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can't solve Forma mask leaks
#1
This is my first post here so bear with me. I've been using my CPAP and mask for about 2 years with few problems. In Dec 2016 I noticed more mask leaks than usual  and fired up Sleepyhead and Rescan. Sure enough, large leaks and AHI indicated. I decided to replace my mask with new stuff but still the Forma Large. I have been struggling since then to lower leaks. Used the jeffy1958 procedure because it made sense to me. However, the results are not happening.
I happened to have a Quatro FX that I used last night. The results are somewhat better but I don't think it's right. When I put on the either mask, they seem OK at first not tight and the 'skirt' inflates and I don't notice leaks. I then move the mask around to see how much tolerance there is for leaks. Then off to sleep. I'm usually awakened an hour or so later with the mask seeming to blow off my face and making a helluva whoosing noise. It's like the S9 is starting LiftOff. I've tried manually forcing the mask against my face to see if the pressure will eventually go down but it doesn't. I then cycle power on the S9. I can repeat this several times and then I just give up and put up with the apneas.
I know I must be making this more complicated than necessary.   I've attached several plots from Sleepyhead in the hopes that you can spot some obvious problems.
imgur.com/UAsFk1m.png       Forma
imgur.com/Dx3FsoC.png          Forma
imgur.com/5FFJtHo.png           Forma
imgur.com/mWCm98Z.png      Quatro (the first data is me trying the mask first to make sure it was working)

Thanks
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#2
Welcome to the apneaboard! Haven't been here long myself but will give you some things I'm seeing in your charts. Your pressure settings are 4-20 which could be part of the problem. Most people find 4 is much to low to get enough air to breathe naturally. Looking at your median pressure I would suggest going with 7 or 8 as a minimum so your PAP doesn't have to make a huge jump which could be causing the leaks. Also when you first start up your PAP you'll get a better chance to fit the mask properly.  In theory, the machine should only go as high as needed but from personal experience I find I get much better results by limiting the high end so it doesn't start a snowball effect when leaks start. Looking at the max pressures you've been getting to I would maybe limit it to 15 initially to see how that works. You may end up lowering it even more after you see how it's working for you. If you've never changed any of the settings on your machine before you can request a download of the clinicians manual following the link at the top of the page titled "CPAP Setup Manuals".

I personally don't use a FFM but have seen numerous post on the board on how to get the best fit. Just search at the bottom of the page. Most seem to think the biggest mistake is people over tighten them.

Welcome
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#3
Thank you Cranberry Ray. Your suggestions make sense. I have to admit that I still don't understand the inner working of the S9. That's hard for an engineer to admit!. I'm reviewing the Clinicians Manual. I also notice that ResScan has a tab that shows the machine settings. Can settings be modified there also? At this point, I don't want to 'experiment' with stuff I don't understand. But will accept advice from the knowledge experts on this board.

Thanks again for the welcome.
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#4
(02-17-2017, 07:08 PM)kblackw Wrote: I also notice that ResScan has a tab that shows the machine settings. Can settings be modified there also?

You can change the S9's setting using ResScan but I don't advise it.  It will wipe out all the data on your SD card.  I believe this feature is to allow a medical practice a way to modify the patient's machine without it being present.
______________________
Useful Links -or- When All Else Fails:
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#5
The setup manual for your machine should explain how to see the settings on the machine itself.
Looking at them won't change anything, so take a look.
                                                                                                                                                                                  
Please organize your SleeyHead screenshots like this.
I'm an epidemiologist, not a medical provider. 
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#6
Hi kblackw,

WELCOME! to the forum.!
Have you considered trying a different mask? There are so many of them out there and you might find a better one. I know it can be challenging but sometimes, a change of masks may be necessary.
Have you tried to use SleepyHead ? From what I have read, it is quite a bit more user-friendly than ResScann, which is more set up for the clinician than the patient.
Another thing, your machine is set to wide open, 4-20 CmH2O. The data-management software such as ResScann or SleepyHead will show you your baseline pressure. For example, my machine is set at a range of 7-20 CmH2o, and my titration pressure is 10. You might need to raise your minimum pressure a bit, and lower your maximum pressure a bit, to..
I hope I haven't confused you, but
Hang in there for more answers to your question, 2 or more heads are better than one.
I wish you good luck with your CPAP therapy.
trish6hundred
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#7
Thanks Crimson Nape. Glad I didn't jump in and try to modify with ResScan. I'm a data freak and would not want to lose all the past data.

