Plz interpret this LEAK graph from SleepyHead

[VikingGnome]

This is from last night. I woke up with a mouth so dry my tongue was stuck to palate. Checked the humidifier. It wasn't empty but was a bit low. I just now down load my data and saw this. This this look like mouth breathing to you? I guess I need to go buy painter's tape. I hate the chin strap I got. Just too much on my head including the headgear from mask.

[Pugsy]

There really isn't any way to know for sure if a large leak is mouth breathing but with the history of the dry mouth along with the 30 minutes of large leaks....mouth breathing would be my first suspect here.

If you want to experiment...Wear the mask while awake for 30 minutes or so with machine on and go ahead and breathe through your mouth for that time frame then compare what the leak line looks line.

Though 30 minutes out of 8 hours or so...unless you have several of those each night it may not be as earth shattering as it first looks like and if a random rare thing it is up to you how you want to try to deal with it. It could also have been the nasal mask getting sideways for the 30 minutes. You had a perfect line until the leak started.

[NateS]

I don't know whether it makes any difference, but it might, so please note that that Leak graph you posted is NOT from SleepyHead.

It's from ResScan.

The way the leak graphs are drawn in SleepyHead always alarm me more than the same day's graph in ResScan.

Also, it is only showing the leak for a one hour period - not the whole night. What was the rest of the night's leak like?

Nate

[Pugsy]

Even being a ResScan leak it looks worse than it is if you compare to the overall night in normal viewing.

Major leak above 24 L/min begin at about 7:20 and lasts til about 7:35, goes down to acceptable level till about 7:45 and for the next 10 minutes goes up and down in and out of large leak territory.
So really only about 25 minutes of large leak time.

I can show lots of similar reports if I zoom in that close on a few of my reports.. Especially with the new Bella loops on a bad adjustment night. I am going to be honest... I don't sweat short periods of time in large leak territory like this unless the whole night looks like this. My Nasal pillows will move around and fall part way of of my nostril and I will semi awake straighten it back up.

I would only do more that shrug my shoulders if I saw this sort of 30 minute leak for the bulk of each hour. Not for a random leak like this. Part of it is near 24 L/min magic red line and some is just above. I don't think this leak here....if it is a random occurrence is a disaster.. If it disturbed sleep now....and caused frequent awakenings...I would work harder to limit it but I don't know if it warrants a chin strap based only on this one showing. I don't expect perfection each and every hour.
And I wouldn't be putting on a chin strap or taping for this leak unless I saw an awful lot of the throughout the night.

[VikingGnome]

You are so correct, NateS. I use both SleepyHead and ResScan. It did come from ResScan here's my entire sleep period from both programs.

Here's SleepyHead


Here's ResScan

[Pugsy]

Other than the 30 minutes between 7:30 and 8:00...your leak line is well within acceptable limits.
If it were my report...I wouldn't be going down the chin strap or taping the mouth road based on this one report.

[avi123]

The upper graph looks to me like a ResScan. Have you tried a chin strap to reduce the mouth leak?


The problem with this kind of nasal mask and a chinstrap is how to place them. Chin strap over the mask's straps or below.

I put the chinstrap over the mask but not tie it tightly. If I tie the chinstrap hard then it is transferred to the mask's cushion.

Lately, I started to use Resmed Mirage Softgel as nasal mask and a chin strap. This kind:

http://www.directhomemedical.com/101291 ... 7AodpRQ72A

I can't believe at the better results that I get with this combination and setting my APAP on 14 cm max, 9 cm min, EPR = 3, full time, no ramp. All the leaks, obstructives, flow limitations are gone for the night. Only about 5 Centrals are left and below 20 sec each.

See here that the APAP after getting rid of all obstructives stayed at the lowest pressure for the rest of the night (though some FL were left):



And the leaks were below the red line:





In my opinion, the improvement in treatment has to do with the vent holes in this kind of mask. The limited flow thru these few vent holes (app 25 L/min) provides a PEEP pressure effect at the end of my exhalation and thus improves the treatment. If you'r new to PEEP check this:

PEEP = Positive end-expiratory pressure.

http://www.ccmtutorials.com/rs/mv/page14.htm

[NateS]

You are so correct, NateS. I use both SleepyHead and ResScan. It did come from ResScan here's my entire sleep period from both programs.

Here's SleepyHead


Here's ResScan

I would be happy to have a Leak chart like that, but I could never get by on only 5 hours sleep! Does that happen to you every night?

Also you stated you

woke up with a mouth so dry my tongue was stuck to palate.

Does that happen every night or was it just an isolated occurrence?

Nate

[Pugsy]

Dry mouth....indicates open mouth and some mouth breathing but it doesn't always mean open mouth to the extent that all therapy is lost and a chin strap, tape or full face mask is critically needed.

I have woke up in the middle of the night with mouth open..for sure because I remember it along with the dry mouth but when I go and look at the leak reports themselves...no big leaks at all. So I must assume that the time with mouth open wasn't very long because it sure doesn't show on the leak lines.

[avi123]

[quote="NateS]
Also you stated you

woke up with a mouth so dry my tongue was stuck to palate.

Does that happen every night or was it just an isolated occurrence?

Nate[/quote]

I also get dry mouth in the morning. It comes from Rx and also from the mouth leaks that you see on the graphs.