Leaks. At the end of my rope.

[Minky]

I regularly have 2-3 hours combined of large leaks. Every. Night.

I feel like I've tried everything and nothing works.

I started out with the P10. I assumed the problem was jaw dropping, so I tried first a chinstrap and then taping. Neither worked. I tried using larger pillows, medium. I then went back to the small pillows and also used a new set of pillows. Nope.

I then switched to the Wisp. Then the Eson. Then the Activa LT. With a chinstrap. With tape. Nope. Nope. Nope.

I then decided that I needed a FFM and bought the Simplus. Nope.

I received a Pad-a-Cheek mask liner last night to use with the Simplus, which BTW is very nice, well-constructed and made of very nice and soft fabric and I will be buying many more of her products. However, I still had two hours' worth of leaks last night.

I've tried cinching all of the masks very tight and have also tried loosening the straps. I've ordered the ruby chinstrap and will see if that makes a difference.

Does anyone have any suggestions for anything else to try?

Sorry for the rant. Between the leaks and the 8 feet of snow in my yard and 2 more feet expected this weekend I'm feeling a little bit desperate.

As always, thanks very much for your help.

[Macpage]

Sorry to hear this. This is quite the puzzler. We would expect some mouth leaking with the nasal interfaces. However, large leak for these times even after straps and taping is indeed unusual at your pressures. I would think the tapes and straps would at least reduce some of the amount in large leak. It seems even a decent fit on a ffm would also solve any mouth leaking at least to the extent of reducing these large numbers some, especially with a functional liner.

A few questions might help others looking at your post. How far into large leak? Do the leaks wake you up? Have you checked the system for a leak in the hose or connections? This would give you numbers like these for all interfaces. Could you do a trial with another machine or version of Sleepyhead in case of software related gremlins. Are you a "really" active sleeper? What tape did you use? Some tape is very breathable. Have you tried the cervical collar?

Perhaps, you have a distinctive jaw drop. I know that I would leak with my jaw drop even with a ffm. Sometimes my mouth would eat the bottom of the mask. I never had large leak numbers because I would wake up, but if you slept through this several times you could get some big numbers. I had to tape even with the ffm. Do you have a partner, family member, or friend who could watch you for an evening to see if anything revealed?

I've recently tried all the interfaces you have used and I would think you could get a good rate out of at least one of them. However, I'm sure some have to try many more. I do note that I leak more with the nasal interfaces. Some is mouth and some is just more leak in general. I get the best numbers ironically with the ffm. Maybe you are better with a ffm, but the Simplus is just a bad mismatch or a bad fit. Would it be easy to try another ffm?

I'm sorry couldn't offer more. I hope it's simple like a hose leak or software error. I'll be interested to follow this.

Best,

Mike

[Pugsy]

Can you show us a leak graph with one of the nasal interface masks and when you taped your mouth?
And did the tape stay in place all night?
If we eliminate the mouth as the culprit (tape was secure all night) then we have to look at other possible causes and that pretty much leaves either mask movement or maybe a leak in the circuit somewhere. Leaks in the circuit or usually more constant where as mask movement leaks are more varied with some time not much leak and other with leak.

[Minky]

Hi Mike and Pugsy,

Thanks so much for your help.

I will try different things (masks, tape, etc.) over the next few nights and will post images of the leaks this weekend.

Because I'm so new to this I didn't even think of the fact that the problem could be somewhere in the hose rather than in the mask. I'm a very light sleeper and tend to wake up when air is escaping from a cushion or when pillows become dislodged. The past few mornings I've woken up thinking that I had had a good night only to find that Sleepyhead said otherwise. Plus, around two weeks ago I noticed that the hose was blowing cold air and I looked at the machine to find that I had a 'Climateline Error.' I had to remove and then reinsert the hose. Thinking back, that's around the time that the large leaks became really severe. I'm going to take the fleece cover off of the hose tonight and see if there's a hole somewhere or if it's not properly connected. I've only had it for two months, but it's possible that the cold temperatures in my room caused it to become brittle. Either that or one of my rotten cats put a hole in it .

Thanks again!

