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High leakage

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Freya +0 points · over 5 years ago Original Poster

Would be very grateful if anyone has any thoughts; been a CPAP user for nearly 4 years - ResMed Autoset 9, ResMed N20 nasal mask. Leaks were identified last year and was given a full-face mask which I didn't get on with and leakage increased significantly. Went back to nasal mask, and last week had a review where the physician turned EPR down from 3 to 1 and increased climate line temp to 21C (I'd had it at 16). My big problem now is that leakage rate is up to the high 20s / low 30s, and my mouth is so dry it feels like it's filled with broken glass BUT my mouth is shut tight too - so how can I be mouth breathing?? I'm at a loss, and feeling very tired and bleak about the whole thing!

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theres126 +0 points · over 5 years ago

Oh my gosh - you sound exactly like me! I've been using my CPAP about a year. First year, low leakage. All of a sudden, my leaks are up in the 30's, and two weeks ago my doctor increased my pressure from 6-10 to 9-15, and my leaks are now in the 30's to 40's. Same as you, my mouth is SO dry, even though I'm taping each night. I don't get it. I've been using the same type mask the whole time. Why start leaking now? Why did your doctor change your EPR? If you find anything to help, let me know. I just want to feel rested!

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Freya +0 points · over 5 years ago Original Poster

Hi thanks for replying - I had never thought of taping my mouth, mainly because it still doesn't seem possible that the leak is caused by an open mouth. But what else could it be? Maybe an ill-fitting mask - I know ResMed recommends changing ever six months or so, I imagine it all stretches through use and washing, but it's not feasible to do that really.

EPR was originally at 2, and it was changed to 3 ages ago for reasons I cannot recall. It was dropped back to 2 because apparently you get better control of AHIs with the lower number and this is in fact what's happened - I was usually between 2 and 3, now it's under 1. But I think maybe if there's a high leakage then the AHIs won't be being recorded correctly, but that's just guesswork on my part.

I do not know if there's any correlation between EPR level and leakage. In fact, despite believing I understand CPAP treatment pretty well, I realise I probably don't know very much. And much of the information "out there" can be confusing and conflicting!

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Sierra +0 points · over 5 years ago Sleep Patron

The best thing you can do is download SleepyHead so you can see when the leaks are occurring and how large they are. The software is not being developed any longer, but it still works. You do need a PC or Mac and a SD card reader. Here are some examples of what a good leak rate looks like in SleepyHead, and what a bad one is like:

Good:

Bad:

What are the pressure settings for the machine? A ClimateLine temperature of 27 deg. C would be the normal setting.

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Freya +0 points · over 5 years ago Original Poster

Hi thanks for your reply - Sleepyhead looks to be pretty much defunct now for download, but I do monitor my leaks every night so can give you figures if that helps. I was told not to monitor the leaks and AHIs every night but to look at the monthly data as this better reflects the overall control of the condition. But I know when I wake up with the thick head and feeling like I have the worst hangover ever that a "bad leak" night will be the cause, so I tend to look at the data to have this confirmed!

Pressure settings are Min 8 Max 15

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Sierra +0 points · over 5 years ago Sleep Patron

SleepyHead should still download and work. It is much more informative than a single number for the night. There is a spin off program from SleepyHead called OSCAR that can be used as well.

The reduction of the EPR from 3 to 1 should have reduced your maximum pressures some and helped with leaks. I run my EPR at 3 but set it to only be active during the ramp period. I goes to zero EPR when the ramp ends.

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Freya +0 points · over 5 years ago Original Poster

I increased the EPR from 1 to 2 last night and the registered leak dropped to 16, so I'm guessing there must be some correlation?
I am so pleased to have found this forum, it's great to be able to connect with others who have the same condition!

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Sierra +0 points · over 5 years ago Sleep Patron

Normally increasing EPR when the machine is in auto results in a corresponding increase in pressure, in your case about 1 cm. The reason is that an increase in EPR is a decrease in exhale pressure. That normally causes more apnea events that your machine has to increase pressure to compensate for. And of course an increase in pressure normally causes more leaks. So I would suggest it was just a coincidence that leaks went down.

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theres126 +0 points · over 5 years ago

Hmmmm - I thought I read last year that setting an EPR of 3 was better for AHIs? I changed mine to be not just during ramp a couple days ago, and the first night my leak was actually down to 12!! But, back up last night......... Darn - guess I should change it again? I had it at 3 on ramp only, which I remember at the time did lower my AHIs

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Freya +0 points · over 5 years ago Original Poster

It really all does seem very trial and error!

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Sierra +0 points · over 5 years ago Sleep Patron

There are some fairly rare situations where EPR may reduce centrals. The basic problem is that it forces the pressure up higher. For most using the AutoSet program setting it to 3 but in Ramp Only mode is the best. It makes it more comfortable to get to sleep, and then does not reduce effectiveness when you are asleep.

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Ruby +0 points · over 5 years ago Sleep Commentator

The older a mask gets, the more likely it is that you will have leaks. Mask material breaks down, stretches and won't hold a seal. I agree that it is a pain to get a new mask. The cost alone is prohibitive. I have not tried taping my mouth but even when I used a chin strap I would wake up with air rushing out of my mouth. Another thing to think about--is your mask size the correct one for your face? Just something to think about.

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S2S +0 points · over 5 years ago

I think the leak may have been from or through your mouth. Try a good chin strap or a neck cushion to keep your mouth closed. However, if air is escaping through your lips it is more difficult to stop. You could try taping then shut to see if this helps, but be careful what tape you use for obvious reasons,

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Freya +0 points · over 5 years ago Original Poster

Thank you. I always imagined mouth-breathing meant inhaling through the mouth, but the other night I awoke to find myself exhaling through my mouth. Since adjusting the EPR from 1 to 2, and tightening the mask, things have settled down considerably (AHIs around 2.5 max, often under; leaks between 9 and 12). I had loosened the mask because I recalled a conversation with ResMed on their phone advice line that if you over-tighten you are more likely to experience leaks. This contradicted the original fitting instructions from the Sleep Clinic to "tighten the mask as much as possible as during the night the face muscles relax and will cause the mask to become looser".

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Freya +0 points · over 5 years ago Original Poster

Thank you all, I appreciate your taking the time to reply to me. Is this a global forum? I'm in London.

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