?Exhale Puff Index of 31 with full face mask and mouth tape?

[Sillyme]

I finally have my AHI down to 3, NRI of 1 with zero leaks but my EPI is up to 31. I swear my lips are sealed. I can't blow out deliberately. I only have the built-in code on my IntelliPap. Any ideas?

[snnnark]

My understanding of EPI is that you return less air to the machine than it gave to you (less mask vent of course) Leak rate, on the other hand, is a constant drop in pressure that the machine tries to make up by increasing motor RPM.

So with 0 leaks and taped mouth and FFM I can only think that you have an intermittent pressure leak. i.e when you breath out you break seal.

Either that or something wrong with your machine.

Any other ideas?

[Sillyme]

My understanding of EPI is that you return less air to the machine than it gave to you (less mask vent of course) Leak rate, on the other hand, is a constant drop in pressure that the machine tries to make up by increasing motor RPM.

So with 0 leaks and taped mouth and FFM I can only think that you have an intermittent pressure leak. i.e when you breath out you break seal.

Either that or something wrong with your machine.

Any other ideas?

Thanks. I may have to give up on my Quatro. Short of caulking it to my face, I think I've exhausted my fixes. This morning my AHI is back up to 8 and my EPI is still 31 I've already tried changing size. Any tighter and I'll get gangreen on my face. I like the Swift nasal cushions but can't seem to control the cheek puffs and with the chinstrap it ends up squishing my nose during the night. Maybe a hybrid with chin support? I can change my mask in about a month.

[snnnark]

Thanks. I may have to give up on my Quatro. Short of caulking it to my face, I think I've exhausted my fixes. This morning my AHI is back up to 8 and my EPI is still 31 I've already tried changing size. Any tighter and I'll get gangreen on my face. I like the Swift nasal cushions but can't seem to control the cheek puffs and with the chinstrap it ends up squishing my nose during the night. Maybe a hybrid with chin support? I can change my mask in about a month.

Have you tried looser? I don't know that mask but I do know that overtightening can cause leaks.

What pressure are you on? Are you on auto?

Another thing to try may be adjusting your mask in your sleeping position under full pressure. You want the least amount of strap tightness that stops leaks. Then relax your head and see if your pillow pushes the mask out of position.

And then again maybe a different mask will be the answer!

[Sillyme]

Thanks. I may have to give up on my Quatro. Short of caulking it to my face, I think I've exhausted my fixes. This morning my AHI is back up to 8 and my EPI is still 31 I've already tried changing size. Any tighter and I'll get gangreen on my face. I like the Swift nasal cushions but can't seem to control the cheek puffs and with the chinstrap it ends up squishing my nose during the night. Maybe a hybrid with chin support? I can change my mask in about a month.

Have you tried looser? I don't know that mask but I do know that overtightening can cause leaks.

What pressure are you on? Are you on auto?

Another thing to try may be adjusting your mask in your sleeping position under full pressure. You want the least amount of strap tightness that stops leaks. Then relax your head and see if your pillow pushes the mask out of position.

And then again maybe a different mask will be the answer!

Funny thing is - before I fall asleep the mask is fine, whether I'm on my back or side. But when I wake up during the night it is leaking with every movement and I can't seem to adjust it to make it secure again. I thought maybe the muscle tone of my face changes and affects the seal. My skin isn't excessively oily and I can't think of any other reason. I've actually switched during the night to the Swift, but by then I have trouble getting back to sleep. I've tried APAP but the pressures got a little wild and my AHI wasn't good. The numbers are better on CPAP. I tried lowering the pressure from 13.5 to 12 and my AHI stayed about the same but it didn't help the seal.

[snnnark]

Are you using the smartflex with the Swift. It might help with the cheek puffs.

[Sillyme]

Are you using the smartflex with the Swift. It might help with the cheek puffs.

Yes, I use the SmartFlex at 3. I love it. It's the reason I fought for a better machine. Thanks for all the suggestions. I guess I'll go back to the Swift with mouth tape for now and try my new CPAP.com elastic chinstrap. There must be something better than wrapping my head up like a mummy each night. I find myself dreaming of the perfect mask. I have some great ideas. Just need a few million for product development. It would start with digitally mapping each face and producing a custom frame with replaceable cushioned seals (at a reasonable price). With a custom fit, the headgear could be a lot more gentle. I would gladly pay $1,000 rather that go through $1,000 worth of masks trying to find one that sort of works. No wonder the compliance rate is so low. I'm going to make this work because I already have seen benefits, but I think someone needs to completely rethink the mask interface. Maybe I'll buy a Lottery ticket.

