Help: mask is tight, but leak is high 48 L/min

[jinroh]

I was using Respironics ComfortGel Full Mask for the first 6 nights. Average Leak is 58.4 L/min, the average AHI = 11.6
I thought it's the problem with mask, so I went to DME yesterday, got a ResMed Mirage Liberty hybrid mask (small)

Last night's average leak is 48.9 L/min, AHI = 9.3.

And I was using BiPAP watching TV for half hour before sleep. The Encore report last night (see below), even for the first half hour, shows the leak ~45 L/min. That's when I was awake, and I know the mask was tight.

So I don't know what to do. I know the mask is tight, and DME technician confirms that too. Leak is high (even for 18/14 pressure), and AHI is still high.

last night report:

[Julie]

Loosen the mask. When you tighten it, you can create leaks in places other than where you think the original one was because your face moves and changes in tiny bits all the time. You tighten in one place, another will compensate, and your purpose will be defeated.

[Guest]

From the Liberty manual, leak rates will be between 41 - 48 liters/min for pressures of 12-16 cm H2O.

[LinkC]

45 sounds like normal venting to me. Why do you think that's high leakage?

I'd look elsewhere for the cause of the higher AHIs.

[jinroh]

You guys are right. I just checked Liberty's manual, The flow is 48 L/min on pressure of 16 cmH2O. So my AHI problem is not caused by leak.

Who should I talk to now? My family doc, or DME tech? or sleep doc? My family doc wrote the prescription, the only time I saw sleep doc's name is on sleep study report.

Sorry for the newbie question, after all these troubles, I just want to make it work.

[Wulfman]

Since you apparently have the software, you can (probably) make this work without bringing the doctors into it. They usually don't know diddly squat about the machine settings. (and your machine has a lot of options)
If you don't have the Provider Setup manual for that machine, say the word and it can be sent to you.
Take control of your own therapy.


Den

[pagebypage]

I was using Respironics ComfortGel Full Mask for the first 6 nights. Average Leak is 58.4 L/min, the average AHI = 11.6
I thought it's the problem with mask, so I went to DME yesterday, got a ResMed Mirage Liberty hybrid mask (small)

Last night's average leak is 48.9 L/min, AHI = 9.3.

And I was using BiPAP watching TV for half hour before sleep. The Encore report last night (see below), even for the first half hour, shows the leak ~45 L/min. That's when I was awake, and I know the mask was tight.

So I don't know what to do. I know the mask is tight, and DME technician confirms that too. Leak is high (even for 18/14 pressure), and AHI is still high.

last night report:

My sleep tech says leaks around the mouth are no biggy. If you have the Liberty, as I do, and you hear the leaks around the pillows, you need to adjust your straps or use a different size pillow. I am able to use either medium or large pillows on a small mask with no problem, but when I was on the Swift Lt, only the medium pillows worked for me; large pillows leaked a lot. The problem I found with the Liberty is that when the cushion fits my mouth the pillows don't reach high enough to seal at my nose. If this is your problem, try using a safety pin to tighten up the strap across the top of the head and loosen the other straps. I see that the newer issues of this model have made some improvements over my older one, so I don't know if they have finally made a headgear with velcro across the top. Since this fix the Liberty has become my primary mask with virtually no leakage.

[jinroh]

Since you apparently have the software, you can (probably) make this work without bringing the doctors into it. They usually don't know diddly squat about the machine settings. (and your machine has a lot of options)
If you don't have the Provider Setup manual for that machine, say the word and it can be sent to you.
Take control of your own therapy.


Den

Hi Wulfman, are you suggesting I change some machine settings? I can access the provider setup manual. Could you be more specific what kind of setting I should experiment with? Thank you.

In the provider mode, I can see these options: therapy mode (bilevel/auto bilevel), ipap, epap, max ipap, min epap, max press up, bi-flex setting, rise comfort, ramp time, ramp start pres, mask alert, auto off, split night time, show ahi/leak, patient reminder.

[Wulfman]

Since you apparently have the software, you can (probably) make this work without bringing the doctors into it. They usually don't know diddly squat about the machine settings. (and your machine has a lot of options)
If you don't have the Provider Setup manual for that machine, say the word and it can be sent to you.
Take control of your own therapy.


Den

Hi Wulfman, are you suggesting I change some machine settings? I can access the provider setup manual. Could you be more specific what kind of setting I should experiment with? Thank you.

In the provider mode, I can see these options: therapy mode (bilevel/auto bilevel), ipap, epap, max ipap, min epap, max press up, bi-flex setting, rise comfort, ramp time, ramp start pres, mask alert, auto off, split night time, show ahi/leak, patient reminder.

IF you "need" to. It's your machine and your therapy.

It all depends on how your machine is currently configured and whether you're having any issues with that configuration.
Depending on how long you've been on this machine and therapy, with an average AHI greater than 5.0, you probably have some room for improvement.

Many of those options/settings.....can affect therapy results.


Den

[snoreking]

For what it's worth, my doctor used a default mode of 10 for my original setting, on the theory that the DME would adjust it after reading a few months worth of results. My AHI came in at around 9. After a week, I raised my pressure setting to 12, and my AHI dropped to an average of 1.1. There it has stayed for a decade. Now I am on a apap and the range is set with a minimum of 10, and a max of 16.5. Ocasionally I hit 15, but the average nightly pressure is 13.4, and the AHI still always ranges from .5 to 1.5, with the average, still, around 1.1. Leak rate is 50ish, and snore rate sometimes a little high, depending on how much wine I've had that night, but all are fully acceptable even when they are at their worst.

[jinroh]

For what it's worth, my doctor used a default mode of 10 for my original setting, on the theory that the DME would adjust it after reading a few months worth of results. My AHI came in at around 9. After a week, I raised my pressure setting to 12, and my AHI dropped to an average of 1.1. There it has stayed for a decade. Now I am on a apap and the range is set with a minimum of 10, and a max of 16.5. Ocasionally I hit 15, but the average nightly pressure is 13.4, and the AHI still always ranges from .5 to 1.5, with the average, still, around 1.1. Leak rate is 50ish, and snore rate sometimes a little high, depending on how much wine I've had that night, but all are fully acceptable even when they are at their worst.

Thank you snoreking. You gave me some idea where to start.

It all depends on how your machine is currently configured and whether you're having any issues with that configuration.
Depending on how long you've been on this machine and therapy, with an average AHI greater than 5.0, you probably have some room for improvement.

Many of those options/settings.....can affect therapy results.
Den

Thank you Den. I plan to buy an oximeter then starting my own "semi-titration" experiment.

[LinkC]

I would strongly "suggest" that you change the settings ONLY when you know what you're doing and have sufficient data to back you up.

Making changes willy-nilly goes against everything this board is about, and is a risk none (OK.."few") of us here would assume for ourselves, let alone advise for others. Having the software and manual is a good start...but it's ONLY a start. A firm understanding of what you are changing and why is also required.