Large leak after changing machine

I changed machines from a PRS1 straight CPAP to an Airsense 10 autoset on Friday. Previously, for the last two months, I have had 0.0% large leak. Now with the new machine, I'm getting 3%-4% every night. Anyone see anything in particular that I'm missing? Or have any ideas. I did tighten my mask (yes, I know usually leaks mean loosen but tighten was right in this case as it made it somewhat better.)

Have you tried a FF mask? You can tighten a nasal one all you like, but it won't help if you mouth breathe when sleeping.

What's your low pressure setting?

Julie, I have not tried any other mask with this machine. I haven't used any other mask since I settled on the Swift FX in 2011. I tried sevreal FFM and hybrids and none were comfortable. But, beyond that, why would I be fine for years, even as high as 14, which is what my pressure was until last year. This just started with the new machine last Friday. My low and high pressure on my new auto machine are 7 and 14, though I haven't got up to 14. I just don't understand why this seems to have started with the new machine. Unless it is an incredible coincidence, this shouldn't have been a side effect of switching machines.

Well let's see...you went from a fixed pressure of 6 to a variable 6-14 pressure and you are now sleeping with a median pressure of nearly 9.0 cm. That can certainly expose some leaks that weren't there before. On the other hand, you have cut your AHI in half, and that's good.

I find the nasal pillows work best when cleaned with a dish soap and rinsed. It removes the oils without degrading the silicone. Your baseline leak rate is still acceptable, so it does not appear to be a problem in the humidifier, hose or connections. You'll have to focus on the interface between mask and skin.

I can accept that my pillow needs replacing (one is on the way). Tightening my top strap on my mask did help and there were no more leaks last night after I did that. Do you think the PRS1 just wasn't detecting those leaks? It isn't mouth breathing as that is really loud and wakes me up pretty quick if it doesn't wake up my bedfellow.

The PR S1 has a more generous leak allowance that it says it can handle before it flags a large leak.
That's why the same leak pattern on a PR S1 report won't get a large leak flag.
On a PR S1 machine I rarely have any large leak flags at all but on my S9 Adapt it's rare I don't have at least one short episode.
ResMed uses the fixed 24 L/min excess only line no matter what...and the PR S1 used a variable large leak line (total leak and not just excess) that was more generous to start with.

Your leak graph looks a lot like mine does on some nights. I choose to ignore a few minutes here or there in large leak because for me to try to make it more perfect will disrupt my sleep quality (which is already fragile enough) and I don't want to do that.

Above 24 L/min the ResMed machine starts getting a little less effective but it will still sense and record events fairly accurately.
Above 30 L/min and it starts getting iffy with maybe some unknown events getting flagged but it can still sense them.
Over 35 L/min and I found it pretty much clueless and would give me a big blank space and I suspect it was missing events.
I had an occasion to have all these different leak rates show up on one night and it let me see the progression of what happens when leaks get bigger. It was an unusually bad leak night from trying a new mask and not having it adjusted well.

Only the time in large leak has the potential to be compromised...so some large leak for a short period of time doesn't mean the rest of the night is in the toilet. It's only maybe in the toilet and how far in the toilet means how far into large leak territory for maybe a short period of time.

3% of the night in large leak...if there is 6 hours that's 360 minutes and means 10 minutes in large leak territory...not the end of the world even it was well over 50 L/min.

KatyDidAgain wrote:I can accept that my pillow needs replacing (one is on the way). Tightening my top strap on my mask did help and there were no more leaks last night after I did that. Do you think the PRS1 just wasn't detecting those leaks? It isn't mouth breathing as that is really loud and wakes me up pretty quick if it doesn't wake up my bedfellow.

The leaks can be improved, but they really aren't a big deal since the waveform data and events are still being recorded during those "large leaks". The large leak flag is user-settable in Sleepyhead, and you seem to have them set at 25. You could change this in Sleepyhead File/Preferences/Waveform tab and modify the upper leak rate to 30. That would be a total leak of about 60 for that mask. It looks like you momentarily changed position and triggered some leakage, that was neither disruptive, nor did it interfere with your therapy.

Pugsy, I had wondered if there was some difference in the algorithm that made the Resmed show leaks the PRS1 wasn't. You just confirmed it. (Also, I'm terrible at math and percentages so thankyou for breaking it down for me.)

Thank you both. I feel a lot better now. Hopefully the new pillows will help too.

Your leaks look like mask movement leaks to me and not necessarily mouth breathing leaks (but wouldn't be totally impossible).
When I start seeing double digit % in large leak territory I start wondering about maybe needing a new nasal pillow but I will usually do a really extra good cleaning of the pillow first.

So I don't really do much worrying until leaks get up in the double digits...remember ResMed doesn't even give you a Mr Frowny face until that large leak number is 30% or more...that's a lot of large leak.

As long as I sleep well and leaks don't wake me up....I really don't sweat the small brief periods in large leak especially if under 35 L/min. My number one goal has always been....sleep...without sleep the rest of the data is pretty much meaningless.
Any leak that disturbs sleep needs to be worked on even if it is a tiny leak but if I sleep through a big leak of 15 minute duration...that's still a victory for me.

I have a fairly recent big ugly leak night that did make me sit up and take notice. Let me see if I can find it and share it with you... The culprit ended up being the P10 headgear.
Be back in a bit with it as soon as I find it.

Here's my record big leak night...it was the P10 headgear that was the culprit...changing to a new nasal pillow didn't fix things but changing headgear did. It was really stretched out and washing in hot water didn't fix it...11 months on one headgear and it was time for new headgear.

You may need to click on the image to see in better detail. I have no doubt that even my PR S1 would have flagged some of this.

To be perfectly honest, leaks don't usually wake me up unless I'm in a light sleep stage. But the big ones are waking up my partner and he has trouble waking me up to get me to reseal my mask.. Let's say my sleep hasn't really been effected that I know of but his sleep has. The good news, I seem to have stopped snoring. Traded one problem for another though.

I'm pretty lax about cleaning - too lazy - but I did give my pillow a good scrub on Saturday after I noticed the large leak. Doesn't seem to have helped. New one is on the way. Sheriff has sent me a total face mask also that I'm really hoping will just fix all of this. I also have a mask re-fit on Friday to see if there is something that could work better. I've always dealt with small leaks with the pillows because my nostrils are different sizes so they don't fit like they could, but it was the only mask I could tolerate. I'm hoping now that I'm really used to pap therapy (can't sleep at all without it) that I will have an easier time since I'm not trying to find a comfortable mask at the same time as trying to adjust to the machine.

Oh wow. That is big leak. I hadn't even thought about the headgear possibly being stretched out, though my headgear is fairly new.

FWIW I didn't sleep through those leaks. I knew it was happening during the night. The P10 headgear is all stretchy...can't believe my first use of this mask I complained about it being too tight.
Your are using the Swift FX which really only has the back strap that can stretch out so not nearly as likely to be a problem unless you are continually readjusting it.
You might try one notch closer on the top strap and see if that helps without giving you piggy nose.

I am going to be a Bad Boy and "Hijack" this thread just a little bit.........

I know you've got Katy all good with her question about the different leak reporting on the different machines, but it brought up one question........I know on the ResMed machines that in the settings you have to tell the machine which mask type you are using, I assume because different mask types have different set vent rates..........so how much difference does that make if someone had the setting on the wrong mask type? I'm not familiar with the newer Resperonics machines, but I am gathering that since they use total leak that you don't have that same setting on those machines?

TangledHose wrote:I'm not familiar with the newer Resperonics machines, but I am gathering that since they use total leak that you don't have that same setting on those machines?

Correct..mask selection is not available on Respironics machines other than Resistance Control which is NOT something that affects the reported leak rate.

TangledHose wrote:so how much difference does that make if someone had the setting on the wrong mask type?

Not a huge difference like one might think...since a nasal pillow mask has the least amount of vent rate...if one of the other choices were made the excess leak reported would actually be less but not hugely less.
It's not like there is going to be a 20 L/min difference in excess leak reported between the various mask model choices at any given pressure.

In this situation even though Katy's sleep isn't affected by short term large leak...spouse's sleep is affected and that is of course unwanted and even if it wasn't a big leak...needs to be fixed. Spouse's sleep quality is important also...no matter what the leak numbers might be saying.