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Leaks vs effective AHI control
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PaytonA Offline
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Machine: ResMed S9 VPAP Auto
Mask Type: Full face mask
Mask Make & Model: Resmed Mirage Quattro
Humidifier: H5i(distilled-top up)
CPAP Pressure: VAuto MinE14.0 MaxI 20.6 PS4.0
CPAP Software: ResScan SleepyHead

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Sex: Male
Location: Orange County,California

Post: #11
RE: Leaks vs effective AHI control
Wow. That is interesting. Never would have figured that. Can't see a rationale for it but what is, is.

Part of the reason that you see so many who have FFM are at higher pressure may be because the higher pressure made it necessary to go to the FFM. I am just not sure which is the chicken and which is the egg.

Best Regards,

PaytonA
(This post was last modified: 10-17-2014 11:21 AM by PaytonA.)
10-17-2014 11:19 AM
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TorontoCPAPguy Offline

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Posts: 143
Joined: May 2012

Machine: S9 Autoset II
Mask Type: Full face mask
Mask Make & Model: Mirage Quattro FFM
Humidifier: H5i; Control III Germicide
CPAP Pressure: 12-20
CPAP Software: ResScan SleepyHead

Other Comments: CMS50EW Oximeter; Everflo Q O2 Concentrator; O2 Analyzer; Climate Control Hose (winter)

Sex: Male
Location: Toronto; Southern USA; etc.

Post: #12
RE: Leaks vs effective AHI control
Keep in mind that not all are able to use anything aside from a FFM due to nasal congestion causing blockages... I suffer from a stuffy nose regularly which results in mouth breathing and as I would NEVER tape or seal my mouth due to safety concerns and paranoia, I have been using a Mirage Quattro for several years now and it does a great job, especially if one knows how to adjust it properly. The FFM does take higher pressure in order to compensate for natural leakage built it (to flush noxious gases from the mask), I often wonder how or if there are any issues with noxious gases with a nasal pillow mask, of which I have a dozen sitting in the drawer and which are 1,000 times more comfy. But with a stuffy nose they simply cannot be used. Ah well.

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Herein lies personal opinion, no professional advice, which ALL are well advised to seek.
10-17-2014 12:07 PM
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retired_guy Offline

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Posts: 2,744
Joined: Jan 2014

Machine: ResMed S9 Autoset
Mask Type: Nasal pillows
Mask Make & Model: Resmed Airfit P10
Humidifier: ResMed
CPAP Pressure: 10.6/14, EPR 3
CPAP Software: ResScan SleepyHead

Other Comments: Is it bedtime yet?

Sex: Male
Location: Beautiful, albeit very wet Oregon Coast

Post: #13
RE: Leaks vs effective AHI control
Well, my original thoughts were in regard to a "Full Mask" as opposed to a "Full Face Mask, or FFM". The Full Mask is truly a full face mask. The FFM's are actually a partial face mask. Maybe it would be best if they (whoever "they" is) changed the name of the full face mask to something like partial mask set. That way the distinction would always be clear.

But as long as we're talking about FM's, FFM's, or whatever: I know lots of people like whichever one they use. I also know there are probably good and compelling reasons to use them versus a less real estate grabbing nasal or pillows mask. But I don't buy that anyone with a stuffy nose should automatically be prescribed a ffm. As I've said lots of times, I was the poster child for "can't breath through my nose" until I tried a pillows mask and found out I could. Not only that but my sinuses are staying clearer during the day than they ever did before.

Finally, I'm not advocating anyone necessarily dump their full masks, I'm just postulating that it seems to me pressure will tend to run higher with those masks. I could certainly be wrong about that too. Or not... Or maybe............ Well, probably not maybe.
10-17-2014 02:28 PM
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Dawei Offline

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Posts: 342
Joined: Feb 2012

Machine: ResMed S9 AutoSet
Mask Type: Other
Mask Make & Model: Respironics "FitLife"
Humidifier: H5i
CPAP Pressure: 10-20
CPAP Software: ResScan SleepyHead

Other Comments: Began CPAP in 2006; spent the first 6 years with a "brick"

Sex: Male
Location: Western North Carolina

Post: #14
RE: Leaks vs effective AHI control
Interesting discussion. Ghost, surprised to read that you're using the FitLife too. It's not often that I run into someone who is using one, which tells me I'm not alone afterall Smile
My primary reason for discovering it was that the various nasal and FFMs I tried all did a job on my nose. Not only red and extremely sore, but at times tending to break the skin as well. And yes, I tried pads, lotions, etc. My trials included the Quattro, which is a very good FFM as well as several others. The FitLife made those nose problems disappear, and it feels even freer than a FFM psychologically, providing an unrestricted view, which a FFM cannot do . I use a sausage of earplug type silicone on the forehead portion of the FitLife to reduce leakage.
Bye the bye, a good way to label the two types of masks: FFM and Total Face mask.
I haven't tried nasal pillows. I know I'd have open mouth problems. For me, a chinstrap isn't the answer. I tried them with nasal masks after first trying the admonition that I would "learn" to keep my mouth closed.
10-18-2014 08:04 PM
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Ghost1958 Offline

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Posts: 957
Joined: Aug 2014

Machine: PRS1 Series Sixty Auto Aflex
Mask Type: Nasal mask
Mask Make & Model: F&P Eson
Humidifier: PRS1 with Heated Hose
CPAP Pressure: 10.5 min 16 max
CPAP Software: SleepyHead EncoreBasic

Other Comments: Moderate to Severe SA Obstructive. Rapid O2 desat off the machine.

