Yet another leak question

[Always tired]

Because of mouth breathing with my nasal mask with chin strap I tried out a FF Mirage Quattro last night and noticed on SH this morning that my leak rate was way above normal. Leaks did not significantly bother my sleep and AhI was about 1.5.
Here is the question-- If your AHI is good, but you have a lot of leaks, and it does not significantly bother your sleep does it really matter from a medical viewpoint?

I imagine this question has probably been asked 1000 times before, but searching under "leak" reveals a ton.

Thanks in advance
A T

[Chikorita]

I'm interested in the answer to this question too please?

[Xney]

It depends on how big the leaks are - a lot.

Above a certain amount, the machine can't detect or respond to all events, and it gets worse the worse the leaks are. Basically, you start getting bad data, and the pressure stops being effective for your treatment.

It could still be "good enough", but you can't tell any more.

[Denial Dave]

My understanding is for resmed masks/ machines. several things apply

If your leak level is below 24 and your AHI is less than 5 & you feel fine. If the remaining leaks don't bother you or your sleep, then you don't need to fret.

it would be great if you could get the leak levels as low as possible to ensure your treatment is doing it's best.

[Sheriff Buford]

If you are in the autoset mode, the leaks for Resmed under 24 l/m are medically acceptable. For me, at one time, I was struggling with leaks below 10 l/m day. I found that I could tell the difference in how I felt during the day. I felt much better with 0 l/m as opposed to less than 10 l/m. But thats me... I know some folks never get a zero leak rate, their leaks are below 24 l/m and generally feel they are getting good treatment. To me its like asking for ice cream alone or asking for ice cream with all the bells and whistles (hot fudge, buts, whip cream, etc...) on top. There are masks out there that can give you a zero leak rate. It's a decision you make as to if you can, want or take the effort to find them or not.

Sheriff

[49er]

If you are in the autoset mode, the leaks for Resmed under 24 l/m are medically acceptable. For me, at one time, I was struggling with leaks below 10 l/m day. I found that I could tell the difference in how I felt during the day. I felt much better with 0 l/m as opposed to less than 10 l/m. But thats me... I know some folks never get a zero leak rate, their leaks are below 24 l/m and generally feel they are getting good treatment. To me its like asking for ice cream alone or asking for ice cream with all the bells and whistles (hot fudge, buts, whip cream, etc...) on top. There are masks out there that can give you a zero leak rate. It's a decision you make as to if you can, want or take the effort to find them or not.

Sheriff

Hi Sheriff,

I would love some tips as to how you obtain a zero leak rate.

Thanks!

49er

PS - As an FYI, I have found the padacheck liners to increase my leak rates. I realize my experience is not common but I wanted to mention that.

[Tino2You]

Hi Sheriff,

I would love some tips as to how you obtain a zero leak rate.

Thanks!

49er

Superglue

-tino

[Denial Dave]

At my Bi-level pressure of 21 IPAP/ 15 EPAP, I've been thrilled to get my 95 percentile leaks under 10 every night.

I'd love to find a way to get my 95 percentile leaks under 5 each night.

Supergluing the mask to my face is not an option.

[49er]

Hi Sheriff,

I would love some tips as to how you obtain a zero leak rate.

Thanks!

49er

Superglue

-tino

[Sheriff Buford]

If you are in the autoset mode, the leaks for Resmed under 24 l/m are medically acceptable. For me, at one time, I was struggling with leaks below 10 l/m day. I found that I could tell the difference in how I felt during the day. I felt much better with 0 l/m as opposed to less than 10 l/m. But thats me... I know some folks never get a zero leak rate, their leaks are below 24 l/m and generally feel they are getting good treatment. To me its like asking for ice cream alone or asking for ice cream with all the bells and whistles (hot fudge, buts, whip cream, etc...) on top. There are masks out there that can give you a zero leak rate. It's a decision you make as to if you can, want or take the effort to find them or not.

Sheriff

Hi Sheriff,

I would love some tips as to how you obtain a zero leak rate.

Thanks!

49er

PS - As an FYI, I have found the padacheck liners to increase my leak rates. I realize my experience is not common but I wanted to mention that.

