P10 mask Leaks -- Need advice please

[Sheepish]

Quote
I have read mentions of lanolin helping seal them. Would lanolin help seal them?......

One thing I have learnt is that I have to wash the space between my nose and mouth thoroughly last thing every night and not apply any face cream to that area otherwise any body oils and my face cream will cause leaks. I have never used lanolin and cannot tell you if it helps.

Lanolin (Lansinoh in my case), is usually used to alleviate pain and/or irritation in/on you nares. Who knows, it might also help create a better seal.

Another thing to do (before and whether or not you apply Lansinoh), is to take the scentless, alcohol-free wipe you've just wiped down your mask with before bedtime (we're all doing this basic hygiene procedure every night, right folks? ) and use the still moist yet unsullied edges to clean off, de-oil and freshen up the lower part of your nose, the rims of your nares and your general philtrum area before masking up.

[sheepless]

when I look at the attached graphs, besides the clusters W2 & others will point out (agree, and still looking locally for a soft collar), I see leaks that rise with pressure (which rises in response to obstruction) and more at lower pressure that look to be more closely related to events and flow limitations. I realize these things are all interrelated, even if I don't completely understand how, and I sure don't know what's chicken and what's egg.  but it does look to me like apnea and flow limitations are associated with leaks (if not the cause), even when pressure is at the low end of the settings. btw, I was aware of leaking from the lips during the first sleep, between 1 - 2 pm.  don't know where other leaks were coming from but other leaks do appear to be climbing before pressure rises and at the time of apnea and flow limitations (see for example around 5 - 6 am).  am I missing something here? 

besides commenting on whether unresolved apnea tends to produce leaks (where does the air go when not into airway & lungs?), feel free to weigh in on efficacy of therapy after looking at this chart.

thanks for bearing with me.  just trying to "get it".

[sheepless]

Quote
I have read mentions of lanolin helping seal them. Would lanolin help seal them?......

One thing I have learnt is that I have to wash the space between my nose and mouth thoroughly last thing every night and not apply any face cream to that area otherwise any body oils and my face cream will cause leaks. I have never used lanolin and cannot tell you if it helps.

Lanolin (Lansinoh in my case), is usually used to alleviate pain and/or irritation in/on you nares. Who knows, it might also help create a better seal.

Another thing to do (before and whether or not you apply Lansinoh), is to take the scentless, alcohol-free wipe you've just wiped down your mask with before bedtime (we're all doing this basic hygiene procedure every night, right folks? ) and use the still moist yet unsullied edges to clean off, de-oil and freshen up the lower part of your nose, the rims of your nares and your general philtrum area before masking up.

nares? philtrum?  sheepish, I'm gonna have to break out the dictionary.   

[Walla Walla]

when I look at the attached graphs, besides the clusters W2 & others will point out (agree, and still looking locally for a soft collar), I see leaks that rise with pressure (which rises in response to obstruction) and more at lower pressure that look to be more closely related to events and flow limitations. I realize these things are all interrelated, even if I don't completely understand how, and I sure don't know what's chicken and what's egg.  but it does look to me like apnea and flow limitations are associated with leaks (if not the cause), even when pressure is at the low end of the settings. btw, I was aware of leaking from the lips during the first sleep, between 1 - 2 pm.  don't know where other leaks were coming from but other leaks do appear to be climbing before pressure rises and at the time of apnea and flow limitations (see for example around 5 - 6 am).  am I missing something here? 

besides commenting on whether unresolved apnea tends to produce leaks (where does the air go when not into airway & lungs?), feel free to weigh in on efficacy of therapy after looking at this chart.

thanks for bearing with me.  just trying to "get it".

I'd set your maximum pressure to 11.5cm to prevent the pressure from running away due to leaks . I think a collar will clear up most of the events with a pressure below 11.5cm.

[tedvpap]

Tedvpap said: "Apnea events do not cause leaks.  The machine targets a pressure so it flows enough air to maintain the target pressure.  When you are not breathing the flow rate is nominal.  Flow rate increases slightly during inhalation, and decreases slightly during exhalation - assuming there is no leaking.  Leaks get worse as pressure increases, as mask position changes, and as the shape of the face relaxes."

tedvpap, I have no reason to dispute this but I don't understand it.  is the target pressure the set pressure or is it wherever the algorithm is taking it?  maybe you're saying the machine algorithm varies pressure necessary to maintain set pressure at/in the airway?  still, I'm not sure what that would mean either.  

when you say flow rate is nominal when not breathing, what does that mean?  the min set pressure? but wouldn't that mean the machine would never raise pressure to the max setting?

if machine is set to 8 - 20cm and I have an unresolved obstructive apnea - I don't think it matters at what pressure - air at some pressure is blowing into my nostrils but not into my airway and lungs.  where does the air I'd normally inhale go?  some, but I think by design not all, presumably exits via the exhaulation port(?), but if that were adequate, why does the mask come away from my face at higher pressures?  are you making a distinction between air pressure and air flow that I'm not getting? or what?

sorry, I'm so thick.  as they say on reddit, explain it like to a 5 year old please.  thanks.

I did not explain the physics clearly so thanks for asking questions.  You are not thick.  This topic causes a lot of confusion so I need to do a better job of explaining.  I am not taking about machine settings or algorithms - just trying to explain the concepts of flow and pressure.  

All of these machines are called flow generators - they generate flow.  When they generate more flow than needed, the pressure goes up.  All machines measure the pressure and flow rate at the machine.  All machines (except for ASV) deliver a desired pressure.  So if the target pressure is 10, it adjusts the flow rate in order to obtain a pressure at the machine of 10.  

