Chasing low level leaks

[nightgagger]

For the past week or so, I've been trying to chase down low level leaks that I don't know where they are occurring.

My current setup for a week so far:
Brevida mask
Knightsbridge Cap
BSN tape (2" strip)
Dental mouthguard.

My Resmed 10 has a new Climalite hose (with cosy), new Humidifier.

I've cleaned the seals going into the humidifier, and have replaced the one that's replaceable.

Furthermore, I've set my pressure to fixed at 11cmH2O for the past week, based on Lankylefty video.

I have been sleeping pretty good, but sometimes wake a bit off, until I have my first cup of coffee.  Noticed improvements of not needing a nap in the afternoon.

My AHI is well below 1, and has been really for about 6 months, except for an occasional night here and there.

I've attached a pop out leak graph from the past week, as well as a summary from the past 6 months.

The 6 months have different masks, that I've tried...full face, pillow, nasal.  I wish there was a graphical way in OSCAR to indicate mask used.
Also, the knightsbridge cap, which I had written off early, has really improved my leak rate with the Brevida mask, as well as the N20.  Maybe because it stabilizes the mask as I wear the chin strap over these masks.  But with the N30i, P30i, and F30i I have to wear it over the chin strap, due to their construction.

One thing I'm considering that may be an issue is hose movement.  I may be pulling on my hose or the heaviness of the Climalite is pulling at my mask if it falls of the bed or moves the mask's hose.  I have on order a hose holder which will arrive today.  Maybe that's the key?

I will say my sleep is better, but I think I can still improve on leaks.
Any suggestions to getting ZERO leak is appreciated.  

[SarcasticDave94]

The hose holder might help as it'll reduce the weight of the hose pulling on your mask.

Probably your detailed OSCAR info may be better suited to show us what you're facing nightly. There's details that's going to indicate mouth or mask leakage and at what intensity, along with duration.

Getting zero leaks shouldn't necessarily be the goal. It needs to be low enough to allow accurate therapy, low disturbance amounts, all while maintaining comfort.

[nightgagger]

Thanks Dave for looking in.

I've attached a few day's detailed graphs and have included one when I was on APAP.

[SarcasticDave94]

Just my opinion, but those 3 samples look acceptable with leaks. None are at or above 24. If those represent your normal leak rates and patterns, it seems ok. It comes down to your comfort. All these has a fairly flat, constant leak. A few blips here and there. So again, it's your comfort that rules.

[quiescence at last]

ditto, i don't see things suddenly leading to heightened leakage, like movement or pressure changes, or hose flailing exercises. it does not seem like this is disturbing your sleep. are you an engineer like me, and just want to make something really good even better?

QAL

[nightgagger]

Thanks again Dave.  Yes, the sleep has been much improved over the course of the year and being below 24L/min was definitely a goal.

QAL, ummm..yes.
I'm a technician, but mostly worked on research projects in my career, so I would also wear an engineer hat to find solutions. 
Always looking for absolutes and better performance numbers.

[Geer1]

My interpretation of the graphs you posted is that they all show a constant leak in the 8-12 range. A constant leak isn't likely to be related to mouth leaks or movement pulling on hose/mask as those are too variable. Likely culprits would be water tank, outlet elbow, hose, seals or mask vents. For example I have only seen something similar in my data back when I tried poking larger holes in my P10 vent. I thought it wasn't venting right but turned out my filter was plugged and after changing filters I always registered a constant leak because of excessive venting. Sounds like you have already checked a few if not most of these items and that they may not be the issue.

One other thing that might cause this is not using the right mask type setting. I know it has been theorized that this setting affects reported leak rate since Resmed calculates and reports unintentional leaks (total leak rate minus an amount considered intentional leak which is theorized to change depending on mask type setting used).

[multicast]

Had some unusual permanent leaks recently which nearly drove me crazy.  Finally I've discovered the culprit: a hole in the hose ...

[CorruptAlligator]

Yeah, if it's leaking fairly consistently accross several different types of mask, it's likely something else besides the usual mask leak. I'd check for any unusual leaks. Settings not likely.

Like the above posters recommended, hose and the water tank areas would be the first areas I'd check.

[nightgagger]

Thank you Geer, Corruptalligator and multicast

Both the hose and tank are new. The previous tank and hose had the same constant leak. Always around 6 - 8 L/min.
Seal for the outlet elbow was replaced. The only seal I can't replace is the main tank to machine seal, AFAIK.

Setting is for Nasal mask for the Brevida, so that's always set.

I'll look at the outlet elbow more.