How much mask leaking is "normal"?

[Peacenana]

I've posted about this problem before but it continues to exacerbate and exhaust me. Looking at the OSCAR data, it appears my leak rate is quite high. However, the cpap machine numbers are not bad and those are the numbers my doctor goes by. I have shared the OSCAR graphs with her but she is unfamiliar with that program. I have had numerous meetings with supply people, Adapt Health. I have tried taping my mouth to see if I'm a mouth breather (it seems I'm not). I have tried many other masks, including full face masks, and gotten similar high leak numbers. Last night's number was particularly high - over 38% large leaks throughout the night. And yet, a couple of days ago, my large leaks were at 0!!! I do know that I am very tired the day after a high large leak night, so It seems the leaks are disturbing my sleep. After over a year of Cpap, I am wondering if I am better off without it.
My question now is, how much mask leaking is considered "normal"? Is leaking throughout the night with 38% of them in the large leak category a sign that something is wrong? Any advice is most welcome. Encouragement too, please. I am attaching last night's data.
Thank you all.

[LSAT]

Are you mouth breathing?

[Pugsy]

ResMed's line in the sand for too much leak is over 24 L/min and more than 30% of the night.
I also add in "if the leaks wake me up" as a factor even if they aren't very large. Anything that disturbs my sleep is unwanted.

With leaks over 24 L/min it's a gradual worsening in terms of potential negative impact on therapy itself. The further you go into large leak territory the worse it gets kind of thing. Above 35 L/min the machine could potentially be losing ability to respond and record apnea events. So I don't worry about leaks until I start seeing leaks that are prolonged over 30 L/min.

If you tape your mouth...then your leaks are mask movement leaks. And yes, we can have some nights with minimal mask movements and the next night have them happen all over the place.

Your leaks are big enough and prolonged enough to be impacting sleep quality as well as therapy so it doesn't surprise me that you don't feel so great after a big leak night.

Did you get the side wraps with your mask? Are you using them? If not, use them as they will help stabilize the mask and prevent mask movement leaks.

[Peacenana]

Pugsy,
I use the pad-a-cheek side covers. Is that what you mean? Also, a fabric headband worn vertically as a chin strap and two headbands worn horizontally to keep my mouth closed. I tried taping my mouth once or twice to test to see if I'm mouth breathing and apparently I'm not. Plus leaks were just as bad on nights when I taped.
So with these worsening leaks, and the possible negative effects they are having on my therapy and my well-being, where can I turn? Who can help? My sleep doc is very nice and caring and keeps giving me new masks to try. But beyond that, what else can I do? Feeling very down about this as I've been dealing with this issue for months and months now.
Thanks.

[Peacenana]

Also, I noticed that the leak reading on the auto set cpap machine is always 17L/min. So that is the number that gets reported to my sleep doc, which is why she thinks I'm doing fine. But the OSCAR data is higher and feels more true in terms of how I feel the next day.

[Pugsy]

Also, I noticed that the leak reading on the auto set cpap machine is always 17L/min. So that is the number that gets reported to my sleep doc, which is why she thinks I'm doing fine. But the OSCAR data is higher and feels more true in terms of how I feel the next day.

The leak number on the machine and what gets reported to the doctor is what we call a 95% number and all that means is for 95% of the time the leak was at OR BELOW that number for 95% of the time. It is within acceptable limits assuming the leaks don't wake you up.
5 % of the time the leak is above that number but it doesn't tell us how much higher but for the most part we don't worry about 5 % of the night assuming the leaks don't wake us up.

Also...the number on the machine is an overall 30 day average of that 95% number unless you change the reporting parameters to somethings else. The default parameter is for 30 day averages of all numbers on the sleep report.
You can change the parameters if you wish but bear in mind that if you lose power the machine will default back to the 30 day parameter.

I don't worry about random nights with large leaks unless the leaks wake me up. So a bad night here and there I just don't bother worrying about it unless the leaks wake me up or I start seeing consistently those bad nights happening on a night after night basis.

Now if those leaks are indeed messing with your sleep quality then of course we need to try to fix them no matter how big or how small they might be.
If you are using side wraps and still getting a lot of mask movement leaks with your mask then maybe consider trying a different size frame or even a different mask.

[Peacenana]

Pugsy,
Thanks for clarifying. I get confused between the leak rate number reported on the machine (17L/min pretty regularly) and the leak numbers reported in the OSCAR data.
For the OSCAR, at the top left under the orange AHI number, there is a large leak number (last night's was better for me - 4.82%). Does that mean that 4.82% of the night I was experiencing large leaks?
Then further down under Statistics, for leak rate, there are four numbers:
Min. (for me last night that was 0.00)
Med (last night 2.40)
95% - 24.00
Max - 34.80
Can you help explain what these numbers refer to?
Thank you so much.

[Pugsy]

Yes...for 4.82 % of the night your leaks were in large leak territory....above 24 L/min.

Now your max leak number was 34.8 L/min so we know that is as high as it went to.

Your 95% number was 24 L/min which just means it was at OR BELOW that number for 95% of the time.

Your median average leak number 2.4 L/min....and then tells me that if we looked at your leak graph line you probably spent a lot more time BELOW 24 L/min than you did up by 24 L/min.

I wouldn't worry about 4% of the night being in large leak unless the leaks woke me up especially since the worst it went to was 34 L/min.
The machine can still do a good job compensating for that amount of leak.
4 % of 7 hours...approx 16 minutes of barely in large leak territory. I don't worry about those leak numbers at all.
Shrug my shoulders and move on.

Now if you spent 50% of the night up around 45 L/min...then I would be more inclined to worry but even then I would look closely at the leak line. Below is a night I experienced some time back where the 95% number was quite high but if you look closely the actual amount of time in large leak wasn't nearly like we might expect. This was a new mask trial and I was having trouble finding initial tension adjustments to keep the mask from moving around.

Numbers alone don't really give us a clear picture of much of anything.

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