Replacement for Quatro FX FFM - Suggestions?

[LakeH1042]

I've been on auto CPAP since May 3rd (17 days over 4hrs). Initially, the mask is fine and I go to sleep right away. Very frequently, the mask springs a leak strong enough to wake me up in order to fix it, sometimes blowing out the cushion entirely. (I chose FFM because of allergies which often block my sinuses.)

The average leak on a daily basis is around 20. When I had my sleep study, my AHI without CPAP was 14.28. Since I've been on CPAP, my lowest AHI was 8.4, my AHI averaged over last 17 days is 12.4, with 5 days equal or greater than my sleep study without CPAP.

Question 1: Can the (what I consider to be a) high leak rate be skewing the AHI figures?
Question 2: Does the frequency of being awakened also affect the AHI reading?

And finally, for those of you who have had similar problems with Quatro FX FFM, did you find a different mask that worked better for you? ( I can still swap masks without charge)

Thanks

[Pugsy]

The average leak on a daily basis is around 20.

The Respironics machines report total leak which is the intentional mask vent rate plus any excess leak and 20 L/min is minimal leak and minimal vent rate (your pressure must be rather low). Without seeing the reports, and I don't think that if I did see them it would alter my thoughts all that much, I doubt that your leak is doing anything at all to cause the AHI to be elevated. Large leak for Respironics machines is around 90 L/min so you have a long way to go before leak becomes a problem.

Before evaluating AHI and possible pressure.... what is the breakdown of that elevated AHI that you are seeing?
How much for each event category especially the clear airway (central) index. If that is rather low and your obstructive component (obstructive apneas and hyponeas) are the bulk of the AHI then likely your pressure is not quite where it needs to be to effectively deal with the events. Did you have a titration study (sleep with mask and they make adjustments to pressure) that was successful or was there a problem like limited sleep or something or no titration study at all?

[Pugsy]

I forgot question #2....yes, it is possible that frequent awakenings can cause the AHI to be elevated especially if the clear airway index is elevated. Frequent awakenings following by frequent sleep onset could possibly cause frequent clear airway events that are normal in sleep onset. To really evaluate would need to see the reports and which type of events and you would need to know for sure that they occurred right after an awakening. The machine doesn't know if you are awake or not and it just reports what it senses and sometimes awake breathing is rather erratic and the machine thinks it senses some sort of apnea event when it really isn't happening.

[rosacer]

I have tried:
Comfort Full 2 FFM
Comfort Gel Blue FFM
Zzz FFM
Quattro
non of those was good for me (no way to stop leaks).
Then I tried
Ultra Mirage FFM
Quattro FX
with both of those masks I had the sudden leaks (which wake me up) or the small noisy ones (which wake me up too). The solution is to use with the mask a mask liner. It could be this http://www.padacheek.com/PAC_Maskliners.html, I made mine very simple gasket with a tissue the closest to microfiber (I can't find microfiber in Montreal). I have no more the small leaks (or this doesn't wakes me up now) and the big ones I had after 3 or 4 hours of use don't arrive now.

The Quattro FX made to me the same thing you described, when I use it without the mask liner. With the mask liner you have less deep marks on the face in the morning. To make my liner I put the mask on a sheet of paper, I mark all around the cushion with a pen, I cut that shape letting something like 3/8'' more all around. Then I cut the tissue (even an old T-shit could be useful) I make the center hole trying to be not too close to the cushion because the idea is when you put the mask against your face the silicon doesn't touch your face but the tissue. I make the hole small and then I make it larger if needed, remember if the tissue is elastic you will finish with an useless liner (hole too big).
I suggest you to try this before making the swap because the perfect mask sometimes doesn't exist for some people (like me for example )

[LakeH1042]

Thanks to both of you,

I'm using Encore Basic 2.0 for reporting from the SD card.
The information from the 19th which was typical (Last nights was not) shows avg leak 26.1 - Min in Large Leak 0.0
2.0 % of night in Periodic Breathing CA : 2.6
OA: 8.1
H: 4.9
FL: 0.7
VS: 0.6
RERA: 1.8
AHI: 15.6

I'm going to try the mask liner and see if that helps.

My appologies for not getting back sooner - We just changed cable companies - so have been off-line for a couple of days.

Thanks again.

[DiverCTHunter]

I'll trade you a MED Quattro FFM for it...

[LakeH1042]

Tried using mask liner (PAD-A-CHEEK) last night. Thank You Thank You

For the first night in years, I slept through the night without waking once. My AHI went from 12.4 to O.9 in one day.

I would have sent PM but couldn't so hope you read this.

Thanks again,

[DoriC]

Glad the liner worked for you! It's good that you posted your results here as it will help others who are having the same problem. It will also make Karen (Padacheek) happy to hear it.

[greatunclebill]

in my opinion after going thru that many masks, either you are getting the wrong size or not adjusting it properly. in 2012, all of the masks you've tried are excellent masks that should be working. in my opinion your quattro fx is the best one made. do yourself a favor and listen to what is being said and keep trying with the quattro fx til you master it. keep trying til you hit your sweet spot. too tight and too loose are no good. there's a very fine line between too tight and too loose that you have to figure out. when it don't work, don't keep tightening or loosening. take the straps off, put them back on and start over.

[LakeH1042]

To GreatUncleBill: To whom are you directing your comment? As you should note, I've only used the Quatro FX full face mask. Without a mask liner, it was not doing the job (my AHI with CPAP was frequently higher then my sleep study without CPAP ). My AHI went from 11.6 without the liner to 0.9 with the liner (got it from Pad-a-Cheek -- but other people have made their own.) I was on the point of trying another mask, but I'll stay with the Quatro FX using a mask liner.

On the other hand, people should determine for themselves what works and what doesn't. We're all different (to a certain extent) and, if there was a "perfect" mask for everyone, there wouldn't be all these different variations.

As my high school French teacher said to me,

"If at first you don't succeed, try try again. Then give up. Don't be stupid about it!"

[Randyp1234]

As my high school French teacher said to me,

"If at first you don't succeed, try try again. Then give up. Don't be stupid about it!"

That is classic!!!

[MaxDarkside]

I was a "liner doubter" until I made one... BINGO! It really helped with the leaks. Now if it leaks, I don't notice, unless it's a biggie, then I arouse briefly, adjust and fall right back asleep.

[avi123]

Since I have started using the Mirage SoftGel Nasal mask plus the chinstrap, about 4 months ago, my leaks disappeared almost completely. For a year before, I tried about a dozen types of masks including Pillows but none managed to seal well.

See my leaks bar graph going back three months (notice also the zero leaks):