New User- possible mask problem?

[justme77002]

Hi All,

I just had my first night with new machine- resmed s9 auto and mirage quatro mask. everything is fine until the pressure gets up to around 10 or so. when that happens my cheeks start fluttering in the wind which of course wakes me up. It seems my mask is leaking at this pressure. I found some info on properly adjusting the mask with the mask fit feature and will try that this afternoon.

there are the numbers from the data card

Details Most Recent Last 7 Days Last 30 Days Last 6 months Last Year
AHI 4.63 4.63 4.63 4.63 4.63
Hours per Night 07:46 07:46 07:46 07:46 07:46
Average Pressure 6.82 6.82 6.82 6.82 6.82
95% Pressure 13.06 13.06 13.06 13.06 13.06
Average Leaks 3.58 3.58 3.58 3.58 3.58
95% Leaks 18.00 18.00 18.00 18.00 18.00

what is the differnce between average leaks and 95% leaks?

i did a home sleep study that showed ahi of 81 and o2 desat of 53%

my question- does the above description indeed sound like a mask adjustment issue? im also concerned that i may need a medium instead of a large. after looking at the sizing diagram on the mask package i think im within less than 1/8 inch between medium and large.

[Pugsy]

what is the differnce between average leaks and 95% leaks?

Average is a median average I think.
95% number means that for 95% of the time you were AT OR BELOW that number. People tend to forget the ''or Below" part.
ResMed's line in the sand leak number to avoid is 24 L/min.

I suspect if you actually look at the leak graph most of the time you were probably well below even the 18 L/min line so leaks aren't likely high enough and long enough to impact therapy all that much.
BUT...if they are waking you up and impacting your sleep then they need to be worked on for that reason.
Anything that disrupts sleep needs to be worked on and mask fit and comfort are high on the list of culprits for disturbing sleep.

First few nights can be really rough. If you can't get the mask comfortable...don't spend a month trying...give it a few nights and then think about a different size or maybe a different mask entirely.

[justme77002]

I actually had a chance for a nap today so off I went. Followed some online instructions to readjust the mask and was able to get about a 1.5 hr nap till about 5pm. I did wake up a few times but messed With the straps and zoned back out. I'm still having an issue with fluttering chipmunk cheeks but have been making an effort to keep younger at roof of mouth. That seems to help a bit. Tonight will be a new night.

Will check back in the morning

[justme77002]

last night a bit better. only woke up two or three times. still feel a bit tired but not exhausted so i guess thats a plus! didnt seem to have major leakes till about 730 this mornign so i git up instead of fighting it.

[JohnO]

My plan was to accept 3-4 really lousy nights when I first started 43 days ago. The first three were pretty rough, just getting used to the machine, the mask, the hose, etc.

On the third night I went to bed a little early, which still feeling sharp, and re-fit my mask - first, while standing in front of the mirror, then, I re-adjusted while laying in bed. I ended up fixing most of my leaks that way.

Good Luck!

John

[justme77002]

still struggling a bit with leaks, Ive ended up cinching the straps way down to what i would consider tight. i can however still get two fingers behind the straps. according to software ahi is still between 5 and 7 most nights and im not really waking up refreshed.

does this still sound like an adjustment period?

[JohnO]

still struggling a bit with leaks, Ive ended up cinching the straps way down to what i would consider tight. i can however still get two fingers behind the straps. according to software ahi is still between 5 and 7 most nights and im not really waking up refreshed.

does this still sound like an adjustment period?

If you pull the mask away from your face, do you have marks where the silicone touches your face? How long do they last? I'm trying to gauge how tight the mask is.

On your base note you mentioned that maybe a smaller mask might work better. Any more thought of trying that?

Another option that folks seem to like are the mask liners such as these: http://www.padacheek.com/PAC_Maskliners.html

I switched to a nasal pillow mask a couple of weeks ago, and that works better for me.

Good Luck!

John

[justme77002]

If there are marks they are gone by time I put glasses on. It is just a bit uncomfortable,much like wearing a hard hat if you ever have. The uncomfortable part is feeling the plastic frame.

