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**leswaller** · 25 March 2009, 09:05

Hi Devonbound
That all seems a bit strange. I use a quattro mask and am not suffering these problems. I wonder if you are turning over in your sleep and trying to push your head into the pillow. As the quattro is a fairly rigid mask the action of pushing your head into the pillow could make it move and leak. If you are staying asleep during this process you would not be aware of the leak, especially if you move your head again and the leak stops. The quattro seem very tolerant to being moved and will readjust its position once the sideways pressure on the mask has stopped.

**GrumpyBiker** · 25 March 2009, 10:12

My machine is registering around 45lpm for my Quatro. I believe this is just a function of the over-nose vents on that mask. These pump out a stream of air that can be felt half-way across the room. I intend to ignore it and adjust the mask for comfort of fit and no leaks round the eyes.
I have lowered the max pressure to 17 (to limit leaking) and upped my base to 10 and am averaging an AHI of 6.2. I shall slowly increase the base over the next week or two. I have set the low end of the ramp to 6, in order to get a slower startup.
For a leak-test, set the base to 15 (including ramp) and ler 'er rip. Its quite a gale, but helps you know the mask fit is working.

Andy

**leswaller** · 26 March 2009, 13:41

Following on from GrumpyBikers comment about the exhaust vent on the nose piece of the quattro, I found this objectionable and a short while after I started using the mask some 8 months ago I fixed a piece of scothbrite over the vent by tacking it round the edges with superglue. There is still an adequate airfloe but the scotchbrite acts as a diffuser and really quietens things down. It might even lower the recorded leakage rate but I havent bothered measuring it with and without the scotchbrite

**gvader** · 26 March 2009, 19:23

Quattro Leakage

Hi Devonbound,

One problem I found with the Quattro is that it leaks from around the socket on the front where the elbow joint attaches. Test this by putting your mask on, turn on the CPAP as normal and then simply put some pressure onto the elbow at an angle (as if you have moved in your sleep but your hose got caught slightly) - you will probably hear and feel the air escaping.

Dead easy to solve, just pull the elbow joint out from the mask and wrap a little bit of plumbers PTFE tape around the joint before putting it back into the mask. Works a dream and the tape is about 70p a roll from B&Q.

I did this right at the start and my leakage rate (when last I used an APAP) was ZERO.

I also go the other way from a loose fit of the mask and have it almost nailed to my face - works for me.

**DevonBound** · 26 March 2009, 19:47

Hi All,

I have tried to make this mask leak by writhing around within the mask yawning, lying on my side, pushing my head into the pillow and yet no leak...

The Leak rate seems to have stabalised at 43-44lmp but my AHI is creeping up - last night I adjusted my pressures to 14.5 + 18...I have adjusted both lower and upper pressures higher....mainly because my 90% was getting higher now at 17.5cm2 at 90%..

These figures are really wigging me out, I hear people getting to AHI of 5 and better off pressures such as 10+17 and yet my pressures are getting much higher without any downward movement in my AHI readout..

Also, delicate subject - but does anyone else suffer from......lets say.....that inflated feeling on waking up in the morning...my stomach hurt so bad this morning until..............well, lets just say the air found it's way out!!

**leswaller** · 26 March 2009, 19:57

DevonBound
The gaseous problem is very common especially if you are a mouth breather. You are subconsciously swallowing air under pressure whilst asleep and sooner or later it has to come out.
I know this sounds a bit crazy, but try lowering your pressures rather than increasing them and see what happens to your AHI. Sorting these things out is a bit of a black art and sometimes the daft things work. Its a bit like the leak problem, you would think that tightening the straps would stop it, but many times it makes it worse and loosening them actually stops the leaks

**Tigers Fan** · 26 March 2009, 20:45

Keep it simple

Hi DevonBound

If your mask is comfortable and does not leak at the silicon seals, you have it right - never mind Sleep Tech's opinion. You can't adjust a mask better than comfortable and not leaking!!!

As your AHI is still above 5, I reckon you still need to increase base pressure. However, I'd keep max pressure within a couple of cm. It looks to me like you are having events, pressure cranks up, you get leakage - so, reduce the number of events by increasing base pressure, this reduces 90% pressure and leakage. Reduce max pressure, also reduces 90% and leakage.

And stop worrying about leakage rate! Chase your AHI and everything else will fall into place!

Tigers Fan

**DevonBound** · 26 March 2009, 21:30

Thanks TF - Good to talk civilly to you again!

