Sudden Unexplained Increase in Leak Rate

[lygodia]

Hello all. I've been on successful CPAP treatment for close to 6 months now, and things are generally going well... until this past week.

I have had a sudden increase in my leak rate. This started very suddenly, with my leak rate nearly doubling overnight. I believe this is because I tried swapping from the medium Resmed P30i headgear to the small. It fits well, but the increased leak rate concerned me. So I swapped back.

The leak rate has improved somewhat, but is still high. This just raises more questions to me. I'm using the exact same set-up I was before the headgear swap, including having returned to the medium headgear. Why the sudden increase in leak rate?

Here are my charts from the past 2 nights, as well as one month ago for contrast.

June 8 (before issue onset):
   

July 7:
   

July 8:
   

[Narcil]

the issue was there all along, it was barely under the 24L/min red line but the issue was there nonetheless.

can you zoom in on a 15 min section on one those leaks and post another pic? have you considered you may be mouth breathing?

[lygodia]

Thank you for taking a look. I’m at work now - I’ll get you what you asked for once I’m home later today. 

I don’t mouth breathe, but I do have mouth leaks. What I don’t understand is why the leaks have suddenly gotten noticeably worse. I’ve had a number of months with consistent mouth leak volumes (and no impact beyond a bit of dry mouth); the leaks increasing is cause for concern to me.

[PeaceLoveAndPizza]

Are the leaks waking you up? Any changes in how you feel in the morning?

The way to not fix leaks is to ratchet down the mask until it is flattened against your face. Bad juju.

Every night is different. The things to look for are the trends. If your leaks are trending up there may be any of numerous causes. In this case as you noted you went to a cushion that was too small, which caused the larger leaks, but the baseline leaks remain similar to your June chart.

Some things to consider:

• Congestion
  
• Allergies
  
• Changes in mask sizing
  
• Headgear needing replacement
  
• Mask cushions needing replacement
  
• Change in humidity
  
• Pillow changes
  
• For men beard or mustache growth
  
• And many more…
  

The only way to get to the bottom is to start working through the possibilities. In your case it seems your leaks in general are associated with flow limitations. I suspect that when you hit the FL’s you open your mouth to bring in air, causing the leaks. 

You could try adding EPR 1 full-time to your repertoire of things to try. A bit of pressure support may stop the FL’s and help reduce leaks.

[paulag1955]

I started having leak issues when my head strap needed to be replaced. Something to consider.

[lygodia]

Here's the 15 minute zoom you requested! I tried to get the beginning of a leak section.

   

[lygodia]

The leaks aren't waking me up, but I have felt more tired yesterday & today. That being said, I may also be getting sick - I have an appointment with my doctor tomorrow to look into it more.

From the list you provided - the main things I can look into are changes in humidity (I was considering turning off the humidifier tonight to see what happened; I do this from time-to-time, even though I usually have my humidity at 4) or the headgear/cushions needing replacement (I did notice a small bit of wear in the cushion last night - I can tell because it wasn't sealing properly at times in one specific area, and I've had this happen to a prior cushion).

I'm not entirely sure what causes the flow limitations. They don't seem positional - I don't tend to move in my sleep, and with my pillow, I have my chin resting in a specific post (since it has inserts for the mask, chin position naturally follows). I'll keep EPR in mind - mine is off right now, but it could be something else to experiment with.

[lygodia]

When you say “head strap”, do you mean the headgear?

[lygodia]

Hello all. I did notice my headgear was yellowing, compared to the new (small) headgear. I procured a new (standard) headgear.

No improvements. So that's out the window.

Other things I will try to do:
- Try a new hose - I have one from my DME that I was keeping as a back-up. May as well see if something is up with that.
- Try EPR (though I'm not sure that's where my flow limitations are coming from)
- Try a chinstrap (I bought one a few months back but was overwhelmed by using it. Soft cervical collar & mouth tape have both been tried already and I cannot tolerate either)

[lygodia]

I wanted to update with good news - EPR has done the trick! Flow limits & leaks down to below where they started over a month ago. I’m experimenting with what level of EPR is appropriate, but this is what I needed.