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Mask Fit and Leakage
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Taxman Derek Offline

Members

Posts: 4
Joined: Jun 2013

Machine: ResMed S9 Autoset
Mask Type: Full face mask
Mask Make & Model: ResMed Quattro
Humidifier: H5i
CPAP Pressure: 19 cmH2O
CPAP Software: ResScan

Other Comments:

Sex: Male
Location: Colorado

Post: #1
Mask Fit and Leakage
First, thanks to everyone on this board. This site was invaluable in the time between my first visit to my sleep specialist and actually getting setup with my CPAP machine. I learned a ton from this site and was able to go to my post-sleep study appointment and ask for exactly what I wanted in terms of my equipment options.

My question relates to the leak rate I have been experiencing over the last few nights. I started treatment with my S9 Autoset on 6/26 (CPAP mode at 19 cmH20--at least until my 1 month follow-up--after that, I may experiment with the auto mode and see if I really need such high pressure all the time). Over the first eight nights, my AHI has generally improved each night. The first couple of nights, I got the smiley face indicator in the morning for mask fit, but over the last five nights, it has been a frown-y face every night.

The leaks seem to happen more around the top half of my mask and, at least the ones I notice when I'm awake, seem to be more like bubbles of air escaping rather than a steady leak. Because my pressure is so high, I think I might be wearing the mask tighter than some people seem to recommend on here, but if I don't, the air pressure will escape constantly from around my nose and cheeks in particular.

My question is, if my AHI is steady or improving every night (had my best night last night at 2.0), should I really care that much about the leaks and the Angry in the morning if my AHI stays lower and lower?

Here's my data so far (AHI; 95th Percentile Leak Rate):

6/26 -- 9.6; 30.0
6/27 -- 7.6; 0.0
6/28 -- 10.1; 18.0
6/29 -- 10.8; 63.6
6/30 -- 6.5; 73.2
7/1 -- 8.5; 81.6
7/2 -- 5.3; 92.4
7/3 -- 2.0; 98.4

Median and average daily usage times for these days are 7:57 and 7:41, respectively.

I think the AHI my first couple of nights may be skewed a little high--Looking at the detail data, I believe I was awake during most of the clusters of apneas that seem to have occurred. These 'false' apneas appear to all be marked as centrals. If I take those out, my obstructive apnea average per hour is 3.2 since I started on 6/26.

I started with an AHI in my sleep study of 161, so I'm very happy with my average AHI of 8.0 over these eight nights. I feel 100% better than I did a week ago and I have not fallen asleep unless I intended to since I got my machine. I'm just not sure if I should worry too much about the leaks if the AHI continues to improve.

Also, if anyone has any tips on fitting a Mirage Quattro for use with a relatively high pressure, I'd love to hear it. Clearly, from the first couple of night, this mask can fit me quite well, I just am not getting the right combination of adjustments to make it work.

Thanks everybody, and sorry for such a long post.
07-04-2013 11:52 PM
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Tez62 Offline

Monitors

Posts: 837
Joined: Feb 2013

Machine: Resmed S9 Autoset
Mask Type: Full face mask
Mask Make & Model: Resmed Mirage Quattro
Humidifier: Resmed
CPAP Pressure: 5-15
CPAP Software: SleepyHead

Other Comments:

Sex: Male
Location: Melbourne, Australia

Post: #2
RE: Mask Fit and Leakage
Taxman Derek, welcome, I use the same mask and machine, your AHI's could be a bit lower but as you said they are much better than 161 and if you feel better that's really what counts, I can't believe 161, that means woud never ever get any quality sleep. Two tips with the mask that you may already be doing, I always have my hose coming from above my head either over a bed head or buy or make a hose lift, that way you don't get tangled and the gravity pulls your mask up instaed of dow. The second is use mask liners, either buy them over the internet or you can make them cheaply, I can give you the instructions if you want. These are two ways to reduce leaks.
07-05-2013 12:02 AM
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Taxman Derek Offline

Members

Posts: 4
Joined: Jun 2013

Machine: ResMed S9 Autoset
Mask Type: Full face mask
Mask Make & Model: ResMed Quattro
Humidifier: H5i
CPAP Pressure: 19 cmH2O
CPAP Software: ResScan

Other Comments:

Sex: Male
Location: Colorado

Post: #3
RE: Mask Fit and Leakage
Thanks for the advice. I tried RemZzzs liners, but with the liner, it felt like air was escaping around the entire mask and not just around the nose/cheek area. I may try again though to see if it makes a difference statistically.

