Week 2, high leaks but low AHI

[KatieW]

I am puzzled by this. Leaks all over the place, usually after an hour of sleep, and worse with the simple cushion, than pillows of the Comfortlite 2. LED says leaks are .2, but graphs show they are much higher. I'm ordering the Direct Seal, to see if that works better for me.

Added challenge is that we are on the road to AZ, so a different hotel every night. And I don't have a hack saw with me to modify my mask per Rested Gal. viewtopic.php?t=8493

But the good news is: I feel well rested, in spite of getting up every 2 hours to make mask adjustments. And only *one* apnea all night.

[DreamOn]

I am puzzled by this. Leaks all over the place, usually after an hour of sleep, and worse with the simple cushion, than pillows of the Comfortlite 2. LED says leaks are .2, but graphs show they are much higher. I'm ordering the Direct Seal, to see if that works better for me.

Hi, Katie! As a fellow newbie, I don't feel qualified to offer much advice, but here are a few thoughts.... Are you still taping your mouth? If so, I assume the leaks aren't coming from there. Have you tried your machine's "mask fit" feature to test the seal? (Get into sleep position, then hold down Start/Stop button for at least 3 seconds. It'll show your mask seal with stars, with 5 being an excellent fit. Once you have the readout, hold down Start/Stop for 3 seconds to begin treatment, or hold down briefly if you want to return to standby mode.) You may want to try this in various positions. Perhaps you're moving into a different position after an hour (smooshing the mask against the pillow maybe)?

I'm not having a problem with leaks using the Mirage Activa LT mask. In the 11 days I've used CPAP, so far my leak rate (on the LCD) has ranged from .02 to .16, which I understand is really good.

I look forward to seeing the responses from the experienced xPAPers! I know that you'll get it worked out.

But the good news is: I feel well rested, in spite of getting up every 2 hours to make mask adjustments. And only *one* apnea all night.

Great that you're feeling so good! It looks like treatment's working very well for you. Enjoy your stay in Arizona!

~ DreamOn

[Pugsy]

Added challenge is that we are on the road to AZ, so a different hotel every night.

But the good news is: I feel well rested, in spite of getting up every 2 hours to make mask adjustments. And only *one* apnea all night.

Your leak isn't that bad. You are in a different hotel bed every night. Your numbers are certainly acceptable and more importantly you report that you are feeling well rested. Given all that, I think you are doing very well and should be proud. When you get the mask adjusted more to your suiting and are home in your own bed so the tossing and turning is more minimal, then you might give a closer look to the leaks.

At week 2, I was no where near your numbers and I still can't report feeling well rested (except for a handful of nights) so I am rather envious.

[Colombia]

Pugsy says: Your leak isn't that bad. You are in a different hotel bed every night. Your numbers are certainly acceptable and more importantly you report that you are feeling well rested.

Pugsy: I'm also using the S8 Auto and my leaks are running between .24 and .30 at present.
You state .40 L/sec isn't bad. (24/Min )

What leakage numbers would be acceptable when using the S8 Auto?

[ozij]

Pugsy's right, because Katie's 95% leak is 12 Litres pre Minute. That's fine considering the circumstances. Look at where and when the leaks occur: Those that are really high are happening when she takes her mask off, or adjusts it after a break. Otherwise (95 percent of the time), the leaks are well within the machines ability to give therapy.


O.

[Pugsy]

Pugsy: I'm also using the S8 Auto and my leaks are running between .24 and .30 at present.
You state .40 L/sec isn't bad. (24/Min )

What leakage numbers would be acceptable when using the S8 Auto?

Actually I think Katie reported leak .20 L/sec on the machine not .40 unless I misread things. I was really looking at her graph for the leak when I was thinking not so bad. I still don't think it is all that bad. For a good part of the night it was pretty much at zero. Yeah, there was some times when the leak spiked a bit but those times were relatively short lived. Probably happened when she adjusted the mask which she reported doing several times. She is not at home in her own bed. Lots of things affect our sleeping patterns on the road. She reports feeling well rested. Given all this, I wouldn't do anything if it were me except maybe say "oh, look at that".

While having a "zero" leak showing on ResMed machines is all wonderful, I think it is a goal that can cause undue stress if not attained. These machines can compensate for a good bit of leak.
I think ResMed says over .40 L/sec and it can impact therapy and over .20 L/sec the machine can compensate for the most part but that it might affect quality of sleep and maybe therapy. Obviously we would like to see less but just looking at the number on the machine doesn't really tell us what happened through the night.

I had a night showing a leak of 44 L/min (respironics) which gives me a 12 L/min (.20 on ResMed) excess. Might think "oh, that isn't so great" but when I looked at the report graph I saw 2 times where I had a large leak for a few minutes. Rest of the time essentially no excess leak BUT the overall average gives the appearance that I had a moderate leak all night when I didn't. So the numbers don't always tell the whole story.

You mention your leak but no mention of AHI, software graphs or most importantly, how do you feel?

