Leak rates

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cancun
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Leak rates

Post by cancun » Sat May 23, 2015 8:06 am

Obviously zero is the best leak rate but what is the largest acceptable leak rate?
I did register for MyAir with my ResMed machine which is pretty useless and doesn't tell you what the leak rate was.
I also downloaded sleepyhead and it does show me the leak rate but I am not sure what is considered acceptable.

Thanks

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avi123
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Re: Leak rates

Post by avi123 » Sat May 23, 2015 8:25 am

you get your leak rate from the machine screen:



The AirSense™ 10 AutoSet will display the following advanced therapy data on the machine display through the "More Info" option in the "Sleep Report" menu:


•Usage Data
•Events Per Hour
•Average Usage
•Leak Rate {this}
•AHI

if you entered your mask type into the machine then this leak rate should be below 24 {liter/Min}

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robysue
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Re: Leak rates

Post by robysue » Sat May 23, 2015 8:30 am

cancun wrote:Obviously zero is the best leak rate but what is the largest acceptable leak rate?
I did register for MyAir with my ResMed machine which is pretty useless and doesn't tell you what the leak rate was.
I also downloaded sleepyhead and it does show me the leak rate but I am not sure what is considered acceptable.
Your signature shows that you are using a Resmed Airsense 10 (A10) AutoSet. Resmed machines only report excess leak rates and Remed defines an official Large Leak as 24 L/min. If the leak rate is AT or ABOVE 24 L/min for 30% or more of the night, then Mr. Frowny Face shows up in the Sleep Report on the LCD.

So Resmed defines the line of where Large Leaks are an official problem when you are in Large Leak territory for at least 30% of the night. Whether that's acceptable to you really depends on how much the leaks are bothering you and how much above the 24L/min threshold the worst of the leaks are.

In general:
  • If the amount of time that you are in Large Leak territory is just a few minutes here and there AND the leaks are not bothering you (in the sense of waking you up or disrupting your sleep), then it's ok to not worry about them.
  • If the amount of time that you are in Large Leak territory is extensive, you need to worry about fixing the leaks regardless of whether they're bothering you or not. Once the leak rate is around 30 L/min, the Resmed xPAP machines have a tough time accurately detecting the breathing pattern, and that means the data they are recording is usually not very accurate: There may be events that happen that are not detected. While Resmed says that spending up to 30% of the night in large leak territory is acceptable, I personally think that's more Large Leaks than I'd want to see. If I was consistently seeing more than about 10-15% of the night in Large Leak territory, I'd be working on fixing the leaks.
  • If leaks are bothering you and disrupting your sleep, they need to be fixed regardless of whether the leaks are large enough to be flagged as official Large Leaks. Small leaks can be particularly bothersome if they're hitting your eyes or drying out your lips. And when this happens, the small leaks can be quite disruptive of your sleep. If leaks are bothersome enough to wake you up multiple times each night, then you've got to deal with them, regardless of size.
  • Small leaks that don't wake you up should be ignored. There's no point in chasing a 0 L/min leak rate if the measures you have to take to get one cause significant disruption to your sleep.

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Pugsy
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Re: Leak rates

Post by Pugsy » Sat May 23, 2015 8:36 am

Do you want what I think is acceptable or what ResMed says?

Remember how ResMed reports leak numbers...it's all excess leak (other brands report it differently) and the vent rate has been removed prior to reporting.
ResMed won't give you Mr Frowny face on the machine for leak control until you spend 30% or more of the night above 24 L/mine. That's a lot of big leak time to get Mr Frowny to show up.

ResMed says large leak territory begins at above 24 L/min. ResMed says that they can handle leaks up to that point.
Above 24 L/min and they say that the machine starts possibly having problems with reporting and sensing and responding.

Now common sense will tell us that at 26 L/min things aren't totally in the toilet so I have seen in my own reports where the farther I went beyond 24 L/min the worse it got.
So from what I have seen...the machine does a decent job up to around 30 L/min and between 30 to 35 L/min leaking it starts getting iffy and I saw a lot of unknown apneas which meant that the machine knew something was happening but didn't know what and above 35 L/min I saw big blank spots where previously I saw green unknown apneas....the machine was clueless as to what was going on above 35 L/min.

So when I evaluate leaks....I don't just look at the 95% leak number....I look at how far I went above large leak territory line and I look at how long I stayed there.