The hose lift idea is a good one. I've noticed the effect of gravity even by just holding some slack in the hose at bed level versus when it just hangs off the bed. Holding the hose at my side helps, but only as long as I am awake to hold it! I foresee a trip to Home Depot in my future...


(07-05-2013 12:02 AM)Tez62 Wrote:  Taxman Derek, welcome, I use the same mask and machine, your AHI's could be a bit lower but as you said they are much better than 161 and if you feel better that's really what counts, I can't believe 161, that means woud never ever get any quality sleep. Two tips with the mask that you may already be doing, I always have my hose coming from above my head either over a bed head or buy or make a hose lift, that way you don't get tangled and the gravity pulls your mask up instaed of dow. The second is use mask liners, either buy them over the internet or you can make them cheaply, I can give you the instructions if you want. These are two ways to reduce leaks.
07-05-2013 12:10 AM
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Tez62 Offline

Monitors

Posts: 837
Joined: Feb 2013

Machine: Resmed S9 Autoset
Mask Type: Full face mask
Mask Make & Model: Resmed Mirage Quattro
Humidifier: Resmed
CPAP Pressure: 5-15
CPAP Software: SleepyHead

Other Comments:

Sex: Male
Location: Melbourne, Australia

Post: #4
RE: Mask Fit and Leakage
I made my own hose lift, depending where your CPAP sits, mine is in a cabinet and I run the hose up it through a clip on ring and sit over the top of my head, that way I can move in any direction as well as from side to side. I just find the liners are better because the silicone is not touching my face directly. Like anything CPAP everything takes some getting used to and everyone will do things differently , as long as it works for you.
07-05-2013 12:18 AM
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PaulaO2 Offline
Wiki Editor
Moderators

Posts: 8,068
Joined: Feb 2012

Machine: S9 Autoset
Mask Type: Full face mask
Mask Make & Model: F&P Simplus
Humidifier: H5i
CPAP Pressure: 14-20
CPAP Software: SleepyHead

Other Comments: Ehlers-Danlos Syndrome, Hypermobility Type; chronic sarcasm

Sex: Undisclosed
Location: western NC, USA

Post: #5
RE: Mask Fit and Leakage
Any events the machine records during a high leak event - those are invalid and should not be considered as accurate. Doesn't mean it was a false reading, just an inaccurate reading.

You do not want a leak rate over 24. There may be some leeway due to type of mask and all that, but that's the number we all aim below.

There's a few people here who have made their own liners out of old t-shirts.

You want the mask tight enough that it stays on but not so tight you increase the leaks. Most masks are designed to float on the face. Many of them have baffles of sorts that kinda inflate and form the seal from inside. Over tightening ruins that inflating and results in a bad seal.

If the mask worked fine for a few nights and now is not, have you cleaned it lately? Oils and the like can contribute to leaks. So can the wrong kind of soaps/cleaners if unsafe for silicone.

Put on the mask and turn on the machine. Then lay down and try to figure out ways to decrease the leaks. If you can't then you may need another mask. Turn about in bed and see what happens when you sleep on your side, your back, etc. Hose holders (can be as simple as a hook and string), machine placement, different pillow, etc.

PaulaO2
Apnea Board Moderator
www.ApneaBoard.com


Breathe deeply and count to zen.

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.
07-05-2013 12:42 AM
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trish6hundred Offline

Advisory Members

Posts: 6,453
Joined: May 2012

Machine: Resmed S9 AutoSet for Her
Mask Type: Full face mask
Mask Make & Model: Fisher & Paykel Simplus
Humidifier: H5i Heated Humidifier
CPAP Pressure: 10 - 7-20 Cm H2O
CPAP Software: Not using software

Other Comments: I started CPAP in 2008. Totally blind since birth.

Sex: Female
Location: Missouri, USA

Post: #6
RE: Mask Fit and Leakage
Hi Taxman Derek,
WELCOME! to the forum.!
Full-Face masks, (FFMs,) can be difficult to deal with but you've gotten great advice so far.
Best of luck in taming your Quatro.

trish6hundred
07-05-2013 07:40 AM
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Shastzi Offline

Advisory Members

Posts: 1,174
Joined: Dec 2012

Machine: ResMed S9 Autoset
Mask Type: Full face mask
Mask Make & Model: FitLife Total face mask
Humidifier: F&P HC150 with Hybernite heated hose.
CPAP Pressure: 15cm-20cm H2O (auto)
CPAP Software: SleepyHead Other Software

Other Comments: CMS50-F wearable Oximeter; Software: SPO2 Assistant

Sex: Undisclosed
Location: Florida, USA.

