Improve Treatment

I am at a loss on how to get better results. All past titrations have shown my therapy needs to be a setting of 11. One sleep study showed two treatment levels, one of 4 and one of 11 so the Dr. recommended a auto. I started with setting of 4-12 but gradually came up with better numbers with settings of 10.5 to 13. That is where I am at now. I use humidification, and a swift FX mask. I am a mouth breather and use a chin strap and tape my mouth. I have tried a quattro FFM and when I used that the numbers go up. My normal readings are about 1.5 AHI. With a FFM, the AHI readings were usually in the range of 5. From the looks of the graph, I would think there are two issues. One is if you look at the lead rate, I seem to be leaking a lot. I find that hard to believe with taped mouth and correctly adjusted nose pads. When I try the mask on there are no leaks???? The second issue is I am wondering if the high level is set too low. I have tried higher but do not seem to improve and it only hurts the mask leak issue. So what I am asking is those of you that are knowledgeable, can you look at the data and see if you have any suggestions. BTW, I have been on CPAP Therapy for 8-10 years and monitor the readings a couple of times per week. Thanks in advance.


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I do not see the report image, only a brief incomplete tag.

To post an image, you need to first put it on an image sharing service like PhotoBucket, Picasa, or Flickr. Once on that, you can capture the image url. Paste the url here and then highlight it and click the IMG button above the edit box. Click Preview to see if it shows up properly, then click Submit.

With an AHI of 1.5, it sounds like you are doing well. Even hitting 5 isn't terrible although less than 5 is what we aim for. Once you get your report on here, folks can help you sort out the problems..... Remember, each mask has an acceptable leak level so unless your graphs show you hitting the high leak level, you are probably within acceptable limits.

Your range seems logical since your titration was for an 11. Usual rule of thumb is 2 above and 2 below titrated pressure so you are right on target with that. I might even lower the low number down to 9.

You have tons more experience than I so I know you are doing all that you can to get this figured out! Best of luck.....

you may need a full face mask and humidifier for your mouth breathing

Stutz wrote:The second issue is I am wondering if the high level is set too low. I have tried higher but do not seem to improve and it only hurts the mask leak issue.

If the pressure increase to your top of 13 is in response to chasing a leak, then it may just be feeding itself. If in response to events different story but your AHI average doesn't support much of an event increase. I still can't see your report but if any increase in leaks correspond with the machine maxing out, then it might just be chasing a leak thus I wouldn't want to increase that maximum pressure and feed the leak anymore. Can you try again to post the image of the report?

Could it be a pillow problem? Pillows as in what your head rests on. If you're not leaking when you first put the mask on, perhaps it's dislodging when you get into deeper sleep.

Sorry I was new to attaching items to a forum. I hope you can see this

Leaks do seem to be the issue.

Which mask were you wearing on the night of this graph?

If it was the Swift FX, here are some suggestions:

1. Look at the Swift FX fitting guide in my signature below. Make sure that your pillows are the right size and properly adjusted. Please don't think I'm insulting you, but some DME's actually instruct patients to cram the pillows up their noses instead of letting the correct size pillow (one too big to fit all the way up inside your nose!) rest gently AGAINST your nostrils. You probably already know this, but some people are told differently, so I always check. Another common mistake is tightening the headgear too much so that the pillows cannot inflate and seal correctly against your nostrils. It seems counterintuitive, but if leaks are an issue with nasal pillows, sometimes loosening things up will help.

2. How often do you change your pillows? Swift FX pillows may only last as little as two weeks before they get too soft to hold a good seal. Have you changed them lately?

3. The inner layer of silicone in the pillow sometimes inverts, and that causes leakage and problems. Check your pillows to make sure that both layers are standing up straight before putting the mask on.

I hope these help.

The normal vent rate for the Swift FX at 8 cm of pressure is 29, at 12 cm it is 37 so we can figure at 10 cm it is about 34.

I just got Encore 2.xxx the other day and I noticed that what I normally see as a 35 cm leak on my EncoreViewer 1.0 is represented as maybe a 5 to 10 in Encore 2. So, it appears that Encore 2 starts reporting the leak at zero instead of say the 25 or so that EncoreViewer 1.0 does. If I remember correctly Encore Pro 1.0 also mimicked Viewer.

