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Air leaks from the mask can make horrid noises. He has to get those leaks stopped to be getting effective treatment. If he is leaking that bad then the air is not getting where it is supposed to be going...his lungs.

Right! And it's not good for all that air to be leaking into his eyes either. That can cause damage in the long run. He definitely needs to mention that to his doctor. Sounds like he needs his mask fitted or to try a different one altogether. The mask is the hardest piece of this "puzzle" to get together. I'm glad the other suggestions worked and that you've managed to get the machine noise sown to size. Hopefully the doctor can either work with him about his mask issues or put him in contact with someone who can.

I have set up many M-series machines, and at a pressure setting of 4 cm, it should be whisper-quiet, almost silent. The only noise you should hear would come from the mask exhalation ports. If the machine is making that much noise, it sounds like something is wrong with it. The flow generator vanes (which create the airflow) can be knocked off balance fairly easily with some of these machines. Also, if he has a poorly fitted mask that has massive air leaks, the machine will try to compensate for the pressure loss by speeding up the blower to maintain pressure. In any case, it should be fairly easy to maintain a good seal (with a properly fitted, decent quality mask) and have a quiet setup with such a minimal pressure setting. I would go back to the DME who sold it to you and persist with them until you get some satisfaction. He should be able to try on some different masks to try to find one that works better for him.

I wish you the best of luck.

Never heard of insurance companies paying for refurbs! Sounds like this machine is malfunctioning. I'd take it back to the DME immediately, wouldn't wait for that Dr. appointment next week.