Mask Fit shows very poor but feels better

I use the Respironics Dreamstation and the Amara View mask. I have had my struggles with this mask, but nothing else I've tried has been close to as good or comfortable. After several months I'm finally getting used to it. My old headgear was stretched and it was leaking so I purchased new headgear and mask liners specific to the Amara View. Everything seems to be working so much better; however, my statistics on the Dreamstation have been showing very poor mask fit. One night was 40% and the next 45%. I have never slept better since I've started this and when I do wake up, it's still fitting nice and relatively comfortable. I have Sleepyhead installed and am going to download that and do some research, but so far I'm not comfortable with reading the data. I'm studying here and hope to do a lot more work on it this weekend. Are the mask fit percentages on the machines typically accurate? Really confused given how it feels versus how it's reporting. Thanks. Steve

stevez wrote:Are the mask fit percentages on the machines typically accurate?

"Mask fit" in Dreamstation is a rough indication of how much unintentional leak there was.

stevez wrote: I have Sleepyhead installed and am going to download that and do some research, but so far I'm not comfortable with reading the data.

SH will get you going in the right direction. Have a look at this --->

https://sleep.tnet.com/resources/sleepyhead
https://sleep.tnet.com/resources/sleepyhead/shorganize
https://sleep.tnet.com/reference/tips/imgur

stevez wrote: Are the mask fit percentages on the machines typically accurate?

Yes. On the DreamStation the % is how much time was NOT spent in large leak territory. They are accurate.
100% would mean a person never made it to large leak territory. 100% would be a great number and from their it goes south and the lower the % the worse the big leaks were.
40% means for 40 % of the time you were NOT in large leak territory. Only 40% of the time were leaks well managed.
60 % of the time you were in large leak territory.

Problem being when in large leak territory we can't trust the other data because we don't know if nothing happened or if a lot happened but the machine simply couldn't sense anything because the large leaks impaired it's sensing, recording and responding abilities.
So for over half the night we can't trust whatever the machine is reporting.

SleepyHead may even may the % worse because it uses a ResMed large lead threshold number as the default and that number is too low for Respironics machines.

Thanks all. I knew 40% wasn't good because I've been running 75-95% with my original mask. What I don't understand is it fits so well and I don't feel/hear any leaks at all while I'm away and trying to go to sleep. When I wake up in the middle of the night the last two nights it has appeared to be fine and so very much better than before. For a while when I would get up to go to the bathroom, I would un-hook the hose and leave the machine running. My sleep therapist told me that registers as a leak and not to do it, so I haven't since then. But I ordered the new headgear because the Velcro was wearing out and the elasticity was becoming weaker (not sure if that's the right way to describe elasticity). So with my new headgear, same mask, etc. my numbers started dropping a lot. Oh well, I'll keep trying and I'll look at my numbers on Sleepyhead tomorrow. Thanks for the links! Steve

Really need some advice here please. Been on Bi-PAP for 3 months now and starting to get better with it and more accepting. Starting to almost feel natural most of the night. I still wake up a few times a night to go to the bathroom as I'm on a diet and drinking lots of water. Anyway, that alone gets me up a couple of times. But, my dilemma is that I feel like I'm getting a decent nights sleep other than when I wake up to go to the restroom, then go right back to sleep. My monitor shows I have a poor mask fit every night and I confirmed it with my Sleepyhead data a few days ago. Long stretches of large leaks. I don't wake up and I don't notice that in the middle of the night. I would swear I'm getting good rest, but my numbers range from 45% - 75%. If I kept waking up to leaking masks, then I would understand, but I don't. I have been on Amara View since I started. Started with the large and moved to medium a month ago or so and noticed great improvement immediately. Then everything started going downhill for no apparent reason. Any thoughts appreciated.

Are you sure your pressure settings are adequate?

stevez wrote: Started with the large and moved to medium a month ago or so and noticed great improvement immediately. Then everything started going downhill for no apparent reason.

Improvement in what....mask fit numbers or how you felt?

Do you have facial hair?

How's the headgear holding up?

Did you ever try a nasal pillow mask?

Do you have chronic nasal congestion by chance?

You've tried the Amara View and the F20 which you hated. Tried anything else?

Just how far into large leak territory are you going? Do you see the top line in SH pressure graph going past 100 or 110? There are degrees of bad... Just how high are your pressures on the bipap?

Can you post a screen shot of a detailed report for a "good" night?

