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Leak Rate Advise
#1
Can someone please comment on my leak rate results and a possible mask change to a FFM (I have one) or a pillow (which would involve either a half day and a long trip to hospital or buying one (not cheap!)).  Is this a mask or mouth breathing issue?

My AirCurve 10 CS Pacewave data flags up high leak rates using my nasal Resmed Air Fit N20.  The images show the results since I started it almost a month ago and close-ups of data from 2 sample events last night.

I've tried tightening the straps and shaving before I go to bed.  These made no noticeable difference.

The machine settings had been set to full face mask. I changed the setting to nasal mask last night; the leaks were worse, although I need to have more samples to have any confidence in the significance.
   
[Image: 262nlmp.jpg]
[Image: 5d125y.jpg]
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#2
If you are waking with dry mouth, these may be mouth leaks, but a big problem that I have with both FFM and Nasal is that I tend to drop my chin when I relax.
This of course, loosens the lower straps, which promotes leaks around the bottom of the mask.

I am now using a soft cervical collar. I no longer need a chin strap to control mouth leaks, and both my leaks and AHI have improved dramatically.
I honestly don't know why sleep docs don't recommend this.
-- Rich
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INFORMATION ON FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.

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#3
A time over redline of 6% is not disastrous. Resmed allows up to 30% before they give you a frowny face Sad , though I think that's a bit too generous. You may be leaking from around the mask (not forming a proper seal with your skin) or else through the mouth. Mouth leaks tend to show up as a long flat-topped trace in the graph.

You could try your full face mask if you have it handy and see if that helps matters. Otherwise stick with your nasal mask and use the mask fitting function on your machine. (Can't remember what it's called - it's late here). This function will blow air at maximum pressure giving you time to adjust the mask and headgear. Don't over-tighten the straps - it can be counter-productive.
DeepBreathing
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INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#4
Thank you.

The mask fit procedure gives a good result.

As the traces don't show those plateaus for mouth breathing, I think the most likely cause is my sleeping on my side disturbing the fit of the mask.  I've tried a wide range of pillows, ending up with a CPAP pillow with the cut-outs in the centres of the 2 ends, so I think there's little gain there. A FFM will only make matters worse in this case, due to its greater bulk and propensity to lift at higher pressures, but I'll try it at the weekend.
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#5
I used my pulse oximeter last night to check out my SPO2 levels and, interestingly, at the time of mask leaks I fell to 80% then back up to my norm of around 95% over the course of about a minute without triggering any AHI counts or the machine seemingly responding.  I can't tie up the oximeter and AirCurve to the second as I was trying a rough run, and I'll try again tonight with better synchronization.

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#6
there is also a delay from breathing and when that blood gets to your finger. You now know you need to fix the leaks and the doctor may adjust your min and max pressures, did the second leak have the drop in o2 too?
new user http://www.apneaboard.com/wiki/index.php...re_success
mask fit http://www.apneaboard.com/wiki/index.php...ask_Primer
From machine or sleepyhead, set the min CPAP 1cm below median pressure. Or 2cm below 90/95%. max at 20cm for now. Forum will help you fine tune settings
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#7
Thanks. There was only one major drop in SPO2.

Last night I tried using some medical tape to hold the straps near my nose to see how that works out, but still had large leaks. I'll try my FFM tonight.

I've got an appointment with a technician in 11 days time to review my initial machine settings. I am, though, happy to play around with the settings myself before then. I'm reading up on interpreting SleepHead's results but taking it all in is a slow process.

As aside, I haven't had a sleep study so don't have much of a baseline to work from; I did a private home oximeter sleep study, used the results to see the sleep clinic, a consultant put me straight onto a CPAP machine and large counts of CAs got me swapped to a BiPAP machine. Additionally, I have a series of frustrating medical issues that may be related to long-term sleep difficulties so am spending time hunting those down; I have thought about a thread on these but have been put off as everything here seems to be direct CPAP issues.
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#8
Quote: at the time of mask leaks I fell to 80% then back up to my norm of around 95% over the course of about a minute without triggering any AHI counts or the machine seemingly responding.

When you have a leak over the redline 24 L/min the machine no longer has the capacity to reliably diagnose events, so it's not surprising it didn't seem to react.

I can't read the detail on your latest chart but your AHI is consistently very low so I think your therapy is pretty well dialled in apart from the leaks (which are not out of the ordinary). You should ask your doctor about that desat though. The main question at this stage is "how do you feel?"
DeepBreathing
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INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#9
(07-29-2017, 05:16 AM)DeepBreathing Wrote:
Quote: The main question at this stage is "how do you feel?"

Well, now there's a question.  The answer is in 2 halves:
  1. The direct CPAP/BiPAP machine half, which is where I think you're coming from. Here, I feel better on the BiPAP than I did on CPAP, which in turn was better than with no machine, and I generally sleep well (falling asleep easily, sleeping through the night and sleeping for less hours (typically 7 hrs vs 8-9 without a machine). I still suffer from some excessive daytime sleepiness, which Provigil helps. According to my wife, I still twitch occasionally, sometimes a few seconds of leg wriggling and sometimes a whole-body spasm.
  2. The wider tiredness issues half, which I hesitate to write about here but add as I am getting desperate. Here, I am really struggling with tiredness (a sensation of having to make a big effort to lift a lead cape in order to do anything other than sit down with something to distract my mind), residual excessive daytime sleepiness and a raft of individually-minor health issues that, in a vicious circle, add up to leaving me somewhat depressed.  I don't know whether or not my issues are a legacy of 35+ adult years of feeling I never feeling fully refreshed after sleep and, if so, will improve with time (sure, there are some medical papers suggesting that CPAP improves the brain's white matter, but how will that work for me?). 
I used a FFM for the last 2 nights. The first night led to my waking a couple of times and a large leak score in the same range as my nasal mask. Last night gave strange results, with an impression of a more-disturbed night and my waking at least once startled by a noisy leak from the side of the mask yet AHI and large leak scores of zero; my wife told me that whilst I was sleeping on my back the mask made such trumpeting noises that she couldn't stop laughing until she went to the spare bedroom.

I'm thinking of continuing with the FFM tonight and adding a jaw strap to try keeping my mouth closed.
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#10
Using the nasal mask and a chin strap to help keep my mouth shut stopped the high mask leaks, so it looks as if the leaks were due to my opening my mouth.

I'm perfectly comfortable wearing the chin strap, so it looks as if it will. be a feature from now on
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