Help with positional leaks, please

[CarolS]

Hi,

I have been using my Resmed 10 for a couple of months now. I am using a Resmed F10 but have also tried the Resmed Air and the Phillips Amara full face mask. I have not been able to get my overall leakage rate below the 24 recommended by Resmed with any of the masks. My ahi numbers range from 1.3 to 2.5.

My leaks occur at the bottom and lower sides of my cushion. I have noticed that when I sleep, I duck my chin down towards my chest which causes leaks at the bottom of the cushion. I also sleep on my side. Despite using the cpap shaped pillows, I think I may be dislodging the mask with my side sleeping. Mask liners have not helped.

I would very much appreciate suggestions so that I can lower my leak rate. Thanks to all.

CarolS

[Julie]

You sound like a perfect candidate for a soft cervical collar that would keep your head up, airway open and mouth closed - many people use them.

[Pugsy]

Which leak rate number are you talking about? The average leak number or the 95% leak number?
and just how high is it running? Way above 24 L/min or maybe just barely above 24 L/min?
and are you sleeping through the leaks or are they waking you often?

[BleepingBeauty]

My leaks occur at the bottom and lower sides of my cushion. I have noticed that when I sleep, I duck my chin down towards my chest which causes leaks at the bottom of the cushion. I also sleep on my side. Despite using the cpap shaped pillows, I think I may be dislodging the mask with my side sleeping. Mask liners have not helped.

I would very much appreciate suggestions so that I can lower my leak rate. Thanks to all.

CarolS

I agree with Julie that a soft cervical collar may solve your problem easily. It may not, but it's sure worth a shot.

But I'd also mention the mask I use, the Hybrid (https://www.cpap.com/productpage/RespCa ... -Mask.html), as one of its features is a chinflap. That feature helps to keep the mouth closed and the mouth seal stable, so it's unlikely that you'd experience the same type of leaking with it vs. a "typical" FFM. (I also love the mask for other reasons, not the least of which is not having anything going over my nose.) Of course, we're all very individual, and one man's trash is another man's treasure (especially when it comes to xPAP masks), so YMMV. Just putting it out there as more info for you.

Or you might try a mask liner, which many say helps stop leaking. Check out http://www.padacheek.com for one that fits your mask. Karen makes excellent products.

Good luck!

[CarolS]

Pugsy,

My leaks are generally between 25 and 30 L per minute. I am getting that number from the sleep report on the machine display. I am not sure exactly what that number represents. Strangely, the machine displays the happy face icon for mask seal, even though my leakage rate is above 24.

If I do not use a mask liner, I am repeatedly awakened by both hissing leaks and very loud leaks. This is many times during the night.

If I use a mask liner, I do not hear the leaks and do not wake up. As I was just awake this morning, while using a mask liner, I heard a hissing leak and realized that air was leaking from the bottom of the cushion.

Using the liner does not change my leakage rates

The therapist at my DME says not to worry about the elevated leakage rate if I sleep well with the liner and my ahi is good. I am not sure whether to trust his assessment.

Thank you.
CarolS

[Julie]

But you still cut off airflow by scrunching your head down...

[Pugsy]

The leak number on the machine's LCD display is the 95% leak number. 95% numbers aren't what people might initially think. They aren't where we were at for 95% of the night...they are where we were at OR below for 95% of the night. So until you use the software and actually see the leak graphs you won't be able to tell just how far you went into large leak territory and how long you were there other than for 95% of the night you might have been at or below 30 L/min (if that's what is showing on the LCD screen).
95% numbers are easily skewed by sometimes a relatively small amount of time in large leak.
I have an example that happened to me once...the 95% number was 27 L/min but I actually didn't spend a huge amount of time above 24 L/min. It wasn't the prettiest of leak graphs but it wasn't as ugly as the 27 L/min might leave a person to believe.

Look at my examples and what I said here in this thread page 4...I think top post
viewtopic.php?f=1&t=86705&st=0&sk=t&sd=a&start=45

These machines are fairly accurate up to leaks of around 30 L/min and above that the data reported starts getting iffy and the farther you go the iffier it gets. If the worst your 95% number is 30 L/min then we can trust the low AHI numbers.

If you are sleeping well with the mask liner....I agree with whomever told you not to be overly worried about these leak numbers. I think that once you get the software up and running so you can see the actual leak line and evaluate how long you are in large leak territory that it will ease your mind. I am betting that you probably don't spend a lot of time over 24 L/min. If you did you wouldn't be seeing Mr Smiley face. Mr Frowny face appears when leaks are over 24 L/min for 30% or more of the night.

Get SleepyHead or ResScan and evaluate those leak graphs just to be sure and also to ease your mind.
You can see easily just how much time you spend in large leak territory.

I almost always will spend some time in large leak territory according to my ResMed S9 machine but unless my 95% numbers were above 35 L/min and I saw on the reports that I spent a lot of time up there, I wouldn't worry as long as I was sleeping well and feeling decent. I personally think that the 24 L/min line in the sand is ultra conservative and the machine can actually do a very decent job up to around 30 L/min and then it starts having some trouble...that's when we see "unknown apnea" flags and above 35 L/min the machine starts to simply miss events. I had this happen one night where I was able to catch a nice progression of leaks from not so bad to pretty bad.
Here in this thread
viewtopic.php?f=1&t=76445&p=698087&hili ... ne#p698087

In this situation I think that I would trust what the DME therapist is telling you but when you have time do get the software up and running just to verify.

[Stewart194]

BleepingBeauty - The mask you recommended, can you breathe through your nose OR your mouth with that mask?

Also, can anyone provide a link to where I can purchase the Soft Cervical Collar? I've tried 3 full face masks and 1 nasal pillow mask, and I'm still getting way too many leaks. I thought the nasal pillow mask would be a game changer for me. The seal is great, it's light weight, doesn't leave marks on my nose or face...but I can't keep my mouth closed once I reach a deep sleep. It also leaks when I sleep on my side using a regular pillow, even with my mouth closed.

I have not tried taping my mouth shut, or using a chin strap yet with the nasal pillow mask. That is next on my list.

[Julie]

The kind of pharmacy that carried other similar accessories for feet, etc. (you'd have to ask around, I'm in Canada), but I also think Cpap.com might carry them and don't believe they're expensive.

[BleepingBeauty]

BleepingBeauty - The mask you recommended, can you breathe through your nose OR your mouth with that mask?

Yes, it's considered a full-face mask (just not the "typical" type). Occasionally, I *do* breathe through my mouth, like when I'm congested, and the Hybrid suits me for that reason.

Also, can anyone provide a link to where I can purchase the Soft Cervical Collar? I've tried 3 full face masks and 1 nasal pillow mask, and I'm still getting way too many leaks. I thought the nasal pillow mask would be a game changer for me. The seal is great, it's light weight, doesn't leave marks on my nose or face...but I can't keep my mouth closed once I reach a deep sleep. It also leaks when I sleep on my side using a regular pillow, even with my mouth closed.

I have not tried taping my mouth shut, or using a chin strap yet with the nasal pillow mask. That is next on my list.

Taping your mouth or using a chinstrap are options to try. Some people hate taping their mouth; others swear by it. Same goes for chinstraps. You just have to try things to see how well you like them.

As to cervical collars, I'm sure you can find them in most any drugstore; they're usually used for a stiff neck. There are lots of options for online purchasing, too. A basic Google search: https://www.google.com/webhp?sourceid=c ... cal+collar