Need advice regarding Dad's APAP

[porete]

It's been a long time since I posted, but I need a little help with my Dad's APAP.
Machine: PRS1 560P (Auto)
Pressure: 10-18
Mask: Resmed Quattro FX

He has yet to adjust well to the machine, but lately it has been worse. I do look at his data with Sleepyhead, but I am at the end of my knowledge, and hope that some of y'all might have some advice. The main problem is that when he goes into a deep sleep, the machine pressure climbs, and his mask leaks. This wakes him up and he can't rest. He has tried mask liners and doesn't like them. He says they make the mask leak even more. I have posted about a week of data below. An advice would be greatly appreciated!

[library lady]

I'm a relative newbie, so I don't have a lot of technical experience, but your dad's leak lines look really good to me, in fact they are better than mine. I don't think you ever completely eliminate leaks because all masks do have an intentional leak rate to eliminate rebreathing the bad stuff in the air. I use the RemZzzzs liners too, and one thing I've noticed about them is that once on, you really need to pull the edges out all the way around - the key is to make sure there are no wrinkles under the mask. It took me a little while to get used to them, The liners were a game changer for me after my first horrible week of use. The other thing about the liners that might be bothering him is the edges around the eyes... every night the cloth bothers my eyes at first, but somehow the feeling doesn't last and eventually the fabric curls outward around the mask edges, and it never keeps me awake or disturbs my sleep. I did wonder at first if I could handle that part, but I stuck with it and after a while I started ignoring it, knowing that it isn't going to keep me awake or poke my eyes once I'm asleep.

The pressures look OK to me as well... my average pressure each night is around 13.5, your dad's don't seem to be as high as mine, so that might not be a factor in the leak situation. Hopefully someone with more technical knowledge will be along to advise you on that end of it. It's possible that a different mask liner will work better for him. I tried Pad-A-Cheek liner and it was the wrong kind of fabric for me, but many people here swear by them, maybe your dad will like them better than the RemZzzzs. I'm not sure of exact web address but a google search will bring them up. I hope this helps.

[STL Mark]

Each of us face different demons when it comes to getting the masks to fit correctly. But if the leaks are keeping him awake then it is time to address it. When I was using the Quattro FX that your dad uses I found the Anti-Leak Strap helpful. It is available on the Pad A Cheek site and should be used to provide a bit more tension on the mask in a centered fashion. It feels somewhat like lightly resting your hand on the mask to remove the leaks.

On another topic he could be over tightening the mask with the headgear, it could be time to replace the cushion, another problem I had with the Quattro FX was the cushion separating from the frame and the leaks coming from that gap. The maximum pressure he goes up to at night can be set as a fixed pressure to test different mask leak solutions then the normal settings could be returned for sleeping.

[Pugsy]

It's fairly common to need more pressure during REM stage sleep...more pressure does create additional hurdles with leaks.
Large leak territory is up around 90 L/min with this machine. We would need to use Encore software to check to make sure if those pushing 85 L/min leaks are actually in large leak territory as Encore will actually flag the time spent in what it perceives as large leak.
Even if they do earn a large leak flag not much time is spent there but since they do wake him up ...even if they were tiny leaks they would need to be better controlled.

The deep sleep/REM stage sleep pressure needs might also be related to supine sleeping.

If it were my report and I was having problems with leaks waking me up I would increase the minimum pressure maybe 1 to 2 cm and see if that would better prevent those increases into higher pressure territory and thus help prevent the leaks from ever becoming a problem and causing the wake ups.
Might need APAP mode with a tight range too as it might be that the pressure changes themselves are also a factor in the wake ups.