So if there is a difference between the 2 software reports we have to allow that OP here appears to be using the older software. If that is true then the leak isn't as awful as it might seem initially, it even has a large leak included in it.

Wonder if Stutz could confirm which software is being used????

If OP is taping and tape is not loose in the morning, then I would think we have some mask movement leaks. Either pillows or straps or both. Not grossly huge but there.

Pressure tries only briefly to go above the limit. Sure doesn't want to stay up there. I would think the pressures are dialed in pretty good especially given the reported AHI for the most part. I wouldn't mess with them if they were mine.
I would try to secure my mask a little better but again, I don't think that the leak is that huge if he is using the old software.

So did I muddy things up? I just happened to notice the 2 differences in my leak report and line between the 2 softwares when I got the old machine to fire up and I compared the two just a short while ago.

EDIT Oops, just went and checked OP profile and it mentions EncoreViewer 2.0 . Looks like my Encore Viewer 1.0

Does anyone else have the old and new software to see if they are showing leak this way? I still think that the leak (yes, it needs to be worked on some) is not a huge factor unless OP is having other problems. The machine can compensate for some excess leak.

I am using Encore version 2.2.14? I also am using the Swift FX with medium pillows. I check every night to make sure the internal cones are not inverted. I think I do have a good seal since I can't detect leakage. I have tried cleaning the pillows every night. The pillows are 6 months old, which I could try new ones. Mainly I was concerned about the graph of the leaks. It seems to show high and I could not figure it out. I also assume if the leaks get better, I have better treatment. Last two nights I tried a different mask (hybrid) and it was a disaster. That is another topic however. It seems likes everyone agrees the pressure is optimal so its back to trying different things with the mask. Am I wrong or shouldn't I try to get a nice even line on the leak graph?

Does the setting of the Cflex have anything to do with what would be the graph of the leaks

EncoreViewer 2.xxx? or EncorePro 2.xxx? Your profile shows EncoreViewer.

Your profile shows M series machine very similar to my machine. My reports on Encore Viewer look like yours. Baseline leak starts around 25 or so. My report on the Encore Pro show a baseline leak starting at 0.

While yes, some people do get a nice straight leak line, some of use can do it sometime, some of us can't get it at all. I am just saying that yes, you have some leak but if you are using the Viewer software it isn't as huge as you might first think. Your overall leak average was around 50 on the report shown BUT that includes a large leak so we can't put the gospel in that particular number.
If your baseline started at 0 then you have significant leak but a baseline of 25 start isn't so bad because we can have a number up close to 39 and it would mean not much leak except the vent rate.

Your AHI is great. If you had a higher AHI then it might be affecting things. You say you tape, if the tape is still secure when you get up then the leak we do see on your report is likely from mask moving somewhere. Most common area for me is the back strap slipping up the back of the head.

C Flex shouldn't make any difference. My machine has AFlex and I use it. I have had some nice straight lines and I have also had some that look a lot like yours with the exception of the large leak and maybe just a wee bit overall average being more inline with the expected vent rate. My pressures are very similar to yous except I have a wider top range. Overall average pressure is pretty much like yours.

So straighter is better but hard to get. A more important line might just be just to have a more uniform graph with your little ups an downs. These machines can compensate for quite a bit of leak so even if our reports are less than perfect, we can get effective therapy.

Now if your profile equipment and software is not correct, it messes up my thinking a bit. That is why I asked for it.

You may be trying to attain something that is going to be very elusive and creating more work than you really need. The Hybrid was a disaster for me also. I understand. I made a decision a long time ago that I would make the nasal pillow mask work or I would just be up a creek.

In short, with an AHI that you report, yes, I would continue to work on the mask but I just wanted to reassure you that the leak might not be as huge as you first thought because of how Respironics scores leaks in their software.

If it were my report I would say "oops, looks like mask slipped around a bit, will work on that, AHI great, I can tolerate these pressures okay, so I will just try to stabilize the mask a bit better and not worry so much about it because I have a large leak reported that sort of skews my overall average a bit."

