Progressive Mask Leak

[rkadams]

Hi Folks. This problem concerns a progressive mask leak, and the progression is overnight. Specifically, when I first put the mask on at night, it fits comfortably and without any leaks at all. Almost always, at some point in the night, I wake with the wind tunnel noise that signifies a major leak, and only by pressing directly on the mask, or really tightening the straps, can I stop this. It's as if the flow has increased substantially through the night to the point that it unseats the mask seal. Needless to say, this hardly makes for a good night's sleep.

I use:
-Remstar Auto, with C-Flex; using the C-Flex setting at 2.
-Humidify at a 4 setting.
-Auto pressure setting between 4 and 15.
-Fisher Paykel model 431 full face mask (which I find comfortable to wear).

When I first got my machine several months ago, I experienced this from the get go, and returned my machine for a warrantly replacement, however this is obviously nothing to do with a machine malfunction as the replacement machine does exactly the same thing.

Could it be a programming error on the part of the Remstar designers, i.e., the machine doesn't respond correctly to unobstructed breathing after a severe apnea episode; not recognizing the changed breathing pattern, etc? Or perhaps I haven't set it correctly myself (I tend to play with the settings, although this problem seems to occur no matter what I set it to)?

Any advice or experiences with this issue you can post will be appreciated.

Regards

Roger

[snoregirl]

While I am by no means an expert a couple things come to mind.

You are starting at 4, that in itself would bother me but if you can breath -- fine.

You are adjusting your mask for a night's sleep at 4 which is where your machine is starting. You need to make sure you adjust the for 15, while it is blowing 15. That is a big difference in pressure from 4.

What is your titrated pressure and why are you set from 4 - 15?

You would probably be better off +/- 2 from your titrated pressure.

I am titrated at 13 and use 10 - 15.

If you really need to keep 15 as an upper limit on pressure....
Try starting your machine and getting a good seal while awake at 15. This may require you to reprogram you machine to CPAP or CFLE 15 to get an idea about how your mask needs to be to handle 15.

Then reprogram your machine to APAP whatever range you want. I would suggest narrowing it around the titration pressure in your sleep study.
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CPAPopedia Keywords Contained In This Post (Click For Definition): humidifier, Titration, CPAP, seal, APAP

[Guest]

Ditto, minum pressure is set too low. You cannot possibly check for leaks at that low pressure.

[OwlCreekObserver]

I have tried the F&P 432, similar to your mask, at a constant pressure of 11 (with C-Flex) and have never been able to keep a good seal. I start off fine, but as the muscles in my face relax and my jaw does whatever it does, the F&P begins its "burping" routine. The only way I have been able to get it even close to acceptable is to REALLY tighten it down, and then I wake up frequently during the night because the thing is so uncomfortable.

I'm not saying it's a bad mask design, but that it's just further proof that even the best masks aren't suited to everyone. My hunch is that there is no problem with your Respironics machine, but that you may have better results with another mask.

OCO

[tooly125]

You are adjusting your mask for a night's sleep at 4 which is where your machine is starting. You need to make sure you adjust the for 15, while it is blowing 15. That is a big difference in pressure from 4.

I think snorgirl hit the nail on the head.
The only things I can add is that I used to wear the F&P431 at a pressure of 19 and was able to achieve a leak free fit. The mask was tight but not unbearable.

Also do you know what position you are in when you get the leaks?
If they always happen when you are on your side make sure that is the position you adjust the mask to while you are awake.

[bdp522]

Just an idea, but...if your humidifier is on 4, too much moisture could be making the mask slide. I have had a cold for the last week and using the HH on 4. In the morning my face is damp. NOT rainout, just enough to make the mask slide a bit. The Aussie hose helps but it is still a bit too much moisture. I usually keep the HH on 3 and have no problems.

Brenda

[snoregirl]

BDP

That crossed my mind too. I use 3 at most on the humidifier.

[rested gal]

Almost always, at some point in the night, I wake with the wind tunnel noise that signifies a major leak, and only by pressing directly on the mask, or really tightening the straps, can I stop this.

Roger, I agree with the others who suggested raising the minimum pressure some (or a lot.)

If you would rather keep your minimum pressure down at 4 where you have it now, then I agree with those who said you might want to get the mask adjusted while temporarily setting the machine for a much higher pressure -- 15 or close to it.

You mentioned that "pressing directly on the mask" will stop the blowouts. You might try adding a homemade strap around the front of the mask, tied behind your head. Might need to add some stick-on velcro "spots" on the front of the mask to keep a homemade strap from sliding up or down on the slick plastic shell of the mask.

I read about one guy using an old chin strap around the front of his FF mask. Any kind of homemade strap would do...probably wouldn't have to be particularly tight. Just enough to give the mask that little bit of extra push against the face -- the way your hand can lightly push the front of the mask to get a little better seal.

[Guest]

Thank you all for your really helpful suggestions. It appears that the most likely reason is the settings of the machine as several of you stated, and I have made the adjustments you have suggested; pressure setting at 11-15, and lowering the humidity setting to 2. I have adjusted the mask harness so that there are no leaks at these pressures, and fortunately the harness seems robust enough to maintain this through the night. Time will tell if these changes will do the trick but my gut tells me they will.

Although it's now moot with the new settings, I am still a little bit curious though, why the machine would not self adjust (with the old settings) when I woke up, after all my breathing would then have been as far away as possible from apnea like, so why did it continue to pump out full flow, high pressure air no matter how long I waited? This is really what made me think that there was either a machine, or programming fault.

Thanks again and sweet dreams.

Roger

[BlueHairBob]

I had the same experience and concerns with my M Series Auto. It would crank way up in the middle of teh night and would not come back down. I set my machine for a constant CPAP and disabled teh auto until I get it figured out. But there must be an answer,

[TXKajun]

Hmmmmm, don't know about your brand of APAP, but my PB 420E has a feature called IFL1 that can be disabled. That took care of runaway pressures for me. Maybe check and see if your machine has a similar feature? Otherwise, the suggestions about adjusting the mask at higher pressures sounds really good.

Kajun

This therapy WORKS!!!

[Somnambulist]

I am still a little bit curious though, why the machine would not self adjust (with the old settings) when I woke up, ...why did it continue to pump out full flow, high pressure air no matter how long I waited?

I wonder if maybe the machine is trying to compensate for the leak with the higher pressure? Or is it not returning to a more "normal" pressure even after you have resolved the leak?