Can Data Tell If I Have a Mask Problem?

[Pugsy]

That leak rate is so high, it makes me wonder if there is a tear in the hose or something!

Pugsy - what is the minimum leak expected with that mask and that machine? Around 40?

I wondered about a tear in the hose or something maybe not put together properly in the mask itself and that is why I suggested trying things for an hour or so while awake.
Not shown here but in another report I saw he did have a period of time where leak was minimal...so he does have some very short time with minimal to zero leak...which if there was a hole somewhere he wouldn't have any time at all with minimal leak.
This link shows the vent rates for ResMed masks at various pressures.
http://www.resmed.com/us/assets/documen ... sa_eng.pdf
With Charlie's EPAP and IPAP variables it makes it hard to come up with a single number but at 16 cm it would be 48 L/min vent rate. I would count a 50 to 55 L/min leak number a huge success if it were me...maybe even be happy up to 60 L/min.
Anything over 75 L/min I would start worrying and over 90 L/min...the machine throws up its little arms and shouts "uncle".
I would take up to 30 minutes in large leak as an okay trade off but over 30 minutes is my own personal line in the sand for a large leak that would actively work on to reduce.
Newbies I give more leeway but I can't give Charlie this much leeway...more time is spent in large leak than not and we are taking massive large leak and not borderline large leak. Borderline being 80s to 90.

[DoriC]

This may be far fetched but I seem to remember our first Quattro FFM years ago was defective because that little flap that opens and closes was stuck in the open position and was supposed to close when the air came on.I think it's called the valve membrane. Can you check that out?

[Char1ieJ]

This may be far fetched but I seem to remember our first Quattro FFM years ago was defective because that little flap that opens and closes was stuck in the open position and was supposed to close when the air came on.I think it's called the valve membrane. Can you check that out?

DoriC, I'll check the valve membrane tonight. I really think the problem is 90% "fit" right around my upper cheeks, just below my eyes.

I donned the mask again last night and went to sleep. Woke up a few times and adjusted. Just let the machine ramp to normal pressure and let it leak or whatever just so I could try to get some benefit without aggravation of constantly tweaking. The last time I awoke, I torqued the mask down with the lower straps and adjusted the forehead piece down 3 notches. Take a look at the last graph segment.
Unfortunately, an or so later, I woke up from nocturia knockin' and my nose somehow magically got 500% congested when I went to the bathroom. So, in my sleeping stuper, I left the hose off the mask, but left the mask on, and went back to sleep for another hour or two. Weird what we do when we're "out of it".

[DoriC]

Yes,That forehead knob does have to be adjusted "just right". I've got my husband's setting around the 9 mark, any further out and he'll feel leaks. You may be onto something, keep us posted.

[archangle]

I believe that the valve vents out of a different place than the exhaust vent. The exhaust vent is out of the holes over your nose, and the valve vents out in the elbow. You should be able to feel where it's venting.

Are you using the Mask Fit Check function?

[Char1ieJ]

I believe that the valve vents out of a different place than the exhaust vent. The exhaust vent is out of the holes over your nose, and the valve vents out in the elbow. You should be able to feel where it's venting.

Are you using the Mask Fit Check function?

I feel the normal venting and the leaking. I am not using the Mask Check feature on my machine. Maybe, I need to back up to square one and do that, too. I did receive a Pad-a-Cheek from Karen Friday afternoon (THANKS Karen!). Used it this weekend. It feels nice and cut down on the leaks. As of last night, here is the graph... looks quite a bit better.



The biggest problem I faced last night was continual "face farts". Same places the Mirage Quattro leaked before -- right below my eyes and at the lower "corners" of my mouth. If I held the mask against my face, they would stop... but eventually start again. However, if I tighten the straps, the mask feels too tight on my face -- and starts to hurt a bit. Nonetheless, at this point I'll take the lower leak rate as a positive sign and tweak a couple more days.

I'm also testing a Swift FX Nasal Pillow (first two small sections of the graph) -- and researching ways to keep my big mouth closed at full pressure (17cm). Up to around 12cm, it worked great. After that, my lips started having "blow outs". Haha! It's a work in progress. And I'm not as frustrated today as I was last week.

[Char1ieJ]

Stick a fork in me, I'm done. I did everything right last night -- everything. I even slept most of the night (a real rarity) and ended up with a low AHI (2.7) for the night -- which is the best yet. Nonetheless, my mask spent most of it's night in Large Leak territory (avg 100). I'm done with it. Moving on to another mask and exploring new options -- especially the Swift FX Nasal Pillow AND some way to keep my mouth closed at full pressure (17/14).

The one thing I don't know is -- what mask to choose since the Mirage Quattro is not working for me. What do you think of my logic that the Respironics ComfortGel Blue FFM might be a good choice -- since I used it during my titration study with very low leak rate. Suggestions, knowing what has gone on thus far, would be appreciated.

As I have done each day for this thread, here is the latest graph. If YOU can glean any useful data from it, let me know your thoughts...



THANKS to everyone who has contributed to this thread.
After your comments today, I think I'll consider it closed -- except to possibly post the results of which mask I end up with next.

[JohnO]

I'm also testing a Swift FX Nasal Pillow (first two small sections of the graph) -- and researching ways to keep my big mouth closed at full pressure (17cm). Up to around 12cm, it worked great. After that, my lips started having "blow outs".

It may take some time, but try the technique of placing your tongue at the roof of your mouth and sucking/swallowing to sort of "seal" the tongue to the top of the mouth. I am conscious of this effort for the first couple of minutes after turning on the machine, then I forget about it, but continue to do it. Another option is to try a chin strap. You may or may not need it long-term. It might be just enough to remind you to keep your mouth shut using the other technique.

I started using the tongue on roof of mouth technique years ago in a failed attempt to stop or reduce snoring. Little did I know it would be very useful when I started CPAP therapy in August this year!

I don't have any experience with full face masks (just nasal mask and nasal pillows) so I can't offer advice on those.

John

[Char1ieJ]

It may take some time, but try the technique of placing your tongue at the roof of your mouth and sucking/swallowing to sort of "seal" the tongue to the top of the mouth. I am conscious of this effort for the first couple of minutes after turning on the machine, then I forget about it, but continue to do it. Another option is to try a chin strap. You may or may not need it long-term. It might be just enough to remind you to keep your mouth shut using the other technique. ...

John, thanks for the tip. I have read that a few times... and was given the tip from Pugsy, too. I'm practicing this daily now. Your encouragement is appreciated! On the semi-positive side...

Another decent night of sleep -- which, for me, equals not waking every hour to 90minutes. My AHI was even low - 1.3. But, the mask is still leaking like a sieve:



I'm heading over to the DME today. Taking my data card, so he can see that DATA shows the Mirage Quattro isn't the right mask for me. I'm STILL open for suggestions on another mask -- and confirmation or rebuttal of my logic that the ComfortGel Blue might be a good choice (see above post).

[5thumbs]

I started with the Quatro and it did not work well for me. Leaks above 30 and just too bulky. The DME fitted me with a Resmed Liberty and I got that to work well (and still use it). The smaller surface area around the seal helped with the leaks (less places for leaks), but you also have to fidget with the nose pillows. When insurance permitted, I tried a Quatro FX. This mask took some adjusting to control leaks (particularly around the top of the nose), but I can now wear it through the night with very good results.

Quattro FX is more comfortable thru the course of the night but is harder to control leaks.
Liberty is better if I want to read or watch TV before I go to sleep.

[Char1ieJ]

I started with the Quatro and it did not work well for me. Leaks above 30 and just too bulky. The DME fitted me with a Resmed Liberty and I got that to work well (and still use it). The smaller surface area around the seal helped with the leaks (less places for leaks), but you also have to fidget with the nose pillows. When insurance permitted, I tried a Quatro FX. This mask took some adjusting to control leaks (particularly around the top of the nose), but I can now wear it through the night with very good results.

Quattro FX is more comfortable thru the course of the night but is harder to control leaks.
Liberty is better if I want to read or watch TV before I go to sleep.

