Leak issues, should I try a different mask before 30 day trial ends?

[Epark617]

Sorry if I'm breaking any rules here, not a regular, got directed from reddit as I'm looking for help and my reddit post isn't getting traction. I'm having a pretty high leak rate (myAir is telling me to adjust my mask the last 9 out of 10 days) and I'm not sure if this is an issue or not. 

TLDR: should I be worried about my leak rate? If yes, what could be the issue? P30i, fixed pressure of 11cm, DME says its a positional leak and makes it sound like I don't need to worry about it. 

I've been using the Resmed P30i. I haven't had any issues with comfort, and keeping the mask on at night, but I've been having leaking issues for past 10 days. I don't notice any leaks while sleeping. I have 5 more days until the end of my 30-day trial, and thus when my free trade-in is up. If it wasn't for the leak issue, I wouldn't be thinking about a different mask, but I'm worried that if I don't try a different mask I'm going to continue having issues.

I did go to my DME to try a different mask at the 2.5 week mark, however they told me that I've been doing really well with the nasal pillows, that full face masks tend to leak more, and that my data showed that my leaks were positional as opposed to opening my mouth; and they told me that dry mouths can still happen even if my mouth is closed all night. I also tried on the full face mask (F30i) at the store, didn't using it overnight, and after using the P30i for 2 weeks, just trying it on, I didn't like how much there was on my face, and all the straps, so I decided to stick with the P30i hoping my leaks would improve, but they honestly haven't.

I am wondering if perhaps it's because my prescription is to be on fixed pressure for the last 2 weeks of my trial period, and that's why I'm experiencing a higher leak rate now than I was before. Up until they switched the pressure, I was on APAP and my leak rate was pretty good, not zero, but most days rated as good on myAir. I switched on Oct 31 to fixed pressure, and my leak rate has been high since then. The main reason I'm asking, is because everywhere I read, as low as possible leak rate is best, and so I'm wary of what my DME is saying, and wondering if they simply don't want to do the free exchange, so they're pushing me to stick it out? However, if what they're saying is true, and I don't have to worry about my leak rate, then I am happy to continue doing what I'm doing.

I've included my oscar data here, let me know if there's any other data or info that would be helpful
On APAP for first 2 weeks, worst night 
   

On CPAP, fixed pressure 11cm, worst night
   

The best night on fixed pressure, which was the night prior, where I actually got "good" on myAir
   

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Overall leak rate since starting
   

[BuzzaJim]

Welcome to the Apnea Board.  You’ve come to the right place.  Leak issues are addressed all the time on this forum.  Getting these leaks under control is essential for maximizing the benefits from the therapy.  The lame answers you’re getting from the DME are very typical. Someone more knowledgeable will be seeing your post and send you wiki articles on addressing leaks.

For what it’s worth, you’ve done a great job getting OSCAR working and giving a good description of your concern in your first post.
Buzz

[Jay51]

Here is some great reading from our wiki on leak management:    

Mask Primer

• Mask leak solutions
  

[SarcasticDave94]

The DME with the don't worry about leaks offhand comment is like the mechanic working on your tire with a hole in the sidewall "eh don't worry about it".

I've never tried the ResMed P10, but it's at the top of the minimal list. I myself like Fisher and Paykel masks. There's an Evora or others that are pretty minimal I'm thinking.

[Deborah K.]

With a P30i pillows mask, some of your leaks probably come from the mask, but the majority likely come from mouth breathing.  The best solution for that, especially with leaks as high as yours are sometimes is to use good quality mouth tape.  Cover Roll Stretch tape and Hypafix tape are both good choices.  I like kinesiology tape better because it is more comfortable and better adheres to facial contours.

I suggest you set your pressures in Apap to 8 to 15.  Your median pressure is just over 8, so that's a good level for you.

