Full face mask valve issue

[Zaiforce]

Hi all,

Thank you everyone for all your help on my previous thread, I have another issue I'd like to ask for advice on also if that is ok.

My mother is using a Philips Dreamstation BIPAP machine currently, and the last couple of nights whilst checking on her during the night I have noticed a fairly loud "clicking" noise coming from her mask.

I am pretty certain that this clicking noise is the little anti-asphyxiation valve opening and closing.

I know this valve is supposed to remain open the entire time the machine is on and only close when air supply to the mask ceases, however I am fairly certain it is opening and closing during her breathing (it's hard to see at night, but i have walked around her bed and pinpointed the noise to her mask).

The noise isn't there all the time, only sometimes, and at times it occurs in a 2-click pattern at the start and end of her inhale breath and sometimes as a 1-click pattern on each exhale.

I have done some research into it and have read that "rainout" caused by high humidity could be causing the noise, is that because water droplets may be accumulating on the little valve and weighing it down into the closed position and only when the higher force of her BIPAP inhale occurs is it being forced open causing the click?

It is hard to diagnose.

Her machine does have heated tubing from the machine but the mask tubing that connects to that is not heated.

I always have water in the humidifier tank however the past few nights it has basically used no water, only a very small amount.

I live in Australia and temperatures have been very hot and humid recently, so I am assuming that is why the machine isn't using much water.

Would turning the humidifier on the machine off fix this issue?

I have tested the mask valve by turning the machine on when she is not using it and the valve stays open the entire time the machine is on and closes when it is off, so it appears to be working correctly, and the clicking noise is not there when we first turn the machine on for her at night, it seems to develop later on throughout the night.

This morning she awoke with an extremely low oxygen saturation of 81% and I am wondering if this valve closing during treatment is the cause.

If it helps, the mask she is using is a Fisher & Paykel Evora full face mask.

Apologies for the super long post, thank you for any assistance!

[MaskedSleeper]

It sounds to me like moisture accumulation is causing the noise. After washing my equipment each week I get the same issue when I first put on the mask. If I exhale as hard as I can a few times, it pushes out the leftover water droplets and the noise stops. Perhaps have her try doing that when it's making the noise to see if it helps? If turning off the humidifier doesn't solve the issue, then the valve could be worn out and needs replacing. Best of luck.

[ChicagoGranny]

Are the machine pressures still set at 22 inhale and 10 exhale?

If it helps, the mask she is using is a Fisher & Paykel Evora full face mask.

You can put this in the Equipment Profile, and it will start showing at the end of each of your posts and comments. (Masked Sleepers comment, for example.)

[Zaiforce]

Are the machine pressures still set at 22 inhale and 10 exhale?

If it helps, the mask she is using is a Fisher & Paykel Evora full face mask.

You can put this in the Equipment Profile, and it will start showing at the end of each of your posts and comments. (Masked Sleepers comment, for example.)

Thank you

[Zaiforce]

Well, I must apologise, I was mistaken about the clicking noise being the valve in mum's mask.

Last night the clicking noise was back, so I shined a light on the front of her mask and the valve was not opening & closing, it remained open as it should.

The noise must be the water or something as suggested.

I did notice a lot of watery gurgling and spluttering/sizzling sounding noise around her mask last night, like air was being forced through water in a tight space, but the noise was not waking her.

I inspected the tubing as best as I could with a light, but could not see any condensation...

Her BIPAP machine is set on level 3 for both the humidifier & heated hosing, in Australia currently where I live it is very hot and humid in our summer, so I am guessing I should try to adjust these settings down? The machine has been using basically no water from its humidifier tray.

Are there any risks from this happening? Or is it more just the annoyance of the noise possibly waking somebody from sleep?

Thanks all!

[ChicagoGranny]

Are there any risks from this happening?

By any chance, are you overfilling the humidifier tank? Another possibility is rainout - excess condensation in the hose. Too much condensation, and the air flow might gurgle through water collected in the bends of the hose.

Humidification is primarily a comfort feature. Some of us don't even use the humidifier. I never use mine, not even in cold, dry conditions. If the nasal passages don't get dry, it's a personal choice whether to use it.

[Zaiforce]

Are there any risks from this happening?

By any chance, are you overfilling the humidifier tank? Another possibility is rainout - excess condensation in the hose. Too much condensation, and the air flow might gurgle through water collected in the bends of the hose.

Humidification is primarily a comfort feature. Some of us don't even use the humidifier. I never use mine, not even in cold, dry conditions. If the nasal passages don't get dry, it's a personal choice whether to use it.

I thought I may have been overfilling it also (even though I stay below the max line), so I tipped it out before last night and only filled it until halfway to the max line.

Thank you for the info , it's not waking mum up (she is a very heavy sleeper), so I guess I will just leave it for now.

It's weird that water is getting in there though as there is no water being used from the humidifier tray and I can't see any droplets in the tubing, could it be perhaps that she is drooling into the mask from the jaw drop? (sorry about that visual...)

[ozij]

My mother is using a Philips Dreamstation BIPAP machine currently, and the last couple of nights whilst checking on her during the night I have noticed a fairly loud "clicking" noise coming from her mask.

I am pretty certain that this clicking noise is the little anti-asphyxiation valve opening and closing.

I know this valve is supposed to remain open the entire time the machine is on and only close when air supply to the mask ceases, however I am fairly certain it is opening and closing during her breathing (it's hard to see at night, but i have walked around her bed and pinpointed the noise to her mask).

Edit: the following post, by Tec5 made me realize that valves may function differently in different mask - so I erased my previous response.

I was a hasty, thinking of the masks I have used, the Evora FFM not being one of them.

Whichever the mask, the silicone leaf / leaves should leave an opening to room air when there is no pressure, and should respond to pressuring by closing that opening.

Machines with auto start and / or auto stop on will stop working when encountering massive leaks.

Given the leaks you're reporting, you may want to make sure the machine does not turn off automatically.

[Tec5]

Perhaps Z's confusion is somewhat along the lines of 'what is open and what is shut'

At least for my FFM masks the AA valves are open to allow air to pass through the valve assembly to the mask cushion when the machine is providing air.
BUT, the little silicone leafs simultanously close the ports to the outside when the machine is running.

So, it could understandable that closed/open can be easily confused as it depends.

Now, I can only speak from my experience but:
When the machine is running providing air flow, the little silicone leafs are almost vertical, when the machine is not providing air flow these leafs are more horizontal.

The little silicone leafs should be always in one position or the other, and not pulsing or vibrating.

Maybe that (nearly vertical or nearly horizontal) will help Z's understanding.

Just a suggestion

* some masks have only one silicone leaf or flap