Thanks. I'm certainly happy that I feel better, but concerned that I'm not getting the full benefits of a Bi-PAP machine. I was in AFIB awhile back and after 3 cardioversions, I'm back in rhythm. That's one of the main reasons I was tested for sleep apnea and I was diagnosed with severe apnea, both obstructive and central. My prescribed pressures are 17/13 and during a follow-up visit a month ago or so, they wanted me to keep that.

Pugsy, I've found the Amara View to be the best for me in terms of acceptance and seem to tolerate that better than anything I've tried. I did try a nasal pillow one time and the pressure was so hard on the nose I put it aside. My sleep therapist who gave it to me suggested I wait awhile before I tried it in ernest because I was doing better and making progress with the Amara View. When it was working well, I was getting 90% + fits and sleeping 7 plus hours. Still waking up for bathroom breaks, but it worked. Seemed to stop working all of the sudden.

Yes, I do have facial hair but keep it trimmed close to my face. Thanks for the replies.

I will post a picture of my sleep results as soon as I can from Sleepy head. Not sure how exactly to read it. I don't have nasal congestion and I bought all new headgear which greatly helped initially as the old one was getting loose and the Velcro wasn't sticking all the time. New headgear seems better and seems to work fine.

stevez wrote:I will post a picture of my sleep results as soon as I can from Sleepy head. Not sure how exactly to read it. I don't have nasal congestion and I bought all new headgear which greatly helped initially as the old one was getting loose and the Velcro wasn't sticking all the time. New headgear seems better and seems to work fine.

On your Sleepyhead display, go to an area of largest leak and zoom in on the waveform. See if the waveform shows steady inhaling and exhaling during the leak.

Have you tried a mask liner?

Facial hair does complicate things but doesn't make it impossible to get and keep a good seal with a full face mask.

When using a bilevel machine I would see pressures over 20 cm nearly every night and I use nasal pillows just fine.
I wonder if you had the wrong size or fitted wrong. We have people using pressures over 20 cm all night long using nasal pillow masks.
It would at least remove the facial hair complication.
Do you still have the nasal pillow mask that you tried a while back? If so, which one was it?

If your leaks aren't so deep into large leak territory that the recording/sensing ability of the machine is impacted I don't know that I would worry a lot about some large leaks happening. It's when the leaks are so bad the machine could miss something that I worry about. There are degrees of "bad"...I see it often with my ResMed machine but as long as I don't go deep into large leak territory I don't worry too much about some large leaks....now as to how much would I let slide...depends on how deep I might go.
That's why I asked to see a report. I wanted to get a feel for just how bad your "bad" is.

Thank you all; Pugsy, I'll check later and post what the nasal mask is. And, I'll post the results. I have tried liners and I thought they were great at first, but then I started getting bad (large leaks) ratings and took them off trying that as a fix. I've gone back and forth on the medium/large Amara View mask size and that doesn't seem to matter now. Still show large leaks and poor mask fit. Thanks again all.

http://stevezky.imgur.com/all/

Hey folks; I am trying to post two screenshots of my sleepyhead data. One was for one of my best nights in terms of mask fit and the other is for last night. Last night I had a poor mask fit (says it fit 65%) and I was in large leak territory around 34% of the time. Pugsy had asked me to try to post some data and that's what I'm doing. I've not tried a chin strap thinking that may help as I just am trying to avoid having another contraption on my face/head. Any advice greatly appreciated. Thanks. Steve

Your leaks are so bad at times that the machines is reporting "Breathing Not Detected"...see those black bars on the Events graph at the very bottom?
And that was on the "good" night.

While I will often let a little bit of large leak slide I couldn't let this much slide if it was happening pretty much every night.
Now a once in a blue moon really ugly night...yeah, wouldn't bug me but to see this sort of leak every night is very troublesome.
Plus when you go much above 100 L/min (which you do fairly often) the machine could be missing recording events. We don't know if that AHI is nice and low because nothing happened or the machine was clueless.
The machine is still fairly accurate up to around 100 L/min total leak (top line on the leak graph) but after that it starts getting iffy and the further you go the iffier it gets.

BND flags....means really, really deep into large leak territory.

I don't know what to tell you to do to fix things...
These reports are with nasal mask...correct? What have you done to rule in or out the possibility of these being mouth opening/breathing leaks?
First you need to know for sure where the leak is coming from and then you consider your options for improving it.

Thanks Pugsy. Wow! I'm not even sure where to go from here. All of the readings have been with Amara View. I guess I'll make an appointment with my sleep doctor and see what we can do. I still have my nasal mask that I may try tonight. Don't have much to lose. Thanks very much for your time looking at my charts and giving me your thoughts. Steve