I did try a medium but it leaked every time I moved. I still have it so may give it another shot.as for the liner, I made one out of an old bandanna but it caused more leaks as well. I'm still sleeping with mouth open so not sure nasal pillow will work

[Pugsy]

according to software ahi is still between 5 and 7 most nights and im not really waking up refreshed.

What is the event category breakdown? What makes up that AHI? 5 to 7 is a little higher than we would like to see.
Are you waking often during the night fiddling with the mask? If so, not much chance of waking refreshed due to the awakenings. Perhaps try a different type of full face mask?
Could you post an image of one of your daily detailed reports? It would help us if we could see what you are seeing.
Maybe we can spot something.

How to post image? This thread talks about it if you don't know how.
viewtopic.php?f=1&t=81072&p=737779#p737779

[justme77002]

last night was a bit better on the ahi. i went back to try the medium mask and tightened the straps a bit. still had some high pressure leaking early morning that i could only stop by removing the hose till the machine shut off.i believe the below may be what you are asking for, this is from last night.

thanks for your help

Channel Min Med 95% Max
PressurePressure (cmH20)
W-Avg: 10.29 5.00 10.76 13.30 15.76
EPAPExpiratory Pressure (cmH20)
W-Avg: 9.29 4.00 9.76 12.30 14.76
Minute Vent.Minute Ventilation (L/min)
W-Avg: 7.98 1.25 7.62 10.75 18.88
Resp. RateRespiratory Rate (breaths/min)
W-Avg: 14.52 4.60 14.20 18.80 27.80
Flow LimitFlow Limit Graph (0-1)
W-Avg: 0.04 0.00 0.00 0.22 0.52
LeaksLeak Rate (L/min)
W-Avg: 9.04 0.00 7.20 20.40 31.20
SnoreSnore (unknown)
W-Avg: 0.10 0.00 0.08 0.22 0.76
Insp TimeInspiratory Time (seconds)
W-Avg: 1.97 0.38 1.82 2.96 5.51
Exp TimeExpiratory Time (seconds)
W-Avg: 2.35 0.04 2.34 3.06 4.14
Tidal VolumeTidal Volume (ml)
W-Avg: 556.90 60.00 520.00 840.00 1340.00

[Pugsy]

No, I was wondering what the AHI break down was..that would be the colored bars above the numbers data you posted.
How much was the Clear Airway index? Hyponea Index? and Obstructive Index....those things make up the AHI.

[justme77002]

it appears mac doesnt have the win7 snipping tool!


ResMed
S9 AutoSet
Mode: APAP 5-16.4cmH2O
Date Sleep Wake Hours
9/21/12 21:25 07:12 09:21:05
AHIApnea / Hypopnea Index 5.24
HypopneaHypopnea 2.03
ApneaUnspecified Apnea 0.00
ObstructiveObstructive Apnea 2.78
Clear AirwayClear Airway Apnea 0.43

Event Breakdown


Mode: APAP 5-16.4cmH2O
Date Sleep Wake Hours
9/23/12 00:00 06:36 06:35:06
AHIApnea / Hypopnea Index 2.89
HypopneaHypopnea 1.52
ApneaUnspecified Apnea 0.00
ObstructiveObstructive Apnea 1.06
Clear AirwayClear Airway Apnea 0.30

Event Breakdown

[Pugsy]

Sorry, didn't realize you were using a Mac.
Your AHI for this last report is great. Less than 5.
And the prior night with AHI 5.24 showed me what I was wondering about...the clear airway index (centrals) not a real factor.

If you start staying consistently below 5 AHI...things are settling in good.

Mac's have a different way to take screen shots. I don't have a Mac so I am zero help there.
If you figure out how to take a screen shot then all you have to do is save it as a jpg file..then the rest of the instructions will work.

[justme77002]

i think i will stick with the medium mask for a few days. can you tell me why there is that high pressure leak early in the am that blows my cheeks about and leaks out the sides?