Sex: Male
Location: KY

Post: #15
RE: Leaks vs effective AHI control
I have the PRS1 series sixty auto aflex, which is not as picky as the Resmed about leaks. Its threshold is 60lpm before it shows large leak.

That being said heres what I have found in my short stint of 60 days as far as leaks AHI vs pressure.

My machine is set at 8 to 18 which is to large a spread but its what the doc ordered and I just havent tweaked the pressures yet.

Docs seem to think more pressure is always better which at home isnt necessarily the case due to leaks.

If I have a nite where Im getting bad leaks due to flipping around etc just a bad nite for leaks, my events will increase even though the machine is compensating for the leak.

Now as the events increase the pressure goes up. Which makes the leak worse, which in turn at least on me will increase the number of events. Pressure goes up again leak gets worse because it did until finally its up to max set of 18 leak is horrible and events are happening. Vicious cycle that Docs dont seem to take into a account and start punching up the top pressure.

Ive found if I can get a good seal at my min pressure and the mask pretty much holds that seal, my events go almost nothing and my pressure will seldom raise above 12. Result? Less pressure, less AHI an less leaks.

That just been my own experience on my machine. Since its leak threshold is higher before it cant keep up and read accurately ive been able to watch that trend as it develolped. So I do my best to keep my leaks down because when the pressure goes above 14 its way harder to not have leaks than it is running with a max of 12 and having a lower AHI to boot.

Basically if one can cut the leaks at least for me it lowers the AHI and lowers the pressure to achieve that lower AHI
10-19-2014 12:53 PM
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PaytonA Offline
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Posts: 3,014
Joined: Dec 2013

Machine: ResMed S9 VPAP Auto
Mask Type: Full face mask
Mask Make & Model: Resmed Mirage Quattro
Humidifier: H5i(distilled-top up)
CPAP Pressure: VAuto MinE14.0 MaxI 20.6 PS4.0
CPAP Software: ResScan SleepyHead

Other Comments:

Sex: Male
Location: Orange County,California

Post: #16
RE: Leaks vs effective AHI control
The 60 lpm threshold for large leaks with the PR machine is the total leak rate. That is mask vent rate plus additional unintentional leak rate. That means that it may or may not be less picky than Resmed machines, since Resmed's threshold is for unintentional leak only.

It would seem that to avoid the vicious cycle that you describe, you need to fit the mask so that it does not leak at the max pressure. If you had a Resmed machine, I would recommend that you use the mask fit option on the machine. I do not know if PR machines have this feature but I would imagine that they do.
10-19-2014 05:30 PM
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Peter_C Offline

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Machine: System One DS960HS
Mask Type: Full face mask
Mask Make & Model: Mirage Quattro "MED"
Humidifier: Attached
CPAP Pressure: Auto mode-script is:15/3/3
CPAP Software: EncoreBasic Other Software

Other Comments: Severe obstructive sleep apnea 1999/Just got an ASV machine

Sex: Male
Location: Akron, Ohio USA

Post: #17
RE: Leaks vs effective AHI control
Last night I woke up gasping for breath. First time in many years. Due to a brace I have to wear for a while, I must sleep on my back, which make everything worse. Near as I can figure, my leaks got bad enough for long enough that the machine turned itself off (auto off is enabled) and 47 seconds later it turned itself back on (when I started gasping) I really thought I had the leak issues done with, but they're back and it seems the only way to stop them is by tightening the mask to the point that I wake up in pain.

Yes, I both have and tried liners. Currently have a P10, a Quattro Air, and an old still in the box 5-6yr old Quattro something that I may dig out and try. On, and cuz I'm on a roll, shoulder surgery is in 12 hours.

*I* am not a DOCTOR or any type of Health Care Professional. My thoughts/suggestions/ideas are strictly only my opinions.

"Only two defining forces have ever offered to die for you. Jesus Christ and the American Soldier. One died for your Soul, the other for your Freedom."
10-19-2014 05:44 PM
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Ghost1958 Offline

Advisory Members

Posts: 957
Joined: Aug 2014

Machine: PRS1 Series Sixty Auto Aflex
Mask Type: Nasal mask
Mask Make & Model: F&P Eson
Humidifier: PRS1 with Heated Hose
CPAP Pressure: 10.5 min 16 max
CPAP Software: SleepyHead EncoreBasic

Other Comments: Moderate to Severe SA Obstructive. Rapid O2 desat off the machine.

Sex: Male
Location: KY

Post: #18
RE: Leaks vs effective AHI control
(10-19-2014 05:30 PM)PaytonA Wrote:  The 60 lpm threshold for large leaks with the PR machine is the total leak rate. That is mask vent rate plus additional unintentional leak rate. That means that it may or may not be less picky than Resmed machines, since Resmed's threshold is for unintentional leak only.

It would seem that to avoid the vicious cycle that you describe, you need to fit the mask so that it does not leak at the max pressure. If you had a Resmed machine, I would recommend that you use the mask fit option on the machine. I do not know if PR machines have this feature but I would imagine that they do.

Yep it has the 45 min mask test at 20. I can set for no leaks at that pressure and normally no problems. But as you know there will be the occasional nite that you flip around bury your face in the pillow etc and knock things loose without realizing it.

That is when I noticed that if you have a lot of leaks at least for me, pressures and events tend to go up vs little to no leaks and events are cleared with much less pressure. Just my observation. Normally I have no problem with leaks. Just on the occasional nite I dream im riding a bucking horse or something LOL.
10-19-2014 08:42 PM
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