APAP Leaks

puskar49 · Post by **puskar49** » Mon Nov 13, 2006 10:29 am

Greetings. I'm new to this and a bit weary (which is common from what I've read). Recently diagnosed with OSA, I was given an APAP machine (set to 4-20cm) and an F&P Flexifit full face mask. I have a titration sleep study scheduled for Nov 29th to determine my "final pressure." In the meantime I'm supposed to use this APAP.

For the past three nights my experience has been exactly the same. I fall asleep just fine, and then two hours later I wake up with massive mask leaks. The first night the pressure was 10cm. The second night it was 13.5cm. And last night it was 17cm. Each time I tried very hard to readjust the mask to eliminate the leaks but failed. Eventually I restarted the APAP and fell back asleep, only to replay the scenario two hours later.

Last night I tightened the straps as much as I could and still the mask leaked. Is this normal? Could I be doing something wrong? Do I need to try a different mask?

Thanks.

oldgearhead · Post by **oldgearhead** » Mon Nov 13, 2006 10:42 am

Yes, you probably need to try a different mask. This year I have tried the following full-face masks: Ultra Mirage, HC431, and Hybrid. I settled on the Hybrid for my full-face mask. The UMFF put too much pressure on my lower jaw. The HC431 was hot and leaky.

Most of the time I use a nasal pillow mask (ComfortLite 2) plus a 5" long piece of Micropore paper tape over my mouth.

The biggest challenge with this therapy is to find the mask that works for you.

I don't think the 4 -20 setting is a good idea, because:
1) Few leaks show up until you are asleep.

2) The check valve found on most full-face masks require more than 4 cm/H2O to stay sealed.

3) Most autos work much better over a narrow range. If it was me, I would set it 8 -16 for your titration trial. But then I'm not a medical professional.

4) etc. etc..

puskar49 · Post by **puskar49** » Mon Nov 13, 2006 10:50 am

Thanks for the reply.

I have read elsewhere that 4-20cm might be a bad idea, but the DME set this and I don't know how to change it. Should I take it back to him and ask him to modify the setting?

As for the Hybrid, my understanding is that it covers just your mouth with two prongs for your nose. Is that correct? I think that would be a good design because it would, in theory, cut down on the pressure points around the face and reduce the potential for leaks. Does that make sense?

I appreciate the advice

oldgearhead · Post by **oldgearhead** » Mon Nov 13, 2006 11:07 am

As for the Hybrid, my understanding is that it covers just your mouth with two prongs for your nose. Is that correct? I think that would be a good design because it would, in theory, cut down on the pressure points around the face and reduce the potential for leaks. Does that make sense?

That is true. The Hybrid is different. With the chin-flap removed, its lighter than several nasal masks, and its by far the lightest full-face mask. However, the curve of the mouthpiece does not fit everyone. Furthermore, the current headgear is awful, and they are taking their time (1/2007) releasing a newer version. I love mine, but I'm one of the lucky ones who got the "trial" headgear. I wouldn't buy a new one until they get the headgear fixed.

Hosed All Night · Post by **Hosed All Night** » Mon Nov 13, 2006 11:13 am

Its beyond me why a DME would set a auto with a range of 4 to 20 cm. In most cases anything below 5 cm would most likely give the user a feeling of suffocation. Recently I switched to a Respronics Bi-pap Auto and found I couldn't go below 7 cm. without feeling suffocated. After I downloading the data it showed a 90% at EPAP 10 & IPAP 15 cm. So I reset the machine range to 8 & 17 cm. This means the lowest it will go is 8 cm and highest is 17 cm. My AHI is averaging 0.9. I would have your DME bump up the EPAP setting.

puskar49 · Post by **puskar49** » Mon Nov 13, 2006 11:21 am

Difficulty breathing at low pressures is a common comment in the threads I've read. However, I really don't have a problem breathing at 4 or 5cm.

I'm usually pretty good at adapting to new situations and I don't mind the mask much at all. It just keeps waking me up with it's flapping and whistling

It appears to be general consensus that 4-20cm is a poor configuration. The buttons on the device appear to be disabled. Pushing them does nothing. The only buttons that do anything are the start/stop button and the heat button.