You are also having positional apnea.  PA appears on your charts where you see hypopneas and/or obstructives clustered together.  No setting can fix this.  PA is when your chin drops toward your chest causing reduced airflow, much like a kinked hose causes reduced water flow.  Some can control this by sleeping on a flatter pillow or a low pillow that has a raised front edge that causes your head to tip back slightly on the pillow (my choice), and more wear a soft cervical collar high enough to keep your chin from dropping.  Lots here like the Caldera Releaf Collar as it's quite comfortable and works well for most, especially women.

Again, welcome, and best of luck with finding your best therapy and comfort!

[Epark617]

Oh wow, the mask primer is so great! I wish I found this earlier, this needs to be shared more on reddit!

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With a P30i pillows mask, some of your leaks probably come from the mask, but the majority likely come from mouth breathing.  The best solution for that, especially with leaks as high as yours are sometimes is to use good quality mouth tape.  Cover Roll Stretch tape and Hypafix tape are both good choices.  I like kinesiology tape better because it is more comfortable and better adheres to facial contours.

I suggest you set your pressures in Apap to 8 to 15.  Your median pressure is just over 8, so that's a good level for you.

You are also having positional apnea.  PA appears on your charts where you see hypopneas and/or obstructives clustered together.  No setting can fix this.  PA is when your chin drops toward your chest causing reduced airflow, much like a kinked hose causes reduced water flow.  Some can control this by sleeping on a flatter pillow or a low pillow that has a raised front edge that causes your head to tip back slightly on the pillow (my choice), and more wear a soft cervical collar high enough to keep your chin from dropping.  Lots here like the Caldera Releaf Collar as it's quite comfortable and works well for most, especially women.

Again, welcome, and best of luck with finding your best therapy and comfort!  

Thank you so much for your suggestions and feedback! 

I definitely want to switch back to APAP, I feel like I had less issues and I'll speak to my sleep doctor about it on Wednesday. 

I didn't know that about PA, it's good to know. I know the cervical collar can help with mouth breathing as well so I think I'll look into that.

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Also thank you so much to everyone's replies and encouragement so far!! I was also was confused and disheartened by the DME's response. It is quite disappointing considering that's the only "expert" I'm connecting with throughout the trial period on my specific progress..

[BuzzaJim]

The Sleep Apnea Forum is the place to go for sleep apnea information. These general purpose social media platform sites can’t possibly provide the in depth information a site like this provides. At best, an unvetted stranger will make suggestions or, in your case, helpfully direct you to a place where free reliable information is available. 

Your suggestion is well-taken, though.  I think Reddit needs to create a way to funnel users to sites like this where useful information is available.

[BuzzaJim]

In my area, the CPAP technicians for the DME are respiratory techs that couldn’t hack it in a clinical environment.  Few know what it’s like to sleep wearing a mask every night.  Their main purpose is to process insurance paperwork.  I was told the same thing about leaks.  As long as the “mask leak” was smiling, all was good.  Simply not true.

[SarcasticDave94]

DME probably means paper and equipment pushers. Throw in payment processing.

[Epark617]

Updated OSCAR data from last night with mouth taping!
   

Leak rate is way way better, no large leaks, however I did wake up multiple times with my mask leaking out onto my face. I don't know if it's because I was more aware of it, or because I mouth taped with my lips inside and so there was less of a ledge for the mask to sit on, when it would slip out of place I was getting air on my face. 

After reading the advice on this forum, and reading the mask primer I watched a few mask review videos, especially from "TheLankyLefty27" (thoughts on him??) and realized that I was having the same issues as he was with nasal masks, where when I'm sleeping on my side, the pillows are moving away from my nose on the opposite side and creating a leak. Sometimes it would be really small, and I thought maybe I was overreacting and it was just the vent, but I'm realizing it is the mask. I noticed last night as well that sometimes even when I'm laying on my back, and I move my head left and right, because the band is between my head and the pillow, it will shift the mask left and right slightly, causing the pillow to shift out of my nose as well. 

So I'm contacting my DME and I want to try the F&P Brevida or at least a different type of nasal mask. Let me know if you have any suggestions