CPAPtalk.com

How did I miss a post like that? I practically live here now. In fact, I believe my rent payment to cpap.com is due next week.

Just curious, though, RG - it seems to me that in your post on the other thread you just posted, you addressed the issue Roger has presented here again - that the Auto reverts to lowest pressure when in Large Leak mode. Is there something I've missed?

Roger, is there something else you're asking that I missed?

CG,

The only thing I could think of as far as Roger's leak rates go would be a full face mask and a full face of facial hair may be incompatible. Since it can't be an issue of mouth breathing since he has a full face mask on, that's out. I have never used a ff mask because, besides feeling they're too cumbersome and would rather train myself to not mouth breathe or use the Tegaderm when I had to control it, there seems to just be too much seal area to worry about leaks from AND too much mask that can be dislodged when you lay on your sides when you sleep. For a back sleeper, seems perfect. But I am a side sleeper, although over the past few months have found myself on my back a few times when I woke up. Think it came from wearing a mask and subconsciously trying to keep it from leaking. Amazing the power of the mind, what it can do without your knowledge, at least consciously.

I did try going to Resmed's site and finding the vent flow rate but couldn't. I think they changed their links. And since I don't have the booklet for that mask, I have no idea what is considered acceptable. Roger seems to think 50 is okay with a mask like that, so an average of 60 is a bit high. It's the 300+ minutes in large leaks that would concern me. And, like RG said, his treatment has to be compromised by these. Personally, if I were Roger, I'd try an alternative to a ff mask.

Wish I could offer some useful advice. These, as you can tell, are just observations.

CollegeGirl wrote:Just curious, though, RG - it seems to me that in your post on the other thread you just posted, you addressed the issue Roger has presented here again - that the Auto reverts to lowest pressure when in Large Leak mode. Is there something I've missed?

Rested Gal-- I have the same question for you that CG has. I don't get it.

I had to get off the hose for a few nights because my persistent coughing made the mask impossible to use. However, on Monday night things settled down a lot and I’ve been puffed-up since. I was surprised how much not getting the treatment impacted how I felt in the morning to how I felt on Tuesday morning. Feeling the difference so clearly sure helps me get through the crap of dealing with mask leaks.

To get a sense of how things are going here, the next two links will show the reports for the last two nights:
Encore Report 29-November-2005

Encore Report 30-November-2005

As is obvious from the above graphic, life isn’t a bowl of cherries yet.

CollegeGirl wrote:Roger...
I'm not sure what's going on with your mask, but it's obviously not good. The percentage of the night you spend in large leak is off the charts! I wish Lori or Laura would chime in here.

As for the anti-asphyxia valve, I have a full-face mask with this sort of valve as well, and my machine (RemStar Auto, like yours) has no problems turning itself on after just two or three breaths.

Also, my pressure definitely goes UP to compensate for leaks, as it's supposed to. I would imagine that perhaps when you're in Large Leak that much, the machine perhaps assumes it's been left "on" but is not being used.

Hello CG,
I looked at the mask and tried a few things to see where the breaths were going when the hose was disconnected. My goal was to understand why your mask allowed you to turn on the machine and mine wouldn’t.

From that look, I found that if I just breathe into the mask as I would with a nasal mask, there is so little air movement at the hose connection that I can see why the machine didn’t notice I was connected. However, if I take a deep breath and exhale hard into the machine from my mouth, I can hear the mask valve closing immediately and feel the air directed out through the hose port. With that result in mind the hose was put back on the mask and the test was tried again with the same result for normal breathing, but strong breaths from the mouth close the valve and the machine starts delivering pressure automatically.

Thanks for pointing out the differences between what I was getting and what you experienced because I had resigned myself to pushing the button.

Your assumption that the machine thinks the mask is off, is the best answer I’ve heard as to what the machine might be thinking when a large leak is in progress, and it explains why the other logic functions are put into sleep mode.

Sleepless on LI wrote:CG,
The only thing I could think of as far as Roger's leak rates go would be a full-face mask and a full face of facial hair may be incompatible.

[snip]
Think it came from wearing a mask and subconsciously trying to keep it from leaking. Amazing the power of the mind, what it can do without your knowledge, at least consciously.

I did try going to RESMed’s site and finding the vent flow rate but couldn't. I think they changed their links. And since I don't have the booklet for that mask, I have no idea what is considered acceptable. Roger seems to think 50 is okay with a mask like that, so an average of 60 is a bit high. It's the 300+ minutes in large leaks that would concern me. And, like RG said, his treatment has to be compromised by these. Personally, if I were Roger, I'd try an alternative to a ff mask.

