FFM Cushion Leak with Data

[Hojo]

I am wondering about the cushion the mask, it seems to suddenly get 'blown' outwards during the night and the sound of escaping air wakes me up.  I am wondering if I do not have the mask tight enough, or is it due to the sudden increase in pressure.

I am including (attempting) the Sleepyhead data, the other thing I think, is I need to have my auto setting of 5/20 changed upwards to maybe 10/20, as I've noticed my Obstructive Apnea to be at least 10 and usually higher.  This data shows the AHI of 6.11, and then the next day it was 4.21 and then last night 3.01.

Any thoughts would be greatly appreciated.

http://imgur.com/4LafSLk
http://imgur.com/WYKsCRS
http://imgur.com/eIU0Id9
http://imgur.com/bp46j9W

So how do I get the image to show up here rather than just the link?

[Sleeprider]

Since your question is about leaks and pressure, maybe you could include that information on the charts? Please post with Events, Flow, Pressure, Leaks, and add flow limits and snores if you have room.

Some observations: You are using a pressure range of 5-20 with EPR at 2 and experiencing mixed events. You would benefit from a higher minimum pressure and more stable pressure. I recommend 8.0 minimum to 14.0 maximum with EPR 2. That will give you an effective range of 8/6 to 14/12. Note the minimum pressure matches your average pressure from this session, and should be comfortable.

Your leaks are actually pretty decent, but you had an episode of large leaks in the middle of the night 3:45-4:00 which disrupted your sleep. The CA events are kind of normal for a person adapting to initial exposure to CPAP, and overall your OA events look like a combination of low pressure or positional issues as they don't corrolate to pressure.

[Hojo]

Since your question is about leaks and pressure, maybe you could include that information on the charts?  Please post with Events, Flow, Pressure, Leaks, and add flow limits and snores if you have room.

Some observations:  You are using a pressure range of 5-20 with EPR at 2 and experiencing mixed events.  You would benefit from a higher minimum pressure and more stable pressure.  I recommend 8.0 minimum to 14.0 maximum with EPR 2.  That will give you an effective range of 8/6 to 14/12.  Note the minimum pressure matches your average pressure from this session, and should be comfortable.

Your leaks are actually pretty decent, but you had an episode of large leaks in the middle of the night 3:45-4:00 which disrupted your sleep.  The CA events are kind of normal for a person adapting to initial exposure to CPAP, and overall your OA events look like a combination of low pressure or positional issues as they don't corrolate to pressure.

What information did I miss on not posting that would be useful? 

I understand changing it from 5/20 to 8/14, but what is the EPR?

Thank you.

[PaytonA]

Where is the seal "blowing out"?  Nose, cheeks , or mouth?

[Hojo]

Where is the seal "blowing out"?  Nose, cheeks , or mouth?

By the cheeks, it's the cushion 'flap' and all I need to do is pull the mask out a bit, allow the flap to flip back towards the inside where it belongs, then set the mask back on my face.  I think it would be better if the cushion was 'solid' (but soft) by way of being filled with air or better yet, gel, as long as it doesn't get punctured.

[Sleeprider]

What information did I miss on not posting that would be useful? 

I understand changing it from 5/20 to 8/14, but what is the EPR?

Thank you.

Hojo, the information was there, but spread between 3-graphs.  It would be easier if you would just organize your Sleepyhead detail charts as described in the first link in my signature.

EPR means exhale pressure relief.  It is under the comfort settings of your machine, and can be set to off, or 1-3.  Your machine acts much like a bilevel where the inhale pressure (IPAP) is higher than the exhale pressure (EPAP).   EPR gives you between 1 and 3 cm pressure relief during exhale.  From your mask pressure and chart summary I was able to tell you are using EPR at a setting of 2, or 2-cm pressure relief.  With a minimum pressure of 5, you actually start at the pressure of 5/4 (IPAP/EPAP).  It progresses quickly to 6/4, 7/5, 8/6 etc. 

My recommendation for a minimum pressure of 8.0 is based on the fact your average pressure is about 8.5.  I left EPR the same.  Since your pressure is too low at 5.0, the machine tends to over-react, so we can safely limit the maximum pressure to 14 and not affect your treatment.  Overall, this recommendation will result is more stable pressure and will be less disruptive to your sleep.  It will also help you to get a good mask seal at a pressure more typical of your usage.

[Hojo]

Sleeprider:  Thank you, I've redone my data screen (for the next time I post data).

[PaytonA]

Hojo,

I have used the Mirage Quattro for some time and find that it seals extremely well even at my pressure which is around 20 cm/H2O. There are a couple of things that you need to pay attention to before you tighten the straps. First, how old are the cushions and when was the last time that you cleaned them and how did you clean them. Second, it may be a good idea to clean your face where the cushions will rest just before bed time. I use an astringent and cotton pads. Let us know if you try this and and what the results are if any.

The way the air filled cushions work is not only do the cushions exert more sealing pressure with more internal pressure but the pressure to blow the cushion outward increases also. That means that the friction between the cushion and your skin is what prevents the blowout. The other scenario is that the pressure in the mask stretches the headgear enough so there is very little surface to hold it by friction. Hence my questions about cushion age, cushion cleaning, and facial cleaning. We have a member of the forum who is awakened in the middle of the night every night with leaks and must wash his face and cushions to make it through until morning.

One side note. It is my opinion that the silicone seal should have a slightly tacky feel. As it gets older the tackiness tends to diminish even if you are cleaning the cushions with soap and water. In my experience using Pampers baby wipes to clean the cushions results in maintaining the tackiness longer. Other baby wipes may do the same but I have no experience with others.

Best Regards,

PaytonA

[Hojo]

Hojo,

I have used the Mirage Quattro for some time and find that it seals extremely well even at my pressure which is around 20 cm/H2O. There are a couple of things that you need to pay attention to before you tighten the straps. First, how old are the cushions and when was the last time that you cleaned them and how did you clean them. Second, it may be a good idea to clean your face where the cushions will rest just before bed time. I use an astringent and cotton pads. Let us know if you try this and and what the results are if any.

The way the air filled cushions work is not only do the cushions exert more sealing pressure with more internal pressure but the pressure to blow the cushion outward increases also. That means that the friction between the cushion and your skin is what prevents the blowout. The other scenario is that the pressure in the mask stretches the headgear enough so there is very little surface to hold it by friction. Hence my questions about cushion age, cushion cleaning, and facial cleaning. We have a member of the forum who is awakened in the middle of the night every night with leaks and must wash his face and cushions to make it through until morning.

One side note. It is my opinion that the silicone seal should have a slightly tacky feel. As it gets older the tackiness tends to diminish even if you are cleaning the cushions with soap and water. In my experience using Pampers baby wipes to clean the cushions results in maintaining the tackiness longer. Other baby wipes may do the same but I have no experience with others.

Best Regards,

PaytonA

PaytonA:  My mask is under 3 weeks old, I do wash it with soapy water every morning and my face before I go to bed.  I'm not sure if I hit the mask or the high pressure causes it to move, but the peak pressure I've seen is only about 14 so that shouldn't be a cause.

[PaytonA]

Do you use the mask fit feature on your CPAP to adjust your straps?