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leaks - how, what, why...
#1
SleepyHead says: Your mask is leaking way too much.. Talk to your CPAP advisor.

I get some leaks around the pillows and sometimes my mouth is leaking. Seemed like last night the pillow leaks were worse.

Ideas on how to isolate and improve this?

Are these numbers really that bad?

[Image: elkAT6e.jpg]
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#2
Yes you do need to reduce your leak rate a bit. Also look at your flow limit. It's a bit choppy. Also I see that your machine is set to APAP mode, with min and max both set to 8.6. That seems a little peculiar to me, but might be fine.

I think I would raise the pressure to 9 and see if that doesn't calm down the flow limit.

As to the leaks? I suspect you may have a tendency to let the jaw fall backwards in the night causing the mouth to open a little, and at that point the chinstrap gently pulls the pillows out of place a little. How are you dressed out? Mask then chinstrap? Chinstrap then mask? Try reversing the order and see if it helps. Also work with the chinstrap to make sure it's tendency is to keep the jaw forward, not cause it to slip backwards when you relax.
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#3
I recommend a full face mask.
Sleepster
Apnea Board Moderator
www.ApneaBoard.com


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
I've been trying to find that sweet spot. At 8.6 I had 1 OH and 1 Hyp. So I figured that's high enough on the top end for now. But maybe I need to open it up some more.

I'm trying to avoid having even more restless sleep. I have been narrowing my range. It was 7-9. Then 8-9. I tried a straight 9 last night, but after 30 minutes of not being comfortable breathing out against it (EPR 1) I stopped the machine and dropped it down to 8.6.

Part of my problem is still not feeling rested. I slept about 12 hours Friday night, 12 Saturday night. I got about 7 Sunday night. Nine last night. Still had a really hard time getting up this morning. I'm happy that I don't have the tight chest and pounding heart from the OA's, but I'm frustrated with still not resting well. Pretty sure waking up many many times during the night is contributing to that.

On a different note, I've seen on here Exp time should be about double Insp time. I'm consistently running Exp a little under Insp. 1.82 vs 2.08 for my median last night. I may need to try EPR 2 again. That also introduces some unnatural feeling into the equation too though.
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#5
I have a Ruby chinstrap. It goes on first. The P10 goes on second.

I've been using the medium size pillow. I may need to go back to the large. The large was pressing on the area above my upper lip and wasn't comfortable. It might seal better, and I might feel better exhaling through it.
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#6
One other stat I'm curious about is the median tidal volume. It looks a bit low at 360. I got the impression it should be around 500. Don't know if that means anything.

It may be inaccurate due to the leaks too.

Doing a quick google search just now - my "ideal body weight" for tidal volume is around 76kg, which gives about 530 using a 7ml per kg figure.

Might mean nothing... just trying to figure out where to go from here.


I did come up with a high red blood cell count on my last cbc. So maybe I'm just more efficient than average. Smile

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#7
(04-21-2015, 12:49 PM)worn_out_in_lebanon Wrote: I've been trying to find that sweet spot. At 8.6 I had 1 OH and 1 Hyp.

One night's data won't do that. Set it on a reasonable range and leave it there for at least a week. Then check to see how much time you're spending near the high and low ends of that range. If you're spending most of your time in the middle of the range you've found your elusive sweet spot. But you still want a range because there are times when you need a higher pressure. I have my max set at 13.6 because I rarely if ever reach that high, but I do come close. If the max isn't high enough you can have an apnea, hypopnea, or flow limitation that wakes you up and interferes with the quality of your sleep.

Quote:I'm trying to avoid having even more restless sleep.


It can just take time to get used to sleeping with a CPAP machine. If you keep tweaking the settings it can make it harder to get used to it.

Quote:I tried a straight 9 last night, but after 30 minutes of not being comfortable breathing out against it (EPR 1) I stopped the machine and dropped it down to 8.6.

Set EPR to 3. EPR is designed to make it easier to breathe out against the pressure.

Quote:Part of my problem is still not feeling rested.

