Help With Understanding Leak Rate

[PastSnorer]

I was diagnosed with a pretty severe case of OSA after telling my MD that "I just did not feel like myself" and thought that something was wrong as I was up and down all night long and not getting enough good sleep. My sleep study results came back with an AHI of 33 and a RDI of 41 and prescribed 13 cm H2O pressure. I have been on CPAP treatment for about 8 week now and am starting to not only feel like a human being again, but actually feel better than I can remember, in part because now that I am actually geting some good sleep I now have the energy to exerise intensely on regualr basis instead of putting it off, and I am getting fitter and feeling better every day.

I am generally getting very low AHI scores of under .5 or less using my S9 Elite Autoset with Swift nasal pilows, but my leak rate is all over the place. Some nights, like last night, my median leak rate was 4.8 L/Min, 95th percentile was 12 and max 19.2. Average over the last 30 days is an AHI of .7, and leak rate of 10.8 L/Min, 95th percentile of 26.4 and Max of 37.2. My pressure is set to 4 min/20 max and past 30 day average is 7.4 with 95th percentile of 11.3 and max of 12.8.

I sleep with a mouth guard and do not think I am mouth breathing (much). Tried taping my mouth a few nights but really bothered me. Is this 30 day average leak rate excessive and likely caused by mouth breathing? When my leak rates spike to 30+ and as high as 60 for Max. is this likely because of mouth breathing?

By the way, I am somewhat amazed that given the life-threatening consequences of OSA, the standard approach of more or less prescibing a CPAP and sending one home with such little in the way of directions and follow up is surprising and disappointing. I got better directions and follow up buying a refrigerator.

Trying to take responsibility for the effectiveness of my treatment and many thanks to the members here for filling in so many of the gaps in knowledge.

[PastSnorer]

Bump...any input? Thanks in advance for your time.

[bdp522]

The machine can compensate for some leaks bu not for large leaks. I feel that most leaks can be just as disruptive to sleep as an apnea can be(at least for me). You really want your leak to be as close to 0 as you can get it. Leaks that are too high (over 20l/m) can also make the data unreliable. Events my not get counted when the leak is too high.
Could the leaks be from mouth breathing? Yep. Could also be from knocking the nasal pillows out of place when turning over or laying on your side. BUT it most likely is mouth breathing. Were your leak numbers lower when you taped?
Your machine is set for 4-20...was your mask adjusted at a pressure of 4? Your 30 day average is 7.4, I would move the pressure to 7-20. A pressure of 4 is waaay too low for most of us, I know I would feel as if I were suffocating. It also takes time to get to 7.4 where you spend most of your time, allowing events. Be sure to readjust the mask at the new pressure.
If you really don't want to tape(I tape every night for over 4 years now) try a chin strap with your mouth guard, it might help.

Brenda

[Ms Piggy]

Hi, you also might like to try a piece of nylon - stretchy material, across the down tube, if you have that type of mask, as it
acts as a stabilizer.

[PastSnorer]

The machine can compensate for some leaks bu not for large leaks. I feel that most leaks can be just as disruptive to sleep as an apnea can be(at least for me). You really want your leak to be as close to 0 as you can get it. Leaks that are too high (over 20l/m) can also make the data unreliable. Events my not get counted when the leak is too high.
Could the leaks be from mouth breathing? Yep. Could also be from knocking the nasal pillows out of place when turning over or laying on your side. BUT it most likely is mouth breathing. Were your leak numbers lower when you taped?
Your machine is set for 4-20...was your mask adjusted at a pressure of 4? Your 30 day average is 7.4, I would move the pressure to 7-20. A pressure of 4 is waaay too low for most of us, I know I would feel as if I were suffocating. It also takes time to get to 7.4 where you spend most of your time, allowing events. Be sure to readjust the mask at the new pressure.
If you really don't want to tape(I tape every night for over 4 years now) try a chin strap with your mouth guard, it might help.

Brenda

I'd hate to have my apparantly great results be compromised by high leak rates. I will probably try tape again to see what results are as far as leaks or go for a chin strap, although the FX nasal mask is so comfortable I really would like to see if I can make it work without chin straps or tape. I'll refit at higher pressure and see if that helps too. Good advice, thanks much for the response.