Leak effects on therapy

I just started APAP 2 weeks ago, the first week with the Forma full face mask. That mask was very uncomfortable and I quickly developed sores on my forehead and nose bridge. I would wake up with headaches from the mask and felt like it was pinching my face. Then, I found out about the Respironics FullLife online and asked my DME to exchange the Forma for that (per 30 day mask return policy). I figured this would be a good alternative since it does not have the forehead part--that was what was bothering me most about the Forma. I read a lot of negative reports about the FullLife online, but figured that everyone's face is different and this may work for me... and I tried it on at the DME to be sure.

I have to say that I really like the FullLife in comparison--it is soooo much more comfortable for me. Also, I always felt like the Forma was leaking, but the FullLife does not seem to for me--when I feel around the edges of the mask, I don't feel any leak coming from the sides or into my eyes at all. However, my APAP Machine (S8 AutoSet II) seems to think the mask is leaky... every night since using it, the next day it reports to me "High Leak in Last Session". Also, if I use the mask-fit feature on the machine, it is hard to get it to say I have a good fit (unless I cover up the exhaust holes on the mask--then I can get it to excellent). What this tells me, I think, is that the mask itself is not leaking around the edges (bad leaks from what I understand), but rather that the exhaust is leaking more than the machine is expecting. I have the Mask Type set to "Mir Full" on the machine, which is I think the closest match.

My question is this... given that I really like the mask and think it fits well, should I pay attention to what the machine is saying about leaks? Is the leak negatively affecting my therapy? I don't have the software or card reader to get more specific info--it looks like that is no longer available to consumers for the ResMed machines, so I don't have any detailed data to examine.

Thanks for any feedback.
-Jeff

Possibly someone can find and forward you a viable source for the ResMed software. I hope so. I don't use a ResMed machine. While you are software-less, are you able to see your AHI on the machine display? Can your DME or doctor get the leak data for you?

Don't cover the exhaust holes! I assume that was an experiment with you, but you need the exhaust to carry away carbon dioxide.

Leaks, especially large leaks, can compromise your therapy. During the time you machine is detecting large leaks you are not receiving your intended therapy. We just don't know is how long your leak was. I would be surprised if this is related to your exhaust. If the mask seem to fit well when you're awake it's possible you are shifting the mask in your sleep at times. If you did this just a few times for very short periods you could be having effective therapy most of the night. Maybe you can try taping it down in one spot such that you'd feel it if you move it. (This solution has been offered to people who actually remove their masks, so that they can feel the tape, wake up, and reposition the mask.)

Without hard data you only have how you feel as a barometer. If you were affected by daytime sleepiness prior to CPAP therapy your alertness now could give you some sense whether you can live with your current leak profile. Even if there is an AHI on your display and that is low, that wouldn't mean much if you were experiencing large leaks most of the night. If you did not have daytime symptoms you are shooting in the dark until you can get more data.

I also do not know a lot about the Resmed machine but I do know you have to tell it what the mask is so that it knows how to read the design exaust rate of each mask. Is the mask properly set.

Jerry

I also am not a ResMed user, but I think the wrong mask setting won't affect your therapy in any way. My understanding is that all that setting does is adjust the numbers ON THE REPORT, subtracting out the exhaust rate of the mask.

Without the software how can you know if you are moving the mask and developing a large leak just as the machine has indicated? All to often newbies sleep right thru very large leaks or even take their mask off w/o knowing they have until morning.

Bring you card into have your DME print out a report for you.

Thanks for the feedback--I'll contact my DME about the leak message I've been seeing. I expect they will be able to read the data from the machine. The display on the machine does not show me AHI or anything other than hours used and session counts. I'll also ask them about the software--I wonder if it is something you can get through them now that ResMed does not offer it directly to consumers anymore.