Thanks Beej, now have the manual and about to make a change. ResScan does show the settings so at least I can take a screen shot to remember the starting point.

Thanks Trish6hundred. So far I have tried 2 FFMs (Forma and Quattro FX). Other recommendations for FFM? As you can see in my signature I have SleepyHead and RecScan. The plots I included are from SH. I just pulled a 'fast one' to get around the 4 post requirement. I don't think my problem can be addressed unless the data are presented.
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#8
(02-17-2017, 02:09 AM)kblackw Wrote: This is my first post here so bear with me. I've been using my CPAP and mask for about 2 years with few problems. In Dec 2016 I noticed more mask leaks than usual  and fired up Sleepyhead and Rescan. Sure enough, large leaks and AHI indicated. I decided to replace my mask with new stuff but still the Forma Large. I have been struggling since then to lower leaks. Used the jeffy1958 procedure because it made sense to me. However, the results are not happening.
I happened to have a Quatro FX that I used last night. The results are somewhat better but I don't think it's right. When I put on the either mask, they seem OK at first not tight and the 'skirt' inflates and I don't notice leaks. I then move the mask around to see how much tolerance there is for leaks. Then off to sleep. I'm usually awakened an hour or so later with the mask seeming to blow off my face and making a helluva whoosing noise. It's like the S9 is starting LiftOff. I've tried manually forcing the mask against my face to see if the pressure will eventually go down but it doesn't. I then cycle power on the S9. I can repeat this several times and then I just give up and put up with the apneas.
I know I must be making this more complicated than necessary.   I've attached several plots from Sleepyhead in the hopes that you can spot some obvious problems.
imgur.com/UAsFk1m.png       Forma
imgur.com/Dx3FsoC.png          Forma
imgur.com/5FFJtHo.png           Forma
imgur.com/mWCm98Z.png      Quatro (the first data is me trying the mask first to make sure it was working)

Thanks

It looks to me from your Forma data like you are adjusting your mask at the low pressure settings and when the pressure goes up the leaks do too. Your machine has a mask fit feature which you can use to adjust the mask. It will give you your max IPAP pressure to adjust your mask. You can find this feature by pressing the rectangular button just below the large twist and push knob. you will see the mask fit option on this menu. Scroll down to it with the knob, hook your mask up, put your mask on and push the knob. Wait for a little while before making final adjustments for the machine to ramp the pressure up. You may want to decrease your max IPAP pressure before doing this since it does not look like you will need to seal at 20 cm pressure.

You want to take your adjustments slow to get them just to the point where they just eliminate the leaks and no tighter. The looser is better crowd is right to an extent but the fact of the matter is that higher pressures require higher strap tension. My IPAP pressures are up around 20 cm and my leaks are generally very good unless I have screwed something up. My mask feels like it "floats" on my face but it does not float lightly.

The leak data from the Quattro look good. You want to get the leaks under control before you start worrying about AHI.

Best Regards,

PaytonA
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#9
Thanks PaytonA, you nailed my problem. I used the Mask Fit function and readjusted both masks at the higher pressure and the leaks went down to almost nothing. 95% leak rate is 1.2 - a huge improvement.
I am also finally sleeping more - 6.7 hours last night, uninterrupted. Much better than the 2-3 hours before.
I also lowered the pressures to 6 - 17.
Now I can start working on the high AHIs. I'll be reviewing posts on this topic first.
Thanks so much for your help. I like making positive progress.
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