Leaks return!

[Karlin]

I have often had problems with leaks. I thought I had solved the problem back in October when I began carefully shaving and washing my face and mask every night before bed. Leaks went down close to zero and I felt very rested. Beginning in March the leaks have come back big time and the "large leaks" are typically more than 25% of the time. I tried  new mask, with no improvement. I didn't change anything, so I'm really puzzled at the dramatic increase in leaks. I'm attaching two screen shots, one from January when things were good, and one from recently when it's bad. My doctor can't see my until August 30. But he has never been helpful with mask leak problems. By the way, I change out the cushions on a regular basis, so that's not the issue. Any thoughts on what my be causing this change, and what I can do about it?

[SarcasticDave94]

With this ASV, leak rates have not been good for either older or newer chart. I myself found that the ASV needs it consistently below 10. I would suggest a review and research on the mask you're using, and also noting what has and hasn't been replaced on the mask. Cushions may be needing changed, maybe the mask install method, the adjusting method, something. Maybe even a different model mask.

[SarcasticDave94]

PS it could also be your pressure set. It appears you have a wide EPAP range and only a 3-8.8 PS. The seemingly high EPAP can be doing the leak frequency issue too. What pressures are you running?

[Big Guy]

Check your headgear straps for correct tension. Mine tend to loosen up over time. I tighten them back up, and no leaks. 

Myself, I do prefer them to be a bit on the tight side. YMMV.

[Karlin]

The EPAP is set at 8 and the mx pressure is 12. Not sure what you mean by a wide EPAP range. In the older picture, my leak rate may have been too high, but the therapy was working and I felt good. Now I don't feel so good. The headgear is new and the cushion is new. Should I reduce the max pressure to see if that helps?

[SarcasticDave94]

A wide range means a pressure that spans a high difference between low and high.

I wouldn't suggest edits to the pressure to eliminate leaks. That's backwards to me. You fix the leaks directly by working on the mask, the fit, the cushion sizing, adjusting, and even to a different mask model if needed. To reduce pressures will very likely reduce therapy. To me edits to pressure over directly addressing leaks is similar to "I won't drive over 35 because my tire leaks air".

I found for myself leaks higher than about 10 and the ASV was working harder to keep up. Maybe with you, you can get away with higher levels of leak.

[SarcasticDave94]

P.S.: my math tells me your EPAP is from 4.4-15. 23.8 Max IPAP minus Max PS 8.8 equal Max EPAP 15. So the EPAP is 4.4-15 and that's the wide range.

Now with this, yes a pressure edit may want to be considered. What I'd do is subtract 3 from Max EPAP and add 3 to Max PS. This gives 4.4-12 EPAP and 3-12.8 PS.

Why consider a change? EPAP is fairly constant. It blows in that range always. PS is added a bit from the lower half of the range for inhales until a Central happens then higher PS comes in. But this higher PS is infrequent compared to the EPAP. Less change of leaks on high pressure.

Bottom line is it's your therapy. You do what you feel is best for you. Your Centrals may be different to handle them mine. My CA preferred a shorter EPAP range than PS. And by that configuration my leaks were less at Max of 10. Yes my mask is different also. My F&P VITERA is the best I've got for mask leak control and comfort.