Ultra Mirage FF still leaks

[always_tired]

I haven't been on in a while, but I have posted before about leaks with my Ultra Mirage FF with medium shallow cushion. I have tried many of the solutions recommended here (lanolin, extra panty hose strap, sleeping on cpap pillow and propped up a little, loosening straps, tightening straps, Macks, etc.) and my leak rates are still unacceptable. The leaks don't always wake me up and I don't know how bad it's been until I look at the data in Encore Viewer. I'm not looking forward to my next doctor visit, and I certainly don't want her to think I'm not trying. I have much the same problems that another poster with this mask described and still haven't come up with a good solution. It's as though there is too much air being blown in for the available mask volume or the exhaust vents. I have tried almost every full face mask on the market on my own over the last 2+ years with little success and the Ultra Mirage has been the best for fit and comfort. But since my pressure went up to 15, I haven't been able to control the leaks well. My DME said in her experience once the pressure gets up this high only the masks with a silicon-type cushion work well. She has tried to fit me with a Quattro in every size and couldn't stop the leaks in the office. She said I have an unusually narrow and shallow nose bridge compared to the rest of my face. The Ultra Mirage FF with a small shallow cushion appears to be too small to completely cover my mouth comfortably but I might give it another try since I have one.

Does anyone have any other suggestions? Is there a custom mask maker/fitter anywhere? I need caulk but don't think I'll try Lowes.

Thanks.

[fidelfs]

Any one on this? I have also the same problem and my pressure is 15.

bump.

[DoriC]

I can tell you the routine we use which seems to work. After some experimenting we have the forehead support one up from the bottom setting which gives my husband a good seal around his nose. He puts his mask on loosely, top straps barely touching forehead, then lies down and adjusts the bottom straps so they're snug but not too tight making sure the cushions are going in all around, we put the machine on , he lifts his mask slightly off his face for a few seconds to allow the cushions to inflate and gently sets it back down,then he turns from side to side and makes any further leak adjustments if necessary and that's it. Of all the FF we've tried, the UM is the best for him. Good luck.

[always_tired]

I believe you had sent me these steps before and I tried them. I can't stop the leak around the nose unless I put the forehead support in the lowest (bottom) position and tighten the top straps. I have no doubt that my straps on the bottom are tighter than they are supposed to be, but if I don't do that, I start the whistling, "farting" noises as soon as I lie down.

With the straps tight, I'm able to fall asleep and apparently the leaking during the night doesn't wake me up unless it gets really noisy. But my data shows significant regions of "large leak" throughout the night. And one night, I basically stayed in large leak starting about an hour after I went to sleep and lasted until I woke up.

So the question is what effect are these "large leaks" having on my therapy? My doctor said she can't infer anything as long as the leaks are this large. I have slept with a pulse oximeter on for a number of nights after I got it, both with and without my BiPAP. I never saw any desaturations or pulse abnormalities in the data. But is this data reliable?

I'm still taking Provigil but I guess I'm going to have to try doing without it for a week or two and see what happens. Unfortunately, I can't afford to have a lengthy absence from work while experimenting.

Thanks for the advice.

[DoriC]

The only thing I can think of is trying the Standard UM. Have you been measured properly? We got the sizing templates from Resmed directly which gives you the right size as well as measurements for shallow or standard. They come in 3 different plastic cup sizes. DMEs don't always get the measurements right.

[always_tired]

I started with the standard medium cushion in Aug. 2007. When I switched sleep doctors in 2008, the new one sent me to see the sleep lab supervisor in the lab he used to check my machine and mask. I had complained about the mask leaking to the point I couldn't sleep and this was at a pressure of 8. She took one look at me and said "You'll never get the leaks out with that mask. You need the shallow cushion." And she was right.

It's hard to believe my 1st doctor came up with a pressure of 8. The second doctor raised the pressure after every sleep test until I was at 15! This is the same value my current physician came up with. She said I had a tendency towards central apneas so I guess I won't be going any higher.

[Wulfman]

What types of leak rates (numbers) are you talking about?
Are your leak lines (VERY) erratic?
Are the leaks waking you up?
What position(s) do you sleep in?


Den

[Jason S.]

What types of leak rates (numbers) are you talking about?
Are your leak lines (VERY) erratic?
Are the leaks waking you up?
What position(s) do you sleep in?
Den

I would like to know this as well. Since switching to the UM from the Quattro a month ago, my AHI has dropped significantly (from about 2.5 to 1.0). However, my leak rate has gone up, but I don't consider it unacceptable. I don't have my numbers in front of me but as I recall my average with the Quattro was around 38 and its around 45 with the UM.

[Wulfman]

Jason,

Those numbers sound about right (within tolerances) for the pressure range you're showing in your profile.

The Vent Flow Rate (expected leak) for each mask is in the user manual......which can be downloaded from here (for the ResMed masks).

http://www.resmed.com/us/products/masks ... c=patients


Den

[jmelby]

I don't know your reasons for needing a full face mask, but have you considered a nasal mask? When I first started CPAP, I thought I needed a full face mask because I was uncomfortable using the nasal one in the lab when they first put it on me--I felt more comfortable in a FFM. I also thought I was a mouth breather. However, after excessive leak issues with 2 full face masks, my DME encouraged me to try a nasal mask (Activa LT). What I found was that my initial negative reaction to it was probably just a reaction to CPAP in general. The Activa LT has worked out great--low or no leak most of the time, and I don't seem to leak from my mouth much at all (even without a chin strap).