Post: #7
RE: Mask Fit and Leakage
I am getting near zero leaks and consistant AHI below 2.8.
You might want to try using SleepyHead to isolate the leaks and
see what else you can find.

Good luck & Sleep-well

"With ordinary talent and extraordinary perseverance, all things are attainable." - Thomas Foxwell Buxton

Cool
07-05-2013 03:47 PM
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Dawei Offline

Preferred Members-2

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: #8
RE: Mask Fit and Leakage
Derek, Here's another suggestion for you to consider. A pressure of 19 cm is certainly a high one and therefore quite difficult to keep leaks under control for anyone. My pressure is also in that range. Because of the high pressure, I also need to keep my mask pretty tight to my face. That need seems to go with a pressure like we're using.
With the mask I'm using, leaks across the forehead were almost constant. The solution I found from another board member was to place a thin roll of silicone earplug material on the sealing portion of the mask in the leak-prone area. This has eliminated my leakage at this pressure. Many nights I see zero leaks, and when there has been some leaking, it's well below that 24 L maximum goal.
I buy Macks brand silicone earplugs at a drugstore and form them into a pencil sized roll in my hands and then gently press it onto the mask seal each evening. The material can be reused for several nights before needing to be replaced.
07-05-2013 06:22 PM
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spdklls99 Offline

Preferred Members-2

Posts: 71
Joined: Jun 2013

Machine: Respironics System One BIPAP Auto SV Advanced DS950
Mask Type: Full face mask
Mask Make & Model: comfortgel full
Humidifier: PR S1 Heated
CPAP Pressure: epap 10-15,psmin 3, bpm Auto
CPAP Software: SleepyHead

Other Comments:

Sex: Male
Location: Eastern TN

Post: #9
RE: Mask Fit and Leakage
I dont know about the 24 leak rate being the gold standard...the higher your pressure..the higher the acceptable leak rate goes for your mask.

My pressure is high ..average 13epap- 17 ipap...does max out at 25 sometimes and my unintentional leak is from 15 to 40...the total leak can range from 45 to 100....yet sleepmapper says my mask fit is excellent at 100%... A percentage at or over 75% mask fit is considered not only acceptable....but doing great...
plus respironics says the intentional leak is around 40 or so for my mask vents at that pressure..

I have heard the 24 magic number repeated constantly in here but I cant find any reason or literature anywhere to backup the claim why that number is the IT number..depending on your pressure,and mask ,what leak number is acceptable and what is not will change.

The remz liners made my leaks go thru the roof..tried one liner one night...then 4 liners 2 nights later...those 2 nights are the highest leak ratenights I have had by far....so they dont work for everyone

I don't believe anything I hear and only half of what I see
(This post was last modified: 07-10-2013 08:39 PM by spdklls99.)
07-10-2013 08:36 PM
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jgjones1972 Offline

Preferred Members-2

Posts: 516
Joined: Nov 2012

Machine: ResMed S9 AutoSet
Mask Type: Full face mask
Mask Make & Model: ResMed Quattro FX
Humidifier: ResMed H5i
CPAP Pressure: 18 - 20
CPAP Software: ResScan SleepyHead

Other Comments: CMS50I PulseOx

Sex: Male
Location: Ohio - USA

Post: #10
RE: Mask Fit and Leakage
(07-10-2013 08:36 PM)spdklls99 Wrote:  I have heard the 24 magic number repeated constantly in here but I cant find any reason or literature anywhere to backup the claim why that number is the IT number..depending on your pressure,and mask ,what leak number is acceptable and what is not will change.

24Lpm is the standard for ResMed S9 Machines to report data properly. S9s automatically take intentional leak (adjusted for pressure) and subtract that from total leak and provide the user with reports of unintentional leak. The machine may very well be able to compensate for higher leaks to an extent and may provide adequate therapy; but ResMed says that data recorded while unintentional leak is above 24Lpm should not be assumed to be accurate. As an example, when unintentional leak is above 24Lpm the AutoSet may not be able to differentiate Obstructive Apnea from Clear Airway Apnea.

Sleep-well
07-10-2013 09:07 PM
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