Leaking: long time user suddenly unable to diagnose and solve leak issue(s)

[Sora]

Hi all,

In brief: I am now leaking at record rates for the first time.  I am unable to fix the problem despite much trial and error.

Longer version:

I've been using the AirFit P10 (L) + Dreamstation since October 2016.  After the typical adjustment period, I've been coasting along ever since.  I follow proper maintenance procedures and replacement schedules (on the latter, however, I often extend the timeline as I don't often seen much wear, I presume due to the former).

Issues first arose last month (Jan 2018) when I started to notice an extremely dry mouth - enough that it would either wake me up or I would wake up and notice it.  The only times I previously suffered from a dry mouth was during rare, mid-day naps when I did not use my CPAP.  I didn't think much of this until I started getting notices in Sleepyhead, stating "Your mask is leaking way too much.  Contact your CPAP advisor."
I don't recall the first time I got it, but it went from never being an issue to occurring more often, to an every night notice.

At some point thereafter, I became much more cognizant of the dry mouth. In a rare moment of pseudo-lucidity, I caught myself breathing from my mouth while the P10 was making much more noise than I typically hear.  That's when I knew something was off and the aforementioned "trial and error" commenced, to no avail, sadly.  Hence my plea for advice from you fine folks.

Unsurprisingly, I'm now hyper-aware of anything that could be causing this - with the obvious caveat that a subjective cause-effect link is spurious.  Nevertheless, here are some things I've noticed since this started being an issue last month:

• Restating the obvious, the extreme dry mouth occurring more often than not.  Previously it never occurred.
  
• A few times of waking up to louder than normal pressure from the P10 + noticing that I was breathing - to some extent - from the mouth.
  
• A few nights of slight/moderate congestion, but this is an example of something I may be noticing only because I'm now 'hyper-aware.'  In any event, at no time have I been sick since this started. Allergies do not affect me in a meaningful way, to my knowledge.  I had surgery for a deviated septum in December 2016.
  
• I've tried a Phillips chin strap and it dramatically affected my quality of sleep.  I loathed using it and after 3-4 nights, I gave up.  I wish I had made a concrete note as to when I used it so I could more easily compare nights, but my recollection was that it did not.  I also tried a regular ace bandage which was more comfortable but the results were largely the same (i.e., inconclusive).
  
• "Mask Fit" in the Phillips iOS app and on my Dreamstation have hit under 100% multiple times during this 6-7 week period.  As far as I can tell, it never had in the ~15 months prior.
  
• I've replaced all components (nasal pillow, tubing, mask).  No difference.
  
• SleepyHead data shows a clear and convincing trend, with dramatic increases Average, 90%, and Threshold Leak numbers.  As well as "Large Leaks."  Here is some data:
  

And, FWIW, all my "Records" for Large Leak have occurred during this period: 



My thanks for any advice or thoughts.  It would be much appreciated, as I have run out of ideas.

Warm Regards,

sorabora

[jaswilliams]

Without seeing a full chart but based on the comment that you have a dry mouth I would guess you mouth breathing. And losing pressure out of your mouth.

[Walla Walla]

A Daily chart showing the leak chart would help. I'd guess mouth leaks due to the dry mouth. There's a long list of things you can do and not knowing what you've tried all I can offer is the link below called mask primer. It covers some of things you can do for mouth leaks.

[sonicboom]

I am in the mouth leaks camp as well but in addition I noticed when I used the P10s that leak rates crept up over time and even when I swapped out the pillows it didn't make a difference. My remedy was to try new masks which worked. I tried the Dreamwear and Brevida. Liked them both. Prefer the Brevida. Give it a try and you might be surprised.

[Sora]

Without seeing a full chart but based on the comment that you have a dry mouth I would guess you mouth breathing. And losing pressure out of your mouth.

A Daily chart showing the leak chart would help. I'd guess mouth leaks due to the dry mouth. There's a long list of things you can do and not knowing what you've tried all I can offer is the link below called mask primer. It covers some of things you can do for mouth leaks.

My apologies.  I neglected to post the most relevant data!  Below from the last week:

[Walla Walla]

Well some of it is mouth leaking from what I see. I'd try a soft cervical collar or chin strap to help keep your jaw closed. I also saw chin up strips being used by a member that worked for them. I myself already use a Cervical collar for positional issues but still had leaks through my lips. I now tape my lips with one piece of tape and that works for me. Lot's ways to try.

[Gideon]

First I agree that you are having some comfort issues regarding the obvious mouth breathing that is showing up in your charts.  Read the Mask Primer in my signature for some helpful hints.

Second Your large leak numbers that you are quoting are (IMHO) based on ResMed.  You have a PR DreamStation and the major areas of concern are those that are showing on your charts as gray.  PR Leak numbers are considerably higher than ResMed numbers because of the way they are calculated.  This is meant just to offer you some peace of mind that your leaks are not as bad as you think they are.  That doesn't make them any easier to fix.

You are apparently more sensitive to mouth breathing than many as evidenced by your dry mouth.  Let's continue to work on this.
You also identified a trend of increasing leaks.  Well done.

My "eyeball" test says your large leakage is 2-5% which is OK IF it's not impacting your quality of sleep, which it obviously is.

Again read the Mask Primer, something might jump at you.

Fred

[MitchS]

I agree with bonjour. Your leaks aren't as bad as they look in SleepyHead. You could try going into the CPAP tab of the SleepyHead settings and change the "Flag leaks over threshold" feature to 64 l/min which is close to the lowest leak rate that SleepyHead starts flagging large leaks on your charts. The default setting is 24 l/min, which is ResMed's large leak threshold. This should give you a better idea of just how bad your leaks really are.

[ajack]

As has been said. It seems like mouth leaking. The dreamstation combine both mask vent and leak. On your chart I would say the base vent is about 30 and I would want to keep my total leaks under 40, up to 55 (the 25 number used to describe a large leak)

[Sleeprider]

Have you been replacing headgear and cushions routinely? I find the P10 needs replacement periodically. If that is okay, then I agree with others that a soft cervical collar may encourage your jaw to stay closed. There is also a "Chin-Up" bandage that looks promising for keeping the mouth closed.