Mask leakage versus AHI

[Powerhands]

I have been using the System One RemStar Auto with A-Flex for about 3 months now. I started out with the nasal pillows (which seemed to work but irritated my nose). I kept being awakened during the night because my mouth would pop open and the gush of air would wake me up. I tried the chin straps, but found them uncomfortable. I switched to a full face mask about a week ago. It actually partly goes under my chin so it's much better at keeping my mouth closed and now I sleep through the night without waking. I have a beard and moustache which is only about a quarter of an inch long. I have been using the Sleepyhead software to monitor things as well as the readout on the machine itself. This is the problem: My AHI with the nasal pillows was averaging around 5. Since I switched to the mask, it now averages around 12! Also, the leaks have increased about 3 times whet they were with the nasal pillows. The facemask fits and seals quite well and if it does leak, I can't detect it - at least when I'm awake! I never wake up with it off my face or even moved around slightly so I cannot guess what this leak issue is, but logic dictates that it is somehow associated with a higher AHI. So here it is: I am sleeping better with the mask and I feel better, but now my leaks and AHI are much worse. Should I be concerned about this? The mask I'm using is the Fisher & Paykel Forma Full Face CPAP Mask.

Thank you!

[Pugsy]

Some people (not everyone) have found that their pressure needs increase when they use a full face mask when compared to what is needed with nasal pillow masks. In theory X amount of pressure is X amount of pressure no matter what the delivery system. Perhaps pressure needs were borderline optimal to start with and when using a full face mask even less borderline. How much is 3 times the leak? While the full face masks do have a higher vent rate than nasal pillow masks they aren't 3 times as much. Respironics machine report total leak which is the vent rate plus excess leak.

Should you be concerned about an AHI of 12? I would be.

[SleepyToo2]

Three things:
1. Why were the pillows irritating your nose? Was the bottom of the cone inserted into your nostril? If so, WRONG! the bottom of the cone (the widest part) should rest on the outside of your nostril. Also, the straps should not be pulled too tight - that will distort the pillows, and/or your nose (think pug nose). I use the new Aloha (love it!) because I have have a beard and mustache but was unable to stop full face masks, etc, from leaking noisily. With the Aloha I have been able to get my AHI way down (had a nap for 2.5 hours this afternoon because of a headache, and the AHI was zero! Yee Ha!).
2. Do a Google search for 'Full face CPAP mask "White Beard" leaks' (including the quote marks around "White Beard" and you will find lots of discussions about how to make a full-face mask work. There will also be some folks who say the only way to fix that is to become clean-shaven. I totally disagree because I found the Aloha + Ruby Red chin strap work like a charm for me.
3. A week is probably not long enough to get used to a new mask arrangement - you really need a month's worth of data to really tell. There are so many things that affect how you sleep that one night is not a reliable way of assessing. I know the sleep study is the "gold standard" and that is a single night, but they have a lot more data to work with than we do. Also, a lot of people (including myself) find that it takes an adjustment or two to get our set-up into the sweet spot.
Don't be afraid to raise your concerns with your sleep doc and/or DME, because there may be some tweaks they can suggest based on looking at your data.

[NateS]

Powerhands,

I believe your machine has an audible leak signal which you could turn on. Does it? If so, have you tried that?

Regards, Nate

[avi123]

When I used F&P full face masks #431 and #432 (which is similar to the Forma except the forehead support) I had lots of leaks which ruined my treatment for almost a year. After I changed to a nasal mask (NOT PILLOWS, see my hardware below) and a chinstrap 4 months ago, my leaks disappeared and so the events. The only things left are some Flow Limitation, and some RES (Residual Excessive Sleepiness after breakfast till noon).

F&P don't use the double layers of Silicone in their cushions which is the secret for a good seal!

[Powerhands again...]

Thank you all!
I have some updates and more questions. The FFM I'm using now has an air hole on either side of the hard plastic elbow that comes from the mask that attaches to the "hose" which attachs to the machine. These 2 holes (which seem rather large to me and are quite audible when blowing) are in addition to the tiny rows of holes in the mask itself. This of course didn't exist on my nasal pillows, they just had sone tiny holes. I actually tried to cover these 2 holes with my fingers and it made exhailing just a bit difficult so I guess that's why they are there. My leak rate with the nasal pillows averaged 18 leaks, 34 total leaks a night. With the mask it averages 130 leaks, 160 total leaks! Maybe this is brcause now there are 2 holes constantly leaking air out of the connection of my mask? Also, one of the reasons I started with the APAP was for really terrible snoring. The nasal pillows indicated an average Vsnore of about 1, which I found odd since I snore so badly. The mask has a Vsnore average of about 7.5! The mask also picks up chain stokes breathing frequently where my nasal pillows never did.
Any thoughts?
Thank you!

[avi123]

If you're talking about the F & P Forma mask then those holes belong to the anti- Asphyxia valve also known as non-rebreathing valve. I would not block those holes. Your best bet is to get rid of this mask and switch to a nasal mask similar to my (with a chinstrap). No PILLOWS!

[SleepyToo2]

Doesn't sound right, but we need to know the mask type ... you probably need to ask your DME how it can be right. The Cheyne-Stokes breathing and some of your other numbers could be because of the excessive leaks.

[Powerhands]

One of the reasons I have had a problem with the nasal masks is they don't seem to be moustache friendly! They don't seal well...

[Pugsy]

My leak rate with the nasal pillows averaged 18 leaks, 34 total leaks a night. With the mask it averages 130 leaks, 160 total leaks!

Please clarify units of measurement above...did you mean L/min? If so the leak numbers 18 to 34 L/min are well within acceptable limits. Your machine reports total leaks...vent rate plus excess leak.

A full face mask will have a higher vent rate but not to 130....
Respironics large leak area is around 90 L/Min go above 100 L/min and the machine throws up its little hands and says I don't know what I am recording.

Check your mask literature for vent rate at whatever pressure you use.

If you are referring to a number of leaks as in numerical unit...I haven't the faintest idea how you came up with that number.

If your full face mask is indeed leaking at the above number...something is terrible wrong somewhere almost to the point that I think that it is not put together properly.

Try an experiment. While awake so you can monitor things..mask up and turn the machine on and use it for about 15 minutes...Check your reports to see what the leak report is for that 15 minutes.