mask leaks

[Bennnyp]

Hi, I have been on pap for 2 months now. I cannot get my leaks under control. I have tried different masks,sizes,pillows, anything that i thought would help. I have pretty high pressures around 16 to 16.5. my leaks are around 45. My AHI on ave is 14. Should I consider lowering my pressures I'm at 16 and 20. Help.

[Pugsy]

What machine brand and model are you using?
Where are you seeing the leak number? Software??? Which software?
Or off the machine?

Please add your equipment to your profile so we can offer more specific help.

[Bennnyp]

I have updated my profile. I will post data from sleepyhead when I figure out how to

[Pugsy]

How to post screen shot images of reports
viewtopic.php?f=1&t=81072&p=737779#p737779

With pressures that high and a full face mask you are going to have extra challenges getting and keeping a seal.

Do you start out the night with leaks under control?

Please post your leak graph when you post your reports.
You can turn off the AHI graph and the mask pressure graphs in SleepyHead....they aren't needed..
just go to Preferences then graph tab and remove check marks for those 2...and leak graph should come into view.

We need to see if your numbers are high because leaks are really bad all night long or just maybe part of the night...

Have you tried mask liners?
And yes, I might try lower pressures....you might get lucky and not need quite so high pressure settings.

[Bennnyp]

http://s743.photobucket.com/user/Bennny ... e.jpg.html
http://s743.photobucket.com/user/Bennny ... f.jpg.html
http://s743.photobucket.com/user/Bennny ... 3.jpg.html

Here is my data from last night.

[Pugsy]

This report below is the only one we really need at this point.

Do you hear leaks or feel leaks when you put the mask on and turn on the machine?
Are you sleeping through all those leaks?
Have you checked your hose to make sure it doesn't have any holes anywhere?

Can you go into the clinical menu and check exactly what your settings are.
Copy them exactly from the mode...through the pressures for EPAP, IPAP and pressure support (PS) ..
The Statistics on the left don't jive with what we see (that's a SleepyHead bug).
The AHI is unreliable at this point.

So what are the settings per the machine's LCD menu? I think a pressure reduction until you can get things less leaky would be better than what we are seeing now but I can't tell what you are using now because it looks like a fixed pressure of maybe 16 and in cpap mode...not in bilevel mode..doesn't make any sense. I don't see 2 pressure lines and we should.
That's why I would like for you to go to the machine to get it exact. Either that or we can use ResScan.

[Bennnyp]

Sorry I have been using Resscan also. From my machine it is Vauto Epap 16 Ipap 24 Pressure support 0 Ti max 2 Ti min .3 I will check my hose asap. Thanks.

[Pugsy]

Okay...the PS of 0 is the culprit and it looks like EPAP doesn't want to go up ...it's staying on 16.
The machine in auto mode with these settings is more or less working like an APAP set at 16.

How about we try just a little experiment to see if leaks can be managed better and check out the settings/functions on the machine?

Leaks are massive even at 16 cm (it isn't going any higher than 16 despite the IPAP max setting...which just means it could go there)
Makes me wonder if the leaks are from somewhere in the gear. That's why I say check the hose. Since you have had similar leaks with other masks...it's unlikely the anti Asphyxia valve is stuck open.

Change your pressure settings to these..
In Auto mode
EPAP....12 cm
Pressure support...2
IPAP max....16 cm
you can leave the Ti stuff alone..I think those are the defaults and they work well for most people and aren't a factor in leaks anyway.
These are likely not optimal for your OSA but should be easier to get and keep a seal if the leak is just at the mask.
Let's worry about optimal for therapy later.
While awake you should see the machine change from EPAP 12 to IPAP 14...look to confirm.

Then I want you to mask up and turn the machine on and just use it while awake for at least 30 minutes...watch TV or read or whatever..don't go to sleep...this test is just to make sure that we get a good baseline for leak numbers.
You should be able to get a nearly flat leak line while awake because you should be able to keep the mask sealed.
Then run your software reports....if the leak line isn't flat while you were awake..the leak is somewhere in the system..either hose or somewhere else.
You should be able to have a flat line or almost flat line while awake.

Until leaks are better managed the AHI numbers are useless.

[Bennnyp]

I wore my mask for 40 minutes. 95% leak was 4.8 max was 8. I also noticed that I had 2 lines on the ipap epap. Weird I didn't get that before I looked back and it has always been 1 line. Thanks again. This community has been a life saver for me.

[Pugsy]

One last thing...make sure that mask selection choice on your machine matches your mask...so if using the Quattro...make sure it is set to full face mask.
This feature will affect the reported leak rate a little...so make sure it is correct.
Each mask type has a slightly different generic vent rate which is used for leak calculations.
It isn't a huge difference but there is a small difference.

Let's see what the report looks like tomorrow.

[Bennnyp]

http://s743.photobucket.com/user/Bennny ... sort=3&o=0

Here are last night's numbers.

[Pugsy]

Let's do a little SleepyHead bug fix....your pressure graphs are off a little. Go to Preferences then appearance tab and remove check mark from "use pixmap caching" if the check mark is there and if it isn't....put one in the box.

The leaks are still too numerous to get big excited yet but it's a start. We want the bulk of the night to be below 24 L/min or at this point I would be pleased with it if it just was close to 24 for most of the night.
When you see the green apneas...that means the machine didn't know what to call what it sensed...unknown event because leak was affecting sensors. When we see that and even larger leaks we wonder if events get totally missed.

Can you tell me what masks you have in your possession available to try and the age of those cushions?
Right now with the full face mask...even if you were mouth breathing with one of the nasal pillow masks...I don't think it could get any worse. How about we now try a different mask?

[Bennnyp]

I am currently using a quarto air in large. I have mirage quarto med and large, and also have a quarto air small. Any recommendations. All the
cushions are less than 30 days old.

[Pugsy]

Use the mask that feels the best and is easiest to seal and is the most comfortable. Do the fitting while laying down with mask on. Check all the videos for mask fitting for each one to make sure you didn't miss something.
We know with the little test last night that it can fit and with the pressure graphs last night the pressures didn't change much so we can't blame big pressure changes...so the mask is just moving around on your face.


I thought you had tried a nasal pillow mask??? Did I miss read a prior post? where you mentioned all mask types, nasal, pillow and full face??

[Bennnyp]

The only masks that I have tried are ffm. I was told by my dme that nothing else would work because I am a mouth breather and have high pressures. I can get a new mask on Friday.