With a low AHI do leaks matter?

[Chairman Meow]

I had what felt like a good night last night - but this morning I see that I spent quite a bit of the night with my mask leaking. My AHI was under 1 and I feel good, if a little tired, but I chalk that up to going to bed later than I should have. I've been having brief periods of major leaks every night, but last night was by far the most. I'm having a problem with trying to sleep comfortably on my side without pressing my face into my pillow and dislodging my mask. I fee like my choice is to sleep comfortably and have the leaks (but a low AHI) or wake up with my neck and back hurting from trying to sleep in a position that keeps my mask from leaking.

I'm sure there are other options, and I've actually ordered a nasal pillow mask to try that - but I'm on the Wisp for at least another couple of nights before my A10 arrives... so for the time being should I be worried, or just focus on how I feel and the AHI?

Last nights graph is below.

[Pugsy]

Yes, with leaks that big and that prolonged it matters.
With leaks that big and that prolonged we don't know if the AHI is low because no events happened or they happened but the machine couldn't sense anything because the leak was so bad it's sensors were useless.
With the ResMed machines leaks over 30 L/min start to really compromise those sensors and above 35 L/min pretty much makes the sensors totally useless.

So...we don't know if your AHI was low because nothing much happened or stuff happened and the machine was clueless during those times with massive leak going on.

[Chairman Meow]

UGH!!! Thanks for the info, I guess I'm back to trying to keep my face out of my pillow for a few more nights!

[Pugsy]

So sorry...I know that wasn't what you wanted to hear at all.
If it was just a 15 to 30 minute time in big leak then I don't think that would be nearly as big of a deal but it looks like almost 50% of the night was spent over 24 L/min and a lot of that time was waaaaay over 24 L/min.
Like if the worst it got to was 26 L/min then that wouldn't be quite so horrible because the machine can still sense and record events up to around 30 L/min...over 30 and it starts getting iffy and over 35 L/min the machine is pretty much clueless.

Also that amount of leak is very likely to impact sleep quality in general at some level.

I don't expect perfection when it comes to leaks if I sleep well and feel decent so I will pooh pooh off some short lived excursions into large leak territory but yours shown here....I wouldn't/couldn't pooh pooh those away. Just too big and too prolonged
Do what you can to limit the leaking until you can get the new mask. Even in big leak it's better than no therapy at all.

[palerider]

I had what felt like a good night last night - but this morning I see that I spent quite a bit of the night with my mask leaking.

jebuz j gosh! yes, those leaks matter so much you don't know what the ahi is.

[Chairman Meow]

Thanks so much for the information - I'd be flying blind if not for this forum! I had read that the machine didn't work properly (measuring events) with a leak, but it just hadn't stuck with me.

Last night was more leaking - I'm not at home so I can't post the graph - but I was good from 11pm - 3:30 am and then it was basically one large leak until around 6am.

My RT is strongly encoraging me to come in and try another mask - but their selection is lacking , and I'm not sure what to change to. Can I return JUST the mask to them and go to a different DME for that, or would I have to return everything and start over with a new DME?

[Jay Aitchsee]

My RT is strongly encoraging me to come in and try another mask - but their selection is lacking , and I'm not sure what to change to. Can I return JUST the mask to them and go to a different DME for that, or would I have to return everything and start over with a new DME?

If you mean, would you have to return your machine as well, no, you wouldn't have to do that, but why not try what your DME is recommending? The only way ever to see if a mask will work for you is to try it. If your DME is offering to swap out a mask without charge, I'd do that first. If you have to buy out of pocket, then you could consider other DME's including those online. Our host (CPAP.com) offers the purchase of return insurance for some masks.

[Julie]

I would try a soft cervical collar - it keeps your head up, and therefore your airway open more, plus your mouth can't open as it would otherwise, even if lips can, and if anything it should help your neck and back.