Sorry, the pulldown menu does not seem to show a encore 2.2.14 pro. I am using the pro. As to the hybrid, I showed all nights of leaks and the machine shut off a number of times thinking it was not hooked up. So, I will go back to the nasal pillows and see if I can get them better and make slight improvements. I might also try other nasal pillow masks. I just want to get the best feeling possible during the day.

Its funny, that the first couple of years, before I got the data capability, I thought I was doing well. I first used a nasal mask and never understood mouth leaks. However I knew something was wrong so just to see the DME convinced me to try a FFM. That did improve things but I had no knowledge of what level I was at nor did they ever tell me what the levels were only that I was doing well. About 3 years ago I found this site, got armed with information, purchased a new data capable machine and walla, I have turned into a hound from hxll about my treatment. I found that the full face mask would only give me results at about 5 AHI. Again, DME said I was doing well. But after reading this site, I asked for nasal pillows so along with this site,and having data capable machines, great improvement over what was. It has only taken me the 7 or 8 years on CPAP to get to this point, and the countless lost years before CPAP. I can't say it enough, thank you all of you on this site who take the time to help others. Unfortunately, of all the people on CPAP, my guess is the people that take the time to research the treatment is a very small amount

I don't have Encore Pro 2.2xx I have Encore Pro 2.4xx on this machine and Encore Pro 1.8 (and the old Encore Viewer) on the old computer.

The base starting point for my leak rate shows around maybe 29 on both the old software reports. Hard to tell, it is above 25 like yours now shows. On my newest version of Encore Pro it seems to start at zero. So when looking at your report look at the baseline which appears to be about half way between 25 and 50. Look at that tiny first hour line on your report.. Then it starts going up and down, up and down.. That line ideally should be closer to that baseline. It fluctuates a lot. We are going to get some up and down but you have a lot of the ups and downs. Not grossly huge for the most part but it does fluctuate.

I still think that you don't need to do anything except work on the mask leak. Could be nasal pillows are tired and need to be replaced as someone mentioned. Could be a change in size might help. Could be the straps needs to be adjusted just a little.
I toss and turn a lot sometimes and I know that my mask moves when I do. Mostly when it does I see a rare up and down like yours. All within what the machine should compensate for. So I just give the pillows a good cleaning and try to maybe readjust things just a bit.

All that being if your mouth stays shut with the tape. If the tape is loose when you get up then we know where the leak is coming from...

To strive for a perfect straight line like I have seen shown on other people's reports... Those are some very lucky people. I can get it maybe for part of a night. So just work on trying to reduce the ups and downs some but realize that while your leak isn't perfect and could stand some improvement, it is far from being like some I have seen.

Remember that your normal vent rate is going to be part of what you see and allow for that before getting upset about the average or one of those ups and downs.

Stutz wrote:I am at a loss on how to get better results. All past titrations have shown my therapy needs to be a setting of 11. One sleep study showed two treatment levels, one of 4 and one of 11 so the Dr. recommended a auto. I started with setting of 4-12 but gradually came up with better numbers with settings of 10.5 to 13. That is where I am at now. I use humidification, and a swift FX mask. I am a mouth breather and use a chin strap and tape my mouth. I have tried a quattro FFM and when I used that the numbers go up. My normal readings are about 1.5 AHI. With a FFM, the AHI readings were usually in the range of 5. From the looks of the graph, I would think there are two issues. One is if you look at the lead rate, I seem to be leaking a lot. I find that hard to believe with taped mouth and correctly adjusted nose pads. When I try the mask on there are no leaks???? The second issue is I am wondering if the high level is set too low. I have tried higher but do not seem to improve and it only hurts the mask leak issue. So what I am asking is those of you that are knowledgeable, can you look at the data and see if you have any suggestions. BTW, I have been on CPAP Therapy for 8-10 years and monitor the readings a couple of times per week. Thanks in advance.


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If you are overweight at all, even a modest weight loss of twenty pounds can make you feel much better. If you are obese like many individuals with OSA, major weight loss can improve your condition dramatically, despite claims to the opposite by many posters here.

If you are skinny as a stick and your problem is thoracic, I guess you are SOL. Otherwise, LOSE WEIGHT while continuing to use CPAP with a FFM. Mouth taping, chin strips and all that other crap does not work good.

Mikey