leaks

I had a visit with my doctor recently and discussed leaks.
My doctor looks at the medium value as opposed to 95%.
I haven't read about the medium value on the forum.
Does this make a difference and if using the medium value, what range is within normal limits?
I use the Airfit P10 and the airsense 10 autoset.
Thank you

Which software?
For leaks ResScan shows
Median
95%
Maximum

No "medium average" that I have ever seen.

Median average is not an overall average...it's in the middle..half above and half below.

Sonnyboy wrote:I had a visit with my doctor recently and discussed leaks.
My doctor looks at the medium value as opposed to 95%.
I haven't read about the medium value on the forum.
Does this make a difference and if using the medium value, what range is within normal limits?
I use the Airfit P10 and the airsense 10 autoset.
Thank you

The "medium" (probably "average" in Philips/Respironics Encore reports) would be lower than the 95% (90% in PR machines). Remember, the 95/90% numbers are typically higher than the "medium" or "average" numbers. The 95/90% is the number you're AT or BELOW for that percentage of the night.
The "normal limits" (or range) would be approximately what your stated mask leakage for the stated pressure from the "Vent Flow Rate" chart that comes with each mask. For example, for my UMFF mask at a pressure of 12 cm., the typical vent flow rate is about 38 - 40. But, as long as it doesn't get too severe or into the Large Leak territory, it's usually OK.

I just pulled some accumulated data from my Encore Pro reports. The first is from the period of 01/01/15 - 06/30/15 and the second is from 07/01/15 - 10/30/15 (last night). The reason it's split at the middle of they year is because my old smart cards won't hold a complete year of data........so, I erase the card before I start the second half of the year. But, this is for informational purposes for your questions.



Average Max Leak
101.6
Average 90% Leak
50.5
Average Leak
43.5
Sleep Therapy Long Term Trend
01/01/2015 - 06/30/2015
CPAP
13.0
Average Large Leak
1 mins.


Average Max Leak
106.8
Average 90% Leak
51.3
Average Leak
45.6
Sleep Therapy Long Term Trend
07/01/2015 - 10/30/2015
CPAP
13.0
Average Large Leak
34.4 secs.


As you can see, it's not too different, even though I have been using some different UMFF masks in different months of this year.

For your situation, if you're using a range of pressures, you'd need to figure out what the approximate pressure being delivered compared to the stated vent leak rate for that pressure.

http://www.resmed.com/us/dam/documents/ ... er_eng.pdf

I think ResMed has changed their website, but there should be a place to download the mask user guides......which have that information (if you didn't get a printed copy with your mask). It's show as a graph/curve for the leak vs pressure data.


Den

.

Pugsy wrote:Which software?
For leaks ResScan shows
Median
95%
Maximum

No "medium average" that I have ever seen.

Median average is not an overall average...it's in the middle..half above and half below.

She uses Rescan.
The doctor may well have said "median".
My guess is she was referring to the value in the middle..half above and half below.
Using the "median", what is the normal range or am I missing something?
Does the 24L still apply.

Since ResMed subtracts the expected vent rate prior to reporting excess leak only having the intentional leak/vent rate doesn't really help a ResMed user in evaluating leak numbers.
We don't know the exact way they come up with the number that gets subtracted but it is likely a generic number based on mask type selection and the pressure.
My "median" leak number is almost always very close to 0.0 or 1.0 even if my 95% leak number is in the upper teens or lower 20s.
It takes some pretty bad excess leaks to get the median number elevated and I don't feel it is something I want to put much faith in.

SleepyHead can be set so it shows an overall average instead of a median average and I think an overall average is more worthwhile.
Doctors and DMEs are probably using ResScan though and there isn't any way to get an overall average that I can find...only median and 95 % and maximum.

Thank you Wulfman and Pugsy,

My pressures are a straight 10 and my AHI great, often less than .5.
I have a problem with fragmented sleep and fatigue.

I have a mental block when it comes to evaluating leaks. I try to use what I have learned from Pugsy and I look at the 95% of the time less than figure hoping not to exceed 24L up to 30L and I look at the time spent in large leaks.
Many nights everything looks great. Other nights my 95% figure can be in the 40's, 50's, even 60's and the median 7-8.

I wonder if movement from PLMD is causing the leaks and fatigue?

I told the doctor I was having a problem with leaks and considering changing my mask. She disagreed and said I did not. I asked what she was looking at to make her determination and she said "medium or median" values.

The doctor ordered Provigil for the fatigue.

Would you agree I am having a problem with leaks?

Sonnyboy wrote:Thank you Wulfman and Pugsy,

My pressures are a straight 10 and my AHI great, often less than .5.
I have a problem with fragmented sleep and fatigue.

I have a mental block when it comes to evaluating leaks. I try to use what I have learned from Pugsy and I look at the 95% of the time less than figure hoping not to exceed 24L up to 30L and I look at the time spent in large leaks.
Many nights everything looks great. Other nights my 95% figure can be in the 40's, 50's, even 60's and the median 7-8.

I wonder if movement from PLMD is causing the leaks and fatigue?

I told the doctor I was having a problem with leaks and considering changing my mask. She disagreed and said I did not. I asked what she was looking at to make her determination and she said "medium or median" values.

The doctor ordered Provigil for the fatigue.

Would you agree I am having a problem with leaks?

Without seeing some "typical" reports, it's hard to say (about the leaks being a problem).

