More leaks? Less AHI? New mask..help?

[SarcasticDave94]

Leaks do several things that are bad:

• it reduces the airflow needed to keep the airway open
  
• it impacts accuracy in sensing events
  
• it disrupts your sleep
  

Those are the first 3 negative effects of leaks I could think of. There's likely others. Look at it this way. Suppose you had a flat car tire and were trying to inflate it but your air compressor was struggling to blow the tire up because half the air leaks out at the valve stem. OK that's a reasonably close parallel to your PAP leaking via the mask or mouth.

[tierdal]

I guess i just dont understand how my AHI could be amazing but cause of leaks its bad? Also how do i fix it?

[SarcasticDave94]

With me there's 3 aspects to a mask selection. 1 is the type, 2 is the cushion size, 3 is the specific model. I've not come across number 4 personally, but certain mask models offer sizes of headgear.

I've tried the ResMed P30i pillows and their similar N30i nasal. I mouth breathe too readily to find leaks control success. So I reverted back to my full face type.

I've tried an Amara View from Respironics, the ResMed F20 AirFit and AirTouch which is silicone or memory foam cushion styles, and more recent is my Fisher and Paykel Simplus and the similar but newer designed Vitera.

With my Vitera especially, I've used it just enough to know how to set my straps with a repeatable and acceptable balance between leak control and comfort. I've not used any PAP or mask in months while I try to convince my doc I need to replace the ASV with something else. Last month I took another titration study with my Vitera. Simply I put it on and did the titration. Leak rate of 7 or less all night while flipping back and forth on my back and left side. And I'm confident I could use my ASV tonight and repeat that leak level.

As for your own situation, I suspect the numbers for treatment are questionable due to your high, that is consistently high, leaks. You cannot expect accuracy and being well treated when you're consistently leaking with your rates and levels of leaking. In my mind I can picture your leaks are as a water pipe that leaks about half the water onto the floor and the remaining water makes it to the sink. It's far from efficient, it's messy, and I believe leaks will also add to the disruptions.

[staceyburke]

I wrote about the leak rate is important in my last post to you.  I thought I would add a little to my thoughts – I had surgery on my upper lip 2 weeks ago and have not been able to use my full face mask.  I am using a pillow mask P30I from resmed so it will fit with the bandages on my lip. 
 
I have not looked at my Oscar results since my surgery until today.  I have included last nights charts along with charts from before the surgery for you to look at and compare.  The first one is last night .15 AHI with one event.  Notice the leak rate chart.  I woke up 3 times in the night that I remember.  Today I am tired – little brain fog – head ache…   The 2nd chart is before the surgery with a .13 AHI.  Also with one event.  Now look at the leak rate – quite a difference!  I remember waking up feeling great – so much so I made a note of in “note section”.
 
This is what I was talking about the leaks, even if your AHI is great, you still need to try to eliminate large leaks.  I hope this shows what I’m talking about leaks are problematic.

[tierdal]

So I can't use this comfortable mask and need to use a full one then or I'm not getting good treatment??? 

Why do they even sell these things if they don't work?!?!

[staceyburke]

You can use any mask you want!

[tierdal]

I mean I went the best therapy and good sleep. I've only used nasal pillows do far and my charts lol nothing like yours.

You have like No leaks. Mine are constantly high and apparently this means the AHI report is artificially low and I could be having apneas all night.. This is scary since I'd never know!

You say with leaks you feel bad and without you feel amazing?? That's what I want.

How do I get there?

[staceyburke]

I don’t think you need a new mask. Your leaks are not that bad, as I said you need to keep working on stopping the leaks. Don’t just look at your AHI. That is called chasing numbers. Look instead to how you are feeling. 

If you believe the mask is the cause try a different size or style. What fits one person does not fit someone else. 

I have tried dozen of different masks in my 20+ years of use. Also 6 different pap machines. 

Just stay with it and keep trying to improve your well being (feeling)!

[SarcasticDave94]

I can't state a certain mask for you that's guaranteed to work just like I would be a bit of a fool to say because I like it you need to buy a Ford F-150. I don't really have that truck myself but it popped into my brain cells to use that to compare vehicle to PAP mask.

The point I'm trying to make is I could attempt to tell you buy the Vitera, it's great, it's comfortable, the leak rate is low and easy to achieve... For me that's true but I'm not you. Our faces are shaped different.

The mask choice in getting CPAP therapy to work is the biggest and hardest decision there is. As I said earlier, you must decide your mask type (pillow, nasal, full face, hybrid), cushion size (and material types on some models), some have headgear sizes, then you need to adjust the straps the correct way, which may vary per mask model.

You do not have to get ZERO leaks, only down to consistent manageably low and also comfortable. I see leaks and PAP therapy success on opposite ends of the teeter-totter, if leaks are high therapy success drops, and vice versa. So you decide if you're OK with accepting high leaks and less than ideal therapy results or keep working at finding YOUR best mask and leak rate ratio.

And just to complicate things a bit more, leaks come in 2 kinds, mask seal and mouth. Again the mask selection aspect of PAP is the hardest thing to get right. That's why it's so important. It affects leaks, comfort, therapy efficiency, and even if therapy is good enough to continue and then to reap benefits for years or you quit and suffer.

[tierdal]

Fisher & Paykel Vitera Full Face Mask Cushion?

I'm in my introductory period so the supplier will keep sending me test kits. Should I try this one?