I've put a call into the DME. Hopefully he'll be amenable to altering the pressure range.

puskar49 · Post by **puskar49** » Mon Nov 13, 2006 12:18 pm

They are going to let me try a Hybrid mask... I'm a little nervous considering the negative comments about the headgear But most of my leaks were occuring on my cheeks between my nose and mouth, and the design of the hybrid just seems to make so much sense.

I hope I'm not being hasty. A lot of people seem to really like the F&P...

snoregirl · Post by **snoregirl** » Mon Nov 13, 2006 1:29 pm

A couple things. While I don't have a hybred I remember reading (I think) from someone that 4 is too low for a hybred to vent co2 properly. Check that out if you get a hybred from the DME.

The second thing is -- and I think someone else touched on it but I want to hit it harder- is if you adjust your mask at 4 cm and then lie down and go to sleep and your usual pressure is 10 or 11 or higher, you have not adjusted your mask properly before sleeping. You are setting yourself up for leaks. There is a huge difference between say 4 and 10 and even more above that.

You need to adjust that mask for the pressure you expect to hit during the night and make sure that is sealing well. Then put the machine back to auto mode and go from there.

You haven't listed your machine brand and type yet so we can't tell you how to change it.

Or take the machine to the dme and have them put it on cpap mode at your max expected pressure, try the mask, adjust and have them put it back on the range prescribed. See what this feels like and play with adjusting the mask at that pressure.

Snoredog · Post by **Snoredog** » Mon Nov 13, 2006 1:33 pm

what kind of autopap is it?

If it is a Remstar, just hit the Ramp button and it will drop back down in pressure to the 4.0cm setting and start back up.

oldgearhead · Post by **oldgearhead** » Mon Nov 13, 2006 3:04 pm

If you are using a Hybrid mask. Its check valve may not close at 4 cm/H2O.
Mine closes at 5.5 cm/H2O. The Hybrid has plenty of CO2 "washout". The problems will be, the check valve, and being able to seal the leaks at a pressure too far below your titration pressure.

I think you will need to increase your "Min" pressure to at least 7 cm/h2O.

The clinical set-up manuals can be purchased on eBay for six bucks. Its sold as either a hard copy or an instant download.

_________________

CPAPopedia Keywords Contained In This Post (Click For Definition): Titration, seal

puskar49 · Post by **puskar49** » Mon Nov 13, 2006 5:38 pm

snoregirl wrote: Or take the machine to the dme and have them put it on cpap mode at your max expected pressure, try the mask, adjust and have them put it back on the range prescribed. See what this feels like and play with adjusting the mask at that pressure.

That's what I did. At 12cm there weren't any leaks with the hybrid. I'm very encouraged.

puskar49 · Post by **puskar49** » Tue Nov 14, 2006 7:55 am

This morning was the first time my alarm went off and I was still wearing the mask. The hybrid still woke me up at midnight and 2am, although the leaks were much smaller and manageable. And after getting in a good position at 2am, I slept for four straight hours!!

I feel like crap today, but at least I know it is possible to sleep and keep the seal. I think now I just need practice.

I'm so grateful for these message boards. Reading so many stories and opinions gave me courage to ask the DME for a different mask.

bdp522 · Post by **bdp522** » Tue Nov 14, 2006 8:30 am

Pad-a-cheeks seem to help the hybrid headgear to be more stable. They also let you tighten the straps a bit more without getting the mask marks. Here is a wonderful post by Rooster about the hybrid;

viewtopic.php?p=121223&highlight=#121223

Hope this helps,
Brenda

oldgearhead · Post by **oldgearhead** » Tue Nov 14, 2006 8:41 am

I agree with Brenda. The Pad-A-Cheeks need to be standard equipment for a Hybrid. I have a full set. However, with my face, I only need the lower ones, but others have said they only need the upper ones.

Disclaimer 1) My set of Pad-A-Cheeks were free. A review was all I paid for them.

Disclaimer 2) I'm NOT a medical professional.

snoregirl · Post by **snoregirl** » Tue Nov 14, 2006 11:38 am

I am so glad you are having some success. Hang in there and it will only get easier!