Question for a friend

[poorflick]

He just started on cpap using the new airfit p10 mask. His machine is resmed s9 autoset, pressure 7-10, diagnosed with mild apnea at 14 ahi. I've checked his data for the past two nights and his ahi is less than 1 but his leak rate is high. His pressure is about 8.5 . So, question is this ... his leak rate is high because he breathes through his nose and out through his mouth. Is this something to worry about?

[Pugsy]

Yes, it is something to worry about if the leak is horribly high because the machine may lose ability to sense and record any events that happens...so a nice low AHI might not be an accurate number.

How high is the leak rate and how long are the times in high leak? 15 minutes may not be a big deal...2 hours is a big deal.
So it depends on just how high is "high" and how long the "high" leak times last.

[poorflick]

I will have to get the card to check on that. Thanks for the help. The leak is reading 13-14.

[Pugsy]

The leak is reading 13-14

Off the machine LCD screen? That would be the 95% leak number which just means that for 95% of the night the leak was at OR BELOW that number and since 24 L/min is the red line in the sand where ResMed says that there could be a problem...that's well below that red line and if there is mouth breathing going on it sure isn't very much and the machine can compensate for it.

If that is from a software report then it would help to know which software and which value.
Minimum, median, 95%, or maximum value.

If it is the 95% or maximum leak number....then leaks aren't likely an issue unless they are waking him up.
Stay below 24 L/min for the bulk of the night and the machine will compensate just fine for any leaks no matter what the cause.

Now any leak that wakes a person up, even if tiny, needs to be fixed but because it is messing with sleep quality.

[poorflick]

Thats from the screen. I dont want him to get frustrated with adding a chin strap, full face etc. so will just keep watching for now and not worry too much. Thanks for all the help.

[Julie]

You may not want to get him frustrated... but if he's not being treated, if he loses all the therapy air out of his mouth instead of it going to his airway, then what's the point?

[Pugsy]

You may not want to get him frustrated... but if he's not being treated, if he loses all the therapy air out of his mouth instead of it going to his airway, then what's the point?

Julie...he isn't losing "All the therapy air out his mouth" when the 95% number is 13 to 14 L/min. It's no where near 24 L/min which is where we would start worrying..
On the S9 machines...that is what is shown on the LCD screen...95% number....95% of the time at OR BELOW that number
Only 5% of the time above that number...5 % even in massive leak the entire time isn't the end of the world and I doubt it is even massive.

If there is mouth breathing involved .....it shows up on the leak numbers...no way around it. If the leak numbers are within acceptable ranges then the machine can compensate and it doesn't matter what the leak is coming from.
Not all mouth breathing equals a massive exit of all therapy pressure out the mouth. I really wish you could come to understand that fact.

[robysue]

You may not want to get him frustrated... but if he's not being treated, if he loses all the therapy air out of his mouth instead of it going to his airway, then what's the point?

Julie...he isn't losing "All the therapy air out his mouth" when the 95% number is 13 to 14 L/min. It's no where near 24 L/min which is where we would start worrying..
On the S9 machines...that is what is shown on the LCD screen...95% number....95% of the time at OR BELOW that number
Only 5% of the time above that number...5 % even in massive leak the entire time isn't the end of the world and I doubt it is even massive.

A big +1 for everything Pugsy is saying here. If the 95% leak rate is 13-14 L/min, that means whatever large leaks (leaks above 24 L/min) there are make up less than 5% of the night. And that's quite acceptable.

It is simply NOT reasonable to expect a "perfect" leak line night after night with a 95% leak rate less than 3 or 4 L/min. Yes, many people DO have perfect leak lines, but many more have acceptable, but not perfect leak lines. And it is often both a futile and frustrating effort to eliminate that last bit of leaking in an effort to get a perfect leak line when you're leak line is already good enough.

If there is mouth breathing involved .....it shows up on the leak numbers...no way around it. If the leak numbers are within acceptable ranges then the machine can compensate and it doesn't matter what the leak is coming from.
Not all mouth breathing equals a massive exit of all therapy pressure out the mouth. I really wish you could come to understand that fact.

Again, a big +1 for everything Pugsy is saying here.

The first goal with leaks is to get them under control. On the Resmed side, that means keeping the 95% leak rate well below 24 L/min. And a 95% leak rate of 14 L/min is indeed well below 24 L/min.

The second goal with leaks is to make sure they're not waking you up. As Pugsy said earlier: If the 95% leak rate is well under 24 L/min on a Resmed machine, you only need to worry about leaks if they are waking you up. Some people are very sensitive to leaks and wake up at the smallest ones; others can sleep through some amazingly large leaks. If you're highly sensitive to leaks, even small ones, then of course you need to fix them. If you're not so sensitive, then you really only need to worry if the leaks are both large enough and long enough to adversely affect therapy.

[Julie]

Hmmm - your explanation this time makes more sense to me (not that you haven't said the same thing 50 times, just that I haven't seen it the same way. I don't have the stats you do - just thought that leaking is leaking, and therefore the air's lost that way. Guess I'll have to look at it a bit differently from now on, though if stats aren't provided by posters, may still suggest FF's on occasion.

[Pugsy]

Hmmm - your explanation this time makes more sense to me (not that you haven't said the same thing 50 times, just that I haven't seen it the same way. I don't have the stats you do - just thought that leaking is leaking, and therefore the air's lost that way. Guess I'll have to look at it a bit differently from now on, though if stats aren't provided by posters, may still suggest FF's on occasion.

Let me see if I can dig up an experiment I did a while back. Woke up mouth breathing but just gently mouth breathing. Mouth was indeed dry but no tornado exiting the mouth. Just gentle mouth breathing. I decided to just continue breathing like that for a few minutes so that I could look at a known time frame on the leak graph just to see how much it showed. May take me a bit to find the image but I think it will reinforce what I say when I say "not all mouth breathing means all the therapy is in the toilet".
Keep an eye out here...I will edit this post once I find the image I took of that experiment. May take me a bit...over 400 images to sort through.

Edit...Okay..this image look at the very end of the night where I have circled the leak and wrote in mouth....I definitely was mouth breathing and awake during this time....can every one see the 7:30 time frame?
This is a S9 report...
Also shows a good example of probably a time frame with larger mouth breathing...3 to 3:30 but still not all that much above 24 L/min and I slept through it.

[poorflick]

Hmmm - your explanation this time makes more sense to me (not that you haven't said the same thing 50 times, just that I haven't seen it the same way. I don't have the stats you do - just thought that leaking is leaking, and therefore the air's lost that way. Guess I'll have to look at it a bit differently from now on, though if stats aren't provided by posters, may still suggest FF's on occasion.

stats were provided. You just failed to read the whole post.

[chunkyfrog]

My leaks are frequently in that range, but ff masks give me far worse leak numbers.
I loves my sweet little P10!

[Julie]

PF - I don't USE the stats you do (and am therefore unfamiliar with them) because my machine's different. I don't always interpret the ones from your machine well.