Assuming no mask leak, all of the flow exits via the mask's vent. The majority of the airflow goes straight out the vent, the rest of it enters the lungs and is then expelled which then exits via the vent.  So it is important to understand that all flow measured by the machine exits via the vent assuming no leaking occurs.  The pressure is a result of the air flow rate and the resistance due to the mask's vent.  So when at a set pressure and no leaking and no breathing, the flow rate is constant.  Any change is due to leaking or breathing.  When breathing, the flow rate will increase a little during inhalation, and decrease during exhalation but on average it equals out.  Pressure stays constant (as measured at the machine) even though the flow rate changes a little.  

So the point I am trying to make is that the machine delivers pressure, not flow rate. So when you are breathing normally, all the flow exits via the mask's vent.  When there is an apnea event, all flow still exits via the mask's vent.  The only difference is that none of it passed through the lungs before exiting.     

There is another subtle concept which is not really relevant to the question as to whether apnea events cause leaks, but it causes confusion so I will try to explain.  Pressure does not cause flow - pressure differentials do.  There is higher pressure inside a balloon than on the outside but it can not flow.  A pin prick creates a flow path so flow occurs.  Our machines measure flow rate and pressure at the machine.  Some machines report mask pressure.  This value is not measure as it is calculated.  When there is no flow, the mask pressure will be equal to the machine pressure. The pressure differential is zero so flow is zero.   Since the mask has a vent, there is always flow as there is a pressure differential and a flow path so mask pressure is always a little lower than machine pressure. 

Hopefully this better explains why apnea events do not cause mask leaks - the mask pressure is essentially unchanged by a slight change in flow rate.
If I confused anyone, please let me know and I will try to clarify.  
I am sure there must be a better way to explain these concepts.  
I am trying to explain them as I see there is plenty of misunderstanding.

[Sheepish]

Quote
I have read mentions of lanolin helping seal them. Would lanolin help seal them?......

One thing I have learnt is that I have to wash the space between my nose and mouth thoroughly last thing every night and not apply any face cream to that area otherwise any body oils and my face cream will cause leaks. I have never used lanolin and cannot tell you if it helps.

Lanolin (Lansinoh in my case), is usually used to alleviate pain and/or irritation in/on you nares. Who knows, it might also help create a better seal.

Another thing to do (before and whether or not you apply Lansinoh), is to take the scentless, alcohol-free wipe you've just wiped down your mask with before bedtime (we're all doing this basic hygiene procedure every night, right folks? ) and use the still moist yet unsullied edges to clean off, de-oil and freshen up the lower part of your nose, the rims of your nares and your general philtrum area before masking up.

nares? philtrum?  sheepish, I'm gonna have to break out the dictionary.   

Sometimes a picture is worth a thousand words. A crash course in applied anatomy:

The columella-philtral angle (6), for example, can sometime become irritated during the first few days of using a new mask, in particular the DreamWear nasal CPAP mask in my case, so that's where the Lansinoh came in handy, whereas I needed to apply some just on the inner rim of my nares (or the vestibule to be more accurate) with the P10, actually for quite a few weeks, off and on, because of irritation and pain (and no, it's not because it was on too tight -- that's rarely a problem with the P10.

*Yes, this will be on the test, class.

[sheepless]

well, no wonder I don't know these terms. I haven't seen my philtrum since the last time I shaved 30 years ago! meanwhile, I'm a little shocked to find out I have a vesibule in my left nare (according to the graphic). you are right; the picture is better than a description. thanks for saving me from the dictionary. sometimes I get lost in them once opened.

[sheepless]

tedvpap, wow.  thanks for that explanation.  sorry to make you go to all that effort.  I'm gonna chew on it for a while to see if I really understand what you are saying.  if not, I might have another question or two.  really great to have access to so much knowledge here.

[sheepless]

when I look at the attached graphs, besides the clusters W2 & others will point out (agree, and still looking locally for a soft collar), I see leaks that rise with pressure (which rises in response to obstruction) and more at lower pressure that look to be more closely related to events and flow limitations. I realize these things are all interrelated, even if I don't completely understand how, and I sure don't know what's chicken and what's egg.  but it does look to me like apnea and flow limitations are associated with leaks (if not the cause), even when pressure is at the low end of the settings. btw, I was aware of leaking from the lips during the first sleep, between 1 - 2 pm.  don't know where other leaks were coming from but other leaks do appear to be climbing before pressure rises and at the time of apnea and flow limitations (see for example around 5 - 6 am).  am I missing something here? 

besides commenting on whether unresolved apnea tends to produce leaks (where does the air go when not into airway & lungs?), feel free to weigh in on efficacy of therapy after looking at this chart.

thanks for bearing with me.  just trying to "get it".

I'd set your maximum pressure to 11.5cm to prevent the pressure from running away due to leaks . I think a collar will clear up most of the events with a pressure below 11.5cm.

thanks WallaWalla.  I'm a little worried that maybe now I really have inadvertantly hijacked gwc2795's thread.  I have a question about limiting max pressure.  mods, please advise me re proper etiquette.

[tedvpap]

tedvpap, wow.  thanks for that explanation.  sorry to make you go to all that effort.  I'm gonna chew on it for a while to see if I really understand what you are saying.  if not, I might have another question or two.  really great to have access to so much knowledge here.

You are welcome.
Please don't hesitate to ask any questions.  These concepts cause a lot of confusion and many people do not explain them properly - which I likely also failed to do.