[Pugsy]

past few mornings I've woken up thinking that I had had a good night only to find that Sleepyhead said otherwise.

Just how bad did SleepyHead say things were?
If I sleep well and SleepyHead reports some time in large leak...I look to see just how much time and just how far into large leak territory I went. Sometimes when I look closely it really isn't all that horrible...like maybe my leak only went 2 or 3 L/min beyond the red line (which isn't really carved in stone anyway) and maybe only there 15 minutes or so. I don't sweat those leaks as long as I slept well.

[SGearhart]

Either that or one of my rotten cats put a hole in it.

A cat claw can wreak a hose and finding the small hole could be a real bugger.

To look for a hose leak you might try a variation of looking for a leak on a tire.
1. Remove the mask at the hose connection.
2. Using a slight soapy water solution and a sponge or cloth coat the hose.
3. Block the exit side of the hose (using a hand or something)
4. Turn on the CPAP and look for bubbles. Recoat as necessary with the soap solution.
5. If there is a leak, you should see bubbles and possibly hear a gurgling sound.
6. If no leak is found, you have successfully washed the outside of your hose and made a mess.
7. If #6 is true, Then I didn't give you this advice.

[Minky]

Thanks, SGearhart. I'll do that. The hose could stand to be cleaned anyway .

[funky-rat]

I used to have leak issues before I had surgery on my nose (which we discovered was packed full of scar tissue of an unknown origin). Before I had that fixed, I used the F&P Forma. It's a FFM that has a "lip" at the bottom that your chin fits into that will hold it shut. It was the only one that worked for me until I had things fixed.

[jilliansue]

Just one item of input here: You can leak through the permeable tapes. I was having leak issues using a flexible, breathable type of tape. I switched to Nexcare's Gentle Paper tape and although it is harder to remove, I do not get leaks through the tape itself. It has made a big difference for me.

[Tatooed Lady]

So, I KNOW that 8-10cm pressure I slow to many people, but could some of the excess leak be caused by you not currently having your mouth trained to stay shut at anything but underwhelming pressures?
I was okay til I hit 10cm...and that took months to get up to, for me. At that point, my mouth forgot to stay closed, I'd wake up dry mouthed. Maybe back off the pressure by .5-1cm and see if it helps, until you get a better handle on things?
This is assuming Pugsy's cats didn't give yours ideas on a new scratch toy...

[Minky]

Thanks, everyone for all of your help.

I decided to order an Airfit F10 to see if that works any better. I'll return it if it doesn't. I'm also going to reduce the pressure and raise it back up slowly. I've actually been turning it up higher because 8-10 is doing nothing for my flow limitations, so my therapy will have to be somewhat ineffective until I'm able to train my mouth to stay shut. Things have gotten a lot worse since I started raising the pressure, so I think you may be right.

I am thinking that Pugsy's cats gave mine some ideas. I should have stuck with pugs. My little avatar boy Finn would never put a hole in my hose.

[symetrisg]

Do you use a full mask or nose pillows?

[RogerSC]

Just one thing, in all this, be careful how tight you cinch things...you can cause some damage to your face if you're not gentle with yourself, albeit temporary. Most masks aren't meant to be cinched down tightly, although a mask liner does give you some protection. From what you're saying, I'm think a leak in the system, which could actually vary depending on the angle of the hose, how far the hose is extended, how much tension you have on the hose, etc., if the leak is even related to the hose. If it were a constant leak, and it's a large leak, I would guess that you'd hear it before you went to sleep. So it's most likely a variable leak of some kind that will show up in your sleep data. Posting that will be most helpful.

Sorry you're having these problems, sounds really frustrating! Hang in there.

[Minky]

I had NO large leaks last night !

I took everyone's advice and removed and then reattached the climateline hose. I also reduced the pressure and will very gradually raise it until my flow limitations are at an acceptable level. Having no large leaks did make a big difference in the number and intensity of FLs, but they're still not okay, so I do need higher pressure. Last night I was at 9-12. I also think that wearing a FFM made a difference. I'll really miss my nasal and pillow masks .

Thanks so much to everyone for all of your advice and support. It's very much appreciated.