Just started ASV after yrs of using APAP: need help w/limiting full-face mask leaks

[QuestionableQuerant]

Good Afternoon,

I'm writing to ask for advice on resolving my father's issues w/ASV. After having used an APAP since Nov 2018, he started using ASV (in auto mode) Tuesday evening...and experienced periodic therapy and sleep-disrupting mask leaks from the outset.

Late yesterday, just before midnight, I found myself having to both readjust the mask straps and lower the machine's settings (effectively throttling it) to limit the leaks. The mask adjustments, together with the now-lowered settings (EPAP: 4/7, PS: 4/9), worked (imperfectly) to help him manage at least some marginally acceptable sleep the remainder of the night.

I'm wondering whether the least-bad strategy would be to up the max settings of both EPAP and PS from their current values (7 and 9, respectively) by 1 each night, in tandem with mask adjustments as needed, until the data suggest further increases are unneeded - or the leaks again become unmanageable, which, I think, might hint at there being too much mask pressure. I could upload screenshots of data for his first few nights of using ASV, but I'm unsure how useful they'd prove given the leakage issues.

Speaking of which...a little over a year ago, he began using an Airtouch F20 full-face mask, which served him pretty well w/r/t both comfort and leak management while he remained on APAP. I'm wondering, however, if there are other full-face masks that might be better suited to maintaining a seal throughout the sharper and more sudden pressure changes associated with ASV therapy. I suggested he might want to try a soft cervical collar, which he summarily rejected; further, the leaks typically present around either the eyes/bridge of the nose or upper cheeks (upper 1/4 to 1/2 of mask cushion). Beyond that, any additional hints or advice would be greatly appreciated.

We'll try using new headgear tonight, along with a fresh mask cushion, to see whether that might aid with further limiting the leaks. Thanks (again) for your help.

[Shadowpup]

Going from medium to large F20 Air Touch helped my leaks a lot.  I hit 25 cmH2O every night and 20 cmH2O is my 95%tile.  Leak rate is near zero.  Best wishes.

[QuestionableQuerant]

Thanks for the suggestion - dad's up for giving it a try (he, too, has used a medium cushion since starting w/the Airtouch).

[QuestionableQuerant]

Here's what worked to limit the leaks from his full face mask:

1) Use new headgear/straps with new(ish) frame and gently used mask cushion.

2) Position the mask cushion to enclose the nose and mouth. While doing so, ensure that the cushion's placement is both comfortable and forms a good seal against the face:

• Top of cushion is both securely placed and comfortably resting against the bridge of nose and centered between (and not interfering with) the eyes.
  
• Bottom of cushion is securely and comfortably resting on chin/below the mouth.
  

3) Adjust/tighten upper and lower straps as appropriate.

4) Run machine's built-in mask check utility to check mask fit (for ResMed devices, the option is called "Run Mask Check").

5) If leaks appear, while the utility is still running, adjust the mask, mask cushion and headgear as needed until the leaks cease.

Sometimes, it's easy to get caught up in the minutiae of data and give short shrift to the most basic (yet essential) stuff.

[Benign]

I am a very "active" sleeper, changing from side to side, stomach to back, and have found the Airtouch F20 to be one of the most comfortable and best fitting masks for me.  Most of my leak issues occur late, 4-6 hours into the night.  Just pulling the mask out, off my face a bit and letting it reseal usually does the trick.  

Sometimes I think the memory foam has become fatigued or my face has developed a crease which makes it difficult to maintain a good seal.  In cases like that, I just take the mask off, take the time to make a little visit to the porcelain throne, and put the mask back on when I get back.  However, many of those little visits have nothing to do with my mask leak.   

Good luck.