Sorry dmypub it's not a fun place to be.
Most masks seem to be a precarious balancing trick.
Too tight and they don't work, too loose and they don't work.
You just get them in the right spot then put your head on the pillow and it's back to leaking again.
How long before your new mask arrives?
It might be worth totally undoing the straps and turning it on and placing the mask in the perfect position on your face then resetting the straps to that angle and position.
Sometime all those incremental adjustments are actually moving it out of position.
If all else fails you could probably turn the pressure down a point or so for a few nights without major consequences.
When I get desperate and the mask persists in constantly shifting (even on the pink satin pillow) I get the shears out and give myself a crew cut (military style short haircut) It makes a big difference to how well the mask stays in place, although it's probably not the option of choice for ladies with pink CPAP machines. :O
As I indicated in my other post, I have no experience with this mask. It is one of the ones frequently recommended for higher pressures though. Have you considered that you might not have the correct size cushion? I believe the frame for the cushion is one standard size and the small, medium, and large cushions will fit the one standard frame. I did find a sizing guide at this link. I have a ResMed F20 which I could not get to seal either at pressures up to 15 cm. I suspected the large I have was too big and I really needed a medium. Did not try that option though and went back to the nasal pillow type and a chin strap, and now even tape on my mouth. I would rather do that then try to make the full face type seal.
The other Full Face mask I tried was the Mirage Quattro. I found this "Taming the Mirage Quattro" blog, but following it to the T didn't help either. Thought I would give it to you in case there is something that might help you with the Simplus. They seem to be similar looking masks.
Interestingly I see this blog also has the Swift FX nasal pillow mask on it, and that is my most recent mask. I'll have to read it to see if I can learn something...
Where exactly is the air leaking from?
Finally received a new mask - resmed airfit f30. I upped my auto cpap to 15 - 16 cm. However, really had to strap this mask on uncomfortably tight to minimize leaking at 15 cm. serious lines on my face this morning after being up for two hours. The great news: AHI dropped to 2.04 and no periodic breathing ! Here's the data:
Looks pretty good. OA events are highest. I only see two of the 9-10 events happened at 16 cm pressure. The rest were at 15 cm. Hypopnea were next, and I see only 2 of those 9-10 events happened at 16 cm. The rest are at the lower pressure. You might want to consider using the fixed pressure CPAP mode at 16 cm, if you can tolerate that pressure all night. Those leaks around 4:00 - 4:30 are a bit high, but you just got the mask and perhaps have some fine tuning to do yet.
Overall, apart from a few peaks in the middle, your leak rate is pretty good. However, if it is bothering you then it is a problem. Are you sure that you have the right size of mask. With the Simplus, the top of the mask cushion should be at the bridge of your nose and the bottom of the mask cushion should be comfortable below you bottom lip. If the mask is to big the bottom of the mask may fall below you chin and create a leak. If it is too small it may go into you mouth if it opens and create a leak. Another common problem I see with many masks is that people over-tighten the top straps. This pulls the masks upward, which causes leaks into the eyes so the patient tightens the top straps more and pulls the mask up further making the problem worse. Generally, you want to top straps to be going straight back just above your ears, and the bottom strap should be pulled low down of the back of your neck. This helps to pull the mask into your face instead of up it. I can't help much more than that without being able to actually see the thing.
I am not very familiar with the AirFit F30 so I can't really give you much help with that either.
Night #2 diary with new mask (Resmed AirFit F30) 16cm cpap
I still get too many small leaks that wake me up - doubt whether they are being registered in data as mask leaks. I still have to tighten straps to the point of being uncomfortable to control leakage. The largest size AirFit F30 is called a "medium"- the top headstrap just barely fits around my head (my headsize is pretty normal). I was hoping that this mask, since it fits under the nose, would resolve the problem I have with "puffy eye bags" - but no such luck. Eyes badly swollen after night 2. I wish I could find a mask that had "plugs" that you could insert into your nostrils slightly. Trying to get a non-leaking fit under the nose seems problematic to me - especially with the very lightweight rubber material that is used. I'm starting to think I should send this mask back - I bought it on the market because my DME is sooooo unresponsive. There's got to be a BETTER mask out there. Here's my data from last night for anyone interested (16cm):
That was not the result I expected to see with a fixed 16 cm. The PB has come back. Your 15 to 16 min max was better. But unfortunately it takes probably a week to two weeks to see the real trend. I think I would go back to the 15 to 16 or try a fixed 15 cm.
