Help with leaks on new mask

Hi everyone,

I've had my CPAP for over 13 years now. I just had my yearly visit, at which the sleep doctor upped my pressure to 8.

She also suggested a new mask. My on site DME recommended a nasal pillow mask. I got a ResMed Swift FX mask. Currently, I am using the L pillows. Whether I use the M or L pillows, the leak rate (as shown by ResScan) is more than I am used to with my old nasal mask (ResMed Mirage FX). The leak rate has gone from a maximum of 2.4 in the 10 days prior to getting the new mask to 19.2 in the 10 days since. Does anyone have any suggestions on minimizing the leaks?

BobF4 wrote:Hi everyone,

I've had my CPAP for over 13 years now. I just had my yearly visit, at which the sleep doctor upped my pressure to 8.

She also suggested a new mask. My on site DME recommended a nasal pillow mask. I got a ResMed Swift FX mask. Currently, I am using the L pillows. Whether I use the M or L pillows, the leak rate (as shown by ResScan) is more than I am used to with my old nasal mask (ResMed Mirage FX). The leak rate has gone from a maximum of 2.4 in the 10 days prior to getting the new mask to 19.2 in the 10 days since. Does anyone have any suggestions on minimizing the leaks?

The Mirage FX is a full face mask that covers your mouth as well as nose. The Swift FX is a nasal pillows mask.

My guess is that you're mouth breathing.

Mouth breathing + Mirage FX = no problem because when the mouth is open, the air just escapes into the mask and so no air escapes and the upper airway is still pressurized.

Mouth breathing + Swift FX = leak problems because when the mouth is open, the air escapes out of the mouth and into the room. So the air escapes from the system and the upper airway may or may not remain properly pressurized.

The only fix I can think of is either going back to the FFM or doing something to keep yourself from mouth breathing when asleep.

robysue

Am I correct in understanding you to say that leaks are not, or at least not a major problem with users of FFM.

I have been exchanging trial masks with my supplier every 2 or 3 days in order to get a better Mask Fit percentage using my Respironics DreamStation. It has a feature where you can check the fit of your mask over a period of 45 seconds and it gives you a yes or no.

After your sleep it gives you Mask Fit % and mine have been in the 30% range which is obviously a long way from 100%

I used Resmed Quattro Air for the first time last night and had a relatively good night with Therapy Hours 7.8, AHI at 11.1, Mask Fit 38%, Periodic Breathing 11%, IPAP 90% 20.0, EPAP 90% 15.0,

Should I forget chasing the 100% Mask Fit goal and concentrate on getting a comfortable FFM with minimal leaks.

I use the Encore Pro 2 software but only do that for 7 day tests.

I use an Auto BiPAP with fairly high pressures.

I am a mouth breather, using a cervical collar and sleep primarily on my back.

The high pressures and mask don't bother me whatsoever but if you are right about not worrying about leaks with a FFM then I can concentrate on other issues to get AHI below 5.

I was diagnosed as Extreme due to my sleep study numbers.

As always, I appreciate any advice.

I have been screwing around for the last 2 months with the Auto BiPAP and Amara View mask and have gone through about 4 different masks in last week or so.

AcedDublB wrote:robysue

Am I correct in understanding you to say that leaks are not, or at least not a major problem with users of FFM.

I never said that.

But the leaks that BobF4 reports when using the Mirage FX FFM are significantly smaller than the leaks he reports with the Swift FX nasal pillows mask. Therefore it's reasonable to think that mouth breathing is the most likely culprit. To put it another way, if BobF4 were using your machine with the leaks that he reports using the Mirage FX, his mask fit would be between 95 and 100%. Even with the Swift FX pillows mask, his mask fit numbers would be between 90 and 100%.

To be clear: Many FFM users have a lot of significant and serious problems with leaks. A FFM mask has a much larger footprint on the face and hence there's a lot more real estate for the mask seal to weaken. Lots of people's lower jaw relaxes enough in deep sleep that a FFM might also slip around more due to the larger foot print. But if the FFM is properly sealed and the person starts mouth breathing, the won't be a leak that is caused by the mouth breathing.

I have been exchanging trial masks with my supplier every 2 or 3 days in order to get a better Mask Fit percentage using my Respironics DreamStation. It has a feature where you can check the fit of your mask over a period of 45 seconds and it gives you a yes or no.

After your sleep it gives you Mask Fit % and mine have been in the 30% range which is obviously a long way from 100%

My understanding of the Mask Fit feature in the overnight data is that it gives you the percentage of time when the unintentional leak rate is small enough to not have a potentially significant affect on the efficacy of the therapy.

And yes, I think that if the Mask Fit is showing up as 30% in your on-line data from PR, then you have a pretty significant leak problem.

Loading your data into SleepyHead or Encore would give you get a much better idea of what might be causing the leak problem and when the leak problem starts to raise its head. (I am aware, however, that not all versions of SH work with the new DreamStations.)

I used Resmed Quattro Air for the first time last night and had a relatively good night with Therapy Hours 7.8, AHI at 11.1, Mask Fit 38%, Periodic Breathing 11%, IPAP 90% 20.0, EPAP 90% 15.0,

A Mask Fit of 38% most likely means that for 62% of the night your leaks were bad enough to potentially cause problems with the accuracy of the rest of the data as well as potentially adversely affecting your therapy.