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cancun
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Re: Leak rates

Post by cancun » Sat May 23, 2015 9:06 am

avi123 wrote:you get your leak rate from the machine screen:



The AirSense™ 10 AutoSet will display the following advanced therapy data on the machine display through the "More Info" option in the "Sleep Report" menu:


•Usage Data
•Events Per Hour
•Average Usage
•Leak Rate {this}
•AHI

if you entered your mask type into the machine then this leak rate should be below 24 {liter/Min}
My DME entered everything on my machine and manual I was given doesn't give me directions as to how to change anything. On my options all I can change are the ramp time and the humidity levels. The sleep report on my machine shows nothing other than the usage hours and a smiley face for mask and humidifier. If I go to MyAir you get a overall number based on hours used, mask seal, times you take the mask off, events (but no explanation as to what they are).

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cancun
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Re: Leak rates

Post by cancun » Sat May 23, 2015 9:10 am

robysue wrote:
cancun wrote:Obviously zero is the best leak rate but what is the largest acceptable leak rate?
I did register for MyAir with my ResMed machine which is pretty useless and doesn't tell you what the leak rate was.
I also downloaded sleepyhead and it does show me the leak rate but I am not sure what is considered acceptable.
Your signature shows that you are using a Resmed Airsense 10 (A10) AutoSet. Resmed machines only report excess leak rates and Remed defines an official Large Leak as 24 L/min. If the leak rate is AT or ABOVE 24 L/min for 30% or more of the night, then Mr. Frowny Face shows up in the Sleep Report on the LCD.

So Resmed defines the line of where Large Leaks are an official problem when you are in Large Leak territory for at least 30% of the night. Whether that's acceptable to you really depends on how much the leaks are bothering you and how much above the 24L/min threshold the worst of the leaks are.

In general:
  • If the amount of time that you are in Large Leak territory is just a few minutes here and there AND the leaks are not bothering you (in the sense of waking you up or disrupting your sleep), then it's ok to not worry about them.
  • If the amount of time that you are in Large Leak territory is extensive, you need to worry about fixing the leaks regardless of whether they're bothering you or not. Once the leak rate is around 30 L/min, the Resmed xPAP machines have a tough time accurately detecting the breathing pattern, and that means the data they are recording is usually not very accurate: There may be events that happen that are not detected. While Resmed says that spending up to 30% of the night in large leak territory is acceptable, I personally think that's more Large Leaks than I'd want to see. If I was consistently seeing more than about 10-15% of the night in Large Leak territory, I'd be working on fixing the leaks.
  • If leaks are bothering you and disrupting your sleep, they need to be fixed regardless of whether the leaks are large enough to be flagged as official Large Leaks. Small leaks can be particularly bothersome if they're hitting your eyes or drying out your lips. And when this happens, the small leaks can be quite disruptive of your sleep. If leaks are bothersome enough to wake you up multiple times each night, then you've got to deal with them, regardless of size.
  • Small leaks that don't wake you up should be ignored. There's no point in chasing a 0 L/min leak rate if the measures you have to take to get one cause significant disruption to your sleep.
Thanks, I think the largest leak was over 17 minutes but it didn't wake me and I had undone one of the straps in my sleep but the mask was still in place. The only way to know how long any of the leaks are is with Sleepy Head, my machines sleep report doesn't provide me with that info. I think for me the most important thing is that my AHI numbers are way down. It has only been five nights and one night was 1.1 and the others all under 1. I am still getting up several times a night but I think the sleep I am getting is probably a more restful sleep or at least that is what I am telling myself to force myself to keep putting the mask back on!

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Re: Leak rates

Post by cancun » Sat May 23, 2015 9:12 am

[quote="Pugsy"]Do you want what I think is acceptable or what ResMed says?

What you think is acceptable!

I trust most of you "old timers" here than I do my doctors or the people selling me their products!

Thanks for all of your posts and input! Especially all the help with Sleepyhead and the glossary which really helped me when I was looking at the sleepyhead reports this morning!

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Re: Leak rates

Post by Pugsy » Sat May 23, 2015 9:14 am

cancun wrote:The sleep report on my machine shows nothing other than the usage hours and a smiley face for mask and humidifier.
You have to make a little change in the clinical menu setup area so that more details are shown on the machine's LCD screen if you want to see what is available.
You have to change to "Essentials Plus" I think it is.
Explained in the manual here.
https://sleep.tnet.com/home/files/resme ... -guide.pdf

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Re: Leak rates

Post by Pugsy » Sat May 23, 2015 9:29 am

My personal ResMed leak guidelines....
First...any leak that wakes me is unacceptable but I sleep through 99.9% of all my leaks.

Then I look at how far I went above 30 L/min and how long did I stay there.
As long as I don't spend more than 10% of the night up there...I shrug my shoulders and move on.