I haven't ever looked at the Liberty before. That looks like one that would fit my face well. The primary place the Mirage Quattro leaks (on me) is up around the eyes. The Liberty doesn't even go up that far. And, after having tried to the Swift FX Nasal Pillow mask, I like the idea of a nasal pillow. Hmmm... the Liberty might be a real option for me. THANKS 5thumbs!

UPDATE: I just returned from a 10 minute meeting with the DME. He didn't have the ResMed Liberty in stock. So, he gave me an F&P FlexFit 432 and a Respironics ComfortGel Blue FFM to try. I have a few days to try each, then return the two masks (out of the 3 I have now) that don't work for me. BTW, there was absolutely no hassle or hesitation on his part. I didn't even take the Mirage Quattro in -- just the data card. And, he didn't even want to see it. He just asked me a few questions and then gave me two more masks to try.

I'll measure data on each mask for a few days, and report my findings for evaluation by the forum experts. So, it looks like I'd like to keep this thread open several more days. THANKS folks! Comments welcome and invited.

[5thumbs]

From the graphs you provide, and assuming you have your machine set on a ramp up (sorry if this has been covered already) it seems like the leaks start right away and you never establish a seal. If this is true with the Quatro, then you should be able to tell right away if the two new masks will work for you. Insist on them fitting the mask on your face with pressure before you leave that office (assuming they are compentant enough to help you adjust for optimum fit). I'm hoping that if you can set the mask to seal properly (and learn to adjust it when it starts to leak), that will be the mask for you.

The low surface area (just around the mouth) of the Liberty is a plus if you open your mouth at night. The challanges of a high integrity seal around the nose and cheeks of a full face mask are avoided. The new challange of a hybrid is the distance of your nostrils from the mouth piece, AND your nostrils being able to accept the pillows. In my case it works. If leaks develop it is always from the pillows loosing their seal. As with your Quatro, the resulting leak will blow in your eye, squeal like a pig, until you get it under control.

[Xney]

FYI, you can't trust your AHI number with such high leaks.

(not that you really can, anyways, without a sleep study, but it's what we got)

[Pugsy]

Next time you talk to your DME ask them if they have the Innomed/Respcare Hybrid in stock.
It is very similar to the Liberty.
https://www.cpap.com/productpage/RespCa ... -Mask.html
It comes with 3 sizes of cushions included where the Liberty only has the one and you have to decide.

[Char1ieJ]

THANKS Pugsy, Xney and 5thumbs. I'm working with the ComfortGel Blue FFM for the next few days. Last night, I had fallen asleep in my recliner for a few minutes, so I was "zonked" when I headed to the bedroom. Put the ComfortGel Blue on, pull the straps and went back to sleep. During the night, I got up to feed the porcelain bowl a drink and forgot to hook the hose back up. (DUMB! ). So, I slept with the mask on, but no machine the rest of the night.

Anyway, here's the graph from the first night with the Respironics ComfortGel Blue FFM -- not tweaked for fit and without the Pad-a-Cheek mask liner:



The only downside - comparative to the MQ - is the bridge of my nose is slightly sore this morning. I think, with tweaking, that will go away quickly. I'm a bit optmistic because, as 5thumbs said, since the MQ leaks manifested right after ramp time, I should know right away if either or both of these masks will work.

The plan is to use the ComfortGel for 4-5 days, then switch to the F&P FlexFit for 4-5 days, then make a final decision. I am also keeping the Swift FX in play as a primary alternative. It's just that I have time to test that one later. The ComfortGel vs FlexFit vs Mirage Quattro question has to be answered in a timely manner for the DME.

FYI, you can't trust your AHI number with such high leaks.
(not that you really can, anyways, without a sleep study, but it's what we got)

I kinda figured that, but wasn't totally sure. THANKS for the confirmation.

Next time you talk to your DME ask them if they have the Innomed/Respcare Hybrid in stock.
It is very similar to the Liberty.
https://www.cpap.com/productpage/RespCa ... -Mask.html
It comes with 3 sizes of cushions included where the Liberty only has the one and you have to decide.

Pugsy, I'll do that. I'm taking the Mirage Quattro back to him tomorrow or Monday, so I'll ask about the Innomed at that time. THANKS for the suggestion!