Root Causes of Leaks

Hi Everyone,
I have been on the hunt for my leak now (last month, .72 l/s, activa lt mask, resmed). I wanted to share with others my research so far. Here is what I have learned...

Root Causes (a leak can come from a few places)

- hose
- mouth
- mask

there may be more, but these are what I have found most postings to discuss.

Rule out the hose
For the hose, check for a leak, pin hole or crack. Beyond visual inspection, I am not sure if there are better ideas.

Rule out the mouth

I tried tape and the leak did not drop. If tape did not work, fixodent seems to only work for people with tape problems??
If tape did not work, try a better chin strap or both together?
I guess I wonder how to definitively rule out that it is a mouth leak.

Once I can elimnate the mouth question, it must be the mask
How do figure out where the mask leak is coming from?

- test the mask fitting using the cpap (fit is excellent)
- change mask (I tried another, no luck)
- try remzzz or t shirt cut out. viewtopic.php?f=1&t=54946&p=513833&hili ... s+#p513833
- increase humidity
- get data from cpap to learn more about leaks * ( i have not done this yet)
Tonight regime will include tape, remzzs and chin strap and increased humidity. Maybe it will drop?? If not, mask leak? Fuuny enough I had a .42 earlier this week.

thanks

When I wash my hose I fill it with water and raise it up. If there is a leak in the hose it with spray out the hole. It is easy to see the leaks in the hose this way. With mask leaks I have good nights I think until I look at the data. Other nights I know my leaks were horrible.

Root cause is not the issue! 0.7 l/sec = 42 l/min. That is about all the air you can get through that mask. The res med leak numbers subtract the actual flow rate of the mask from the calculated flow rate and should always read close to 0 l/sec. The biggest problem with leaks is simply your mouth falls open while you are relaxed and all the air that goes in your nose, goes right back out your mouth and does your therapy is not doing you any good. A good full face mask such as the ResMed Ultra Mirage Full Face or Quattro full face that is the smallest mask that will fit you will probably solve your problem in the least amount of time. Taping is hard and you (I) can breath through my mouth with the tape on it. I tried everything and finally bit the bullet and solved the problem with the full face mouth. The DME said I needed a medium, but it actually took a small to seal and not blow air into my eyes. Good Luck!!! Inexpensive masks can be bought from the CPAP auction site, either new or used slightly at much lower cost. Most DME's will exchange masks if you are having problems in the first couple of months for no cost!

I am puzzled by your answers and only ask for clarity, I am not trying to be a wise guy.
First, you said root cause is not the issue.
From what you have told me, the root cause would be a mouth leak.
As an aside. the hose leak test is a cool idea to rule out that cause.

"Next. 0.7 l/sec = 42 l/min. That is about all the air you can get through that mask. The res med leak numbers subtract the actual flow rate of the mask from the calculated flow rate and should always read close to 0 l/sec."

I don't understand the implications of my leak rate = to all the air you can get through the mask.
If the correct answer is 0 l/sec. then is 0.7 close and not an issue or rather it is terrible?

After last night, I had a leak rate of .02 l/sec, Tada. My DME said anything over .40 l/sec is not good.

For the first four months, I did not have a problem, lost a lot of weight, got a mask cushion update and whalla, the leak appeared. Maybe I became more of a mouth breather, which is couter intuitive since I would be getting more air/oxygen with a BIPAP. Why start mouth breathing now?

I do appreciate your input, that if a leak is a problem and you use a nasal mask, the a FF might be the solution. However, someone on the list once posted 10 reasons to not FF mask. thanks again

Another option is a hybrid mask. It combines the advantages of Nasal pillow and FF masks. The two best-known ones are the Liberty and the RespCare Hybrid. Check 'em out.

Is it possible since you've lost "a lot of weight" your mask just doesn't fit your new facial contours anymore? There is no reason for a mouth breather to not use a FF if you find a comfortable one that fits with no leaks and allows you to eliminate taping,chin straps,etc. You may be sleeping more deeply now causing your jaw to relax even more. Keep us posted.

Thanks DoriC,

Next step is to try one of two ideas to find cause....

Mask?
Remove the Remzzz and/or go to tshirt cut outs..
or
Mouth?
try tape and chinstrap w/o Remzzz.
if mouth, try FF mask....

For now, I want to document a few more nights this way and see if I get a new low or consistent low.
Then start changing things once I have a baseline. It is probably mouth. Funny enough, after 4 hours sleep last night, at 2am I work up, wrote an article for an hour, and then went back to bed. High Quality Sleep makes you wake up??

My main motivation for writing this post is to give people a framework to process all of our collective knowledge. Without knowing the root cause, the advice posted would be ridiculous. Could you imagine someone trying fixodent or tape when the problem was the hose??

THX

lhpangler wrote:For the first four months, I did not have a problem, lost a lot of weight, got a mask cushion update and whalla, the leak appeared.

Is it possible the mask seal has been improperly assembled?

I do like your approach. Very logical.

Do you have the software? Posting a leak graph is helpful.

ok small update.
every once in a while I hit . 0.0 leak or 0.15
then I slip back to .5 l/s or so...
taping can fail (drool...)
or I think I can still knock my nasal mask off using the side of my pillow...
for me, DoryC may be right.
chin stap etc, makes a FFM at $168 or so not such a bad idea.

thx you so much.
LHP

lhpangler wrote:...FFM at $168...

RespCare Hybrid Universal FFM mask is $119 at https://www.cpap.com/productpage/RespCa ... -Mask.html. It's a comfortable mask!

Wahoooooo.... okay, I still have leaks and now I have data. I will try my best to post a picture

two detailed charts and one summary. Last two nights fighting leaks.

A night.



a bad night, data is suspect.



averages not so bad starting with an AHI of 70.



any input gratefully appreciated.....

thanks

LHP

I'm sure you'll get a more in depth analysis of your data from others, but it seems to me that until you get your leaks under control all the other data is invalid. Again,You seem to be a good candidate for a FF mask unless you can find a way to keep your mouth closed with your current mask. My husband has been very successful with the UltraMirageFF but other recommendations like the Hybrid or Quattro are popular ones too.

thanks DoriC,
Tape is not working with drool......
maybe FF is due. I am trying a few resmed and deciding on size and what the options are.

thanks again DC
LHP

Are you sure you have the correct size mask? If your leak line is riding on the 0.00 line sometime during the night the equipment your using ( hose or mask ) does not have a leak and I don't see that anywhere one your leak chart. If your not using the correct size mask you will have trouble with leaks.

https://www.cpap.com/cpap-mask-sizing.php

This might help. #5 is an important one especially when measuring for a FF.