Edit: I searched your posts and I see you are new and that while your initial leak rates posted in another thread was over .60 L/sec I see that you seem to be bringing it down. To be honest if it were me and I didn't have the software to show me when or where the leaks were occurring to give me the average you see, I wouldn't worry so much about the leak unless it went over the .20 L/sec mark and I had more events than I was comfortable with and IF I wasn't feeling so hot. Would I still try to improve it? Sure I would but I wouldn't think that a .22 L/sec rate was horrible or anything like that. Your .34 L/sec rate is getting up close to where ResMed says it doesn't think its machine can compensate well but again it is better than when you started. The best thing is to be able to look at the software reports so you know exactly what is going on. The machine average is easily falsely elevated by maybe just a handful of sporadic larger leaks.

[GaryG]

Katie, I agree with Pugsy. A 95 percentile leakage of 12 L/min with is not bad at all. And a median of 1.2 L/min is great. Typically the "cut off" if there is one is at 24 L/Min (or 0.4 L/sec). But like anything else, its all personal. And how you feel is more important. But your leakage seems fine to me. Of course we all want 0.00.

Also, the AI of 0.1 is excellent. Yeah, we all strive to get the leakage down to 0.00, but numbers wise I think you're doing not just ok, but great. And with the extra burden of travelling... Hang in there. You'll find it interesting to look at 1 week, 2 week, 3 week, and monthly numbers. Over a longer period, these numbers will start to stabilize.

[DreamOn]

Hi again, all. Perhaps some of you experienced ResMed S8 machine users can explain something that may be relevant to this discussion....

It is my understanding that the S8 Elite II, S8 AutoSet II, etc., leak rate is calculated based on the expected mask vent flow rate. Since these machines have an option to select the type of mask that is being used (and only ResMed masks are listed!), is the leak rate shown with another manufacturer's mask, such as Katie's Respironics ComfortLite 2, even accurate/relevant?

I am happy with my ResMed mask right now, but in the future I would like to try other manufacturer's masks as well. If we have a ResMed machine and another manufacturer's mask, how should we set the "mask type" on the machine, since it won't be listed?

Thanks.

~ DreamOn

[Colombia]

Pugsy:

Thanks for the comments.
I have the same question as "DreamOn" relating to the mask settings on my S8 Auto.
It was purchased from Cpap along with my mask and I assume they set the machine to use the "Ultra" mask since the Headrest Nasal is not listed as an option.

My mask is the "Headrest Nasal Pillow CPAP Mask with Headgear"
My S8 Auto is set to use the "Ultra"

Question: Do you see any problems?

Thanks,

[Pugsy]

It was purchased from Cpap along with my mask and I assume they set the machine to use the "Ultra" mask since the Headrest Nasal is not listed as an option.

My mask is the "Headrest Nasal Pillow CPAP Mask with Headgear"
My S8 Auto is set to use the "Ultra"

Question: Do you see any problems?

My understanding is that ResMed only offers mask selection for ResMed branded products. This is to be expected. Respironics brand new PR System one machines offer a similar feature but only for their machines.
Seems like I read where ResMed states to choose "standard" when using anything other than a ResMed mask and that a "standard" setting then sort of allows for a 24 L/sec factoring when reporting the leak rate to the LCD screen. Some people will search the ResMed mask's vent rates for a mask that has similar rates to what is showing in their NonResMed literature and use that selection. In theory this standard choice leaves a one rate deduction to cover lots of different types of masks that probably are going to have different flow rates.

I don't see that either is a huge problem. It is what it is and a person just has to deal with it. I often thought it would be better just to show the whole flow like my machine does and let us do the math. BUT they didn't want my input. Nasal pillow masks have a typically lower flow rate than a full face mask would at the same pressure. So how can a setting of standard include all those other brands flow rates? Not ideal but it will get you in the ballpark.

People tend to look at these machine's numbers as the gospel according to the cpap God but again these numbers are averages only. They get us close. The software reports are needed to really for sure see exactly what is going on as near as possible. Then a person could really truly see if the leak is of a magnitude or timing to really impact data.

Isn't the "Ultra" in the ResMed line a nasal mask? Your Headrest a nasal pillow mask? A person would need to compare the pressure flow rate of each but I would think that either the standard choice or even the Swift choice might be better. In other words, look at the flow rate for your mask at your pressure and see if the flow rate for the Ultra is similar??? I will have to defer to the ResMed experts as to what might be a better choice in the mask menu but I am thinking standard.

[KatieW]

Added challenge is that we are on the road to AZ, so a different hotel every night.

But the good news is: I feel well rested, in spite of getting up every 2 hours to make mask adjustments. And only *one* apnea all night.

Your leak isn't that bad. You are in a different hotel bed every night. Your numbers are certainly acceptable and more importantly you report that you are feeling well rested. Given all that, I think you are doing very well and should be proud. When you get the mask adjusted more to your suiting and are home in your own bed so the tossing and turning is more minimal, then you might give a closer look to the leaks.

At week 2, I was no where near your numbers and I still can't report feeling well rested (except for a handful of nights) so I am rather envious.

Pugsy, thank you so much for your reassuring and informative post. I see what you (and Gary) are saying, and will stop being so obsessive.

[DoriC]

Also wondering if you brought along your own bed pillow or using the hotel's?

[KatieW]

Also wondering if you brought along your own bed pillow or using the hotel's?

I had purchased the little PAPillow, and brought that along. Some nights I use it, other nights, I don't. I like it for side sleeping the most. Haven't found my "best pillow combination" yet.