If I should happen to have a really bad leaky night I don't panic because we all have bad nights but I don't/won't change my routine until I see bad nights happening consistently.
That mindset goes along with all my therapy stuff...I never get in a panic when an ugly night happens.
Can't do a thing about what happened last night anyway and I don't know for sure that tonight is going to be more of the same or not.

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Re: Leak rates

Post by cancun » Sat May 23, 2015 9:34 am

Pugsy wrote:
cancun wrote:The sleep report on my machine shows nothing other than the usage hours and a smiley face for mask and humidifier.
You have to make a little change in the clinical menu setup area so that more details are shown on the machine's LCD screen if you want to see what is available.
You have to change to "Essentials Plus" I think it is.
Explained in the manual here.
https://sleep.tnet.com/home/files/resme ... -guide.pdf
Thanks, you would think they would give you that manual with the machine! I will play with that later!

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Re: Leak rates

Post by palerider » Sat May 23, 2015 11:19 am

cancun wrote:Thanks, you would think they would give you that manual with the machine! I will play with that later!
in their eyes, we're too stupid. that's why there's that "essentials" setting, to even further dumb down the information.

and, I suppose, in all fairness, there are people out there who it's best to just say "push this button" "huh? this knob?" "NO, THIS BUTTON" and anything more will confuse them... or they'll get into the hidden setup screens and start changing settings without any understanding of what they do... and thus make their treatment ineffective.

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Re: Leak rates

Post by bwexler » Sat May 23, 2015 12:16 pm

Well I just looked at my Sleepyhead for the last week. My AHI varied from 0.6 to 7. And surprisingly the leak rate seemed to follow the AHI. I still seem to be a bit ignorant on the leak rates on my PR 960. Sleepyhead shows me two lines, one that seldom gets above 10 and the other can bounce from 55 to over 90. I don't believe either Sleepyhead or PR know anything about my Sleepweaver Élan masks leak rate and neither do I. My pressures vary from 6.5 to 18.6 where I have them capped.
Insights from Pugsy would be appreciated.

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Re: Leak rates

Post by Pugsy » Sat May 23, 2015 12:43 pm

bwexler wrote:Well I just looked at my Sleepyhead for the last week. My AHI varied from 0.6 to 7. And surprisingly the leak rate seemed to follow the AHI. I still seem to be a bit ignorant on the leak rates on my PR 960. Sleepyhead shows me two lines, one that seldom gets above 10 and the other can bounce from 55 to over 90. I don't believe either Sleepyhead or PR know anything about my Sleepweaver Élan masks leak rate and neither do I. My pressures vary from 6.5 to 18.6 where I have them capped.
Insights from Pugsy would be appreciated.
First of all you can believe SleepyHead as I have compared its results with Encore and it is pretty much spot on.
The top line in the SleepyHead graphs will pretty much match the intentional leak line in the Encore reports.
The bottom line in the SH leak graph will pretty much match the unintentional leak line if a person changed Encore to show only unintentional leaks (yes, there is that option in Encore).

The top line in the leak graph in SH is going to vary widely when someone is using a machine like your ASV machine because remember....that top leak line includes the vent rate and the vent rate at your higher pressure needs is going to be way up there anyway. So it is very possible that the large leak area line in the sand for your machine at your higher pressures is going to be above 90 L/min.

SleepyHead and Encore both just report what the machine reports. Is it a little confused by your Elan? Maybe...maybe not.
But I know that the top leak line is going to show wild fluctuations just from the wild pressure changes you are using with your machine. It changes a lot and very quickly and it would show that no matter what mask you used.

We are never given a number where the line in the sand is for unintentional leak are considered "large leak territory" so we can't really give a set number like ResMed has come up with (and I personally think there is still some wiggle room in that ResMed number).
But the machine will tell us if it thinks that a large leak territory crossing has been made and gives us a Large Leak flag and I just have to trust the machine. SleepyHead and Encore will just report what the machine reports.

I personally don't dwell much on the actual leak numbers themselves. I look at the large leak (if flagged) and evaluate how far it went and how long was I there.

Here's an example (ResMed machine) of a really, really bad leak night. It was one of 4 consecutive nights that trended like this. I picked the worst to use as an example. In this case my P10 headgear had finally given up the ghost and I couldn't get it to shrink back to give me enough tension to keep things from sliding all over the place.
These leaks weren't mouth leaks....these leaks were mask movement leaks because I woke up multiple times with the mask sliding all over the place. 10 months of continuous use of one P10 headgear...fixed the leaks with new headgear. That first little large leak flag with the small circle around it....if that is all it was then I wouldn't worry but the rest of the night was ugly and too ugly to ignore.

