Help with air leaks waking me up

[Jlfinkels]

Total newbie here and have been reading for a bit before asking but still apologies if I missed a similar post.

I've been on CPAP (ResMed Airsense 10 with an F30i mask) for a month and am seeing improvements over that time in the AHI number (went from 10 at the sleep study to 6 when first using CPAP and now down to 1.5 last week with a few nights of 0), so no complaints there. My pressure numbers for the last month from OSCAR are:

min: 4
max: 20
avg: 14
95%: 18
avg leak: 1.5

Back to the question. With the F30i when at peak pressure it wakes me up a few times nightly with the occasional release of air typically out of the bottom of the mask around the cheeks. It is not over a long time, just a momentary burp that wakes me up.

The sleep doc gave me a few masks to try for a few nights each (nasal pillow P10, nasal cushion N30i, full face F20, and mouth with nasal cushion F30i - I am very lucky to have a sleep center nearby that let me try different masks), and settled on the F30i. However, after a month I am questioning if I made the right choice for masks and should consider trying something different. I had no problem with nose breathing but I do have to use a chin strap and still get a few mouth leaks, and did not like the full face F20 at all. Not sure if changing any settings are worthwhile but wanted to check on that as well.

Hopefully that makes sense. I understand it may just be a matter of continuing to use the current setup and just getting used to it, but wanted to ask those more experienced as well.

[Pugsy]

Leaks that wake us up are unwanted because they are disturbing sleep no matter how big or how little.

Your pressures range considerably. Are you fitting the mask at the lower starting pressure or the higher near max pressure?
What seals well at lower pressures is unlikely to seal well at those higher pressures.
So you could try fitting at the higher pressure and see if that helps or not. Using the mask fit feature on your machine if you aren't using it.

Also it might be that settings could be adjusted a bit so the max doesn't go quite so high (depends on why the machine is going high) and that limitations might keep the leak from happening.
Doing this involves using available software though to see why the machine is going so high and what happens if you limit the max.
Like with OSCAR
OSCAR https://www.sleepfiles.com/OSCAR/
http://www.apneaboard.com/wiki/index.ph ... stallation
http://www.apneaboard.com/wiki/index.ph ... rpretation

[Jlfinkels]

Thanks for the response. The min-max pressure is what the machine is set by the sleep center to according to OSCAR data. I have not mucked about with the settings as I'm not sure what I would change.

They did fit the mask(s) at high pressure, but admittedly I do sleep in a far different position than they fitted it which may be part of the problem.

I have a months worth of OSCAR data. Any suggestions on what I should look for as a causative source?

[ChicagoGranny]

settled on the F30i.

Find your mask on youtube and carefully watch three or four videos on fitting and adjusting. https://www.youtube.com/results?search_ ... esmed+f30i

[Pugsy]

viewtopic/t158560/How-to-post-images-for-review.html

It all depends on why the pressure is going up so high and how long it is up there.

From past history evaluating pressure graphs and low AHI numbers....the flow limitation graph is critical since often FLs are what are driving the pressure up and sometimes the FLs aren't as big of a problem as the leaks are.
ResMed auto adjusting algorithm is well know to go trying to kill FLs with more pressure even when the FLs aren't growing up to be full blown OAs or hyponeas.

Just had a chat last week with a sleep tech about his experience in the lab and titrating pressures with the idea of dealing with leaks at the higher pressures that ResMed machines want to go to sometimes just to deal with FLs.
He is finding that limiting the max often fixes the leak issues and doesn't necessarily cause the AHI numbers to go up.
When people are waking often because of leaks...that's sometimes a bigger problem than letting the FLs slide a bit.
His idea was reduce the max and not worry about the pressure line maxing out and watch the AHI for increases in flagged events.
Make a compromise of sorts.
Without good sleep....a nice low AHI doesn't mean much.

[Miss Emerita]

I have a months worth of OSCAR data. Any suggestions on what I should look for as a causative source?

Try taking a screenshot of a daily chart and posting it. Pick one where you know the leak problem woke you up. Please turn off the calendar and pie chart, and stack your graphs so these will fit in one screenshot:

Events
Flow rate
Pressure
Leaks
Snores
Flow limitations.

[Jlfinkels]

Here is a representative screenshot. Note that at 06:30 I took off the F30i and put on a P10 out of frustration. The gaps at 01:30 and 06:30 are where the leaks woke me up.

Screen Shot 2021-06-21 at 1.11.28 PM.png

[Jlfinkels]

settled on the F30i.

Find your mask on youtube and carefully watch three or four videos on fitting and adjusting. https://www.youtube.com/results?search_ ... esmed+f30i

Thanks. I watched those to make sure I wasn't doing something wrong, well at least more wrong than usual. I did have it fit at the sleep center and tested at max pressure, so at least in that scenario everything was fine. I clean the mask with wipes daily and everything non-electronic weekly, so should be in good shape there.

[Jlfinkels]

I have a months worth of OSCAR data. Any suggestions on what I should look for as a causative source?

Try taking a screenshot of a daily chart and posting it. Pick one where you know the leak problem woke you up. Please turn off the calendar and pie chart, and stack your graphs so these will fit in one screenshot:

Events
Flow rate
Pressure
Leaks
Snores
Flow limitations.

Here is a second screenshot from a different day. No mask change this time. Thanks so much for helping!

Screen Shot 2021-06-21 at 1.30.14 PM.png

[Pugsy]

The P10 large leak....your pressures weren't all that high at that time and since the mouth is uncovered with the P10 that always opens up the risk for mouth opening leaks...or it could simply have been mask movement leaks.

It does appear that you may not need quite as much pressure with the nasal mask as you do with the full face mask. This is actually fairly common.

Your FL graph isn't horrible but it is still fairly active and likely is playing a factor in the pressure increase. That is to be expected as well but to give you an idea why I say it is fairly active...compare yours to mine which is essentially boring.


One very important question...do you have much nasal congestion at all? If so, some of your FL activity could be related to the nasal congestion and more pressure won't fix it. The machine only measures air flow and has no way to know where the air flow reduction might be. It can and will sense nasal congestion reduction in air flow and think it needs to increase the pressure because it thinks those FLs are early warning signs of an impending airway collapse. Nasal congestion flow limitations have to be dealt with in the more traditional ways...decongestants, nasal rinses, etc.

If the FLs are indeed airway related...an experiment with increasing EPR might be in order. Sometimes FLs reduce with more EPR.
No guarantees but worth experimenting because if they do reduce then maybe the machine won't want to go so high.

If you want to continue with the full face mask...try limiting the max to 15 and see if large leaks continue to wake you up.
Watch the Events graph and AHI....if the events stay low and don't increase then it might be an acceptable compromise if wake ups from leaks are stopped.

If you want to continue using the P10 or nasal mask...we need to figure out if those leaks are mouth opening leaks or mask movement leaks and the only way to know for sure is tape the mouth shut one night to see if that stops the big leaks or not.
If it is mouth opening leaks then you have to decide if they are bad enough to need addressing and if they are bad enough how do you want to address them....should you prefer to use the P10.

Always something...nothing is ever all that easy or simple.

Also...your machine is essentially setting a new minimum once you go to sleep. That 4 cm minimum becomes a moot point.
You never really return to the 4 cm.
BTW...4 minimum and 20 maximum...not really settings made by the machine supplier....they are the default settings from the factory.
You probably really should be using at least 8 maybe 10 minimum pressure to start the night.

[Jlfinkels]

The P10 large leak....your pressures weren't all that high at that time and since the mouth is uncovered with the P10 that always opens up the risk for mouth opening leaks...or it could simply have been mask movement leaks.

It does appear that you may not need quite as much pressure with the nasal mask as you do with the full face mask. This is actually fairly common.

Your FL graph isn't horrible but it is still fairly active and likely is playing a factor in the pressure increase. That is to be expected as well but to give you an idea why I say it is fairly active...compare yours to mine which is essentially boring.


One very important question...do you have much nasal congestion at all? If so, some of your FL activity could be related to the nasal congestion and more pressure won't fix it. The machine only measures air flow and has no way to know where the air flow reduction might be. It can and will sense nasal congestion reduction in air flow and think it needs to increase the pressure because it thinks those FLs are early warning signs of an impending airway collapse. Nasal congestion flow limitations have to be dealt with in the more traditional ways...decongestants, nasal rinses, etc.

If the FLs are indeed airway related...an experiment with increasing EPR might be in order. Sometimes FLs reduce with more EPR.
No guarantees but worth experimenting because if they do reduce then maybe the machine won't want to go so high.

If you want to continue with the full face mask...try limiting the max to 15 and see if large leaks continue to wake you up.
Watch the Events graph and AHI....if the events stay low and don't increase then it might be an acceptable compromise if wake ups from leaks are stopped.

If you want to continue using the P10 or nasal mask...we need to figure out if those leaks are mouth opening leaks or mask movement leaks and the only way to know for sure is tape the mouth shut one night to see if that stops the big leaks or not.
If it is mouth opening leaks then you have to decide if they are bad enough to need addressing and if they are bad enough how do you want to address them....should you prefer to use the P10.

Always something...nothing is ever all that easy or simple.

Also...your machine is essentially setting a new minimum once you go to sleep. That 4 cm minimum becomes a moot point.
You never really return to the 4 cm.
BTW...4 minimum and 20 maximum...not really settings made by the machine supplier....they are the default settings from the factory.
You probably really should be using at least 8 maybe 10 minimum pressure to start the night.

Thanks for the most helpful response. Answers to your questions below...

Re P10 large leak, I know it was from opening my mouth as it woke me up. When I use a good chinstrap I don't have the same episodic behavior of expelling air through my mouth. I just got lazy that night.

I live in Georgia and Florida so have year-round nasal congestion from allergies. I have allergy meds and use a nasal rinse before bed which helps a lot. I have no issue with using the full face F30i or nasal pillow P10. I mainly want to get a good nights sleep and keep the number in check. My sleep problems are minor compared to others on this forum. If I have problems sleeping with my simplistic issues my heart goes out to those with more difficult to solve problems.

I'll try the KISS approach and set the machine to 8-15 while staying with the F30i to see if the makes a difference. I assume the pressure would run more at max with those settings but if the AHI stays good and I don't get woken up I'll take it.

Any thoughts on the EPR setting? It is currently on 2. Did you mean giving it a try at 3? I would only change it once I had stabilized on the 8-15 pressure setting to avoid changing too many variables.

Thanks once again. This is most helpful.

[Pugsy]

EPR choice in this situation....I would simply go with whichever I like the best in terms of how it feels.
I discovered a few years ago that more exhale relief was more comfortable for me and I slept a little better and a little longer...so that's why I use what I use.
If you want to go that way...you would probably need at least a month to evaluate sleep quality itself with no other factors being involved.

You will find that I always put getting good quality sleep at the top of my "to do" list because without good sleep the best "numbers" in the world don't mean much. For me good quality sleep is critical to feeling any good numbers. I can have an AHI of 0.0 and the most perfect leak line and if I don't sleep well...I still feel like crap.

[Jlfinkels]

EPR choice in this situation....I would simply go with whichever I like the best in terms of how it feels.
I discovered a few years ago that more exhale relief was more comfortable for me and I slept a little better and a little longer...so that's why I use what I use.
If you want to go that way...you would probably need at least a month to evaluate sleep quality itself with no other factors being involved.

You will find that I always put getting good quality sleep at the top of my "to do" list because without good sleep the best "numbers" in the world don't mean much. For me good quality sleep is critical to feeling any good numbers. I can have an AHI of 0.0 and the most perfect leak line and if I don't sleep well...I still feel like crap.

Sage advice indeed. Thanks for taking the time to help!

[Okie bipap]

Have you ever tried using a mask liner? They won't stop the leaks, but often prevent them from bothering you as much since they will help eliminate the mask fart sound. You can either buy one (padacheek.com) or try making your own. I made mine from an old, well-used tee shirt. I found the pattern for the liner at the following site:

http://montfordhouse.com/cpap/diy-cotton-mask-liner.pdf

This pattern with work just fine for small or medium cushions, but can enlarged for large cushions. The center hole allows clearance for you mouth and nose. The hole can be enlarged, as long as you leave enough material to go under the edges of the cushion.