Good AHI - Mask Leaks Still Important?

My AHI is down to pretty decent numbers now, but I'm still dealing with mask leaks. Usually in the 10% to 25% range in SleepyHead.

Since my AHI's are good, should I care? What is the main problem with large mask leaks? Is it that SleepyHead can't report Apneas when that is happening?

I'm on my 3rd type of mask and will keep trying to find the right one...but I was just curious how important that is now that I'm getting AHI's under 2.0. It's usually when I lay on my side that that the large leaks occur. Not sure if I can do anything about that or not.

Thanks!

If you are sleeping well and your AHI is that low, I wouldn't worry about the leaks.

It's not SleepyHead that might be having a problem during times of large excessive leaks...it's your machine that might be having the problem.
It depends on how excessive those leaks are....it only a tiny bit into large leak territory (like 25 to 30 L/min with your machine) then the AHI is probably accurate and the machine can't still respond and flag events.
Over 30 L/min and it starts getting a bit iffy in terms of the machine being able to sense what it going on and respond during the periods of large leak. Over 35 L/min excessive leak and pretty much all bets are off as to whether the AHI is nice and low because nothing happened or the machine simply couldn't sense anything because the large leaks got it confused.

So excessive leaks over 24 L/min (with your ResMed machine and those with Respironics or other machines have a different number to avoid) can be really important depending on just how far you go over 24 L/min and how long you stay there.

ResMed will still give you a Smiley face for leak control up to 30% of the time in large leak...exceed 30% of the night and you get Mr Frowny face.

Any leak that disturbs sleep needs to be fixed no matter how big or small.

If you are sleeping well and feeling decent and you don't spend much time over 30 L/min then I would trust the AHI to be accurate and probably not worry too much about the leaks.
I wouldn't want to spend 25% of the night with leaks up around 40 or 50 L/min though. The AHI will be low because the machine would throw up its little arms and say "I quit...I can't work in this big leak"

So it depends just how far into large leak territory you go and how long you stay there as to just how important the big leak might be.

-just to add to Pugsy's awesome input... it also depends on how long those large leaks last.

I quite often see a leak spike out at 60-80 that last less than 60 seconds. These "positional" leaks come from my sleeping on my back and when I roll to my side, the leaks are gone.

My personal opinion is that ResMed's line in the sand at 24 L/min is a bit conservative and there is probably more wiggle room there than one might be led to believe.
I get large leak flags all the time with my S9 and never get them with my PR S1 machine.
With the S9 they are very brief for the most part and don't go very far above 24 L/min for the most part and I sleep well so I don't worry about them. I don't believe for one minute that I have more bigger leaks with the ResMed than I do with the Respironics.

Also that 95% leak number that the ResMed machines spit out....it doesn't necessarily mean that the leaks were all that horrible if the 95% number is above 24 L/min. I once had a 27 L/min 95% number and all I had was 30 minutes of leak around 29 L/min and maybe 5 minutes over 30 L/min. 95% numbers (pressure or leak) are very easily skewed so they aren't always the holy grail they are held up to be.

Pugsy wrote:
Any leak that disturbs sleep needs to be fixed no matter how big or small..

This is so true. Most of my leaks occur during REM. That's also where I have the most events and I wake up. So, despite a low AHI (below 1), I'm getting problems during the most critical period and that is causing problems. I no longer have the leak issue with either the Wisp or the P10 nasal pillows, but still getting it with the Sleepweaver. So keep trying things with your current mask. Some people on here went through 8-10 masks before they found one that worked for their face and sleeping style. I'm also thinking most of my problems happen when pressure is at 11. It's not supposed to be the upper limit for these masks, but could be the limit for my specific facial contour. Still working the problem, so just a thought to consider.

Thanks everyone for the great advice. I truly appreciate it. I'm actually trying a nasal pillow mask for the first time. Last night was pretty rough but I think this might be the best solution if I can get used to it.

I was surprised that I still get leaks while laying on my side though. I thought this mask would allow me to do that. Oh well. Time will tell. Maybe I need a special pillow?

It does seal great when I'm on my back and I didn't wake up with a raw nose this morning like I do with my full face mask.

Keep monitoring your leaks with Sleepyhead but when you get settled on your mask it will get better. I use a P10 with a regular soft pillow that I scrunch up with my arms and sleep on my sides and stomach. I do turn several times at night but reposition the pillows and go right to sleep. Another thing I do is drape the hose over the bed headboard and put one hand on the connection of my short hose to the regular hose and it doesn't move much. Some people use hose hangers to take the pressure off the mask.
When I did my sleep study I told them I sleep on my stomach always have and that's how they let me sleep. They did try to get me to turn on my back once during the night but I couldn't go back to sleep and turned back on my stomach. I would find it very difficult to try and sleep on my back.

I've had good results by using a "memory foam" pillow that's kinda' firm. I "hang" my face and mask over the edge of it and nothing contacts or pushes on my FFM to cause any large leaks. (usually) . The prices on these pillows always made me hesitate to buy them and I just stayed with a 'down alternative" type. Recently, I discovered one at Costco called Novaform-comfort curve for $20, I am very happy with it and..........it's made in the USA ! Might be worth trying in your situation. Good luck ! http://www.amazon.com/Novaform-Memory-C ... B00CM3AUYE

Thanks again everyone. I will probably purchase that pillow and hang the hose from the headboard of my bed to see if that helps.

Here is the best AHI I have ever had to date. My wife just told me that she witnessed these leaks that night, and they were "mouth leaks". So I'm going to try a chin strap tonight and see if that helps.

Regardless, this was the most successful night I've had. If I could get this number every night, regardless of leaks, I'd be extremely happy!!

Good luck ! I tried several chin straps and even made up one custom, I was always able to overcome them and mouth-breathe anyway. I gave up and started using full face masks, which after a little trial and error, are working well for me (AHI always less than 1.00) and I'm not nearly as claustrophobic as I was with the nasal masks AND a chin strap, so I'll stick with em for now. (F10 ffm)