Does more pressure = larger leaks?

Over the last 4 nights, I have gradually increased my pressure by 1 cm. I'm handling it fine, but my leaks appear to have gotten worse.. spending 30-40% of time in large leak territory according to the LED on machine... the numbers from sleepyhead show that leaks are getting up to as much as 105. Mostly I sleep through them, my snoring has not lessened, but AHI continues to be quite low... 1.2 last night, 7-day average 1.8. Pressure RX was 8-18; I've increased to 9-18, rarely going over 13 during the night.

Would it be a good idea to set the pressure back to 8?

The answer is maybe! While higher pressures make the propensity for leaks greater, it doesn't always mean that they will be worse.
Keep in mind that when you're in large leak territory the machine may not be able to pick up events so your AHI may not be accurate.

It sounds like you need to address the leaking before making any other adjustments.

What were your leaks like before changing the pressure?

library lady wrote:Over the last 4 nights, I have gradually increased my pressure by 1 cm. I'm handling it fine, but my leaks appear to have gotten worse.. spending 30-40% of time in large leak territory according to the LED on machine... the numbers from sleepyhead show that leaks are getting up to as much as 105. Mostly I sleep through them, my snoring has not lessened, but AHI continues to be quite low... 1.2 last night, 7-day average 1.8. Pressure RX was 8-18; I've increased to 9-18, rarely going over 13 during the night.

Would it be a good idea to set the pressure back to 8?

If you're going to run in a range of pressures, you're going to need to adjust your mask for the HIGHEST pressure you may go to. Otherwise, yes, you're going to see higher leakage above the pressure you have it adjusted for. That could be unnecessarily uncomfortable. So, if your mask straps are adjusted for 8 or 9 centimeters and it's going to 13 or more, you can expect to see more leakage if you don't readjust the straps.


Den

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Higher pressures will increase the expected vent rate but shouldn't increase into large leak territory.
Your machine reports total leak which includes the expected vent rate but that won't explain going into large leak territory.
Higher pressures do make it more difficult to get and maintain a good seal but a 1 cm increase shouldn't be that big of a deal.
Now if you start out the night at say 9 cm...and are using auto adjusting pressures and it goes up to 18 cm...and you have fitted the mask to work with 9 cm...then it will leak because of fit.

If you are seeing large leak % of time in double digits...the mask is simply not being fitting properly or there may be the remote chance of a leak in the overall system but when that happens it usually is all not and not half the night.

chart with expected/intentional leak/vent rate here
http://www.resmed.com/assets/documents/ ... er_eng.pdf
notice how with higher pressures the vent rate increases but no where near large leak territory even at max pressure.

If you don't have one, here is a link to the Tap Pap User Guide.


http://www.directhomemedical.com/masks- ... or-use.pdf

Even at higher pressures, this mask has a vent rate (mask leak rate) of less than 45 so when you are seeing leak rates above 100, there is a serious leak.

Pugsy, I don't know how to fit the mask for a higher pressure... obviously if I wake up I can refit it, but they usually don't wake me up. Any clues for me? When I get to large leak territory my LED usually indicates no more than 3 or 4% of time in large leak,if that.... just in the last few days it has gone to double digits, without waking me up, as far as I know. Maybe it does wake me and I'm not aware of it... last night I woke up once and went to the bathroom, and that was it, but I wasn't aware of excess leak when I woke up. All I can think of is to set the pressure back to 8 and see if that takes me out of double digits, at least. I am getting close to my 90 days, I may opt for a different mask to see if that makes a difference.

How high are your pressures going on your reports?
There should be a mask fit feature on your machine. This feature allows for temporary higher pressures to be used for mask fit and then you revert to lower pressure to go to sleep.
Let me see if I can find the information on how to do that and what it does. Will report back when I do.

You could also go into the setup and temporally set your minimum pressure to the maximum you're seeing on your reports, and then after you have your mask adjusted, set it back to what you wish to start with.

Don't feel alone, I can soundly sleep through some VERY leaky periods......but pressure changes will wake me up immediately.


Den

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Crap. It doesn't explain at what pressure it uses for fit...I thought it was a higher pressure. Wouldn't hurt to try it though.
You may need to turn it on first to make it available..this is done in the clinical setup menu...you have to enable it first...then use the ramp button to try it. I am pretty sure all the 60 series machines offer this feature.

If your leaks are mainly later on during the night then maybe your face is changing with sleep or moisture or something. Mask liner might help.
I need to see the pressure graph and leak graph to have a better idea when the leaks are occurring..for all we know they may not be related to higher pressures but may be happening at lower pressures during the night due to face change or whatever.
If they are related to pressure changes...may need to limit the range of pressures to limit the changes. Going down with the minimum probably won't help if that's the issue.

My pressure limit is set at 18, but the reports are rarely above 13, and have never gone above 15. I don't know how to use mask fit, and have wondered if I would be able to use it... I imagine there are some beeps when it gets to the right place, but I wear hearing aids which I don't wear to bed... I suppose I could wear them until after I fit the mask, if I can find a safe place to put them w/o getting out of bed... I don't want them anywhere near the machine in case water from the humidifier gets on them for some odd reason. I do live alone these days, so nobody is around to help me "hear" any beeps.

Pugsy, thank you. I do have Mask Fit, and I will post those graphs you mentioned later today... and I will look at the Mask Fit, maybe do a trial of it with the mask this afternoon as well.

If you were going to try a different mask...what would you want to try?
I might have one you could try that might work better than what you have...and wouldn't cost you anything and you wouldn't have to use up your insurance mask allowance.

when I first started, I tried the mask you are trying. I did get this product and it did help some. I believe you can get them from various places. This was just what I saw when I googled. Is there any reason you are not trying other kinds of masks or is it that you just started this process?

library lady wrote:My pressure limit is set at 18, but the reports are rarely above 13, and have never gone above 15. I don't know how to use mask fit, and have wondered if I would be able to use it... I imagine there are some beeps when it gets to the right place, but I wear hearing aids which I don't wear to bed... I suppose I could wear them until after I fit the mask, if I can find a safe place to put them w/o getting out of bed... I don't want them anywhere near the machine in case water from the humidifier gets on them for some odd reason. I do live alone these days, so nobody is around to help me "hear" any beeps.

Then, set your minimum pressure to 15 while you're adjusting your headgear and then after you get it adjusted set it back to "normal".


Den

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@Wulfman, good point, to set at highest pressure for fitting and then set back to the minimum. I will try that.

@lliann, I am using mask liners, thanks. Padacheeks did not work for me, so I'm using RemZzzs and home-made ones.. they are a game changer!