Leaks! Frustrated!

[Hexfly]

Hello,

I started off CPAP a month ago using the Resmed Quattro FX in small. Nice mask....but when my pressure went to max 15, it would blow the seal (according to sleepyhead) some nights. When I test it before bed, I try all positions I sleep (back and side)...and can tell by moving the muscles in my face, I can cause a leak.

So I got a Resmed Mirage Quattro in medium. This mask felt so much more secure and comfortable to me. But alas, leaks again when pressure goes to 15. So frustrating since I hear these are the best masks.

I tried the remzzz liners and that seems to cuase the mask to leak worse!!!

Any ideas to try or new masks to try? I am kind of at a loss.

[Pugsy]

Have you tried using the max pressure of 15 at your bedtime for max fitting and thus anticipating the higher pressure needs and try to compensate for it ahead of time?
You may be doing this already but it was unclear from what you said if you were prefitting at the higher pressure or the auto minimum (whatever it might be).

[Hexfly]

Hi Pugsy,

Yes, I use the mast fit feature on the Resmed Autosense before bed to determine leaks. I notice when I move my face, I can get a small leak. It must be when I am moving around in my sleep. I also notice that most of my leaks are between when I fall asleep and midnight......then less leaks throughout night. Maybe I don't move around as much later in the night. I dunno. At a loss....

[Pugsy]

Are the leaks disturbing your sleep? Waking you up often? Any leak that wakes us up needs to be fixed no matter the size because anything that disturbs sleep is unwanted.

Or are you seeing large leaks being reported on your software reports and you are worrying about them because of the report? If this is the case just how much leak are we talking about here and for how long?
If you are sleeping through the leaks then I would maybe try to decide if the leaks are bad enough and prolonged enough to be seriously impacting therapy in a negative way. This is where I try to evaluate just how bad/big the excess leak is/was and how long it lasted.
If you are using SleepyHead and going by the little warning "you had significant leaks last night" then I would instead evaluate the leak graph itself. Often SH makes leaks out to be a lot worse than they really were.

[Hexfly]

Thanks, Pugsy.

I do not ever wake due to the leaking. I just see it either from resmed (if its really bad) or sleepyhead. I had a really bad leak night the night before but last night wasnt bad. Anyway...

My averages from sleepyhead are(last 30 days):

Average leak rate: 11.72
% of time above threshhold : 9.81%

But then I have days where it is has been:

Average leak rate: 17.46
% of time above threshhold : 24.16%

Not sure what all this means...

[Pugsy]

Ahhh....the threshold is 24 L/min but going over it slightly isn't nearly as bad as going way over it.
Give me a little while to go find some leak explanation that might help you understand what you are seeing on the graphs.
Or if you could post one of your leak graphs I could explain it.
But I have some examples that might ease your mind a bit....just let me go find them. Threads and previous discussions where large leaks were evaluated.

It all depends on how far you go over the 24 L/min line and how long you stay there and the fact that your % of time over 24 L/min isn't horribly high and your average leak isn't horribly high and you are sleeping soundly without the leaks waking you up.....I wouldn't worry about that little bit of large leak if it were me.
Good sound sleep is more important than having a "perfect" leak line report. The machine actually does a fairly decent job of reporting and responding up to around 35 L/min...and while not ideal it doesn't mean that the therapy is totally in the toilet when you go over 24 L/min and even if it did/was in the toilet briefly you didn't spend all that long there so it isn't the end of the world.
10 % of the night over 24 L/min on a 7 hour night isn't the end of the world and I am betting that the leak line is sporadic when it is over 24 L/min anyway.

ResMed will give you a smiley face for mask fit up to 30% of the time being over 24 L/min.
Give me a little bit to find those old threads.

[Pugsy]

My usual large leak thread has broken links for some reason so I found this one.
viewtopic.php?f=1&t=76445&p=698087&hili ... ne#p698087
if it takes you to the bottom of the page just scroll up to my first post at the top.

also look here at my posts number 3 and 4 from the top
viewtopic/t88983/Pugsys-PointersSleepyH ... nding.html

If you want specific evaluation of your leak line graph then we need to see what you are seeing because just the numbers don't tell a clear story.
How to post images is explained here if you don't know how...
https://sleep.tnet.com/reference/tips/imgur

and a thread with some examples as well as some how to hints
viewtopic/t103468/Need-help-with-screen-shots.html

In general unless you spend a lot of time over 35 L/min leak line then I don't know that I would worry so much about your software telling you that you experienced "significant time in large leak"...SleepyHead makes it out to be a lot worse than it is and has told me that 5% of the time was in "major leak" when in reality I spent only a short time above 24 L/min and nothing above 35 L/min.

Sometimes we just make a little compromise in what we find is "acceptable" even if not ideal because good sleep and feeling decent is the primary goal and not so much perfect numbers. While I don't necessarily go along with ResMed's 30% line in the sand....I don't give any % less than 10% more than a second glance.
I could get a perfect leak line but to do so would mean that I would have to use external methods (like a chin strap or really tighten the mask because I wear mine really loose) but then I most likely would experience discomfort and the discomfort would either wake me up or affect ability to go to sleep and I am unwilling to do that just to fix a short period of large leak. In other words it would affect my sleep all night vs maybe just the short period of large leak that I sleep through anyway. I accept less than perfection as long as the time that is less than perfect isn't horribly prolonged. Up to you what you want to accept but if the worse you see is well under 30% of the night....it isn't the end of the world.

[Hexfly]

Wow! Thanks so much, Pugsy. That makes me feel a lot better. I will read through your threads when I get home tonight.

Overall, I would say the CPAP therapy has been really beneficial. I used to have reflux and IBS symptoms that have comepletely gone away. I sleep better of course. SO I am happy with things, I just want to make sure I am getting the full benefit.

Thanks again, Pugsy for the informative reply. I will read thru the rest of the threads when I get home.

[Pugsy]

FWIW I rarely have nights where I don't go into large leak for at least a short period of time. Now whether it is a little of mouth breathing (possible since I use a nasal pillow mask) or just the mask getting loose and breaking the seal since I wear it really loose...I don't know exactly what might be happening but I have elected to not worry about those less than perfect times. I used to worry about it but I learned years ago that I felt the same no matter if the leak line was perfect or not as long as I slept well. Sleep for me is precious. I have some arthritis issues that mess with my sleep. I do the best I can to minimize that impact and reduce awakenings as much as I can because I know that multiple awakenings are far more destructive to my overall well being than 30 minutes in big leak might be. I have done the things that are needed to get that perfect leak line and while not horrible to do I found that they also disrupted my sleep and the benefits simply weren't there to make it worthwhile to go to extraordinary efforts to get a "perfect" leak line.

My personal line in the sand in terms of percent of time in large leak is 10%...If the time is less than that I don't even bother looking further. If it is above that then I look to see just how far I might have gone...and I make mental note of it and then I wait to see if it happens again frequently. If it does then maybe it is time to bring out new nasal pillows as these might be getting tired. If it doesn't repeat I shrug my shoulders and move on.