Mask seal: ResMed AirSense 11 AutoSet, AirFit N20 mask

I’ve been using a ResMed AirSense 11 AutoSet CPAP for a bit over a year. My case of sleep apnea was fairly mild, so the improvement from the CPAP hasn’t been dramatic, but it’s been noticeable (and appreciated).

I got the CPAP through Apria Healthcare and have worked with them since. I’ve been using a ResMed AirFit N20 mask, tried an AirFit N30i mask for a few weeks several months ago, and went back to the N20.

When I’d had the CPAP a short time, I arranged a F2F meeting with a respiratory therapist at Apria’s local office to resolve some issues I was having at the time. I’ve had 3 videoconferences with respiratory therapists since. The most recent videoconference was about a month ago.

The reason for the latest videoconference was my concern about the mask seal. Tightening the straps on the mask is a very imprecise, seat-of-the-pants thing, and I’m having a lot of difficulty hitting the sweet spot where I get a good seal but the mask isn’t uncomfortable. The RT said that sometimes the seal will just be suboptimal depending on the position of your head, and it isn’t necessarily cause for concern. Well, I don’t think 3 “good” ratings out of 8 nights is very good. The website said, “That’s a great score” for most of the scores, even on the nights that I got an “adjust,” but still. The usage hours just above 4 hours were because I woke up an hour or two ahead of the alarm to urinate.

August 9: 7:02 usage hours, mask seal 16/20 (adjust), score 96
August 10: 2:48 usage hours (I know I slept longer than that!), mask seal 18/20 (good), score 56
August 11: 6:50 usage hours, mask seal 13/20 (adjust), score 90
August 12: 4:33 usage hours, mask seal 17/20 (good), score 73
August 13: 6:34 usage hours, mask seal 12/20 (adjust), score 88
August 14: 6:09 usage hours, mask seal 10/20 (adjust), score 82
August 15: 4:01 usage hours, mask seal 20 (good), score 70
August 16: 6:04 usage hours, mask seal 15/20 (adjust), score 85

If the score is good, is that good enough, even if the number for the mask seal is in the “adjust” range?

After the last videoconference, the RT sent me an N20 AirTouch foam cushion to try. I ordered some of the special cleaning wipes for it on Amazon, and they should arrive any day now. If I find that it’s more comfortable and gives a good seal without being so picky about how tight it is, that will be reason to switch.

Thanks for your thoughts.

PacificNW wrote: ↑

Sat Aug 17, 2024 9:09 pm

I’ve been using a ResMed AirSense 11 AutoSet CPAP for a bit over a year.
....
If the score is good, is that good enough, even if the number for the mask seal is in the “adjust” range?

The problem with the MyAir Mask Seal score is that there doesn't seem to be any published information on how that score is determined. Resmed's How is mask seal calculated? webpage is the only documentation that I could find, and it doesn't go into any real details how the score is computed.

In particular, terms that are not defined include both moderate leaks and large leaks. We know from other sources that Resmed defines any unintentional leak that is greater than 24 L/min as an official "Large Leak". But what is the threshold for "moderate leaks"? That's anybody's guess. Equally opaque is the fact that Resmed does not tell MyAir users how long the leaks have to last before being flagged with a less than perfect Mask Seal score in MyAir. We know from other sources that Mr. Red Frowny Face shows up on the Resmed's on-board sleep report when large leaks---i.e. those at or above 24 L/min---last for at least 30% of the night. If the large leaks make up less than 30% of the night, Mr. Green Smily Face shows up in the machine's on-board sleep report.

So, to properly answer your question requires really understanding what's going on with your leaks and whether they are something you need to work on. And to do that, you need to make sure there is an SD card in the machine and then download the data on the SD card into OSCAR or upload it to SleepHQ.

If you have an SD card in the machine to record the detailed data, then both Oscar and SleepHQ will show you how large your leaks are, how long they last, and when they occurred. All three pieces of the leak data can be extremely important when trying to troubleshoot a leak problem.

Now there's also another thing you need to understand about leaks: They become problematic in two specific situations:

1) The leaks are both large enough and long enough to have the potential to affect the efficacy of your therapy and the accuracy of the data that is recorded on the SD card. One very crude way of determining that is to just look at the on-board sleep report (rather than the MyAir app). If Mr. Red Frowny Face shows up, you definitely know that the leaks are both large enough and long enough to affect the efficacy of your therapy. Once large leaks comprise 30% or more of the night, you definitely have a problem even if those leaks are not waking you up.

2) The leaks are waking you up at night and disturbing the subjective quality of your sleep. In this case it really doesn't matter if the leaks are large leaks or small, but pesky leaks: Anything that is frequently waking you up during the night can destroy the quality of your sleep, and if you're spending a lot of time in bed awake and fixing leaks, that's likely going to leave you less than rested in the morning. It's worth noting that some people are just physically more sensitive to small, pesky leaks than others are. And if you're one of those people cursed with noticing small leaks, then you need to figure out a way to prevent them from happening so you can get some decent sleep.

It's also worth noting: If you've got some small to moderate leaking going on but the leaks are not waking you up AND you're feeling decent during the daytime, then it may be best to just accept the leaks: Trying to eliminate every last bit of leaking can be counterproductive when the leaks are not waking you up and they're not really large enough or long enough to affect the efficacy of your therapy.

You also write:

Tightening the straps on the mask is a very imprecise, seat-of-the-pants thing, and I’m having a lot of difficulty hitting the sweet spot where I get a good seal but the mask isn’t uncomfortable. The RT said that sometimes the seal will just be suboptimal depending on the position of the your head, and it isn’t necessarily cause for concern.

I don't often defend RTs. But your RT is correct here: Sometimes a bit of leaking is going to happen for one reason or another, and it's not always a cause for concern. And mask comfort is a major factor in being able to sleep well with the mask on your nose. If the choice is between an uncomfortably tightened mask with no leaks and a comfortable one with some small-to-moderate leaks that do not wake you up, then comfort wins every time.

I'll also add: It's easy to overtighten a modern mask with an air cushion seal. Overtightening the straps can prevent the mask cushion from fully inflating, and an under-inflated air cushion will spring more leaks than a properly inflated air cushion will. My advice is to aim for comfort and then use Oscar or SleepHQ to check just how bad the leaks are---if you are not noticing any leaks when you're trying to get to sleep.

I use both a Swift FX pillows mask and P10 nasal pillows mask. In both cases, my "sweet spot" on the straps is "ridiculously loose." If the pillows themselves are in the right place and fully inflated, it really doesn't seem to matter how loose my mask straps are.

I don't have an SD card in the machine and wasn't aware that it was possible to install one--live and learn! Apria apparently has access to the data that I see on ResMed's website, as does the RT from my medical clinic, who checked in with me a few weeks ago. Are you saying that uploading the contents of the SD card to Oscar and SleepHQ would give me more granular data? I assume this is the report where Mr. Red Frowny Face or Mr. Green Smiley Face would show up? I just dug around and found this video on how to install an SD card:

https://www.youtube.com/watch?v=YsVDbXbfuwE

I assume a generic SD card will do, I don't have to buy one from ResMed?

FWIW, when I wake up at night it's from discomfort from the mask or the need to urinate, not from sleep apnea.

As for feeling tired during the day, we need to consider that I'm on hormone therapy to suppress my testosterone, which isn't conducive to being bright-eyed and bushy-tailed.

Thanks for your response.

When using the MyAir app, tap on your leak score and you will see your scores for the month. Up in the RH corner there is a (?). Tap on it and you will see how the score is determined.

PacificNW wrote: ↑

Sun Aug 18, 2024 9:34 pm

I don't have an SD card in the machine and wasn't aware that it was possible to install one--live and learn! Apria apparently has access to the data that I see on ResMed's website, as does the RT from my medical clinic, who checked in with me a few weeks ago.

Get yourself a (cheap) SD card. You are entitled to see your own data, but the health care system is not going to show it to you.

Are you saying that uploading the contents of the SD card to Oscar and SleepHQ would give me more granular data?

Yes. With the SD card and Oscar or SleepHQ, you can see a graphical representation of every single breath you took all night long, along with what the pressure was (if you are using Auto mode) and the unintentional leak rate at every point during the night. You can see exactly when each apnea and hypopnea occurred, how long it lasted, and how the machine responded (if you are running in Auto mode).

I assume this is the report where Mr. Red Frowny Face or Mr. Green Smiley Face would show up?

No, Mr. Red Frowny Face and Mr Green Smiley Face show up on the machine's LCD by using the "My Sleep View" side of the home screen. Use the round button to select "My Sleep View" from the main home screen on the machine and click on it. Depending on what setting the clinician used when setting up the machine, you may see very limited information (number of hours used and "mask seal" info---i.e. Mr. Red Frowny Face or Mr.Green Smiley Face) or you might see more detailed information including some stuff that is not available in My Air, such as your 95% leak rate your 95% pressure level, along with the AHI data. If you don't have the detailed data, that means the RT set Patient View to "Simple" instead of "Advanced".

Here's a link to a pdf of the Clinician's manual for the AirSense 11: https://www.manualslib.com/manual/22131 ... se-11.html. (Added after PacificNW pointed out that I'd forgotten to add it. Thanks PacificNW!) It will show you how to get into the clinical settings, which will allow you to change the Patient View from Simple to Advanced so that you can get all the nightly summary data from the machine itself. You won't get a massaged "score" the way you get in MyAir, but you will get numerical data about the 95% leak rate.

I just dug around and found this video on how to install an SD card:

https://www.youtube.com/watch?v=YsVDbXbfuwE

I assume a generic SD card will do, I don't have to buy one from ResMed?

A generic one works fine. The cheapest/smallest one you can find works fine.

FWIW, when I wake up at night it's from discomfort from the mask or the need to urinate, not from sleep apnea.

Good to hear mask discomfort is not waking you up. It's worth noting that some people who had multiple wakes during the night to pee before starting CPAP for sleep apnea had the number of those pee breaks go down after optimizing CPAP therapy. But sleep apnea is not the only cause for needing to pee multiple times during the night.

robysue1 wrote: ↑

Mon Aug 19, 2024 8:52 am

Here's a link to a pdf of the Clinician's manual for the AirSense 11.

I assume you meant to post the link?

Based on your suggestions, I'm tightening the mask a bit less, and I got a good seal the last couple of nights.

PacificNW wrote: ↑

Mon Aug 19, 2024 9:20 am

I assume you meant to post the link?

Thought I did. But obviously I forgot. Thanks for letting me know.

Here's the link to the AirSense 11 Clinician's manual: https://www.manualslib.com/manual/22131 ... se-11.html

Late to this conversation but I have the N-20. Tightening the straps did not help my leaks but when I went down to a smaller cushion it helped a lot.

I had had Apria send me a memory foam cushion a while back:

https://www.cpap.com/productpage/resmed ... al-cushion

I held off using it because I wanted to "use up" the cushion I was using at the time. I've now used the memory foam cushion for 4 nights, and the mask seal scores were 19/20, 18/20, 18/20, and 20/20. It's also more comfortable, with minimal or no red marks in the morning. I happen to be at a point where my insurance will pay for some more cushions, so I asked Apria to send memory foam cushions.

I still plan to get an SD card and check out OSCAR and SleepHQ.