Hubby CPAP troubleshoot

[snuzyQ]

Hi everyone:

I'm new to this forum, but not new to CPAP. I enjoyed trying to help others on the ASAA forum for the 3 years before it disbanded. We've been CPAPPin' to ourselves in the 3 years since then without any problems until this August 5th to present, when Hubby's mask leaks went through the stratosphere (maybe it's not really as bad as it seems). He has the Resmed Airsense 10 set on auto, no ramp, pressure settings are 9cm minimum and 11cm maximum and uses the ResMed Swift FX nasal pillows mask. He had only 1 night with the dreaded red frowny face. I installed sleepyhead on our computer on August 1rst and have been following the data nightly. Hubby isn't into the data, so I do all that stuff. He just wants to sleep undistracted. His before AHI was always under 1. His after AHI is close to 4 most nights now. His 95% pressure is 10.5 regularly and that hasn't changed in spite of the leakage.

On his worst night, he experienced major leakage 39% of the time he slept. On his best night, he had 5.5% of his time in major leakage. All the other nights are in between with no trending toward improvement. This is up from 0.0 major leakage for years.

He mentioned that his bed pillow wasn't as comfortable as he would like, so we got a new bed pillow to his liking. We checked and found his headgear to be under 3 months old and his nasal pillows are replaced every month. He hasn't changed the tightness of his headgear straps. He snugs them down fairly well to keep the mask on his head since his hair is kept at 1/4 inch.

The only thing I've noticed that has changed is he no longer wakes himself up at the sound of his mask leaking in order to reposition and make the sound stop. When his mask leaks now, the sound of the leaking wakes me up, so I try to stir him by pushing on his arm. I push several times but he doesn't respond at all. I slap his arm to make some noise above the whoosh of his mask. Nothing. I slap a little harder. Nothing. I punch-push. Nothing. So, before I get arrested for spousal abuse, I just give up, turn over and fall back to sleep. I know that soon, in my own quest to get unfragmented sleep, I'll start tuning out the sound of his leakage. But, I won't stop worrying about it. I remember it in the daytime, check it out on sleepyhead and wonder what can be done about it.

So, any and all help is welcomed. Many thanks in advance to all of you. I'm so impressed by your posts I've been reading in the last few days. A lot has changed since the time I spent on the disbanded forum. It appears I've a lot to learn.

[palerider]

August 5th to present, when Hubby's mask leaks went through the stratosphere (maybe it's not really as bad as it seems). He has the Resmed Airsense 10 set on auto, ... and uses the ResMed Swift FX nasal pillows mask. He had only 1 night with the dreaded red frowny face.

Mr frowny face means over 30% of the night in > 24lpm leak territory.
There's some tips on the swift fx video about leak problems: https://www.youtube.com/watch?v=rWqd4c4Zbn8&t=7m43s

And I notice, in the video, that the pillows are double walled like the P10 pillows, one thing that happens with them is that the inner cones can get inverted (usually while cleaning) and then the pillow is floppy and leaks, it's easy on the P10 to fix, maybe the same thing happened to one or both of his.
https://www.youtube.com/watch?v=MylY6a6KXMY&t=1m27s

Please add your and his equipment and mask in your profile, it'll cut down on future questions.

I'm new to this forum, but not new to CPAP. I enjoyed trying to help others on the ASAA forum for the 3 years before it disbanded
....
A lot has changed since the time I spent on the disbanded forum. It appears I've a lot to learn.

We do things a bit different here than on the old ASAA forum. (I was a moderator over there for a while). There, it was all about "don't change things, don't learn, rely on your doctor". That's unrealistic in this day and age, the new paradigm is patient empowerment, patients taking control of their treatment, If diabetics can monitor and adjust their insulin doses, (a mistake of which can be fatal), then we apnea sufferers can certainly adjust our little air blower things to make our lives better.

[Sheriff Buford]

Gosh... I've never even seen a sleep doctor!.... lemme check and see if I'm alive!!

Sheriff

[Pugsy]

The Swift FX is a fairly stable mask if it is snugged up so it does make a person wonder what has changed to make it want to move around too much.

Can he try a different size nasal pillow?

I don't worry about less than perfect leak numbers as long as sleep isn't disturbed...at that includes your sleep and as long as the numbers aren't horrible for a prolonged period of time. Anything less than 10% of the night in large leak I really don't even give a second look.
It takes a LOT of large leak for Mr Frowny to come for a visit....30% or more of the night in large leak.

In terms of therapy effectiveness itself...these machines actually do a better job compensating for large leaks than we give them credit for and what I always do when I see some rather higher percentages in large leak is look to see just how deep into large leak territory I went.
Like was it barely over 24 L/min (ResMed red line) or was it deep into large leak territory at 40 L/min for a prolonged period of time.
The machine won't start really maybe having a problem sensing, responding and recording until a person hits 35 or 40 L/min territory.
So take a look to see just how deep he is going into large leak territory.

[Julie]

Even a little weight gain or loss can make a definite difference to how a mask fits... could that be an issue?

[palerider]

Gosh... I've never even seen a sleep doctor!.... lemme check and see if I'm alive!!

Sheriff

Well? Are ya?

[snuzyQ]

Thank you all so very much. I feel better just knowing that our CPAP support team has grown bigger and better overnight. I like this new paradigm!

I checked his mask and neither of the inner prongs are inverted. I had another look at his data to see how deep he's going into leak territory. When the leaks happen, hubby goes all the way over 50.0. Last night, his longest time segment very close to 50.0 was 5 min and 44 sec. The rest of the 6.12% of his time spent in large leak was in smaller segments; 3mins 36secs and 7 other lesser length of time periods. They all seem to happen well into the night. Last night's leaks didn't exceed the 25.0 leak rate threshhold until 4:45 am, and continued, off and on, up as high as 50.0, until 8:00 am. Between 8:00 am. and 9:00 am. when his sleeptime ended all was well in the data and leaks were uner 25.0. As far as the leaks are concerned, this seems to be his sleep pattern, with most of them happening in the 4:00 am and after time period.

It was great to see the percentage of time in large leak dropping - down to 6.12 last night. Maybe the new bed pillow is helping him after all. I'll watch for trending data.

He put on about 7 pounds last month, but his weight is stable now.

He uses a medium size nasal pillows. Maybe we should try the large size?

A kazillion thanks, once again, for all your input.

[Pugsy]

Wouldn't hurt to try the large size pillow one night and see if it is more stable. Won't know unless you try.

If it wasn't disturbing your sleep I wouldn't worry about 5 minutes deep in large leak territory since it sure isn't disturbing his sleep.
50 minutes I would start worrying about but not 5 minutes. I learned a long time ago that sometimes the cure is worse than the disease so I don't start looking for a cure unless I just have no choice and 5 minutes in large leak here and there isn't the end of the world.

[palerider]

. Last night's leaks didn't exceed the 25.0 leak rate threshhold until 4:45 am, and continued, off and on, up as high as 50.0, until 8:00 am.

at 50lpm leak the machine is going to be very confused about what *kind* of apneas he may have during that time, but it will still be able to maintain therapy pressure.

Like Pugsy says, the worst part of it is that it's disturbing your sleep.

[Muse-Inc]

I will sometimes get large leak numbers if I use mask wipes to clean my mask. Uncommon if I wash my mask. Washed mask + washed face usually means good seal, at least for me.