess leaks using a nasal pillow mask show up on their reports it primarily because of mouth opening leaks.
How much leaking are you seeing? Are you seeing large prolonged big leaks or just sporadic leaks or is it just that you are having very minor leaks around the nasal pillows themselves that wake you up a lot but on the reports aren't in large leak territory much?

If it's a lot of leak to the point of seriously impacting therapy then our choices are tape mouth, chin strap or use a full face mask.

If it's not a lot of leak an maybe just a poorly fitting nasal pillow...maybe try a different model????

So how much leak are you seeing?

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MaryGordon
Posts: 38
Joined: Fri Mar 28, 2014 5:00 am
Location: Scotland

Re: leakage

Post by MaryGordon » Sat Apr 19, 2014 7:26 am

Thanks Pugsy. It's a lot of leak, a lot of the time, but with ups and downs. So it isn't a constant from the mask not fitting. I only downloaded the software this morning and I am not yet familiar with the graphs - but this was clear and it was something the clinician had pointed out in my first follow up visit.

I am not aware of leakage at night on the whole. A few times I have woken up and noticed air going in my nose and straight out of my mouth and a few times I have woken up with air just going round and round in my mouth.
I can't make the chin strap any tighter! As for taping, the one night I tried it I still had air going round in my mouth. I am not keen to try it again as I occasionally - maybe once a week - have an episode of very severe apnoea from which I waken really gasping for air. I really would be afraid to experience that with my mouth taped up: I don't know if I'd get the tape off in time.
How would the machine know if the air is going in my nose and out of my mouth? and how would a full face mask prevent that?
I don't have another apt with the clinician till late May, but I do have a phone number which I can ring to talk to her and I will do so tomorrow. I am sure the leakage is impacting on therapy and just want to do all I can to get that right.
I'm really grateful for any help: users have a different perspective from clinicians!

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Pugsy
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Re: leakage

Post by Pugsy » Sat Apr 19, 2014 8:03 am

MaryGordon wrote:How would the machine know if the air is going in my nose and out of my mouth? and how would a full face mask prevent that?
The machine wouldn't know but using a full face mask prevents the loss of therapy pressure out into the room air by keeping it within the full face mask seal.

When using a nasal mask and mouth opening/breathing/leaking the air enters the nose and exits the mouth and doesn't make it down to the airway under significant pressure to hold the airway tissues open.
When using a full face mask the air exiting the mouth is still kept within a sealed area and pressure therapy is maintained..not lost into room air.

Some people simply can't learn to keep the mouth closed either from habit or maybe nasal congestion makes it imperative that they mouth breathe.

Sounds like when you taped and mouth inflated when the air entered it..cheeks likely inflated and we call that chipmunk cheeks. It's common. The problem is the tongue isn't blocking the airway well enough to prevent the air in the airway from trying to enter the mouth. When the tongue stays in proper position (roof of mouth) the tongue acts like a closed door and air going up the nose and down the airway can't enter the mouth. Easy to do while awake but not so easy to maintain while asleep as the tongue gets lazy. With time and practice keeping the tongue in the roof of the mouth people can sometimes teach the tongue to stay where it blocks that door.
I can do it now to the point that I can talk and even yawn with mask and machine on and zero pressure will enter the mouth and exit my mouth. Takes practice though...took many months to master the talking thing but it can be done.

Some people either can't or won't do the needed practice with the tongue or maybe the tongue is just too stubborn to learn a new habit and if the leaks out the mouth are big...full face mask is a must if chin straps and/or taping is unsuccessful for whatever reason.
At least with a full face mask you can maintain optimal pressure in the airway and that helps prevent the airway tissues from collapsing...thus preventing the apnea events.

It can be a challenge. Full face masks present a bit more of a challenge in terms of leak control simply due to the surface area involved but a lot of people use them quite successfully.
So people have to decide how they want to try to fix mouth opening issues.
There are options but all have some pros and cons.

I use a nasal pillow mask. I sometimes mouth breath but from the reports the time spent in large leak territory is rare and brief. I sleep right through it...so I opt to just ignore it. 30 minutes of big leak out of 8 hours of sleep isn't the end of the world since I am sleeping well anyway. For me to try to fix that 30 minutes by using a chin strap or tape or full face mask would cause me more sleep disruption all night. Been there and done that with chin strap and tape and I simply don't want to use a full face mask due to other reasons which are important to me.

Any leak (even tiny) that wake a person up repeatedly during the night are of course unwanted because they mess with sleep quality.
Now if a person sleeps through the leaks and the time spent in large leak territory (with you S9 machine that would be over 24 L/min) is not hugely prolonged...maybe doing like I do is acceptable but if time spent in large leak territory is prolonged (like over 25% of the night) then I usually suggest doing something serious to try to manage leaks better and if that means a full face mask...then so be it.
Chin straps and tape are mainly there to help remind the mouth to stay closed. Sometimes that is enough help but sometimes it isn't.

