Respiratory therapist says leak amount OK

[RRL]

The respiratory therapist at my DME supplier called back today. I told him that air has been leaking out through my lips despite using the chin strap. He said the data indicates the leaks are "very light" and don't last long which he said is OK because my numbers are good. I asked whether it would make sense to try a mask that covers the mouth. He said not at this time because of the aforementioned reasons and that minor adjustments to the chin strap would help minimize the leaking.

The past two nights I taped my mouth shut with 3M Transpore tape. It was uncomfortable and somewhat difficult to get a proper seal since I have a beard. I trimmed it shorter all around my mouth and shaved close with the mini foil shaver. The tape sealed well last night and I didn't wake up with air leaking. The tape is breathable and hypoallergenic, etc. which helps, but it still irritates my sensitive skin. As a result, I would prefer to not tape my mouth shut every night if it's not necessary. I'd really rather not use the chin strap either! I could order and try the InnoMed/RespCare hybrid mask with the chin flap thing, but I don't think insurance would cover it and the replacement supplies and I'm not in a position to be able to afford 100% out of pocket. So anyway, I'm going to use only the chin strap this week and try to get it positioned again so that my lips stay closed as much as possible. I know there will still be some leaks, but apparently it's not negatively impacting my therapy. This is frustrating I'll post a few data screenshots for comparison if anyone has any interpretations or observations. It looks like there was more leakage with the tape? Thanks for reading/listening!

A night with AHI under 1.0 with chin strap only:



and last night (1.0<) with chin strap and tape:

[palerider]

I would prefer to not tape my mouth shut every night if it's not necessary. I'd really rather not use the chin strap either!

a couple ideas I've heard here from people working on mouth leaks.

use a sweatband over your mouth, it gently helps keep your lips together and thus cuts down on leakage... works for some.
an athletic type mouthgard, but not the type with the hole in the middle.

[RRL]

Thanks for the suggestions!

[Sleeprider]

From the posted graphs, your leak rate is not a problem, and doesn't get close to "large leak" criteria. That doesn't mean it's not disruptive. You should continue to optimize your comfort, but I wouldn't throw in the towel on nasal therapy yet. It's much harder to use a FFM leak-free.

FWIW, good work on using the therapy, being relatively leak-free and getting great results. Keep going, and comfort should soon follow.

[RRL]

Thank you, Sleeprider, for your interpretation, advice and encouragement. I'll continue with the nasal mask and chin strap for a while and see how it goes - it's only been a week anyway. I imagine it would be harder to use a FFM leak-free, as you mentioned. At my sleep study they had me try one on and I felt air leaking out from several places. I've read on the forums too about people having trouble with FFM seal, leaks and some beard issues. The Wisp is actually fairly comfortable overall and feels much less intrusive and constricting than others with their head supports and large, clunky frames. It rests lightly over the nose and keeps a good seal, although it did take a lot of strap adjustment to allow this.

The chin strap is reasonably comfortable and with the right positioning it keeps the lips pushed together enough to prevent most fluttering or leakage, but some does occur. Since the taping is so unpleasant, I'd rather accept the chin strap leaks and move forward since my numbers don't seem to be affected. I do practice keeping my tongue on the roof of my mouth, so I think with time that will become more natural and lead to less tendency to mouth-breathe and help maintain a 'mouth-vacuum' so the PAP can go where it belongs. Thanks again!

[OkyDoky]

Those leak rates look great. The Respironics machines report leaks with 2 lines on the graph. The top line is the total leak which includes the mask venting rate. Each mask has a rate that increases with pressure and is shown in the mask manual. The bottom line is what is called excess leak and that is what you want to try to prevent. Yours look well controlled and not effecting your therapy.
You may hear us talk about the Red Line being at 24L/min but that is on ResMed machines because they only report excess leak.

[RRL]

Thanks for the helpful info yet again, OkyDoky!

[OkyDoky]

The top line is the total leak so if you look at your mask vent rate and subtract that the rest is leak. The top line is reported by the machine. The bottom line is a close approximation of what the leak line would be if only excess leak was reported...it is very close..probably not exact due to it being a Sleepyhead calculation.