[Chairman Meow]

The RT at my DME isn't making a recommendation... just encouraging me to try something else. So after reading recommendations here and reviews at CPAP.Com - I called to ask about trying the N10 or the FX Nano. My DME doesn't carry either of them... and my RT is VERY discouraging of nasal pillows for pressures over 9 or 10 (I'm at 12). So I was just wondering if I could take my Wisp back to the DME and try another local DME that offers the masks I'd like to try.

Thank you for the suggestion, Julie. I'll give it some thought, but I already have to wear an eye mask for floppy eyelid syndrome, a wrist brace for carpal tunnel syndrome, the cpap mask for OSA... as it is, I feel like I'm suiting up for battle when I go to bed at night (I guess I sort of am) and I'm not sure I can handle the idea of wearing another device to sleep in.

[palerider]

Thanks so much for the information - I'd be flying blind if not for this forum! I had read that the machine didn't work properly (measuring events) with a leak, but it just hadn't stuck with me.

remember that the machine does all it's observing of you based on the changes in airflow as you breath in and out, and the pressure that it measures.... then it does a lot of math and comes up with all that data you see on the charts. when you stop breathing (apnea) then it wobbles the pressure up and down by 1 cm 4 times a second, and sees what happens, if it doesn't get much pressure change, but sees more flow, it figures your throat is open, if it sees spikes in the pressure and very little flow changes, it figures your throat is closed... that's how it picks between obstructive and central apneas...

when you have a lot of leak, it can't tell the difference, and when you have even more, like you have, the whole picture becomes very muddled... zoom in on the flow chart during those big apneas, and you'll probably see it doesn't look nearly as good as when the leak is lower.

[robysue]

Chairman Meow,

Given the size, length, and shape of those official large leaks, they look like they're being caused by mouth breathing. And in that case, switching to another nasal mask might not do diddly-squat in regards to getting the leaks under control. You may need to consider a full face mask. Or you may first want to try a chinstrap of some sort with the nasal mask you are using. Or you may want to try training your mouth to stay shut, but that may involve taping. Personally, I'm not sure I could handle taping, but a lot of folks here do it or have used it in the past in order to help train their mouths to stay shut when they're asleep.

[Chairman Meow]

Robysue - Thank you for the suggestion. The tech at my sleep study said that there were no indications of mouth breathing, and I'm a notorious teeth grinder (and it's hard to grind your teeth with your mouth open) but I wouldn't discount anything. I did have a lot of belching this morning - which was new... is aerophagia a side effect of mouth breathing? Can you give me some pointers on what to look at in the graph to recognize the difference between mouth breathing and just a displaced mask?

I ask because both yesterday and today I woke up to air gushing from the side of my mask due to the way my face was pushed into my pillow, so I'm positive that the leaks at 'wake up' time were acual mask leaks and I'd like to compare those to the ones that look like mouth breathing to learn the difference.

[Pugsy]

my RT is VERY discouraging of nasal pillows for pressures over 9 or 10 (I'm at 12).

You know that's an old wives tale about nasal pillows and higher pressures. If you haven't even tried them you don't know if you will like them or not or if they will work or not for you. I see pressures over 20 cm every night and I sleep quite well right through those pressures and never know they happen until I see the reports.
There are people using pressures over 20 cm all night long who use nasal pillows with great success.
I don't know who came up with this "don't use nasal pillows with pressures over 10" thing but it sure wasn't someone who actually was a cpap user.

[teambalch]

My pressure is set at 13 and I use pillows with no difficulty at all.

[Chairman Meow]

And my RT is not a CPAP user, as she was very quick to tell me. I've already purchased a P10 For Her from CPAP.Com (since my current DME doesn't carry that) - so as soon as that arrives I'm going to give it a try. When I asked about nasal pillows at my initial fitting, the RT gave me a Swift FX to try... and I didn't like it for a variety of reasons... but now I think that all of those reason may have been combated by me bringing it home and actually trying it while lying down and starting with a ramp (which I have to use even for my wisp.) Also they didn't have the 'for her' version and I have a very small nose and tiny nostrils - so even the 'small' pillows may have been too large.