Large leaks

[js12278]

I am using the medium nose pillows. On Sleepyhead, I am constantly seeing leaks. It says major leaks. I don't know if it's normal but I can feel a very small amount of air coming from underneath the pillows. Even if I push up on the pillow, I seem to get leakage in Sleepyhead. I also notice an event shows during the leakage. Any ideas? Thanks.

[Wulfman...]

I am using the medium nose pillows. On Sleepyhead, I am constantly seeing leaks. It says major leaks. I don't know if it's normal but I can feel a very small amount of air coming from underneath the pillows. Even if I push up on the pillow, I seem to get leakage in Sleepyhead. I also notice an event shows during the leakage. Any ideas? Thanks.

Are you sure they're not coming from your mouth?
That would be my guess, since you're using a nasal mask.


Den

.

[Pugsy]

The small amount of air you feel under the pillows is probably the normal venting. All masks do that.
The ResMed AirFit P10 nasal pillows has vent holes right under the pillow and it diffuses the air so you can barely feel it.
Turn it over and look where the hose is and to the side...those are the vent holes. I can't feel it unless my hand is pretty much touching the mask.

SleepyHead calls a big leak if you go over 24 L/min but how significant it might really be is what % of the night are you spending in large leak.
The wording makes out like it is "significant" even if it is 0.5% of the night...or if it was 50% of the night. O.5% of the night in large leak is nothing to worry about...50% would be something to worry about though...and SleepyHead's wording is the same for either.
So how really worrisome would be just how much of the night was spent in large leak territory?

What % of time spent in large leak is SleepyHead reporting and how long is that sleep session?

[js12278]

I am using the medium nose pillows. On Sleepyhead, I am constantly seeing leaks. It says major leaks. I don't know if it's normal but I can feel a very small amount of air coming from underneath the pillows. Even if I push up on the pillow, I seem to get leakage in Sleepyhead. I also notice an event shows during the leakage. Any ideas? Thanks.

Are you sure they're not coming from your mouth?
That would be my guess, since you're using a nasal mask.


Den

.

It's not from my mouth. I am actually clenching my teeth to the point I have jaw and tooth pain now. Not good.

[js12278]

The small amount of air you feel under the pillows is probably the normal venting. All masks do that.
The ResMed AirFit P10 nasal pillows has vent holes right under the pillow and it diffuses the air so you can barely feel it.
Turn it over and look where the hose is and to the side...those are the vent holes. I can't feel it unless my hand is pretty much touching the mask.

SleepyHead calls a big leak if you go over 24 L/min but how significant it might really be is what % of the night are you spending in large leak.
The wording makes out like it is "significant" even if it is 0.5% of the night...or if it was 50% of the night. O.5% of the night in large leak is nothing to worry about...50% would be something to worry about though...and SleepyHead's wording is the same for either.
So how really worrisome would be just how much of the night was spent in large leak territory?

What % of time spent in large leak is SleepyHead reporting and how long is that sleep session?

I do think that is what I am feeling. the vents. But why all the leaks in the report then? I can hear the leaks and it is really high pitched. Sometimes I can touch my nostril and change the pitch, lol. Anything to worry about? I do not go any longer on the machine than maybe 5-5.5 hrs. I am just trying to be compliant until I document enough to justify an in lab study.



Avg Leak rate 4.16
90% Leak Rate 19.20
% of time above Leak Rate threshold 3.33%

[Pugsy]

With the ResMed S9 machine ResMed says that leaks up to 24 L/min the machine can handle.
Above 24 L/min is starts getting iffy the farther above 24 L/mine that you go

% of time above Leak Rate threshold 3.33%

This number just means for about 3 % of say your 5.5 hours you were above 24 L/min...that's not horrible at all.
That's roughly 10 minutes...Part of that could very well be while awake if you feel air while fitting the nasal pillows in the nostril.

90% Leak Rate 19.20

This number just means for 90/95% of the night you were at OR BELOW this leak number...people assume it means you were there all night long but that's not true...they forget the"or below" part of the definition.
Besides...even if you were at this leak level all night it's still below 24 L/min.

Avg Leak rate 4.16

This is the average leak...now I don't know if you have it selected to be a median average or a weighted average but it doesn't really matter. It's still very low and this along with the 19.20 L/min 90/95% number tell us that there's some leaking but it is for the most part well within the machine's ability to compensate.

3 % of the night above 24 L/min...not the end of the world at all and is far from "significant" despite what SleepyHead says.
Resmed doesn't even give you Mr Frowny face for leaks until leaks exceeding 24 L/min number 30 % or greater.
You are a long way from it.

The vented air you are feeling...that's normal. All masks vent so that we don't keep rebreathing our own exhale air in the mask.

I wouldn't worry about 3 to 4 % large leak time at all. Some of it is going to related to mask refitting while you are awake and some will be mask movement or even maybe a little mouth opening...but it isn't nearly bad enough to get all worried about.

[palerider]

[I can hear the leaks and it is really high pitched. Sometimes I can touch my nostril and change the pitch, lol. Anything to worry about? I do not go any longer on the machine than maybe 5-5.5 hrs.

you don't have the mask fitted right, try a different size pillow.

why aren't you using the machine more?

