Suddenly developed leaks!

[Anniett]

A couple of nights ago I awoke to a real gale blowing from my mask. I switched off the machine, took off the mask and re-fitted it using a Remzzz. Switched on the machine, no problems and I was asleep again before the ramp finished. The following day the machine reported a large leak, 1%. Not surprising really! Since then I have not been aware of any problems but today the machine reports a large leak, 5%! I washed the hose this morning and filled it with water but there was no sign of a leak. Anyone any idea why this might be happening?

I am using a Respironics System One A-flex machine with a Comfort gel full face mask. I do have a nose mask as well but my nose has been blocked on one side at bedtime this week so I have been using the full face instead. If the large leak report is up again tomorrow, I will try using the nose mask and see if that helps.

Any suggestions gratefully received!

Anniett

[Tigers Fan]

How is your machine set up? We need to know your Pmax and Pmin. I suspect that the machine is set 'wide' at 4 and 20cm. What is your AHI during the large leak nights? Do you know your 90% pressure for those nights, too?

Have you had the settings changed - upward - recently?

TF

[Anniett]

How is your machine set up? We need to know your Pmax and Pmin. I suspect that the machine is set 'wide' at 4 and 20cm. What is your AHI during the large leak nights? Do you know your 90% pressure for those nights, too?

Have you had the settings changed - upward - recently?

TF

Yes, you are quite right. I am told that the machine is set at the default of 4 and 20cms. The AHI is 1.9 (usually around 1.2 so not a huge change) and 90% pressure 10.3 up from around 9.8. Again not a huge change. Just by chance, the second leak, that didn't wake me, happened to be the same night that I was using a pulse oximeter to see how I was doing. That showed an event index of 6.9 - excellent! I am very happy how well everything is going but concerned by the report of leaks that I am unaware of. Perhaps I shall have to bite the bullet and purchase the software to allow me to read the SD card to get a full set of results. I have to return the card every so often by post and then get a letter back saying everything is fine and to carry on. I do not have a sleep clinic to visit but can ring a helpline. When I reported a large leak all they did was talk me through how to put the mask on! It is not leaking when I put it on but they did not seem to understand that.

What surprised me was that I have been totally unaware of any leaks apart from the first one 3 nights ago which I dealt with. I am amazed that I can sleep through anything like that! I have attached the oximeter summary for information.

No settings have been changed since I got the machine in July. Many thanks for your help.

Anniett

[Tigers Fan]

If you can sleep through an apnoea, why do you suppose you shouldn't be able to sleep through a large leak? With an AHI between 1 and 2, you are getting lots of deep REM sleep - would an earthquake rouse you?

Not to worry about the large leak, it's easily fixed. When you have an apnoea, your machine detects the beginnings of it and winds up the pressure to keep your airway open. Two things at work here - Pmin = 4 permits apnoeas to get started and then the machine has a choice to go all the way up to Pmax = 20 to prevent the apnoea. Guess what happens at the higher pressures?

To overcome the same problem, many moons ago, I narrowed the operating band of the APAP. You have a 90% of 10cm so I guess that Pmin = 8 would be enough to prevent many apnoeas starting and Pmax = 12? 13? even as high as 15 would be enough to keep you breathing for the vast majority of the reduced number of apnoeas you would then be having, whilst not being high enough to cause large leakage. It would also , perhaps, not be high enough to deal with a real douza of an apnoea - but maybe 20cm wouldn't either. It's a balancing act tailored to your needs and a little experimentation is required to find the best compromise.

You can find the 'how to' of adjusting pressures on line or badger your clinic to keep making minor adjustments.

Large leak time does not count as therapy time.

Other than this, you look to be doing very well indeed! You have all the stats needed to fine tune your therapy without the expense of buying software - but if you go the DIY route, the software is full of helpful info and stats.

TF

[Anniett]

I have always been known as a 'light' sleeper but you could well be right! Since being on CPAP I sleep much better and don't even notice when my husband comes to bed.

I now understand the mechanics of the large leak. Thank you very much for explaining it so well.

Am I right in thinking I should make small changes at one end of the scale to start with, slowly increasing the lower level and then when I am used to that, decrease the upper level? (Or vice versa!) I admit that over the last couple of weeks I felt that I was not getting enough air when I first switched on the machine which is why I switched back to the full face mask. Then I could at least open my mouth and take a good breath!

I have found a site which explains how to make the changes to my machine. I don't have a clinic. I am renting a machine direct from Respironics at the moment and their telephone helpline has not filled me with confidence. I shall not be renting after mid October, it works out too expensive! If I was with the NHS I would still be waiting so soon I shall be using a machine that I own and I am not sure what sort of support I can expect then.

I am aware that leak time does not count as therapy time which is why I was concerned. I am still in correspondence with DVLA regarding my driving licence. I notified them of the diagnosis and that I had started therapy. I have returned the questionnaire they sent to me but have not heard back yet. As they have not requested me to surrender my licence, I haven't sent it back.

I originally saw my GP because of my dreadful snoring and it was he who suspected OSA. I was not dreadfully tired during the day but since being on therapy I am a new person! I have more energy now than I had as a teenager I think. Well, most days anyway.

Thanks again for all your help.

Anniett

[Anniett]

I posted a reply last night but it seems to have disappeared into the ether!

Thank you very much for the information. I understand much better now and will see what I can do.

Thank you for taking the time to explain things to me, I am most grateful!
Anniett

[Barely Awake]

As I at present have a large leak that has popped up one day last week and two consecutive nights this week (duration of 30 mins, 2.5, and 2 hours), I looked first at what if anything has changed (new mask for example) and check the hose the mask and the headgear. When this happened some years back the hose had split but sometimes sealed itself depending on which way it lay, and the split was so fine I would never have spotted it. I tried filling it with water and the old cycle inner tube trick of immersing in a bowl of water with the CPAP running, but if the split is near the end connector you may still not spot it; so I have opted now for a spare hose marked with an indelible pen so I don't mix them up, and similarly keep a spare mask of the same make, and also spare filters. If anything goes wrong I can then swap one thing at a time, and am in the process of doing that now to find my leak.

[Tigers Fan]

Can you check your large leak times against time in apnoea? See if it corresponds to high pressure periods?

I'd have thought a large mechanical leak would have made itself obvious and be present all the time. Self-sealing hairline splits do not sound to me like the stuff of large leakage.

TF

[Barely Awake]

Can you check your large leak times against time in apnoea? See if it corresponds to high pressure periods?

I'd have thought a large mechanical leak would have made itself obvious and be present all the time. Self-sealing hairline splits do not sound to me like the stuff of large leakage.

TF

Good idea - cheers!

I also take your meaning about the split, something of that sort probably wouldn't be responsible for the present large leak reading. I chucked that hose so can't check it on what this machine registers. Even so I think it good practice when any problem arises to check all the kit through methodically as sometimes it doesn't get a close inspection of that sort for ages if ever.

[Tigers Fan]

That is sound engineering pratice - much neglected in our chuck-away culture!

TF

[James @ Intus]

Note that the humid weather may have affected things too as it affects your CPAP's pressure stability. It's hard to combat but with the temperature dropping now again, are you seeing the leaks disappear again?

Note that if you don't have access to a clinic and fele like your pressures need adjusting, but you are not comfortable with this yourself, you can send your REMstar data card to us (in Surrey) and we can assist you with this.