Hello Lori,
Thanks for the feedback.

I went into this Full Face mask business knowing there was a risk the stubble would cause a problem, but when I’m wearing it, the leaks don’t seem to come from the beard area but from the cheek area along side the mouth. This mask has the chin seal area pressing hard against my chin leaving too little pressure on my cheeks. I’ve looked at trying to get the mask to open more, but other than removing the silicon pads at the forehead brace, I don’t see anyway to change the geometry of the mask. I’ll try removing the pads this weekend to see how it goes, but I’ve got to find something like Moleskin to keep the brace plastic ends from creating a distracting pain.

As for the mask’s designed leak rate, this next link will bring up the image in the RESMed manual.

Ultra-Mirage Vent Flow Rate

On the chart I places some amber lines to bracket the pressure and the resulting leak values I should expect. With that in mind, when I look at last night’s leak graph, it shows I start out close to the design’s max flow rate, but someplace during the slumber portion something changes and the wind blows at the machine’s allowed max rate. I’ve been surprised at how high and prolonged this leak rate last because I’m sleeping through it. Even where the mask shows there were some corrections to the leak rate, I don’t remember doing anything. Maybe as I get more rested I’ll notice when a hurricane is blowing the blankets and then do something about it.

Roger,

One good thing in this whole ordeal is that you realized that the therapy is, indeed, working since you couldn't stay on the mask while you were coughing and ill. Now that you know this, maybe the leaks aren't sabotaging your therapy as much as we all thought it could be.

Have you ever tried any masks other than the ff mask? Or, in the alternative, have you ever tried any other ff mask than the one you are on now?

Sleepless on LI wrote: One good thing in this whole ordeal is that you realized that the therapy is, indeed, working since you couldn't stay on the mask while you were coughing and ill. Now that you know this, maybe the leaks aren't sabotaging your therapy as much as we all thought it could be.

This is an interesting comment and is coming when I’m beginning to think what you’ve expressed.

For a while I’ve been struggling with mask leaks that most people would consider excessive, and yet I get off the pipe for a few days and I’m back to needing naps after I wake up in the morning. When I went on the hose again after 10-day hacking spell, I could certainly tell that I needed to get my daily fix of gas to feel half human.

In looking back at all my data, I think dealing with mask leaks are important, but only so that the leaks don’t causes excessive noise, blow eyelids open, or exceed the wind machine’s upper max leak limit. In fact, I’m thinking that as long as the leak never exceeds the machine ability to deliver the required titration pressure, then the leak doesn’t diminish the treatment.

It would be interesting to see this as a separate thread so a broad range of anecdotal experiences could be shared. From my experience this week today is another good day with a bad report. I feel a lot better today than yesterday and yesterday was the best day of the week. However, last night’s report would get me a failing mark in mask fitting.

Encore Report 01-December-2005

Sleepless on LI wrote: Have you ever tried any masks other than the ff mask? Or, in the alternative, have you ever tried any other ff mask than the one you are on now?

I have the “Face-Dancing Activa” and a remodeled “Comfort Curve” nasal interface. For comfort, the Curve is the easiest to don, endure and remove.

I went for a full face because as the treatment pressure pushed toward 14cm my lips are exhausting the pressure while asleep. I discovered this when I awoke to strange “motorboat” like sounds in the bedroom and couldn’t find any boats. With my consistent 5-day facial shadow, I didn’t think the fun of taping my trap shut would expand my mind as much as it might expand my list of expletives, so I went for a full-face interface.

I find the full-face comfortable, but clumsy to get sealed at the beginning. I don’t know what it does in the middle of the night because the report shows it goes downstairs for milk and cookies while I’m cutting Z in the sheets. It even seems to fix itself at random times, go figure. In the morning, it usually has my mouth open feeling like it has been stuffed with sawdust.

This mask is surely a puzzle.

Roger,

I think the key is, don't get too involved in your reports and go by how you feel. If you really start to feel horrible, then look to your reports for trends or something that stares back at you to try to discover if there is any link between the feeling lousy and your therapy. And sometimes feeling bad has absolutely nothing related to therapy and is just a result of "other things."

I looked at that chart you supplied the link to and it seems to me that only one of the times you had a larger leak correlated to an episode. So with all things considered, you are doing pretty good.