I hate to say this because I will be bombarded by folks (for sayin this), but the pad-a-cheek was sooo comfty, but it did give me small leak rates. Because of the comfort, I was willing to live with it. But on the few nights that I did get a zero leak rate, I felt much better. I decided to go a few weeks without it and I realized I did feel much better. For me and my mask, the leaks were on my forehead where the padacheek has padding. When I adjust my mask, the mask sorta "floats" on my face. When I turn on the machine (cpap mode - no ramp) the mask will slightly lift off the face. If it doesn't, the mask is too tight. If the air leaks by (the farting sound), it's too loose. Between the lift and the "farts" is my sweet spot. No leaks.
Again, if I didn't notice the difference between zero and less than 10 m/l leaks, I would wear the padacheek every night.
Sheriff

[Pugsy]

tried out a FF Mirage Quattro last night and noticed on SH this morning that my leak rate was way above normal. Leaks did not significantly bother my sleep and AhI was about 1.5.
Here is the question-- If your AHI is good, but you have a lot of leaks, and it does not significantly bother your sleep does it really matter from a medical viewpoint?

Your Respironics machine reports total leak. Total leak is mask vent rate plus any excess leak. How large was the leak number?

ResMed machines report only excess leak...so their line in the sand is 24 L/min. Don't try to compare your leak number to a ResMed leak number. You won't ever see that low of a leak number. So when ResMed users are telling you they get below 10 L/min or zero leak rate they are getting a different value than you will get with your machine. Apples and oranges comparison. Not accurate.

Mask vent rates vary by mask type and pressure used. Full face masks have a higher vent rate so the leak numbers will always be a bit higher than a nasal only mask even if no excess leak. They are also harder to keep sealed.

Respironics don't ever tell us where the line in the sand is as far as leak numbers. They just say "large leak".
Past experience with lots of reports that showed large leak (Encore software) have shown me that large leak territory is somewhere around 80 to 90 L/min.

[Always tired]

Total leak is mask vent rate plus any excess leak. How large was the leak number?

Pugsy,
When you ask for leak number, which number are you referring to? Total, 95%, leak or the breakdown by number?
Sorry to report that I'm on overload right now--new mask, new meds, converted to an APAP from CPAP bla bla bla.
I'll post the data in graphic form later in the day and get comments.
I do appreciate all of the input.
BTW Leaks were down last night, dialing in a mask is harder than tuning a Ferrari (like i've ever had one)

[Pugsy]

When you ask for leak number, which number are you referring to? Total, 95%, leak or the breakdown by number?

Either the average or the 95% leak number. I mainly go on the average if I was looking at a number. The 95% number can be falsely elevated by a short time in large leak so I don't get all excited about it unless it and the average are both higher than I want.

Mostly what I do when evaluating leak is just look at the leak line on the graph and the highest it ever went to. If it stays well below large leak territory I don't really care what the actual numbers are because I know that it never got to large leak territory. I do the same with either machine that I use...my S9 VPAP or the PR S1 BiPap.

Sometimes I do cross over into large leak territory and when I do I just make a mental note of the approximate time I spent in large leak territory. I don't panic with 10 or 15 minute blocks in large leak. It isn't the end of the world.
15 minutes or so out of 7 or 8 hours isn't that big of a deal and really isn't going to impact overall therapy all that much.
Also depends on just how much over into large leak territory I might go....if I barely cross over it isn't going to impact things all that much. On your Respironics machine you would need to hit 100 L/min and stay there for quite a while before it really impacted therapy all that much. It's not like if you hit 90 L/min that the whole thing gets trashed...there is still some therapy there and the machine can still sense some events. Over 100 L/min and the machine really has trouble knowing what to do or what to call the events it does sense.
I have seen a couple of user reports where the leak was really prolonged at 120 L/min and the machine (auto adjusting) was so lost it couldn't even sense pressure needs and the pressure line looked like a cpap mode line. That's pretty bad.

I don't wake up with leaks but if I did and even if they were small leaks I would want to do something about them but because the leaks were disturbing my sleep and not because they are really impacting therapy. Anything that disturbs sleep is unwanted.

So for me all I do about leak reports is just a quick visual of the leak line graph. If I have stayed below large leak territory I don't even bother looking at the numbers because they really don't mean all that much if they are all below large leak territory. If I were using my PR S1 BiPap and the worst leak I had hit 40 L/min...that is so far below large leak territory that it doesn't really matter what the average or 95% number happens to be.

[Mama Pinky]

"Sheriff said: Between the lift and the 'farts' is my sweet spot. No leaks."

I LOVE this!!! So descriptive of what I'm experiencing with my mask right now. That's my goal for tonight when I'm trying to get my mask properly adjusted. Thanks!

KathyB

[birdygirl38]

So, Is the large leak line on the top of the sleepyhead leak graph and the bottom line the one I should be comparing to it?