This is the frustrating part of CPAP therapy. Long after the machine and mask are tweaked to their best, the body continues to wake often and feel tired. All I can tell you is you have to be patient. You will feel better, it just takes time. Keep in mind that the alternative to CPAP therapy is a miserable sleep-deprived life and an early death.

Here's my 1-2-3 of CPAP therapy.

1. Compliance. The hours-used that are recorded by the machine must prove that you are wearing the mask all the time you're sleeping, every time you sleep.

2. Leaks. Even if the machine is reporting acceptable leak rates you have to look at your leak graph. Spikes that last for many minutes indicate problems that can be interfering with the quality of your sleep.

3. AHI. Check and monitor your AHI and its components (OA, CA, and H).

Do these in order. You don't worry about 2 or 3 until you've mastered 1. You don't worry about 3 until you've got 2 at least under control.

You can have a good AHI but if leaks are interfering with your sleep, or worse you're taking your mask off in your sleep, you won't be getting the full benefit of your therapy.
Sleepster
Apnea Board Moderator
www.ApneaBoard.com


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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#8
All good points.

I've let it range up as high as 11.6 a month ago. I got 35 CA's that night. The lower the max, the less the CA's.

(I readily admit, I am a tinkerer...)

It seems that no matter where I set the max, my 95% goes right up there with it. But there are always very few OA's and Hyp's. So I thought the higher pressure wasn't needed. The machine keeps responding to "flow limitations" but those limitations aren't turning into events anyway.

My 95% on 11.6 was 11.3.
My 95% on 10.8 was 10.7
My 95% on 10 was 10.


As far as the 1/2/3:

1. I'm at 100% compliance since the start, averaging 8:26 per night. Last week averaged 9:04. Should be good to go here. Concentrating on #2 now.

2. My average leak rate, last 30 days was 5.32. Last week 7.95. Most recent 11.02. Trending up... thought lowering pressure would help. Pillow is four weeks old. Might be a factor.

3. AHI last 30 days 2.70. Last week .83. I'm not shooting for a particular AHI. When I have variation, it's primarily in CA. Those increase with pressure in my limited experience. Since OA and HA are "under control" I'm leaning towards minimum effective pressure. (to help manage CA/arousals/leaks)


If I could sleep 12 hours every night, it might not matter, but I can't manage that during the week. I need to get the arousals and leaks managed - somehow.

Going back to an FFM is last resort but not off the table. I definitely need to try a different one though, the other one caused intense nose bridge pain lasting all day, and peeling that showed up after the first few days. Plus leaks were a big problem there too.

I do appreciate all input here.
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#9
EPR 3 - tried it, didn't like it. The pressure would drop quickly on exhale (good thing). But it never really came back fully on inhale (bad thing). Unless I _really_ prolonged the inhalation and felt like I was fighting to get the air back in. Was uncomfortable. EPR 2 is probably a good compromise.
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#10
(04-21-2015, 12:49 PM)worn_out_in_lebanon Wrote: I've been trying to find that sweet spot.

I think you're right on it. Or very nearly. Maybe don't do anything with pressure for a couple of days and see how the events do?

In my experience, when I got to that "right and perfect" sweet spot pressure, I upped the pressures just a smidgeon, as in not more than 1/2 a point. When I did that the flow rate went to baby butt smooth. That was my nail-it-down point.

(04-21-2015, 12:49 PM)worn_out_in_lebanon Wrote: On a different note, I've seen on here Exp time should be about double Insp time. I'm consistently running Exp a little under Insp. 1.82 vs 2.08 for my median last night. I may need to try EPR 2 again. That also introduces some unnatural feeling into the equation too though.

I would go to EPR 2.

Other than that, wash the pillows and dry them thoroughly, make sure the inner cone does not get turned inside out because of the experience and sleep well tonight.

You could put the chinstrap on over the mask to see how that works, but that's not really an ideal thing to do (just makes it harder when you get up in the middle of the night) so hold off on that. Solve the leaks with jaw placement, tongue placement, and clean pillows.

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