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

[Tigers Fan]

Trouble at t'mill!

Hi DevonBound

Sorry I seem to have deserted you! that sudden influx of newbies while I was away frightened me off and I've only just found that your troubles continue.

Please remind me which machine you have. I've always assumed from the way you discuss stats that you have access to a printout. I think you have a Resmed like me. A Remstar M Auto. If you do and you have a Smartcard stuck into the back of it, I'll be more than happy to print your stats out for you. PM me if you wish.

A couple of nights ago I picked up a Resmed ComfortFull 2 mask in a multi-tasking sort of way and then decided to give it a go. Haven't used it since my early CPAP days. Anyway, I've had two really good nights with it so I thought to look at the stats. Much the same as the Quattro except - an 80 - 90% reduction in leakage! There is a cliff in the weekly report!

Like you, I sleep well with the Quattro, which doesn't leak as far as I'm aware but gives 120 leakage and a large leakage of an hour or two per week (I chose a weekly report, not the seven day average on the machine). With the ComfortFull the large leakage was zero for two nights.

One minor problem - I guess due to the cavernous proportions of the ComfortFull, I get condensation inside it. I use a humidifier and heated hose, but the air has so long inside the mask and so far from the hose to nose flow path that condensation occurs. I've not had rainout but boy! was I surprised when I put it back on after a trip to the bathroom!

Let me know if I can help with your stats printout.

TF

[DevonBound]

mmmm - Not Sure Guys!

Thanks TF,LW & TWW for your comments and advice - all very much appreciated and hope that through a combination of all, will overcome this issue.

Firstly, I have now checked thoroughly the hose for leaks and can, with some confidence say that the hose is sound, I have also checked the humidifier unit and can also say this too is sound, so that only leaves the mask!

Les, I do not sleep on my face, I always fall asleep on my side and wake up on my back - I have tried pushing my face into the pillow with the unit at full flow and pulling funny faces inside the mask - none of which give rise to any leaks....as I said I really do nail this thing to my face...it doesn't hurt and is actually quite comfortable.
There are of course some gapping great escape routes in this mask, which I fail to see how this unit can do anything but leak.....there is a large set of vent holes in the inlet joint where the hose joins the mask, there is also a vent hole just under the Oxygen nasal tube inlet (which are blocked with rubber fitments) and of course there are nasal vent holes around the bridge of the nose which let out such a constant strong flow of air I think it may actually be disturbing the Atlantic Jet Stream! So with all these vent holes, I would imagine it nigh on impossible to achieve anything like a 0.2lpm leak rate??
TF, I do indeed have a Resmed M Auto...and this is where you guys start to hate me for my whining.....I am a postcode winner and picked my Machine up FOC from the Leicester Sleep Clinic where once diagnosed you are an instant winner - so to speak! The machine was brand spanking new in Feb 09 and on return in March picked myself up a free humidifier to boot.....before I added the humidifier and on last return to the Sleep Clinic, my LPM was exactly the same - it has never improved or become worse. I know you must be thinking that this mask simply must be leaking in the night and maybe it is, but believe me the mask really is as trouble free as I make out and if it was leaking I would imagine it to have been giving me a few tell tail signs, like blowing in my eyes..the farting noises etc......can't think of any of these occurrences?

TF, I do have a card stuck in the back of my machine, the sleep lab tell me they do not use this data at all.....so how do I go about extracting this information from the card?

Does any one else use the Mirage Quattro with a Resmed Auto?? If so what are your leakage rates with the same machine? maybe it's a norm for this particular machine....I don’t know -or I am simply starting to just accept something that I shouldn't be?

Here's a thought.....on an earlier thread I mentioned that in the morning I suffer very badly with wind (all orifices!) to the point of pain!....could it simply be that the air is being lost inside me?? - Just a thought......