[palerider]

The vented air you are feeling...that's normal. All masks vent so that we don't keep rebreathing our own exhale air in the mask.

I can hear the leaks and it is really high pitched.

he shouldn't be able to hear anything from the p10.

[js12278]

Thank you very much, Pugsy. You've explained it clearly for me. I was worried someone might say it was an issue. Thanks again.

[Pugsy]

PR...I was referring to original statement about the air coming from under the pillow...which I am pretty sure is the vent holes.

I can feel a very small amount of air coming from underneath the pillows.

I was going to mention the noise from the pillows at the nostrils but I saw you had already suggested to try a different size nasal pillow while I was composing the leak number explanation so I decided not to include that comment since you said what I would have said but maybe I should have for clarification.

[js12278]

[I can hear the leaks and it is really high pitched. Sometimes I can touch my nostril and change the pitch, lol. Anything to worry about? I do not go any longer on the machine than maybe 5-5.5 hrs.

you don't have the mask fitted right, try a different size pillow.

why aren't you using the machine more?

I am using a medium pillow, it usually fits fine. I only mentioned the high pitch because Sleepyhead says it's significant. I do think it is from the setting on and off of the mask.

Personally, palerider, I don't think I need cpap therapy. I am doing what I have to do to keep my job. That's it. I have always monitored my blood ox and it is never below 92, usually about 97-98. Being told one night at 86 is an issue, I don't buy it. I won't say anymore about why I don't do it more because I fear some people take offense to my opinion. I mean no disrespect to anyone.

[Pugsy]

Gottcha...you are the truck driver aren't you?
5 hours is better than no hours and better than 4 hours and 10 minutes (which I think is what is needed to get the ResMed machine to kick into the "over 4 hours" thing that is the requirement.
Knowing what I know about truck drivers (hubby is one) sleep schedules...you are probably lucky to get 5 to 5.5 hours anyway.

I won't give you the sermon. You are a big boy...at least you were concerned enough to worry about the leaks which fortunately are unlikely to be a big negative impact on the therapy when you do use the machine.
That's better the blowing off the entire night.

I heard that after the first of the year that not only will hours of use need to be proven but that it's working or effective will also need to be proven when the health card gets renewed.

[js12278]

I hadn't heard about the first of the year news. Yes I am the driver. How does someone prove therapy is working if there was nothing to start off with? Anyone can say that the data collected by the machine is what it is because it's working. And because it's working these are the results which the data shows. So if I get smiley faces, 0.0 nights. AHI avg of 1 or lower, events of less than 4 a night and those events totaling less than a minute of the 4-5 hrs of use....can I really say the therapy is working or can I say the therapy isn't actually needed. I think insurance companies should mandate compliance at 100% . how do they come up with 4 hrs at 70%? It makes no sense. The ONLY reason I am doing this therapy is because it is required by employer because THEIR doctor, not mine, said so. Once a year, for as long as I work for them I get a physical now. No more 2 yrs medical cards. It's not about denial, it's a bout a person's right to their own medical care and treatment, that doesn't include the federal government.

[Pugsy]

How does someone prove therapy is working if there was nothing to start off with?

Now please understand that this is what I heard from a doc who does the CDL medical cards and something I read (which I can't find it again but I did read it once and it took miles of digging through the CDL/DOT rules) was that after the first of the year hours of use alone wouldn't be enough and proof that it was effective (like low AHI and leaks within acceptable range) would be needed.
A couple of options for "proof"....a repeat sleep study using the machine...you are going to love that one I am sure.
or a copy of a letter from a sleep doctor who says therapy is effective and that sleep doc would likely want proof from a data capable machine such as yours.
Or the doc doing the medical card renewal could also obtain the data from the machine and be happy with that as proof.

That's what I have heard and read....like I say...I can't provide the documentation but unless they change the rules (and we both know that they could very well do that) I expect that is what we will see unless some one comes up with some block to the implementation.

I am not going to get into the debate with you about how your employer handled things...remember...my husband is a truck driver and I do get an earful from the driver's point of view. I actually do understand your frustrations...not saying you are totally 100% right...but I do understand the frustrations. I also know that truck drivers are a hard headed lot and trying to explain some stuff to you about where you are in denial....I might as well go thump my head on the wall..so I won't go there.
I will tell you what I tell him when he starts ranting about anything....it is what it is and if you don't like it...find another job....but he can't find another job now at his age. We both know that. We all know it isn't that easy.
He has to play by whatever rules his employer mandates (and yes, some of them are just plain stupid) and the DOT or whomever....it's their sandbox and we have to abide by their rules or go play/work somewhere else.

[palerider]

PR...I was referring to original statement about the air coming from under the pillow...which I am pretty sure is the vent holes.

could be... but that shouldn't make noise... but air between pillows and nose sure will, maybe even high pitched sounds... and if he's not leaking around there, then the leak line on SH should be very low. not up to 19 or so as he said.

just my thoughts.