ResMed mak vent rates and MASK SETTING for their masks: http://www.resmed.com/us/assets/documen ... sa_eng.pdf

I use the RespCare Hybrid, it's vent rate is higher than any of the ResMeds so I use the highest vent rate setting MIR FULL and expect to see a higher reported leak. Just got my AutoSet II a little over a wk ago...so far, reported leak is 0 to the expected higher vent rate; the nights I have reported leak, it's from a pillow that has some amt of rainout and starts sliding & leaking a bit. The mask fit feature tells me my mask fit is excellent; I thought it'd be only possible to get rated as good as my mask's vent rate is higher. There is a STANDARD mask setting that assumes the mask's vent rate is 24 Liters/min.

Muse-Inc wrote: The mask fit feature tells me my mask fit is excellent

Funny how my DME never told me about the mask fit feature. Took me over a month to discover it, and its great. I never go to bet without seeing excellent on this feature.

jmelby wrote:Thanks for the feedback--I'll contact my DME about the leak message I've been seeing. I expect they will be able to read the data from the machine. The display on the machine does not show me AHI or anything other than hours used and session counts. I'll also ask them about the software--I wonder if it is something you can get through them now that ResMed does not offer it directly to consumers anymore.

You can get a copy of the S8 AutoSet II Clinical Manual here:

http://www.apneaboard.com/CPAP%20Adjustment.htm

If your DME has not enabled Smart Card, you won't be able to see your results on your LED screen. You could ask them to enable it for you, or (gasp) do it yourself.

The software is available from a site in Australia, some people have purchased it on ebay. The card reader is at cpap.com.

I also have the FullLife mask and am struggling to get a good fit (I mostly use a Swift LT). However, I did set my machine for MIR FULL as well and have not been able to get the Mask Fit (or the data) to report anything other than huge leaks. With my Swift LT I get zero leaks (or at least <0.1 leaks) almost every night.

Muse-Inc wrote:ResMed mak vent rates and MASK SETTING for their masks: http://www.resmed.com/us/assets/documen ... sa_eng.pdf

Thanks SO much for this link, Muse-Inc! I was looking up flow rates for each mask individually. This is much easier to have the information all together and not have to interpolate the graphs in each user manual!

~ DreamOn

Sorry if this is a total newbie question, but I am pretty much a total newbie ...

I'm using the Swift LT for Her, which shows expected flow rates of 21-42 L/min depending on pressure.

For the 10 nights I've used my Remstar Auto M Series A-Flex, I've had leak rates ranging from 13 to 18 L/min. Pressures ranging from 5 to 9 (as far as I know). There's no adjustment that I can see for mask type on this machine.

So is that leak rate OK since it's below the expected leak rate? My AHI has been consistently less than 1 and I feel great.

Just want to make sure I'm understanding this leak rate business correctly.

Thanks.

Pam

Oops ... did a little more searching and I've answered my own question. Yes, that leak rate is okey-dokey.

Correct me if I'm wrong, but I think I've got it now.

Pam

An update on my experience with the FullLife... I met with my doctor's office "Sleep Educator" yesterday, who read the data from my machine and said she has not often seen such huge leaks--there were days where the machine could not auto-titrate (I'm on APAP) due to the leak level. She said the AHI data certainly cannot be trusted with such a high leak level. She thought there must be something wrong with my machine, and sent me to the co-located DME to check out the machine. Nope... same results with another S8 AutoSet II with the Mask Fit feature... it won't go beyond "Adjust Mask".

The DME blamed my beard... but the fact of the matter is that I could not feel air coming out around the beard. It didn't feel like there were leaks coming from any side. I think that the FullLife just has an unfortunate design flaw. When I feel the air venting out, it seems to be a much higher rate than the other masks I have tried... maybe the exhaust rate is just way too high for the mask and goes beyond the specifications? Maybe this mask will only work with the Respironics machines?

They sent me home with a loaner nasal mask (Activa LT) to try and see if I can tolerate it--I was hesitant to go with a nasal mask at first due to my initial reaction of feeling like I couldn't breathe correctly. In the office, this one showed an excellent Mask Fit and worked well last night, so I'm optimistic, but saddened that I could not get the FullLife to work.