OCD about mask fit?

[Nate]

I have recently been diagnosed with severe sleep apnea and have a few questions I'm hoping the forum can help me with.

I received my CPAP this past Thursday, and I've used it for each of the past 5 nights with no compliance issues. I'm running a S9 Elite with H5i, Resmed Quattro large, 15 pressure and 3.5 humidity. I've downloaded ResScan and Sleepyhead, and I think my numbers look good. I feel like I'm tolerating the mask fairly well, but I am having some leaks and fitting irritation. Being really new to this, I'd like some confirmation. Here are stats from the last five nights:





Leak Graph from Monday


Overall I feel like I'm adapting very well, but I might be getting a little OCD with my mask fit and looking at my numbers. I'm having some leaking around my nose/eye area, and fully expect to see bad numbers when I pull up the previous nights data. Based on the data I'm not sure I can expect much better results. Should I consider this a good seal and move on?

[BlackSpinner]

If you were going to run a marathon, would you be "OCD" about your shoes fitting? Of course you would.

You wear this mask every night for 7-9 hours. It is one of the most important parts of your therapy. Leaks, discomfort will all affect the quality of your sleep.

[Nate]

If you were going to run a marathon, would you be "OCD" about your shoes fitting? Of course you would.

You wear this mask every night for 7-9 hours. It is one of the most important parts of your therapy. Leaks, discomfort will all affect the quality of your sleep.

My concern is that I don't know what I should expect, perfection and fitting well are two different objectives. I think my numbers look good, but I'm really not sure what my goal should be. Striving for no leaks, and an AHI of 0 is unrealistic (I think). I'm looking to balance leaks vs. comfort, are my numbers acceptable? I can start to tweak fitting if they are, or I can look at other options if I'm far from the target.

[chunkyfrog]

Have you read the "taming the Mirage Quattro" blog?
Are you getting any sore spots on your nose?
Do you notice "face farting" consistently from one place or another?
Have you considered a mask liner? Pad-a-cheek, or rem-zzz's, or home cut from an old soft t-shirt?
Mask fit is a VERY big deal-and it should be.
It is the first thing to concentrate on; unless it fits, any data is compromised.

[Nate]

Have you read the "taming the Mirage Quattro" blog?
Are you getting any sore spots on your nose?
Do you notice "face farting" consistently from one place or another?
Have you considered a mask liner? Pad-a-cheek, or rem-zzz's, or home cut from an old soft t-shirt?
Mask fit is a VERY big deal-and it should be.
It is the first thing to concentrate on; unless it fits, any data is compromised.

Yes I have read the blog on the Quattro, and I used some of the suggestions. The bridge of my nose is a little sore, and is the reason I'm pursuing a better fit. The kicker is that the leak numbers look to be adequate, and I'm not sure how they could be skewed positively if the mask was indeed leaking badly. I have ordered a Pad-a-cheek liner for comfort, and hopefully deal with the few spikes I'm having. What do you think about the leak numbers I posted? Are they decent? I really have nothing to compare them to.

[chunkyfrog]

The leaks you are having don't appear to be of long duration; they may only be problematic if they are waking you.
(--just my opinion) My median is MUCH higher.
Most of your leaks are well below the magic number 25; your liner may take care of the spikes,
or at least quiet them down--and it will give a break to your poor nose.

[Pugsy]

I don't expect perfection so I don't really watch the leak line all that closely. Quite honestly I bet yours is better than mine from last night. I don't panic if I spend a short time in large leak area either as long as I never know it till I look at the report.
What I do expect is not to be awakened because of the leaks (no matter what the size)...if the leak is disrupting sleep then it needs to be fixed no matter what the size because sleep disruptions are unwanted.
It takes time and experience to get leaks managed well so that they are minimal and don't disrupt your sleep.
Last spring I tried a new mask and it took me a week to get it dialed in so that leaks didn't wake me up.

Your leak line is fine just looking at it and the "numbers"...so if you could say you slept through the night and didn't wake up with the leaks then I would say don't worry about it. Part of being a newbie is that the brain is sort of hyper vigilant and the least little thing will cause a person to wake up. With time the brain relaxes and some of those "little" leaks may not wake you up.

The mask is really the hardest part to this therapy I think. Getting a comfortable fit and keeping leaks to a minimum so they don't disturb sleep is a challenge. With time and experience you will get a better handle on things.

Your numbers are indeed acceptable. The spikes into large leak territory I am sure are when you are having to move the mask around a little to get a better fit and stop annoying leaks into the eyes and such. It will get better with time, I promise you. Full face masks present an additional challenge simply due to the surface area that contacts the skin and you have to manage a larger area. It takes time, patience, experience and a lot of fiddling with things. Sometimes it takes a different mask...sometimes it takes adding mask liners but you will get there. Just keep trying little things to see if you can find the right balance. Check with your DME and see if you have a time frame where you can try other masks...use it. You may come back to this first choice and you may not. You might find something you like better.

Regarding the leak numbers....the 95% number means you were at OR below that number...people tend to panic when they see an elevated leak number and forget the OR BELOW part. Your 95% numbers will be elevated due to the spikes of leaks when fiddling with the mask...so don't worry about them right now. Instead just eyeball the leak line itself.
Large leak territory begins at 24 L/min. Stay below that red line for the bulk of the night and the machine can do its job just fine. Short spikes into large leak territory aren't the end of the world either. What's 5 minutes out of 8 hours? Not much time for there to be much impact on overall therapy. Besides...just because someone hits 30 L/min for a few minutes doesn't mean that everything is totally wasted and worthless...there is therapy value even in large leak territory..may not be ideal but it is there. Now if you spent a couple of hours with leak line at 40 or 50 L/min then we would be having a different discussion.

I haven't looked at my report from last night but I can pretty much guarantee you that your leak line is probably better if we toss out the fitting spikes. You are doing great for being a newbie.

[MyIdaho]

I have the same mask and same CPAP machine. IMO, your leak profiles are excellent over the last two nights. Great job! The key question is how do you feel during the night and in the morning? If you're sleeping comfortably, are unbothered by leaks, and wake up rested, then you're good to go! I have experienced some nights where the leaks were small but still disturbed my sleep because they were short blasts right into my eyes. I've finally gotten the mask properly adjusted for me and no longer have these short term leaks.

Are you using the mask fit function with your S9? It has helped me tremendously to use this feature.

[Nate]

Thanks, this info helps me understand the situation a little beter! I don't notice being woken up by a leak, however I do wake up to roll over and notice it leaking after moving to my other side. So by my estimate it is not significant enough to wake me (typically). I have a follow up visit with my DME company to do another mask fitting, but I'm really hesitant to give up what I have. I'm leaning towards ordering a different mask to try, I might have it really good and just nothing else to compare it to.

I'm fortunate enough to have enough vacation time saved to take off the rest of the year (my last day in the office was 12/11), my routine has been to clean my mask and go pull the SD card to see what happened the night before. By nature I have the tendency to pour over data and tweak things. I'm going to try and hold off a little and just go by how I feel, the numbers (and your confirmation) seem to show I'm on the right track.

[Pugsy]

Here's my leak line from last night. Looks like I did really well for most of the time but had a short excursion over the red line. I slept right through it. I am not going to worry about it. I didn't go hugely far past 24 L/min and while therapy may have been impacted slightly it wasn't total trash either.
Bear in mind that I am using nasal pillows...they are so easy to keep sealed for the most part. I don't know what happened with the leaks that are showing. I suspect I probably opened my mouth a bit or maybe turned over in bed and the nasal pillows slipped out a bit since I wear them really loose. Since it didn't wake me up and disrupt my sleep...I won't be worrying about it. Now if I spent one fourth to half the night above the red line then I would be back peddling a bit trying to figure out what is going on but I am not going to worry about that relatively short period of time barely above the red line.

My numbers? I didn't even bother to look because it is easy to see that I was in good shape for the bulk of the night.