[Jason S.]

Jason,

Those numbers sound about right (within tolerances) for the pressure range you're showing in your profile.

The Vent Flow Rate (expected leak) for each mask is in the user manual......which can be downloaded from here (for the ResMed masks).

http://www.resmed.com/us/products/masks ... c=patients


Den

Thanks, since my avg pressure is about 9.6, my flow rates might be a bit high, maybe 20%, but if I'm not seeing any large leaks I don't know what I can do about it.

[Wulfman]

Jason,

Those numbers sound about right (within tolerances) for the pressure range you're showing in your profile.

The Vent Flow Rate (expected leak) for each mask is in the user manual......which can be downloaded from here (for the ResMed masks).

http://www.resmed.com/us/products/masks ... c=patients


Den

Thanks, since my avg pressure is about 9.6, my flow rates might be a bit high, maybe 20%, but if I'm not seeing any large leaks I don't know what I can do about it.

May be nothing to worry about. Depends on what's causing the leak rate and/or pressure increases......headgear adjustments, bed pillow, tossing/turning.......even differences in machine reporting.


Den

[always_tired]

What types of leak rates (numbers) are you talking about?
Are your leak lines (VERY) erratic?
Are the leaks waking you up?
What position(s) do you sleep in?


Den

The leak rate on my Ultra Mirage FF mask at pressure of 15 should be 47. The leaks with the UMFF do not wake me unless it's right in my eyes. It's the only mask that I consistently keep on all night. I have been a "mouth breather" since I was a child and feel like I can't breathe if I tape my mouth shut. On the very first titration, a nasal mask with chinstrap was used because they didn't have a FF mask small enough to fit me. I still managed to breathe a little through my mouth.

The leaks on other masks I have tried either keep me from falling asleep or wake me up. For example, I have a ComfortGel FF that I have been trying out and my leak rate was steady around 52 but I pulled it off after 1 hour because it was leaking in my eyes. I already have dry eyes from Sjogren's Syndrome so I don't need any air helping to dry them out.

I start on my left side and try to use pillows to keep from rolling on my back. I've even tried sleeping on the couch so I wouldn't have as much room to move about. I don't know how much time I'm on my back but during the sleep test I spent 31% of the time on my back and the rest on a side.

I seem to have two leak patterns. One I start out OK and it slowly grows to large leak (LL) for a while, then drops back down where it should be and repeats the pattern (sawtooth-like). The other pattern is I go quickly to LL shortly after going to sleep, spend quite a while there, drop back down to normal for a while, and then go quickly back to LL (a square wave type look). I have spent close to 50% of the night in LL but kept the UMFF on all night. I also have regions that don't register at all, no leak line and no large leak indicator. I know I don't take my mask off and then put it back on during my sleep, so I don't know if this is a machine or EncoreViewer problem.

I'm still experimenting with a chinstrap. One is flimsy and doesn't keep my mouth shut and the other one is like wrapping your head in an Ace bandage (Tiara ? brand). The second one seems to keep my mouth shut but interferes with the mask, regardless of whether it's under or over the mask, and is uncomfortable.

I have some nights that look good all night but don't know what is different about those nights and the nights I have lots of LLs.

[Wulfman]

One final thought......
Bed pillows can make a huge difference when it comes to mask leaks. I've been using a Chiroflow water-based pillow long before I started CPAP therapy and it has worked very well since I started. About a year and a half ago, I decided to try a "regular" pillow again. I made it through a night and a half before I couldn't deal with the leaks anymore and switched back to my Chiroflow. My head was sinking into the pillow and then the part of the pillow at the end was shifting my mask to the point where it was leaking.

The way I look at it, if I can sleep through the leaks, I'm still doing OK, because my machine is still blowing and I'm still breathing. I've had my share of "interesting" leak lines, too.

It's not a problem with your machine or the Viewer software.


Den

[Jason S.]

One final thought......
Bed pillows can make a huge difference when it comes to mask leaks. I've been using a Chiroflow water-based pillow long before I started CPAP therapy and it has worked very well since I started. About a year and a half ago, I decided to try a "regular" pillow again. I made it through a night and a half before I couldn't deal with the leaks anymore and switched back to my Chiroflow. My head was sinking into the pillow and then the part of the pillow at the end was shifting my mask to the point where it was leaking.

The way I look at it, if I can sleep through the leaks, I'm still doing OK, because my machine is still blowing and I'm still breathing. I've had my share of "interesting" leak lines, too.

It's not a problem with your machine or the Viewer software.


Den

I'm back to the flat pillow because the tempurpedic was giving me neck pain. My leak rate seems a bit high, in the low 40's with my avg pressure about 9.6cm. Usually I don't see many, if any, large leaks. And I'm not usually waking to leaks not detecting them before I sleep. I guess I could tighten the mask and see if the leak rate drops.

My AHI has dropped significantly since using this mask, but if my leak is too high maybe its messing with my numbers and I'm not as good as I think I am.