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Keep waking up with leaks
#1
I have a Liberty hybrid and I use a pad-a-cheek liner. I have a Resmed S9 APAP. The pressure starts at 4 and ramps up over 45 minutes. The minimum pressure is 8 and the max is 20.

I fall asleep okay most nights, but I invariably wake up when the pressure goes over 18 or so and it starts leaking. I start the ramp over again (because there is NO chance I'll fall asleep with it at 18 cm), pressure ramps up, I wake up again. After about 4 hours of this I am ready to cry and I just take it off so I can sleep a little bit before work.

This is the best most comfortable mask I have found (I've tried multiple) and the liners are a godsend. The leak is on my cheekbones and I think it is the air on my cheeks and in my eyes that wakes me up.

Do you have any suggestions? My sleep doctor and DME are basically like, you're never going to get rid of all the leaks so deal with it the best you can. I made an appointment with my regular doctor to see if I can get medication to sleep through the night. The ONLY way I can sleep soundly through the night is to not use the machine, which obviously is not an option. Surely there is something else I can try?!

Please note: I cannot use nasal pillows only. I cannot breathe through my nose involuntarily. I have a cleft palate and other issues from birth. (I've had issues with people not believing me on other boards, so I am emphasizing it here to deter "use nasal pillows instead" answers.)
#2
FYI My leak data from ResScan is as follows for the last three weeks.
Median: 3.6
95th Percentile: 16.8
Maximum: 30.0

Last night (used 4 hours):
Median: 9.6
95th Percentile: 13.2
Maximum: 15.6
#3
Hi user12345 and WELCOME! to the forum.!
I'm sorry you are having such a rough time with CPAP therapy right now.
There are quite a few different masks you can try; that is the hardest part of CPAP therapy and takes LOTS of PATIENCE so don't give up.
Hang in there for more suggestions and best of luck to you.
trish6hundred


#4
welcome to the board
yo want to reduce the time or turn ramp off ... 45 mins is too long
are you using the mask fit feature, if mask fitted at ramp pressure would leak as pressure increases
I would start using the machine at fixed pressure (titrated pressure is good start)
so the pressure stay constant all night and might get better sleep

we don,t know whats going on ... machine increase pressure in response to events or leak

your leak numbers look ok, below the 24 L/min threshold
any leak disturb your sleep is bad leak
4 hours might be good for insurance compliance but cannot get by 4 hours with leaky mask and fragmented sleep
also 4 hours is usage not actual sleep hours

check Resmed and cpaplibrary video Liberty fitting instructions
http://vimeo.com/20452512
http://www.resmed.com/au/products/mirage...c=patients






#5
I had a similar problem when they set my auto at 5 - 20. The drastic change in pressure can cause real problems. You could try adjusting your mask and headgear at 17 or 18. I'm not sure which S9 you have, does it have a "Mask Fit" feature? If it's an AutoSet it does, if it's an Escape Auto it doesn't. If it has "Mask Fit" you just go to the home screen and press down on the knob button for about three seconds. The pressure will come on and increase to your median pressure for the previous night. Now you can fit and adjust your mask and headgear so it won't leak at that pressure. After you have your mask fitted you can just wait three minutes and it will reduce to your low-end starting pressure or you can just click the knob to turn mask fit off and start the therapy the way you always do. The only problem is that when the pressure decreases the mask might mash against your face a little tight and this might cause some leaks. It's worth giving it a shot though. If you don't have mask fit then you can use the clinician menu to manually change the settings in order to adjust the mask and headgear; or, what I used to do when I had an Escape Auto and didn't know how to change pressure settings was to put the mask on and fake snore 'till the pressure got up to 15 - 19, then adjust and fit the mask, turn the machine off and turn it back on again to start at the lower pressure.

What has really helped me in dealing with leaks and mask fit is narrowing my pressure range very slowly over a long period of time. My PAP can only go between 16 and 20 now and my pressure usually runs at about 18. This has really cut my AHI back also. Maybe you should talk to your Doc about trying to get that range narrowed down.
#6
Have you heard of the Oracle mask? it is just a mouthpiece, just like a SCUBA gear.

And your leaks aren't that bad so you are at least getting good treatment. But good treatment means squat if it keeps waking you up!

Try the Mask Fit feature. It may help to figure out how it is coming off and what you can do to fix it. Over-tightening can actually cause more leaks that it will fix.

And try to cut the time down on the ramp. I did so much better falling asleep once I turned the ramp off. Now, I'm so used to the high pressures, that anything less and I feel like I'm smothering. Turning the time span down as well as sitting up during the day with the mask and air on will help you get used to it.

Quote:Please note: I cannot use nasal pillows only. I cannot breathe through my nose involuntarily. I have a cleft palate and other issues from birth. (I've had issues with people not believing me on other boards, so I am emphasizing it here to deter "use nasal pillows instead" answers.)

You will quickly notice that we aren't like other boards. We fully believe that masks are such a personal thing, that you can only use what works for YOU, not what works for me.
PaulaO2
Apnea Board Moderator
www.ApneaBoard.com


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#7
Welcome to Apnea Board! In my experience, the Liberty hybrid mask was a very difficult mask to get a good seal throughout an entire night and when I was using one, I was using a fixed CPAP pressure setting of 10. Your min/max range and the ramp is going to make it very difficult to get this mask to work for you.

I agree with you that it's a great mask because of its small footprint. However, if you can't sleep through the night, then it's not providing effective therapy. I tried a number of things to try and get a better seal with the Liberty but nothing worked, so I moved on to the Quattro FX and that has been the best mask for me. Many nights, I will get zero leaks through an entire night and when I do get leaks, they are very minimal and of short duration and never anything strong enough to wake me from my sleep.

Also, I used to use Padacheek mask liners when I first started therapy because they made the mask more comfortable to wear, however I found that I got higher leak rates when using them than without them. I stopped using them for awhile and within a short amount of time, I became accustomed to the mask without the need for a mask liner.

So maybe try sleeping without the liners and/or keep searching for another mask. Masks are a very personal thing and while the Quattro FX works great for me, your experience with it might not be the same. Good luck!
We're all family here...you can call me B36 if you'd like!Cool
#8
I always use full pressure to check the fit with as well. I never use the ramp feature.
After getting a good seal I just sit up and breathe for several minutes to acclimate.
When I was starting out I was getting sore chest muscles and sore sinuses for a few days but
your body adapts to the pressure and now sometimes I will awaken from some external event and
feel like the air pressure is normal. I have to check the machine to make sure it's working. (it's very quiet)
#9
Thank you so much! I will try reducing the ramp time tonight and also use the mask fit feature - I didn't know about that!


#10
(01-12-2013, 09:45 AM)user12345 Wrote: Thank you so much! I will try reducing the ramp time tonight and also use the mask fit feature - I didn't know about that!

Another possible solution, for any silicone mask, your face should be clean and free of any moisturizer's as well as the mask cushion also has to be clean and oil free, daily cleaning is a must for a leak free fit.

Sleep-well

Ren


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