As ever - appreciate all your thoughts!
DB

[leswaller]

Hi Devonbound
I use a Resmed AutoSet Spirit with a quattro mask and I can promise you that I am only getting an average of 0.2 leakage, in fact this morning it was 0.0 !!. (will send you a printout if you wish)
One thought that does occur to me is that you need to tell the machine that you are using a full face mask rather than a nasal mask so that it can allow for the vent holes etc. This is done in the settings menu and should be set to MIRFUL (or similar). The various gaps and vent holes are there to stop you from suffocating in your sleep if the power goes off My guess is that perhaps the machine is set for a nasal mask and thus thinks the extra air it is pumping to compensate for the vents etc is a leak

[DevonBound]

Hi Les,
The Resmed Auto M hasn't got such a menu option unfortunately - otherwise it would have been a good theory!

Last night was a good night, smeared a bit of Vaseline around my face last night to try and effect a good seal - and have to say that again personally experienced no leaks - again wife confirmed no leaks and she gets up a lot she's a very light sleeper.
I dunno it really does have me very myth'd and cannot bottom out this problem, if indeed there is actually one....but I do feel that this could be the reason for my figures not getting any better....having said that, I remember seeing in one of Grumpybiker's threads that he too gets LPM of 42+ and has an AHI of 5 & lower?? he too has exactly the same machine and mask as we frequent the same sleep lab....

DB

[Tigers Fan]

Apparently, we always do!

Hey DB

You are beginning to remind me of a guy who didn't want to phone home because his wife would be out - we used to go ashore in a lifeboat from anchorage in Chesapeake Bay every Saturday afternoon. Finally, he was persuaded to give it a go - and, of course, she was out, doing what she did every Saturday afternoon. Next week the same, and the next. Then he started fixating - why isn't she in? What's she doing? With whom? Whilst all the time, he knew fine well that she wouldn't be in - it was Saturday afterrnoon.

Next piece of psychology: apparently we humans first look to ourselves for having done something wrong when a machine isn't giving us the results we expect. Could it be that your machine is at fault - giving an incorrect readout or measuring incorrectly?

I use a Remstar 'M' Series with A-Flex and a Mirage Quattro full face mask so we have identical rigs. I have just down-loaded from my Smartcard a two week period and I'm told that I had -

Last 2 weeks Jan 1st - 14th
Average Max Leak 120 lpm 119.2
Average 90% Leak 119.8 lpm 70.0
Average Leak 91.9 lpm 53.5
Average Large Leak 2 hrs 1 min 13 secs 0hrs 18mins 20 secs
(which is per session/night)
AHI 4.6 7.8

Same figures for three nights of CPAP with ComfortFull 2 mask are
111.7 57.4 41.3 0:5:00 2.0 AHI
and one night with all same settings except APAP
120.0 60.0 44.0 0:0:03 5.6 AHI

Why my average large leakage jumped from 20 mins to 2 hours several weeks ago, I cannot say (black bands suddenly appeared on the green bands of hours of sleep in the printout) but my AHI dropped.

Understandably, my large leakage is lower on APAP than CPAP but my AHI higher. As I use the APAP in a CPAP-like way (15 cm base pressure, 17 cm max) I intend to stay CPAP for a while.

I note 120 lpm leakage and that seems a ridiculously high figure but is constant for both masks - surely 120 lpm is a gale?? but I am aware of nothing, nada, except through the designed vents.

Les - your 0.2 lpm and 0 lpm seems dangerously low, does it not. There has to be a goodly volume of leakage to carry away the CO2 of our outbreath. I have been unable to discover the designed leakage rate for any mask.

I'm still convinced that we can leave leakage rates to sort themselves while we chase AHIs ever downward. If it's not blowing in my eye or into my partner's face, who cares? (though those black bands do look extremely ominous!)

Three ways I can think of to get your card read, DB - send it to Resmed, buy a card reader and software, mail it to me and I'll send you the printout. Four, if GrumpyBiker has a reader you could pop round, maybe.

TF

[leswaller]

TF
I took the machine and mask to Resmed 2 weeks ago for a service, they didnt comment on the leakage rate and they did a download to show me the results, so it cant be a problem. How very strange isnt it. As my machine allows you to enter the type of mask you are using I still believe that the machine compensates for this when calculating the leakage

[DevonBound]

What!!

TF - You make me laugh!
How on earth any thing I said brought about that memory I do not know...great story and analogy, of course with the added benefit of making me chuckle!

I guess that whilst a forum such as this is a great place for people with similar problems, it can also be a minefield of information that can simply cloud ones view somewhat.
You see, there was me, happily concentrating on my AHI when I happen to read a posting about leakage and the effects on your therapy and then I found a new daily hobby - worry about my leakage rate!

In all seriousness, My focus on leakage came about because I simply could not shift my AHI below 10....you'd think I be happy at that, as it was 40+ after all pre APAP...But a part of me can't help feeling that I am missing out on that last drop of really beneficial therapy from lowering my AHI from 10 to 5 and so have become fixated on the one area of my data which looked and sounded decidedly high - the leakage rate.
But TF having seen your figures; and here's hoping your not pulling some kind of reverse psychology on me here by announcing unbelievably high leakage; I think I have nothing to be concerned about....and will simply start relaxing and see if this initiates any further drops in AHI.

Logic tells me that a leakage of rate of 0.anything is odd, especially given the nose vent 'jet stream' emmitted from the quattro but no one seems to know what is an accepted leak rate.

Thanks for the info on the smart card....at this stage I am not sure whether it would be of much assistance to me, simply because everything I have tried to lower my AHI has been unsuccesful and so not really sure what else to tweak with to inititate a drop beyond my plateau level of 10....despite what the readout was telling me. I have tried all pressure settings now for at least 3 days at a time....so maybe the only thing left to try is James's theory of the '7 day tweak-Free plan' and see if this settles things down.....But TF thanks for the offer and may one day yet take you up on that.

Currently have my settings at 14-18 and will see how this goes.

Gents, thanks for your comments on this to date and will let you know how this fairs over the next few days.
DB

[James @ Intus]

A good leak rate is one that doesn't bother you or your partner.

With modern machine compensating for leak rates, whatever the rate is it has little to no bearing on the actual therapeutic pressure given. So in terms of treating OSA, leak rate doesn't matter. In terms of comfort, which of course is subjective, it may vary. Some get annoyed with the smallest bit of air escaping. Others can sleep in a windtunnel.

Remember that one person's stats mean very little in comparison to your own. Everybody is different and has different needs, tolerance levels etc.

You;re right in your comment about forums like this where at a certain stage you know too much for your own good and can become obsessed with things that may ultimately not matter too much. Sometimes it's good to step back from the details and just look at the bigger picture.

[Tigers Fan]

Now see what you've done!

Hi DB

No reverse psychology except I've done it to myself!!

I read your leakage rate of 44lpm as 441 lpm - which we can all agree is high! So I thought my 120 lpm must be OK, if hard to believe. Now I see you are at 44 lpm and that makes mine way too high.

I'm in great danger of catching your problem, something like Swine Flu!!!

120 lpm!!!! Arghhhhhhhhh!!! and big, black bands to confirm it!!!

Thank g I sleep well and feel even better!

TF

[leswaller]

Still averaging a leagage of about 0.2, have checked with ResMed who confirm that this is OK and due to mask selection on the Autoset Spirit

[GrumpyBiker]

DB - sorry for the late reply but ihave been away on a 9 day camping tour of Britain on my motorcycle - 3,000 miles traveling from Land's End, St Davids head (Wales) Peterhead, John o Groats, Applecross (via the Pass of cattle - the highest road in Britain), Isle of Skye, Haltwhistle, Lowestoft and finishing in Holme Fen, Norfol (the lowest road in Britain).

I have the same kit as you, with leakage rates kin the 44-46 lpm range. These days I just ignore that stat. My API is hovering just below 5.

Andy

[Tigers Fan]

Taking it from the machine

Lo! and so I looked at the stats given by the machine read-out and find that I, too, have a leakage in the mid-40s.

Which is a little weird considering the stats given in the Clinicians' printout, as per my earlier posting. I'm going to guess the machine gives us the Average Leakage.

TF

[leswaller]

TF
You are correct, the machine, if it is a ResMed machine gives the average for the session/night. However if you download the data and look at the reports you can see the median, the 95th percentile and the maximum

[DevonBound]

Wow GB quite some holiday...listen, I'm reaching middle age and that sounds like just the ticket for my impending crisis??....but I can't ride a motorbike, so guess I'll have to find me a different stress ball!!

Mean while, this machine continues to drive me closer to that Crisis.....Thanks for the reply about your leakage rate, comforting to hear that it now sounds like Mid 40's is about right..leakage that is, not the time for a mid life crisis! lol.

Les- my Respironics, GB's and Guessing TF's if he has the same machine, all measure Leakage as a 7 & 30 day average and not per session, not sure if TF's smart card readout can give him a sessional read out? sounds like it can......but listen, I'll not worry about this figure anymore due to re-assurances from GB & TF's readout's and subsequent good AHI levels.....all I have to do now is get my AHI somewhere near theirs and I'll be chipper!

Guys, My 90% is at 17.3% with my max pressure at 17.5% - does it sound to you like I should set the max - higher than 17.5%? - My rationale tells me that perhaps max pressure is not delivering enough pressure at this level.....therefore max pressure hovering too long at this level 90%, but whilst not delivering sufficient pressure and subsequently not lowering my AHI? what d'ya think?

I have Had my levels at 13 + 17.5 for about 5 days now - seems to have helped my.........flatulence issues having the lower level set at 13 rather than 15.5 but my AHI is starting to drift slowly upwards again now at 12.2AHI

Any suggestions.......
DB

[Tigers Fan]

A clear choice!

Hi DB

Seems like you have to choose! Lower AHI or less anti-social morning behaviour!

I suspect you are tackling the wrong end of the problem - of increasing AHI, I mean!

My rational goes as follows: with base pressure 13 cm there are more events than at 15.5 cm - your windpipe is less well held open. Your machine detects these events and cranks up the pressure to deal with them - and stays up there for long periods, as we know. Thus you get 90% pressure only a smidge lower than your max - 17.3 and 17.5 cm. Your 12.2 AHI includes those events that your machine effectively dealt with as well as any it couldn't deal with at 17.5 cm. Raising the max pressure may increase the number of events the machine deals with correctly but won't lower your AHI (as the machine records all events, dealt with or left blowing a gale and maybe wake upi).

So - if you want to lower you AHI, the number to adjust is the base pressure. Increase it and your airway is better held open and you have fewer events. Fewer events means the machine cranks up the pressure less often and your 90% falls. When you do have an event, up she goes to 17.5 and hopefully that is enough - you wake up or rouse if it is not.

The proof of this is to change your machine to CPAP, whereupon C-Flex is automatically chosen. Now you are breathing in a constant pressure. If you select the minimum amount of Flex relief (setting 1) you breath out under some pressure as well. (What I dislike most about CPAP is no Flex. Using Flex stops my sense of suffocation in the early minutes.) Now, adjust/tweak/experiment with the CPAP pressure (equating to your base APAP pressure) to get your AHI as low as possible (remembering James' sound advice to step back - I use a four day average from the smartcard but you may have to be even slower and use a seven day average from the machine).

Thus, you have an optimum base pressure when you switch back to APAP. I set my maximum pressure as close as possible to the base pressure to minimise the wake-up-with-a-gale-blowing experiences.

With an optimum base pressure you say you will get an amount of bodily pressure relief from t'other end. I guess you have to choose the balance.

Currently and for a while now, I use my machine as CPAP with minimum C-Flex. This gives me AHIs which wobble up and down well below 5 (unless I get hot in the night, toss and turn, finish up on my back, de dah) and long periods without waking. When I switch back to APAP just to see, everything stays much the same except I'm woken by gale leakage a couple of times a night.

Talking of which, I tracked my sudden increase to high leakages as coinciding with reducing my Vibratory Snore Index. My high VSI was put down to over-tightened mask straps pushing my lower jaw backward to my airway. I loosened the straps, solved the snoring - but leakage went way up, un-noticed because I wasn't watching that stat and wasn't aware of leakage due to being asleep. A twitch on the velcro, a few nails added, and measured leakage has tumbled. Snoring? Up a tad according to stats - but neither partners, cats, neighbours nor myself are otherwise aware!

Hope you can pick some useful ideas out of that!

TF