Lips and Cheeks & Full Face Mask question

Luthie2006 wrote:is a leak of 26-28 bad?

It depends on what number it is...is it the max? The 95% number? The median number?
If it's the max number..no not bad.
If it's the median number...it's horrible.
If it's the 95% number it isn't necessarily all that bad but one would have to take a good look at the leak graphs to know for sure if it was just a little bad or a whole lot bad. Remember what a 95% number is...it's at OR BELOW that number for 95% of the night. We tend to forget the "or below" part.

ResMed machines can pretty much deal with leaks up to around 30 L/min. Over 30 L/min and the machines start having trouble identifying events and responding to them. Over 35 L/min and things are really bad and the machine will likely miss scoring events and not respond at all.
It's not like things immediately go into the toilet when we go just barely over the 24 L/min line...it starts degrading but doesn't get really bad until around 35 L/min and above.

Here below is why I tell people to look at the graphs and not the numbers because the numbers don't always give us a good picture. Here below is why I don't immediately jump on the "you need a full face mask" band wagon without having proof that things are in the toilet first. An hour with leaks between 24 and 30 L/min is not the end of the world and for sure it doesn't mean that the entire night's therapy is totally wasted and in the toilet.

Here's an example I had a while back. 95% number was 27.6 L/min and one might think the whole night was trash due to leak if looking at that number and forgetting the OR BELOW part of things.



But when I go look at the actual leak graph it isn't nearly as horrible looking. I barely went above 24 L/min for maybe an hour or so and had a short time with some leak spikes and the max was 30.0. I suspect my mouth was open part of the time but it also could have simply been that I turned over in bed and dislodged the nasal pillows a little. I don't know for sure what happened because I normally sleep through stuff like this. This report is a prime example of how the 95% number could possible cause alarm because on the surface it might point to a horrible leak night when in reality the bulk of the night was really quite acceptable and often zero. If I was mouth breathing....it wasn't enough to cause the entire night to go to hell. It's not the prettiest of leak graphs but I slept well and this isn't going to make me go to extraordinary measures to fix it.



and here below is an example where I know for sure I was mouth breathing because I was totally awake. I woke up mouth breathing just a little and decided to continue it so that I would/could see it on the graph since I was wide awake and it was time to get up.
Look at the very end of the night where I have the leak line circled...not all mouth breathing puts a person deep into large leak territory. In this case...you can barely even spot the leak and if I didn't know for sure I was awake and mouth breathing I wouldn't have though anything amiss.

Thank you Pugsy for the graph. You are extremely informative and helpful and a wonderful asset to our team. However, what my sleep apnea dentist told me, too, is that so much is, subjective, how do we physically feel? He said, "Do I feel refreshed in the morning?" (No, I don't) "Do I have fatigue most of the day?" (Yes, I do, all day long) "Do I have constant cotton mouth?" (Yes I do). "Have I cut back on the bathroom trips?" (No, I have not) "Do I still wake up several times a night?" (Yes, I do) Obviously, this investigates further evaluation of my sleep disturbances, of which I am going to my sleep doc at the end of next week. I am going to try a full-face mask too. So maybe the leaks are too big. Even if they are not, I think it is time for me to try a FFM because of the dry mouth alone and puffs of air coming out of my lips.

Please note I never said that you shouldn't try a FFM. I was just explaining that the numbers don't always tell the whole story and that's why I don't rely on numbers alone. You wanted to know if those leak numbers were bad...well, they might be and they might not be "bad"...or they might just point to a "bad" time briefly...and to have a better idea how "bad" things are one must look at the bigger picture.

Given what you say...I think a FFM is something that you should at least try.

Even if your leak numbers were really, really good....your sleep quality isn't so that's when I say that even tiny leaks must be fixed if they are messing with sleep quality (waking you up a lot). So big or little...if they wake you up...they need fixing.
How someone chooses to try to "fix things" is up to them and everything is fair game in my book.

Thanks Pugsy!! And everyone else!