Leaks out of control

[Eddy]

Successfully used the RESMED F20 for 6 years. Recently, since changing to an AS11 from AS10, my leak rate is all over the place. One night no leaks, next night minimal. Almost like my mask is off. I have tried several other masks and recommendations ( Medium AirFit™ F20 Full Face, ResMed AirTouch F20 Cushion, Med and Large Masks, Ruby Red Chin Strap, Cervical collar, Remzzz liner, fisher-Paykel-vitera-full-face-mask, Fisher & Paykel EvoraI). The chin strap, when really locked down works, but is difficult to tolerate. Both F&P give me headaches. My AHI is less than 5, but the leak is so high that I am concerned that the AS11 is not registering the AHI accurately. I have found that the AS11 humidifier does not stay locked but that is not the problem. My pressure for years was 12-18 ... now set at 11-17 trying to reduce the leaks which are severe above 17. Last night's Oscar graph (worst large leak night) ...



The leak rate is up to 120 L/min and constant. I checked the humidifier, and it appears to be seated. The humidifier does leak at the back when I fill it. Any insight/recommendations appreciated.

[Dog Slobber]

Swap out every component, and ensure they are all properly seated.

You do have a spare hose and tank I hope?

[palerider]

My AHI is less than 5,

That doesn't mean anything, 5 is a BAD AHI. Shoot for under 1.5

but the leak is so high that I am concerned that the AS11 is not registering the AHI accurately.

The highest pressure I see is around 12, because the leaks are so bad that the machine isn't even trying to respond to the events, which it's flagging, just flagging as UA since when the leak gets much over 30, it can't differentiate between obstructive and central.

Do what Dogslobber said.

[tyrinryan]

Can you hear of feel any place around the mask where there is an obvious leak? At 120 lt/min, it should be a roar.

[SleepGeek]

The leak rate is up to 120 L/min and constant. I checked the humidifier, and it appears to be seated. The humidifier does leak at the back when I fill it. Any insight/recommendations appreciated.

Honestly, I would check that humidifier again like ryan sugessted. Look, listen, & feel with the cpap ON but your mask OFF.

If you have a stethoscope or even a piece of tubing (O2 or otherwise) NLT 2ft. can be helpful locating air movement.

You May be better off going back to the AS10 if all else fails?

[tyrinryan]

how do use the stethoscope or the tubing to find the leaks?

[tyrinryan]

error

[SleepGeek]

how do use the stethoscope or the tubing to find the leaks?

Hold one end to an ear while moving the other end around connections you suspect may be (or want to confirm are not) leaking. So anywhere the air moves thru and there is a seal or connection.

Give it a try - you will be suprised when you hear the hurricane.

The other way I didn't want to mention is to use soapy water in a spray bottle. Spray each connection and look for bubbles. But if the leak is too big it may not blow a bubble. And its also more messy.

Plus I would use distilled water because then you can use the same spray bottle to clean windows.

Of course if you want to you can use pond water - your call
- I prefer distilled so as to not leave mineral deposits.

[Eddy]

Can you hear of feel any place around the mask where there is an obvious leak? At 120 lt/min, it should be a roar.

Unfortunately, I am very hard of hearing ... but my wife says she does not hear anything, and her hearing is very good?

Really confused ... Here is the next night. Same setup except went back to 12-18 pressure. No leaks at all.



The CSR is during awake time as I sometimes have trouble falling back to sleep after nighttime wakeup. Sleep and heart doc have no concern for these CSR. How does it change from one night to the next? Currently do not have extra tub or hose for new AS11.

[Eddy]

That doesn't mean anything, 5 is a BAD AHI. Shoot for under 1.5

My AHI average for 6 years prior to AS11 is 2.09, OA=0.14, HA=1,72, UA=0.06, CA=0.17, RERA=0.23, % time CSR=0.15%, Average Leak Rate=11.35, Average pressure =12.78, 95% pressure= 15.40

I doubt I can ever achieve AHI=1.5 ... seems excessively low since my sleep study in 2016 had AHI=83? How did you determine this figure?

[Julie]

It doesn't matter how high your AHI was on testing if Cpap does a good job since then. It's like wearing glasses - take them off and your eyesight will be as bad (or good) as it is without them. Use Cpap and (hopefully) your apnea goes - mostly - away, don't use it and testing will show a high AHI. There isn't necessarily any relation re how bad apnea is to how well controlled it can be with Cpap, everything else being equal (e.g. taking meds now but not pre-Cpap, or any other 'variable' that wasn't present initially).

[Miss Emerita]

It sounds as though you don't have Cheyne-Stokes breathing but instead just do some periodic breathing from time to time. (That's breathing that waxes and wanes in the flow rate.) It's nothing to worry about, and it can be as variable from one night to another as any other aspect of sleep.

I think a lot of people here would say that an AHI between 1 and 2 is good, and an AHI below 1 is excellent. These judgments really just concern the extent to which sleep apnea interferes with your ability to get restful and restorative sleep. I'd say that someone with an AHI of around 2 who is getting good sleep shouldn't worry about getting down to 1.

[palerider]

That doesn't mean anything, 5 is a BAD AHI. Shoot for under 1.5

My AHI average for 6 years prior to AS11 is 2.09, OA=0.14, HA=1,72, UA=0.06, CA=0.17, RERA=0.23, % time CSR=0.15%, Average Leak Rate=11.35, Average pressure =12.78, 95% pressure= 15.40

I doubt I can ever achieve AHI=1.5 ... seems excessively low since my sleep study in 2016 had AHI=83? How did you determine this figure?

An AHI of 2.09 means that your sleep is getting interrupted, on average, every 28 minutes, actually probably more often, because the AHI doesn't count other respiratory issues that disturb sleep.

2 is an upper limit for having a good chance of getting some restful sleep.

[Eddy]

An AHI of 2.09 means that your sleep is getting interrupted, on average, every 28 minutes, actually probably more often, because the AHI doesn't count other respiratory issues that disturb sleep.

2 is an upper limit for having a good chance of getting some restful sleep.

Ok, sure I cannot disagree. When my AHI is below 2 I feel better, more rested the next day. I did not feel tired before I began therapy in 2016. In the last year I began to feel tired the next day ... I am now 82, and that has much to do with how I feel. These days I feel better as the day goes by, and dread having to go to bed ... the variability of the therapy and AHI night-to-night and LL impacts the sleep quality. I will experiment some with pressure and try the Resmed F30i mask.

A pressure of 12-18 was good in the past as I rarely saw an OA event ... now 3-5 OA per night not unusual and more HA clusters. I will try 13-17 with EPR at 2 for a few nights. Resmed F30i mask to come later.




Thanks for the insight and recommendations.

[SleepGeek]

Unfortunately, I am very hard of hearing .

Using a hose or stethoscope to find leaks is helpful even for those with normal hearing. If you try it you will see what I mean.

ps. Remove the Diaphragm part from the stethoscope when looking for leaks - leaving the hose end open and move that part over connections you think might be leaking..