Leak rate, Central Apneas and Clear Airway

[lindsayschach]

Hello all,

You can see below what machine and mask I have been using since the beginning of July. The mask is pretty tight on my face, but I still seem to have periods of large leak rate. I tried tightening it but that did not help.

Can anyone help me with mask fit, or do I need to try another kind of mask? I had XS nose pillows before, but this mask's smallest size is Small.

I'm attaching last night's data from Sleepyhead. What are Unclassified Apneas? What does "Clear Airway" mean, or what are the implications?

Any comments are most welcome.

Thanks,

Lindsay

[Pugsy]

Clear Airway apnea events...Central apneas. Airway is open but no air is moving.

Unclassified apneas or unknown apneas....the machine couldn't decide which category to put the flagged event in because the leaks were bad enough to affect the sensor's ability to decide what kind of apnea event.

Are you sure that these leaks are mask movement leaks and not mouth opening leaks?

[LSAT]

I vote for mouth leaks !

[BlueDragon]

I started CPAP therapy a month ago and also use the N20 mask. The leak rate graph looks very much like mine when I am having mouth leaks -- air is rushing in the nose and back out the mouth. If they are mouth leaks, tightening the mask straps won't make any difference.

[Pugsy]

Here's a test folks...look at this report and tell me if you think those are mask movement leaks or mouth breathing leaks.
It is a nasal mask being used.

[Okie bipap]

If it were my chart, I would call it a mouth leak. I have tried several nasal pillow masks, and have never been able to keep air from leaking out of my mouth. Once I go to sleep, my jaw relaxes and air starts blowing out of my mouth. I start sounding like an outboard motor and it wakes me up. I had the same problem when I was first tested back around 1995 or 1996. At that time, I opted for UPPP surgery and I think that is one of the things that makes it impossible for me to use the nasal and nasal pillow masks today.

[Pugsy]

Anyone else want to make a guess as to what those leaks are from?
It is my own personal report. I was testing a new/different nasal mask and really needed to know if mouth leak or mask movement leak...I slept right through those leaks though and no dry mouth. I was consistently seeing this type of leaks happening but slept great and felt great....so I taped my mouth to make sure that mouth opening leaks were eliminated from the leak evaluation.
The is a leak report from a night where I taped my mouth shut and the tape didn't come off during the night.
So it is all mask movement leak.

My point is you can't tell for sure unless you tape your mouth to 100% totally know for sure if it is mouth opening or mask movement.
It does look like mouth breathing but it wasn't.

When evaluating leaks and working on fixing them....make darn sure that you are trying to fix the correct problem. This was the DreamWear Gel pillows...I was using the medium frame...someone was kind enough to give me a small frame to test out and the mask movement leaks pretty much went away.

[palerider]

My point is you can't tell for sure unless you tape your mouth to 100% totally know for sure if it is mouth opening or mask movement.
It does look like mouth breathing but it wasn't.

You may be able to get a pretty good idea about the leaks, but it requires zooming in and looking at the breath shapes... as Jay Aitchsee has done, though still not certain.

No way to tell from an overview.

[Pugsy]

You may be able to get a pretty good idea about the leaks, but it requires zooming in and looking at the breath shapes... as Jay Aitchsee has done, though still not certain.

I have tried doing what Jay does with the flow rate to see if I can spot differences...I can't do it well enough to be comfortable trying to teach it to someone else. I figure if with all my experience I am having trouble being for sure...I sure don't want to go try teaching it to someone else.
Especially since there is a quick, easy and reliable method available that involves much less work. Just tape the mouth one night and you have your answer without much work and no brain strain.

[lindsayschach]

Thanks, guys.

I tape my mouth every night.

Lindsay

[Pugsy]

I tape my mouth every night.

I rest my case. All of you guys so quick to jump on the "it's mouth breathing" bandwagon...
We simply can't tell just by looking.

Always so quick to say "OMG you gotta be using a full face mask for the mouth breathing" and it's not the solution because that's not the problem. Doesn't take but the same amount of time to ask for confirmation of the cause of the leak instead of being so quick to offer FFM advice.

To the OP.....
Since you know for sure your leaks are mask movement then you just have to keep trying different things to eliminate or reduce to a manageable level the mask movement.
It is possible that this mask simply isn't the best one for you. Maybe one of the other nasal masks might be a better choice.
I will let some large leak slide as long as I am sleeping well and the AHI is decent....your AHI isn't decent and you are having more large leaks than I would be comfortable with letting slide.

[palerider]

You may be able to get a pretty good idea about the leaks, but it requires zooming in and looking at the breath shapes... as Jay Aitchsee has done, though still not certain.

I have tried doing what Jay does with the flow rate to see if I can spot differences...I can't do it well enough to be comfortable trying to teach it to someone else. I figure if with all my experience I am having trouble being for sure...I sure don't want to go try teaching it to someone else.
Especially since there is a quick, easy and reliable method available that involves much less work. Just tape the mouth one night and you have your answer without much work and no brain strain.

I agree completely, I was reinforcing your point that there's zero way to do more than just wild guess about what's causing leaks from looking at the charts above, to have even a hope of it, you've got to look at individual breaths. (and I don't feel confident of my abilities to figure it out... I'd refer that question to Jay if someone asked me).

[Pugsy]

I agree completely, I was reinforcing your point that there's zero way to do more than just wild guess about what's causing leaks from looking at the charts above, to have even a hope of it, you've got to look at individual breaths. (and I don't feel confident of my abilities to figure it out... I'd refer that question to Jay if someone asked me).

Yep, I agree.

And to make matters even more confusing...not all mouth breathing equals massive leaking.
I know that for a fact and have proof.
Woke up one morning mouth breathing ...a nice slow gently mouth breathing without massive tornado out my mouth. Decided to just continue to do it so that I would have a good chance of seeing what known mouth breathing leak looked like for sure.
Imagine my surprise when I saw this below on the report. No help at all since no large leak.
Known time awake and known for sure mouth breathing...circled in red.
Now the big leak at 3:00....dunno about that one. I was asleep and I don't really care anyway. It's far from horribly horrible.

[palerider]

Doesn't take but the same amount of time to ask for confirmation of the cause of the leak instead of being so quick to offer FFM advice.

That's one of my gripes about overly eager 'advice'... making too many assumptions about what's happening on the other end, instead of just ASKING...

[lindsayschach]

I'll use extra tape tonight and see what happens. There have been a few nights where there was no leaking and my AHI was < 1.

Thanks,

Lindsay