To see your leaks better, you may want to manually set the scale to 50. The top trace is kind of meaningless as it included intentional leakage. The bottom trace should be the true unintentional leak rate, which is the important one.
Wondering if I should try a different mask, similar to the Simplus design. Is the Resmed F20 mask a better alternative than the Simplus ? The Simplus just can't hold pressure at 14cm + It appears that I need a mask that can handle 16 cm of pressure. Thanks !
I have the F20 and gave up on it for the same issues you are having with the Simplus. I have used a ResMed AirFit P10 nasal mask up to about 15 cm with reasonably good success. Perhaps Bonjour could comment as I believe he uses that mask too. The problem with that mask is the headgear is kind of flimsy. The ResMed Swift FX nasal pillow could work for you. ResMed claims it is good up to 20 cm of pressure. The air vent on it is a bit of a problem depending on how you sleep with it. I have now been able to attach the Swift headgear to the P10 mask and it seems to be working really well for me, but I limit pressure to 11 cm. The one issue with a nasal mask is that if you open your mouth in the night air can leak out. The solution to that can be mouth taping and/or a chin strap. See the recent thread on mouth taping, as well as those on the mask hybrid solution, and the Swift FX comparison to the P10. One solution may be to buy the P10 and when the headgear gets too stretched then buy the replacement headgear for the FX and fit them together.
Night #3 diary with new mask (Resmed AirFit F30) Apap 15cm-16 cm
Disappointed with new mask. I seemed to take a step back from previous night at fixed 16cm so I decided to go back to auto 15-16cm. At break three in the data, I think I got up and put on my old Simplus mask - which I did much better with, comfort wise. Strangely, PB shows up more after switching to the Simplus. Go figure. So, I'm returning the F30 and decided to give the ResMed Swift FX nasal pillow a try. I'm a mouth breather so I plan on taping my mouth shut and work harder at keeping my gammy sinuses clear. I previously tried taping for three nights and got used to it. So here's my data for night #3 - one half F30, one half Simplus. I did have a rough stomach indigestion night - accompanied by some A-Fib.
The strange part is that most of your obstructive and hypopnea events happen at 15 cm and many of them cause the machine to bump pressure up to 16 cm. Then the machine goes back down and it starts over again. That was why I thought a fixed 16 might work better. While the PB is appearing, there are no CA events. It seems to be mainly an obstructive issue. Have you tried zooming in on some of those OA events and see what is leading up to them? You might want to look at the ones starting about 6:40.
Close up of OA cluster starting around 6:40. Flow rate does some weird spiking. mouse-over indicates "Pressure Pulse 14" Flow rate does weird spiking/dipping for most of the OA events.
I would agree with bonjour's comments. You were asleep but there were flow restrictions as indicated by the somewhat rough cut off peaks on the inspiration half of the cycle. Then you went into a full flow obstruction apnea. You possibly woke up partially and then another obstructive event at 15 cm. After that periodic breathing started. These may be central events that end in a full obstruction. On a ResMed when you plot mask pressure you can actually see the machine pulsing the flow to test for obstruction. Harder to tell on a Respironics. I think a ResMed may have responded to those flow restrictions earlier, and increased pressure earlier, but really hard to say. I don't have much experience with a Respironics, but I see fluctuations in flow between the Periodic Breathing events. They seem smaller on the second OA event, and then larger on the third one, and the next. I'm wondering if those may have been central events. When the machine tries to pulse flow/pressure to test for obstruction flow will go up if the airway is open.
But, the unfortunate bottom line is that the pressure is not high enough to prevent flow limitation that seems to initiate the whole sequence. I suspect if you zoom in on the sequence before the RERA events you see similar cut of tops on the inspiration?
Left to right
The "Pressure Pulse 14" is Philips method of checking for obstructions, the machines way of checking for Centrals.
I went back to my Simplus mask, and set my pressure at fixed 16 cm. Thought I had the Simplus leakage problem under control at 16cm, but the data showed a couple large leaks. Woke up feeling pretty good so I was eager to see if my AHI had improved. However, it was disappointing to see that my AHI has regressed to 6.92 last night. Guess this is how it goes.. two steps forward, one back.. I do sense I spent some time sleeping on my back - maybe reason why AHI was not so good.
i don't know ?
See this link: