How Important is Leakage

[zinnia]

I've had problems with leakage with all the masks I've tried. Sometimes I don't feel them but they register on myair.com. With the newest mask, an Amara View, I definitely feel the leaks. I'm only into this C-Pap experience for 2 months. If my AHI is low, does it really matter if the leakage is between 40 and 60L with all masks I've tried? Am I still getting the benefits?
Thank You.

[LSAT]

I've had problems with leakage with all the masks I've tried. Sometimes I don't feel them but they register on myair.com. With the newest mask, an Amara View, I definitely feel the leaks. I'm only into this C-Pap experience for 2 months. If my AHI is low, does it really matter if the leakage is between 40 and 60L with all masks I've tried? Am I still getting the benefits?
Thank You.

If your AHI is low and the leaks don't bother your sleep, it's not a problem.

[Pugsy]

does it really matter if the leakage is between 40 and 60L with all masks I've tried?

Where are you getting the 40 to 60 L/min number?
Off the machine or off the software somewhere?
Have you got SleepyHead up and running yet?

You are still getting some benefit (for sure during the times of no big leak flags) and maybe most of the benefit and maybe all the benefit.
The problem is that during periods of really big leak when no apnea events get flagged....is it because nothing happened or the machine missed sensing them because the leak was so big it was clueless?
So how important can depend on how deep into large leak territory and for how long and is that nice low AHI accurate or not.
It's very possible that the nice low AHI is accurate even in the face of the times in big leak but we can't prove it.

If those numbers are off the machine or the MyAir website they are what we call 95% numbers and the definition is AT OR BELOW that number.
It's not where the leak was at all night or an overall average. It's not an average of anything. The "or below" part of the definition is pretty important.
If we were to look at the actual leak graph your leak line probably spent some time below 24 L/min where the ResMed defines large leak territory but you spent some time above it. 95% numbers are easily skewed to the high side and don't always give us a good picture of how the leak really went during the night. I once had a report with a 95% number of 37 L/min. On the face of it that sounds pretty ugly but when I looked at the leak graph itself I actually only had about 30 minutes out of about 8 hours where leaks were up around 40 L/min. I slept right through it though.
Did the mask move or did I mouth breathe? Dunno...and to be honest for 30 minutes out of 8 hours that I slept right through it...I don't really care.

The 95% number made it sound like I was really leaking badly and I was but only for 30 minutes.

ResMed had to have some line in the sand and they came up with 24 L/min. It's an ultra conservative line in the sand.
If you spent the entire night at 25 L/min....it's going to show bad leak report for sure but in actuality in terms of therapy effectiveness there's not that big of a difference between 23 L/min and 25 L/min. It's not like the machine loses all effectiveness once it crosses into large leak territory.
It's a potential maybe loss that gets worse the deeper you go into large leak territory.
Now does it always mean that in large leak territory apnea events are happening and the machine is missing them....no.
But the problem is we don't know for sure if nothing happened and that AHI is real or not because it might be missing the apnea events.

Usually in the face of really big leaks ...like 35 L/min or more we would expect to see some unknown apnea flags on the regular cpap/apap reports if the events were happening during big leak time. So it doesn't necessarily lose all the sensing abilities but does lose a bit because it can't tell what kind of apnea is happening and thus the unknown flag.

So you really need to be evaluating the leak using available software to know exactly what is going on and how bad it might be or might not be and then decide if you want to let the times in large leak slide or not. I will often let some time in large leak slide because I learned a long time ago that for me to try to get perfect leak graphs involved my doing something that ended up causing more sleep disruption problems than 30 minutes in big leak might cause. The cure is worse than the disease sometimes but I made that decision based on software evaluation.

If you are going to just use the 95% number as evaluation tool....it's not the best tool and you have to assume the worst case scenario with it.
We don't know for sure that nothing happened to earn you that nice low AHI or if the machine missed a bunch of stuff during the times you were deep into large leak territory.

Finally...if you are sleeping through the big leaks I assume your sleep quality is decent.
How are you feeling during the day? Feeling good or crappy like you did before cpap?

[FishLips]

It might be SUPER important to your significant other, if it's keeping him/her up.

I use CPAP myself. When my SO started on it, I had to use earplugs until we found a good mask setup. I was pretty cranky for a while there.

[SewTired]

I can't help with the leaks since I don't use a full face mask, but you don't need an oximeter unless your current therapy doesn't appear to be working for you. I also recommend getting one if you have a heart problem because low oxygen can occur even with good AHI. For a lot of people, it's a gadget that you use once or twice and throw it into a drawer. Don't really want to spend good money if you are already feeling pretty good.