My leak percentage is too high

[JaceS]

Firstly I am grateful that so many of you here armed me with the information I needed to convince my DME to upgrade my "Escape" to an "Elite". Although there was a little push-back from the DME, I was ready for it, thanks to your help, and went after them like a hunter who goes after a mosquito with an elephant gun. After the first shot was fired (proverbial, not literal) they retreated and were only too happy to swap out my brick for an Elite. My error, I should have pushed for the model 1 step higher, the Escalade!

Todays issue du jour - I saw the CPAP tech at my MD's office today and she said my "leak percentage" using nasal pillows is at 50%. The issue is I am breathing through my mouth (too often) apparently. She suggested a chin strap, or changing to a full face (mouth and nose) mask. I have a chin strap that I purchased years ago pre-CPAP thinking just a chin strap might "cure" my apnea.

Question: chin strap? Face mask? Other suggestions/recommendations? BTW I love the nasal pillows and am very comfortable with them, I would hate to go to a full mask unless absolutely necessary. My AHI is 0.01 Cant get any better than that

[Pugsy]

The Elite doesn't report leak in %...so I don't know where the DME got that number. If it was the max leak number and you were only there briefly...may not even matter.
Get the software and see for yourself just how bad the leaks are. Read my tutorial on understanding what you see in SleepyHead. I talked about acceptable leaks in that thread.
SleepyHead will work just fine with your machine...links in my signature line.
Your machine reports excess leaks only..so any leak is excess but ResMed says it can handle leaks up to 24 L/min. Above 24 L/min it starts getting iffy as to how well it can deliver therapy and record events..the higher you go with the leaks... the iffier it gets.

A little mouth breathing may not be the end of the world requiring semi drastic measures as a nasal pillow user myself who would not want to use a full face mask either...I totally understand and for me would be a drastic measure.
And yes, I probably do a little mouth breathing at times but I watch the software reports and it doesn't often go beyond what the machine can handle and when it does go there it doesn't stay there for very long. So I don't worry about 20 minutes in big leak if it goes there.

So let's figure out just how bad the mouth breathing actually is before you start worrying about fixing it.
The chin strap sometimes is enough reminder to keep the mouth closed for some people...but let's figure out if leaks are really bad before we worry about fixing them with whatever.

[JaceS]

The tech pulled the SD card from the back of my CPAP and examined the data of 14 days. It was there she determined the number was "50" not from my 20 min office visit. I don't know if "50" was percentage, or raw-score, or what... I'm not versed *(that is why I'm asking here). I saw the report that she downloaded and saw the dark green bar-graph that appeared on the ResMed on-screen report.

Whatever units of measurement the "50" is, she said it was too high.
Now with this corrected information, does that shed any light?

Jace

[Pugsy]

Whatever units of measurement the "50" is, she said it was too high.
Now with this corrected information, does that shed any light?

Not really...it could have been the max leak number..it could have been the 95% number...it could have been the average leak number.
What it referred to is real important.
If it was the max leak number...not a big deal if short and sporadic and likely related to just reseating the mask.
if it was the 95 % leak number (definition is where the leak was at OR BELOW for 95% of the night) it might be a problem.
If it was the average leak number....most definitely a big problem.

Yes...50 is too high but without knowing what reference number she is talking about...we don't know how bad.
The software she used reports all of those numbers I mentioned..max..95% and median average...really need to know which one she was referring to before letting worry set in.
And was she looking at overall average of each of the above choices???? A really bad night in terms of leak could potentially skew the overall average and make things look worse than they were overall.

You need to learn how to evaluate your own leak data so that you can tell if leaks are really an issue.
Even high 95% numbers don't always mean the whole night was totally trashed in terms of leaks being so bad that therapy was totally wasted.
See my post here..top of this page
viewtopic.php?f=1&t=86705&st=0&sk=t&sd=a&start=45

[bavinck]

Whatever units of measurement the "50" is, she said it was too high.
Now with this corrected information, does that shed any light?

Not really...it could have been the max leak number..it could have been the 95% number...it could have been the average leak number.
What it referred to is real important.
If it was the max leak number...not a big deal if short and sporadic and likely related to just reseating the mask.
if it was the 95 % leak number (definition is where the leak was at OR BELOW for 95% of the night) it might be a problem.
If it was the average leak number....most definitely a big problem.

Yes...50 is too high but without knowing what reference number she is talking about...we don't know how bad.
The software she used reports all of those numbers I mentioned..max..95% and median average...really need to know which one she was referring to before letting worry set in.
And was she looking at overall average of each of the above choices???? A really bad night in terms of leak could potentially skew the overall average and make things look worse than they were overall.

You need to learn how to evaluate your own leak data so that you can tell if leaks are really an issue.
Even high 95% numbers don't always mean the whole night was totally trashed in terms of leaks being so bad that therapy was totally wasted.
See my post here..top of this page
viewtopic.php?f=1&t=86705&st=0&sk=t&sd=a&start=45

Could have also been % of time in large leak territory, no?

[Pugsy]

Could have also been % of time in large leak territory, no?

No, not with the S9 Elite.
ResMed doesn't report that number as it is only a data point offered by the Respironics System One machines.
So percent of time in large leak is only seen on the Respironics reports.
Different brands report different things and sometimes it is a bit confusing trying to keep which one does what separate.
Resmed reports only excess leak..Respironics reports total leak which is mask vent rate plus excess leak. So a leak rate that is acceptable on a Respironics report would likely be an unacceptable leak rate number on a ResMed report.

ResMed does offer the Smiley feature...Mr Smiley as long as 70% of the time the leaks aren't excessive. This is something that is seen on the machine's LCD screen though..not in the software reports.
Mr Frowny shows up if more than 30% of the night was spent above 24 L/min...and it takes a lot of big leaks to get Mr Frowny to show up.
When I was using the S9 machine...I had one night where I had some really big and prolonged leaks but still didn't trigger Mr Frowny (new mask wasn't tight enough).
When people tell me they see Mr Frowny on their machine...I don't have to ask to see the leak reports..I already know they wouldn't be pretty.

So Respironics is the only one that does the % of time in large leak.
ResMed does the Mr Smiley/Frowny thing on the machine.
I always prefer to see the actual report though...that way we know for sure exactly what we are dealing with.

[JaceS]

I'm trying to imbed the image of the report-chart that shows the Leak but can't seem to figure that out either.
It appears the following:

Median is 10 L/min
95th Percentile is 50 L/min
Maximum shows nothing

But once I figure out how to imbed the image, perhaps that will shed more light.

Thanks for your help.
Jace

[Pugsy]

How to post images of reports discussed in this thread.
viewtopic.php?f=1&t=81072&p=737779#p737779
also some examples of reports so you can see what we like to see.

In SleepyHead..turn off the AHI and mask pressure graph so the leak graph will come into view. That's done in Preferences..graphs tab..remove check mark. Those graphs are not needed anyway.
You can also resize the graphs a little. Hover mouse on the bottom like of the graph till you see a little short double line...then click and drag.
SleepyHead will remember the resizing so you only have to do it once.