I would give you a Respironics large leak example if I had one but I rarely ever get a Large leak flag with Respironics machine and if I do it's maybe 2 or 3 minutes. If anyone wants to compare leak reports on a Respironics machine (Encore vs SleepHead) let me know and I will see if I can find a good report so people can see what SH says and the same report in Encore and I will do both intentional and unintentional leak graphs in Encore if you want them. Just let me know.

Image

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Re: Leak rates

Post by bwexler » Sat May 23, 2015 3:02 pm

I was never questioning the veracity of SH. I also have Encore but I only use it to present reports to sleep doctors who don't want to learn SH.
I do know that the nights with high AHI also had unintentional leaks based on obvious mask farts, even though the Élan often silences them politely.
Your explanation was very helpful as usual. Tuesday morning it's time for a call to Crcadience to see about a leak rate chart.
I also need to figure out what I am doing differently on my bad nights. With the night of AHI equal 7 and leaks and mask farts all night, I must have done something different than the night of 0.6.

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Re: Leak rates

Post by VolDog » Sun Jun 05, 2016 6:34 am

Can someone please tell me if the following leak rate is acceptable:

AHIApnea Hypopnea Index 0.48
ResMed AirCurve 10
ASVModel 37043 - 22151825854
PAP Mode: ASVAuto
Min EPAP 6.0 Max IPAP 17.0 PS 0.0-5.0 (cmH2O)
Date Sleep Wake Hours
6/4/16 22:01:02 06:20:03 08:19:01
Large Leak 3.59%
Clear Airway 0.00
Unclassified Apnea 0.00
Obstructive 0.00
Hypopnea 0.48

Event Breakdown

Statistics
Channel Min Med 95% Max
EPAPExpiratory Pressure (cmH2O)
W-Avg: 6.27 4.08 6.22 6.84 7.66
IPAPInspiratory Pressure (cmH2O)
W-Avg: 8.04 4.08 7.66 11.28 12.62
Minute Vent.Amount of air displaced per minute (L/min)
W-Avg: 9.05 0.00 8.62 13.38 29.75
Resp. RateRate of breaths per minute (Breaths/min)
W-Avg: 16.08 0.00 15.80 20.00 29.80
Flow Limit.Graph showing severity of flow limitations (Severity (0-1))
W-Avg: 0.00 0.00 0.00 0.00 1.00
Leak RateRate of detected mask leakage (L/min)
W-Avg: 5.94 0.00 3.60 21.60 43.20
SnoreGraph displaying snore volume (?)
W-Avg: 0.00 0.00 0.00 0.00 0.14
Insp. TimeTime taken to breathe in (Seconds)
W-Avg: 1.68 0.22 1.56 2.46 5.06
Exp. TimeTime taken to breathe out (Seconds)
W-Avg: 2.09 0.32 2.08 2.68 5.92
Target Vent.Target Minute Ventilation? (L/min)
W-Avg: 8.16 4.25 8.25 10.12 11.88
Tidal VolumeAmount of air displaced per breath (ml)
W-Avg: 563.39 0.00 540.00 800.00 1840.00

Total time in apnea 00:00:40
Time over leak redline 3.594%
Machine Settings

ModeCPAP Mode ASVAuto
Min EPAPLower Expiratory Pressure 6.00 cmH2O
Max EPAPHigher Expiratory Pressure 12.00 cmH2O
Min IPAPLower Inspiratory Pressure 6.00 cmH2O
Max IPAPHigher Inspiratory Pressure 17.00 cmH2O
PS MinPressure Support Minimum 0.00 cmH2O
PS MaxPressure Support Maximum 5.00 cmH2O
Antibacterial FilterAntibacterial Filter No
Climate ControlClimate Control Manual
Humidifier StatusHumidifier Enabled Status On
Humidity LevelHumidity Level 3
MaskResMed Mask Setting Nasal
Patient AccessPatient Access Yes
RampRamp Enable Off
Smart StartMachine auto starts by breathing Off
TemperatureClimateLine Temperature 27 ºC
Temperature EnableClimateLine Temperature Enable 2
Session Information


CPAP Sessions
On Date Start End Duration
ResMed Session #1465092062
Click to disable this session. 6/4/16 22:01:02 06:20:03 08h 19m 01s
20160604_220102_PLD.edf
20160604_220102_BRP.edf
20160604_220102_SAD.edf
20160604_220056_EVE.edf
STR.edf