[rested gal]

I find myself dreaming of the perfect mask. I have some great ideas. Just need a few million for product development. It would start with digitally mapping each face and producing a custom frame with replaceable cushioned seals (at a reasonable price).

It's always good to dream, and great things have been known to develop from "dreams."

Not to throw cold water on your good idea, but here are discussions about some places that have been doing that, or (in the case of the Hans Rudolph company) thinking of doing it:

"Inquiring Mind Wants to Know 1 (ontopic semirant)" - topic started by M.D.Hosehead - July 2010
viewtopic.php?p=500864#p500864

"Mask for Sale: $1450.00" - topic started by roster - May 2009
viewtopic.php?p=364894#p364894

"Hans Rudolph" - topic started by FL andy - Dec 2005
viewtopic.php?p=56092#p56092
That was five years ago -- never have heard any more about that company's digital mapping of the face idea.

But, hey...if you win the lottery and invent a great mask, I'll sure join the line of lab rats beating a path to your door!

[Sillyme]

I find myself dreaming of the perfect mask. I have some great ideas. Just need a few million for product development. It would start with digitally mapping each face and producing a custom frame with replaceable cushioned seals (at a reasonable price).

It's always good to dream, and great things have been known to develop from "dreams."

Not to throw cold water on your good idea, but here are discussions about some places that have been doing that, or (in the case of the Hans Rudolph company) thinking of doing it:

"Inquiring Mind Wants to Know 1 (ontopic semirant)" - topic started by M.D.Hosehead - July 2010
viewtopic.php?p=500864#p500864

"Mask for Sale: $1450.00" - topic started by roster - May 2009
viewtopic.php?p=364894#p364894

"Hans Rudolph" - topic started by FL andy - Dec 2005
viewtopic.php?p=56092#p56092
That was five years ago -- never have heard any more about that company's digital mapping of the face idea.

But, hey...if you win the lottery and invent a great mask, I'll sure join the line of lab rats beating a path to your door!

"You may saaaay I'm a dreamer
But I'm not the only one . . ."

Wish you would've gotten the trial

[guestguest]

DeVillbis has always had a problem with the 'exhale-puffs' report. Aside from actual lip puffing, chipmonk-cheeks will will be reported as 'puffs'.

[Junebug999]

Wait a sec. Hold da phone. I would ignore the "31" number. Because when I take off my mask I usually take off the hose or I reach over and hit off then pull off hose. On that day looking at the machine window I ALWAYS have a leak number of 31.5 -- always. But when I check smartcode or take out the card and put it in computer and ck my night stats I always get accurate numbers.....and the 31.5 number isn't in there. I think the machine just registers that number on the display when mask/hose is taken off. If you are not hearing/feeling a lot of leakage around your FFM then I think you are okay.

What reading do you get with smartcode?

[Emilia]

I am well into my 3rd month w/ my Intellipap Auto, and my EPI is rarely over 0.4 per hour. 31 does seem high, but I use a lower pressure than you do (7-10). That said, if this is continuing, you might PM DeVilbiss Marketing (user on here) and ask her about it. She is a marketing rep for the company and very helpful.

[Grantb]

Original poster (and anyone else who is puzzled how to interpret a high EPI while using full-face mask)-

Has anyone come up with a better explanation?

I have been in touch with DeVilbiss and all they'll tell me is "Ask your doctor." They are either unwilling or unable to answer the simple question, ""What does it mean when I have a high EPI (30+) while using a full-face mask with the DV54D?" [ONE EDIT: I am not using mouth tape as the original poster did.]

Seems like they should have a better answer as the equipment manufacturer.

[nanwilson]

May I ask why you are taping with a ffm, that is what they are for---to breath through your nose AND your mouth. If we weren't supposed to breath through our mouths, they would have never made ffms. Taping is sometimes needed when we use a nasal only mask, but not with ffms.
Why add an additional discomfort to an already uncomforable therapy.
N

[DeVilbiss Marketing]

Grant -

Expiratory puffing occurs when a patient who normally breathes in and out through the nose begins to exhale in short, high-volume puffs through the lips.

This breathing pattern can create a poor signal that can interfere with therapy. The IntelliPAP AutoAdjust tracks expiratory puffs, but does not respond. Increasing pressure would not reduce puffs and may increase puffs. Exhale puffing in excess of 30 per hour should be monitored. Have you tried a dual airway interface like the Hybrid?

As an FDA regulated medical device manufacturer, DeVilbiss cannot legally provide therapeutic input or medical advice which is why we referred you back to your treating physician.

We have a detailed document that explains how the IntelliPAP AutoAdjust alorithm works and the parameters it monitors.

http://www.devilbisshealthcare.com/file ... T-2089.pdf

I hope this helps. Please let me know if I can be of further assistance.