I will reduce my Upper Limit and increase my base and see how that works...Cheers!

**Tigers Fan** · 28 March 2009, 09:27

Well - I didn't know that!

Hi DB

Last night I tried to reduce the difference between base and max pressures on my 'M' Series - only to find that I couldn't.

After getting good results from a CPAP whilst travelling, I wanted to make my APAP less windy at max pressure. But - at 15.5 cm base, the lowest max pressure available was 17.5 cm. It was 11.30 pm so I didn't investigate whether 17.5 is the absolute minimum or just the min for a base pressure of 15.5 cm (I reckon it'll be an absolute, else we are getting into very expensive machinery - I mean, truly expensive, not just priced high).

So it looks like my conjured out of the air, magic 2 cm difference which seems to work very well, is not so much a function of reduced max pressure (as I had thought) but of increased base pressure. Or, put another way, if you wind the max down as far as it will go (17.5) you are stuck with whatever difference you get according to your base pressure.

Unless you want to do the investigation and find the max pressure varies with the base pressure setting. But I so bet it doesn't that I can't be bothered to walk up the stairs to find out! (and I can't believe I've just written "so bet"! Jeesh!)

Tigers Fan

**GrumpyBiker** · 28 March 2009, 10:40

Tigers, my Resmed has a CPAP setting in the setup menu, you could try that.

Andy

**Tigers Fan** · 28 March 2009, 14:48

Best of Both

Thanks GB - mine has CPAP, too, but I'm reluctant to go there on a 'permanent' basis, not only because of the extra money spent for APAP but I reckon APAP to be better for me. The advantage is also the problem, of course, with the extra windiness an APAP brings with an event.

Seems to me that somewhere between APAP and CPAP lays the promised land, so I want to try to lure the best of CPAP out of my APAP by bringing the base and max pressures closer together - at an 'optimum' value for each.

It occurs though, that as well as changing masks periodically, I could have a few nights on CPAP every now and then. Or perhaps, swap one to the other when I'm having less than a good night. Is flexibility and variation in PAP therapy as good a way forward as it is in other areas of life?

Tigers Fan

**leswaller** · 28 March 2009, 14:57

Hi TigersFan
How was the holiday, am off again myself on Monday

I have decided to invest in an APAP and have been following with interest this thread. For someone who has managed quite happily with a CPAP from the word go but wanted a bit more control with what it is doing to me, how do you suggest I set things up. (I am getting a Resmed Auto Spirit)

**Tigers Fan** · 28 March 2009, 16:45

Easy peasy

Hi Les

This is still connected to DB's thread topic so I don't think we are entirely hi-jacking it. Apologies if you disagree, DB.

I would take your CPAP pressure, ramp start pressure and ramp time straight over to the APAP. I'd set the max pressure my magic 2 cm above base/CPAP pressure - scope for the auto in APAP to work but without being able to blow you out of bed. With experience you can vary the difference to discover what best suits you.

Try to resist getting bogged down with all the numbers and curves that (I expect but don't know) your APAP will make available to you. AHI is the driver. Stick to chasing that ever downward and you'll do just fine.

Ironic, innit? You finally decide to go APAP from CPAP just at the time I'm getting very interested in CPAP from APAP? I suspect you'll ask yourself the age old "Why didn't I do this ages ago?", especially if you have exhalation relief. And how about a humidifier - does your Auto Spirit have one? and you'll ask the same "Why didn't I .....?"

Malta was great in a Maltese sort of way and the opera was classically dire. Still, Anna Netrebko and Elina Garanca at ROH next week will sound the sweeter for it. Enjoy the sun next week! By, it must be good working for the NHS!

Tigers Fan

**leswaller** · 28 March 2009, 17:24

Hi Mate
Thanks for the info I will give that a go, the model I am buying which is the second hand one that was offered on the forum is the mark one version so doesnt have exhalation relief. However I dont find this a problem with the CPAP so hopefully wont be a problem with the APAP. It has a built in humidifier but yet again I have never used one, but I might give it a whirl to see what the difference is.
Life in the NHS is coing to an end as I retire at the end of May. We have our own place on Lanzarote so the cost of going is only the flights.
Have you ever been? you should go there for the opera in the famous underground auditorium designed by C�sar Manrique. The sound is out of this world.

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I can't get to grips with my Mask Leakage!! or Can I?

I can't get to grips with my Mask Leakage!! or Can I?

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