Quick question on mask leak

[FreeIndeed]

I've been trying different masks and sizes to get one that doesn't leak without pulling the straps super tight. I haven't had much luck, but I've had two nights of weird data. My leak rate has gone super high, up to about 66, but my AHI went from 60+ down to 10. IS the AHI changing real? What I mean is, did it actually go to 10, or is the data corrupted by the excessive mask leak?

[BleepingBeauty]

Sorry you're having issues. But yes, when the leak is really high, the data is suspect and shouldn't be relied upon. The machine can't accurately score events when the leak is high.

Properly fitting a mask is the most challenging part of the process for most (if not all) of us. You may just have a mask that's wrong for your face/head. I'm not familiar with your particular mask, but a general rule of thumb is: The straps should be loose enough that the mask seal can inflate properly under pressure, but not so loose that you have leaks. It's important to do your fitting while lying down at your maximum pressure, and try to relax your face as if you were sleeping.

Hope that helps.

[Pugsy]

With the ResMed machines if you spend much time over 30 L/min the leaks are potentially bad enough to affect the machines ability to sense and record apnea events. If the leak is over 40 L/min the machine is pretty much clueless as to what is going on and you could be having a gazillion apnea events and the machine totally misses them.
There's no way to know for sure if you didn't have any events because you didn't have any or if the machine just was clueless when big leaks like that are present. For someone who is having a high AHI otherwise and nothing show up during big leaks...my bet is on the machine totally missing the events.

[FreeIndeed]

Thanks for that information. I'm getting pretty frustrated trying to get a mask that seals without over-tightening. I started with the Resmed Airfit F10 full face in medium, but I couldn't get it to stop leaking at the bridge of my nose. So, they gave me a Resmed Mirage Quattro which didn't seal any better AND was much less user friendly. So, then I went to the Airfit F10 in a small, which is what I've been using. I have been sitting up and trying to get it to seal using t5he mask fit feature of the REsmed S9 autoset. I eventually get it to stop leaking by tightening the strap very tightly, but then I still end up with a leak rate of 66. Bummer. The DME told me to give the masks a longer shot, so I will, but I'm thinking the end solution might be to try the Resmed mirage liberty, which is a full face that only goes around your mouth - and has two nasal prongs for the nose instead of one big cup. I seem to have all my problems with leakage at the bridge of the nose, so maybe i can eliminate it. I'm just getting frustrated....

[Pugsy]

Go try the Liberty....it's painfully obvious that these other masks aren't working out. Don't waste anymore time.

Also, you can't fit a mask while sitting up....you need to do it laying down for the final fitting. You whole face changes when you lay down.

At this point I will tell you what I have told others whose leak was in the 40s to 60 and more with the S9 machine.....nasal pillows and mouth breathing wouldn't give leaks that bad because at least some of the time the mouth would be closed.

Did I ask you in your other thread to make sure there weren't any holes in your hose?? I think I did but just in case I didn't...look for holes somewhere that there shouldn't be holes.

[library lady]

Mask liners are used by many here on the forum. They can protect the face from irritation, but they are also good for eliminating leaks. I use the F10 with liners, and they come up around the top of the nose bridge to stop that leaking into your eyes. I couldn't find another way to control the leaks during my first rotten week of cpap 5 months ago. No one had told me about them and I only learned of them after I came here for help ... they were a game changer for me! If you haven't tried them, that might be the place to start before you go looking for other masks. Cheaper if you can get by with liners. RemZzzzs are what I use, they are available online from our forum sponsors, https://www.cpap.com, and most DMEs also carry them. Alternatively, there a Pad-A-Cheek liners that Karen, a member here, makes, available at http://www.padacheek.com. Many of the forum users like those better, I've tried them both but the RemZzzzs are better for me. Some many are even making their own liners from old t-shirts, and that is something I've also started doing - so I actually have both on hand.

[SandysSpot]

Also find out how long you've got with your supplier for mask exchanges. I've found the "give it a week or more" was eating into my 30 days time limit so I kept pushing to switch out sooner rather than later.

[FreeIndeed]

Well, last night I gave up on the F10 small size and went back to medium. Like I mentioned before, it all comes down to air leaks at the bridge of my nose. I did fit the mask while lying down this time and that did make a world of difference. It was easier to get the mask to puff up and seal off (except for the dang nose bridge). So, I ended up with a leak rate of 7 last night, which is great! Thanks for the advice! However, my AHI was back up to 71. I'll llook int the pads since the F10 seems to be really close to what I need. Maybe try the liberty.... And then press the DME/doc to give me another pressure.

[Pugsy]

Well....if the leak rate was only 7 and the AHI was 71.....something else is going on in terms of therapy.
Can you get us the AHI breakdown into event categories please? Maybe get us a screen shot of last night's nightly detailed report showing AHI breakdown and the events graph along with flow rate, pressure and leak graph.

[palerider]

Well, last night I gave up on the F10 small size and went back to medium. Like I mentioned before, it all comes down to air leaks at the bridge of my nose.

here's something I've heard of, but, never actually seen, or tried, or anything, but given how much trouble you've had, it *might* be worth a try... http://www.cpapseal.com/

[FreeIndeed]

Here's last nights' data. The breaks are weird. I did have issues in the middle of the night getting it going again after going to the restroom. I've been doing leak test each time. Let me know if there's a different timeline you want to see.

[Pugsy]

Could you please show these graphs along with the AHI stuff on the left that you already show?
Events (like you have)
Flow rate
Pressure...this one is especially important.
Leak

Did you wake up at 2:45 for about an hour?

Don't need AHI graph or mask pressure graph or those others that you have included above. You can turn those off in Preferences/graphs by removing the check mark and it will allow the leak graph to move up so you can get pretty much everything in one screen shot.
So that it looks like this one.

[Pugsy]

One other graph I would like to see...the flow limitation graph.

The report says you are using cpap mode at 13 cm with EPR at 3. I suspect you either need to increase the 13 cm at least 2 or 3 cm or reduce EPR to 1 or turn it off. If you want to continue with cpap mode.
Or you could switch over to apap mode and set the minimum to 13 and max to 20 and let's see where it wants to go.....if you feel comfortable doing that yourself.

Your pressure isn't doing a good job holding the airway open....need more pressure...snores are ugly...I suspect the flow limitation graph will also be ugly. It's primarily OAs...so not centrals which was a concern until saw the report.
I don't know how much more pressure you need but I suspect it is a significant amount.
Did you have a titration study in a sleep lab to come up with the 13cm pressure?

If you aren't comfortable making changes to the settings yourself then you need to get with your doctor because these settings as they are now aren't working and won't work no matter how much time you give it.

[FreeIndeed]

Like this?

[FreeIndeed]

With flow limitation: