Sleep Tech Tip of the Week

By Michael Miller, RPSGT

I recently received a request to write a tech tip about dealing with CPAP mask leaks and how huge air leaks affect the integrity of a titration. The short answer is that large air leaks compromise the accuracy of the CPAP titration. I am sure that if you have read any of my other entries you are wishing that I would end it with my short answer. I apologize in advance, but this issue actually deals with two important topics that you should take into consideration when performing titrations.

The first topic is in regards to intentional versus unintentional air leaks. Intentional leak or acceptable leak is the amount of air leak intended by the mask manufacturer for the displacement of CO2 by the patient. This intentional leak is crucial for the patient’s well being during CPAP usage in order to dispel the harmful retention of CO2. Unintentional leak or unacceptable leak is the total leak minus the intentional leak. Unintentional leak most often is a result of mask leaks (around the seal) other than that from the exhalation port or from the mouth if using a nasal mask or nasal pillow setup. Unintentional leaks can be corrected with proper mask fitting and ensuring that the patient is able to tolerate nasal breathing. I reviewed several “leak rate charts” and took an average of acceptable or intentional leaks with a variety of different mask types on a CPAP pressure of 30cm and the average was close to 50 lpm. Most new in lab titration devices have the leak correction rates built directly into the software. Please refer to your current titration device and cross reference mask type with pressure settings to ensure acceptable intentional leak rates.

The second topic to consider when performing titrations is side effects to the patient. I felt that this topic was important to cover because no matter how accurate the titration is, if a patient does not comply with treatment then there is no benefit if CPAP is not used. The most common side effects to CPAP treatment are as follows; mask discomfort, nasal congestion, difficulty with nasal breathing, ear pressure, headaches, “gas” or air in the stomach, air from CPAP is too cold or too hot. It is crucial to minimize and alleviate as many of these side effects as possible. Taking time to properly fit a patient with a mask, adding cool pass over or heated humidity when needed, slowly increasing pressure settings in small increments, and ensuring that a patient can breathe adequately through their nose are all simple solutions to reduce the side effects that CPAP can often create.

Reducing the amount of unintentional air leakage while minimizing the amount of side effects to the patient is the key to performing the most accurate titration possible.

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Tags: apnea, cpap, cpap acclimation, cpap desensitizing, cpap mask, PSG, sleep apnea, sleep study, sleep study preparation, Sleepvirtual, Sleepvirtual BWII PSG