Large Leaks and other issues

[doickle]

Hi Forum,

I need some assistance and advice.
I have recently moved countries (USA to Canada) so I am "in between" health care providers at the moment so I can't just go to the local sleep clinic and ask for help.
I have just reached 1 year of treatment and overall it has gone great.
Recently I have been battling with large leaks that I can't seem to sort out on my own. For the first 7-8 months of therapy I had only minor leak issues. Now everyday my ResMed gives me a red frowny face.
Based on the leak profiles it seems like mostly mouth breathing but I'm not sure why that would start happening all of a sudden and then continue consistently.
I will attach some SH graphs from the past few days and would appreciate any feedback.
What I also notice is that some pressure responses happen at times when no events are indicated. What would cause this?

I have tried a new mask F20 Air Touch and I found this worse that my older F20 because the memory foam leaks into my eyes and the mask is narrow so it doesn't fit my nose right.
I just bought the CPAP pillow to see if it would provide a better position and less interference with the mask, no improvement yet.

I am open to any comments and suggestions and analysis of my charts.

Thanks 

[Walla Walla]

I think the first thing I'd look at is if you have the right size mask. You might end up having to try another type mask. As far as the pressure increases that's because of the flow limitations. Pressure will rise for obstructive events, flow limitations and snores.

[doickle]

Thanks for the quick response.
Regarding the flow limitations, if it is not an OE then what would be a cause of a flow limitation?

[Walla Walla]

Any obstruction that is below 50% obstructed and/or lasts less than 10 seconds. Resmed uses at or above 50% for hypopneas. Philips Respironics uses 40%.

[Gideon]

With P10 pillows anchor the hose to your PJs or pillow. I find that the weight of the hose can cause large leaks.

Look at the manufactures video for fitting your mask. Most have real good hints.

Read the Mask Primer (link in my signature), many hints on leak management

Fred

[Melman]

If you have been using the F20, or any full face mask, mouth breathing alone should not result in leaks. A possible source of leaks may be your jaw dropping and your mouth opening to the point that the bottom of the mask seal is compromised. That is an issue I have and it is solved by wearing a soft cervical collar. I am a mouth breather and use the F20. With the collar I rarely have leaks. Without it I have serious leaks. The collar also prevents chin tucking which can compromise your airway.

[jaswilliams]

You leaks don’t really look like mouth breathing far too spikey topped or consistent try a mask liner purchased or cut from an old Tee Shirt here is a template

DIY mask liner

[OpalRose]

doickle,
If you like your Full Face Mask, then the suggestion for mask liners is good.  If your mask just doesn't fit, then you will have to try others.
Check out some of the Suppliers from the Supplier list above.  Many offer a 30 trial on masks, but you may have to pay postage to send back.  

Looking at your graphs, it appears you have a combination of mask leaking and mouth breathing.  Unless you get your leaks under control, the AHI reading could be suspect, as your machine will have a difficult time flagging apnea events.  

Good luck.  For now, finding the correct mask is the most important aspect of your therapy.

[ajack]

are you using the mask fit function on the machine that blows higher pressure, while you adjust the mask?
well done on your pressure range and AHI numbers, it's working well.

[Hojo]

I have the F20 and it has been outstanding in the leak prevention mode (non-foam model).  What I have noticed is that I was given the 'standard' head gear and it tends to pull the mask upwards on my head (large head) and I have to tighten even more to prevent air from blowing into my eyes.  I am going to try a larger head gear and see if that works, if your head is large, perhaps you too need a larger head gear.