When you get a chance can you post an image of your actual leak line graph? It would help us to see just how long you might spend in large leak territory and how far you might go. 26 L/min territory isn't horrible...46 L/min is horrible.
5 minutes at 46 L/min...not the end of the world though.
So how much leak and how long it goes on needs to be evaluated.....assuming a person is sleeping through them.

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MaryGordon
Posts: 38
Joined: Fri Mar 28, 2014 5:00 am
Location: Scotland

Re: leakage

Post by MaryGordon » Sat Apr 19, 2014 10:24 am

Thank you again. I am not sure how to attach an image. well, for not sure, read "I have no idea"! I can't see a way to add attachments, and I don't have any screen shots in the cloud anywhere. ??

Suneesh S
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Joined: Sun Apr 13, 2014 7:59 pm

Re: leakage

Post by Suneesh S » Sat Apr 19, 2014 10:54 am

viewtopic.php?f=1&t=81072&p=737779#p737779

Click on the above link. Its a thread from Pugsy. This should help you.

gsbuck
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Re: leakage

Post by gsbuck » Sat Apr 19, 2014 11:01 am

When I asked the forum about a leakage problem with a mask I was using, someone suggested I get some "Laniloh" in the baby section at Walmart to help with the leakage. The Walmart closest to me did not have it, so I have not tried it. Maybe someone else can elaborate?

Also, once upon a time, I had a problem with mouth opening and leakage occurring. Tried chin straps, taping, etc. to no avail. But since then I have taught myself to keep my mouth closed. First thing that helped teach me to do that was a mouth piece that a dental specialist recommended as I clench my teeth at night. So the full face mask with mouthpiece may be just the thing to try.

Good Luck!

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MaryGordon
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Joined: Fri Mar 28, 2014 5:00 am
Location: Scotland

Re: leakage

Post by MaryGordon » Sat Apr 19, 2014 11:21 am

I've just spent a few minutes looking at a YouTube clip on my mask, then trying mine on again, fiddling with it a bit, lying down with it on. I think I had tightened the straps too much. I think I had the pillows rammed up my nostrils and it was having a detrimental effect. It is now really comfortable again and breathing is wonderful with all that glorious air blowing down my wind pipe! This is how it felt when i first got it and somehow i changed it. Can't wait for bed time!

gsbuck
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Re: leakage

Post by gsbuck » Sat Apr 19, 2014 3:33 pm

I'm so glad it is working for you now! Sweet dreams!

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MaryGordon
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Location: Scotland

Re: leakage

Post by MaryGordon » Mon Apr 21, 2014 9:28 am

I found that the looser straps enabled the mask to slip around when I moved. So last night I used the looser straps and taped over the arms of the mask on my face. I did feel much better when I woke up although the stored information on the machine didn't look dramatically different - and I don't think it was wishful thinking!
I haven't had a chance to put graphs up yet but will do that.

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Pugsy
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Re: leakage

Post by Pugsy » Mon Apr 21, 2014 9:45 am

When using a mask that leaves the mouth uncovered there's always the chance of mouth breathing/leaking leaks being a factor and the best mask fit in the world won't/can't fix that issue.
When you get a chance post the leak graph image...sometimes mouth leaks have a certain appearance that makes them easy to spot...if you are still using the Swift FX nasal pillow mask shown in your profile.
It would at least point you into a direction of what needs to be worked on.

_________________
Machine: AirCurve™ 10 VAuto BiLevel Machine with HumidAir™ Heated Humidifier
Additional Comments: Mask Bleep Eclipse https://bleepsleep.com/the-eclipse/
I may have to RISE but I refuse to SHINE.

If you want to try the Eclipse mask and want a special promo code to get a little off the price...send me a private message.

MaryGordon
Posts: 38
Joined: Fri Mar 28, 2014 5:00 am
Location: Scotland

Re: leakage

Post by MaryGordon » Mon Apr 21, 2014 10:56 am

Thanks so much again, Pugsy. Let me see if I can get som
e graphs in here...<a href="https://www.flickr.com/photos/ ... 2014"></a>
I'm not sure if that's working...

MaryGordon
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Joined: Fri Mar 28, 2014 5:00 am
Location: Scotland

Re: leakage

Post by MaryGordon » Mon Apr 21, 2014 10:57 am

ok. so it's not. I have some graphs on Flickr... now to figure out how to get them here...

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Bama Rambler
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Re: leakage

Post by Bama Rambler » Mon Apr 21, 2014 11:09 am

To embed pics from Flickr make sure the pic is public, and then go to the pic that you want to embed and select the share box and then the html/bbcode box.
Under the code are 3 buttons, select the BBCode button.
Then it's just a matter of selecting the entire code, copy it and paste it in the post you want it to show in. Just like I did below.
Image

Ok I lied a little. I had to manipulate the code you posted because I don't have access to your Flickr account.

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