Should I forget chasing the 100% Mask Fit goal and concentrate on getting a comfortable FFM with minimal leaks.

You don't need to chase a 100% Mask Fit, but you do need to work on improving your mask fit from 30-40% to something much, much higher. A good, reasonable goal to start with is to try to get your mask fit figure up into the 75-80% range.

So yes, you should concentrate on getting a comfortable FFM (or other mask) with minimal leaks: Aim for a mask fit of at least 75% to start with.

I use the Encore Pro 2 software but only do that for 7 day tests.

Run a "Detailed Report" rather than a "Summary Report". You will get detailed data (including the leak lines) for the last seven days of the report period. It's the leak lines in the Detailed Report that you need to be looking at.

I use an Auto BiPAP with fairly high pressures.

I am a mouth breather, using a cervical collar and sleep primarily on my back.

High pressures can make the mask harder to seal. Also what's the difference between your EPAP and IPAP? If you run in Auto BiPAP mode, what are the min PS and max PS settings?

The high pressures and mask don't bother me whatsoever but if you are right about not worrying about leaks with a FFM then I can concentrate on other issues to get AHI below 5.

Your leak numbers are large enough to need to be dealt with. Until the leaks are under control, the AHI numbers are not particularly meaningful.

I have been screwing around for the last 2 months with the Auto BiPAP and Amara View mask and have gone through about 4 different masks in last week or so.

You need to consider whether you are fitting the masks correctly---even if the way you adjust the mask passes the 45-second "Mask Fit" test on the machine itself at the beginning of the night.

Generally speaking, the most common fitting error is to overtighten the mask. JanKnitz used to have a detailed description of how to properly adjust the Mirage Quattro FFM on her blog. Her tips apply to any FFM that uses an air cushion type seal.

You might also want to look into using a mask liner. They can also make a big difference for some people when it comes to conquering leaks from the frame of the mask not sealing against the skin properly.

Ro use

Thank you very much for the prompt and comprehensive reply to my post, I very much appreciate your suggestions.

Mask liners are next on the To Do list as reading the reviews of RemZzzzs and others seem to be quite positive for a considerable number of users.

I would like to try the Innomed/Respcare Hybrid as I quite like the Amara View which has a somewhat similar approach of a smaller FFM.

This is much more difficult than I imagined when I started over 5 months ago but I will persist and find a solution, with ongoing advice from the many great people on this forum and elsewhere.

Much better 2nd night with the Quattro Air FFM

Good sleep, never wakened and mask was comfortable even though I need it tight.

Never noticed any leaks until I awoke.

Results, AHI 5, Mask Fit 55%, Periodic Breathing 5, IPAP 90% 20.5, EPAP 90% 15.0

That is the lowest AHI for months so certainly encouraging.

I will do the Encore Pro 2 Detailed 7 day PDF once I have had 7 days experience with the Quattro Air.

I will try and find a Mask Liner here locally or I may have to wait until I head south to USA in 2 weeks.

Any comments are welcomed.

What a roller coaster I am on.

After a great Saturday night with new Quattro Air I had a terrible Sunday night.

Went to sleep quickly but after 3 hours all kinds of leaks that I was absolutely unable to stop the leaks no matter what I tried.

Took mask off for rest of night, first time I needed to do that in 3 months.

I am trying the T shirt home made liner tonight.

Well the home made mask liner using an old T Shirt wasn't too successful for me at least.

Just bought a box of Remzzzs yesterday and tried one last night for first time.

It takes a little getting used to as the excess material gets in my eyes but no big deal pulling it down.

I did turn down the pressure for both IPAP and EPAP for last night as I have been having bad leak problems.

I just got a new Quattro AIr FFM on loan and last night was 3rd night with it. Previous two nights leaked badly although I like the mask.

I was able to sleep through the night and I never heard any leaks whatsoever but I was very dismayed when I checked the DreamStation in the morning to see Mask Fit was only 9%, the lowest number ever.

Because I heard no leaks and read everywhere that do not over tighten your mask, I did loosen it off somewhat to where it was very comfortable feeling.

How can I have a 9% Mask Fit when I never heard a leak. My wife remarked how quiet it was.

When I had obvious leaks the Mask Fit was 43%.

My AHI was 12.1, Periodic Breathing, 9%, 17.0 & 13.0 for 90% IPAP and EPAP.

Do these Remzzzs mask liners just muffle the leaks rather than prevent them?

I will do an Encore Report after 7 days using the Remzzzs.

The Mirage FX is a full face mask that covers your mouth as well as nose.

Robysue, I use a Mirage FX for Her . . . it's a nasal mask, not full face.

Some tips from an old post of mine --->

To reduce unintentional mask leak -

- Make sure the mask is fitted properly. (See mask manufacturer's video.)

- Make sure the headgear is adjusted properly (See mask manufacturer's video.)

- 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.

- If you still have problems, learn from the forum what mask liners are available.

- If your mask still has excessive leak, try other masks. Many people report trying several masks before they find one that works well for them.

Note: Links to just about all of the mask manufacturers' instructional videos can be found on the forum host's website - https://www.cpap.com/cpap-masks.php

Good luck,

ChicagoGranny

Hopefully this from last night may offer more insight. I went to sleep rather early and slept mainly through the night until around 3(ish) when i awoke briefly before going back to sleep. I awoke around 6am. Any information would be gratefully appreciated.