Have you started on the Provigil yet? You may want to do a forum search on it. I remember lots of discussions about it and I was thinking there was some discussion about WHEN to take it as it is for staying awake and it may bleed over into "sleep time".


Den

.

2 kinds of potential problems with leaks.

1...Any leak that wakes us up no matter how big or small is unwanted because it is disturbing our sleep.
2...Big leaks that are prolonged can affect the machine's ability to sense, report and respond resulting in sub optimal therapy despite a nice low AHI.
ResMed gives us the 24 L/min red line in the sand as the boundary for large leaks but things don't go totally into the toilet at 26 L/min or even 30 L/min but the farther we go the iffier things get and above 35 L/min the machine can't sense, record or respond well at all. You may or may not have apnea events and it may or may not flag them but we don't know if there are no flags because there wasn't anything to flag or the machine just didn't record them

Are you having a problem with leaks? I don't know. It all depends on how deep into large leak territory you go and how long you stay there and how often it happens.
95% numbers over 35 L/min means we have to look more closely at the leak graph and figure out just how much time was spent in large leak.

In general though...if you regularly see 95% numbers over 40 L/min...then yeah, you've got a problem but how big or serious of a problem I don't know. Was it 1 hour in big leak or 4 hours in big leak? That's why the leak graph itself needs to be evaluated.

Thank you Pugsy and Wulfman,

I started the Provigil today. I did a lot of reading and I know to start with a small dose and take early in the morning. No side effects so far.

I have an appointment with a different sleep specialist but I have a long wait.

While waiting I want to make sure I have done all I can to optimize Cpap treatments. I like the P10 so it was hard for me to tell the doctor I was planning to try a new mask because of the leaks and then I was really surprised when she said I did not have a problem with leaks.
I need to work the rest of this weekend so I will post some charts showing my leaks early next week. Thank you for your help.

Hi

Here are some examples of leaks I am concerned about.
I ended with a good night so you can see that not all my nights have a lot of leaks.
Please let me know what you think.

I could not locate the thumbnail function on imgur so I improvised, the shots look funny, but readable I hope.

I have the Airsense 10 for her and the Airfit P10

Pressure: Straight 10

Thank you

http://i.imgur.com/6LLXOfU
http://i.imgur.com/fiMl9Hi
http://i.imgur.com/hfToIKr
http://i.imgur.com/PS2WlEb
http://i.imgur.com/KQvtA2o
http://i.imgur.com/PGPHTso
http://i.imgur.com/Pxrz7vE

I am sorry but I am having internet difficulties so I can't access webwites with images at this time.
I have been banished to dial up speed and it is hit or miss with images at imgur and totally useless for images at photobucket.
So at this time I cannot see your images as they won't load for me.

In general...my personal line in the sand is I don't worry about 10 % or less time in large leak and even then I wouldn't worry with a little more if it was rare.
ResMed says 30% of the time before Mr Frowny shows up.

From my past experience with my S9 and big leaks...the machine would be fairly accurate up to around 30 L/min leak (still flagging events)...between 30 and 35 L/min I still got some flags but they were unknown apneas so the machine was having difficulty figuring out what it was sensing.
Over 35 L/min and there was big blank areas where just before at 30 L/min there were events so I don't think they went away...I think the machine missed them and didn't know they were happening.

So the AHI becomes suspect when much time is spent over 35 L/min...or is at least suspect during that time frame only.

Sonnyboy wrote:Hi

Here are some examples of leaks I am concerned about.
I ended with a good night so you can see that not all my nights have a lot of leaks.
Please let me know what you think.

I could not locate the thumbnail function on imgur so I improvised, the shots look funny, but readable I hope.

I have the Airsense 10 for her and the Airfit P10

Pressure: Straight 10

Thank you

(I also have dial-up but I was able to see the reports)

Mouth leaking? Those are rather abrupt spikes in the leak line, so that's one of the things that comes to mind, along with the fact that you have a nasal mask in your profile.

Are you taping?
Dry mouth?


Den

.

I'm taping and I am not aware of mouth breathing.
My mouth is not dry.

I'm wondering if I am shifting the nasal pillow out of place at night?

I am thinking of trying the new dreamware mask???

I'm concerned because my sleep doctor says I do not have a problem with leaks.

I got 2 images to load...I am not on dial up...I am on satellite and have used up all my download allowance and that means my internet speeds are drastically cut to probably slower than dial up.
They don't charge me more but they sure make life miserable with the speed. I have 6 more days of hell before it resets.

Your doctor is likely going by the ResMed 30% thing and from what I could see...your leaks are a bit ugly but actual time in large leak doesn't go above 30% of the time very much and some nights not at all.

If you are taping your mouth and the tape is still secure in the AM then those leaks must be mask movement.
If they aren't disturbing your sleep and the nights with more than 20 to 30 % of the night are relatively rare...I don't know that I would worry about it.
From the 2 images I saw the time spent above 35 L/min was minimal and while not the prettiest of leak graphs...for the most part the leaks aren't horribly excessive.
Time between 24 and 35 L/min was probably the majority of the large leak flagged time and the AHI you see is probably fairly accurate.

Might be time for a new mask though...that's a lot of movement and it's worse in the second part of the night...makes me wonder why it gets worse for only half the night though.

How long with this current P10 headgear?
In got similar reports and leaks after about 10 months of use..first replaced the nasal pillows and that didn't fix things so I then got new headgear and that did fix things.
I had been washing the headgear in hot water to shrink things but it finally got to the point it wouldn't shrink enough to stay put.