Leak Rate

Ograx · Post by **Ograx** » Thu Jul 18, 2019 12:56 pm

I have some questions about leak rate.

I am using the Resmed N20 nasal mask and seeing leak rates at 6.2-20 pressure in the range of 17-24l minute over the night. Am I supposed to be taking into account the leak rate that the mask puts out in its instruction book?

For example the leak rate for my mask falls in that range. Does that mean everything is working fine and the leak rate is actually just the normal venting of the mask?

Pugsy · Post by **Pugsy** » Thu Jul 18, 2019 1:01 pm

Your ResMed machine is reporting excess leak only...leak above the normal venting.
ResMed machines subtract vent rates prior to reporting leaks.

So what you are seeing being reported is all excess leak above the expected vent rate.

Ograx · Post by **Ograx** » Thu Jul 18, 2019 2:01 pm

So my mask seems to have a pretty good seal and I’m not getting dry mouth at all. What would be the best way to figure how the leaks are happening. Is it an acceptable leak where it’s not affecting treatment or do you need to see the sleepyhead logs to determine that?

zonker · Post by **zonker** » Thu Jul 18, 2019 2:05 pm

Ograx wrote: ↑
Thu Jul 18, 2019 2:01 pm
So my mask seems to have a pretty good seal and I’m not getting dry mouth at all. What would be the best way to figure how the leaks are happening. Is it an acceptable leak where it’s not affecting treatment or do you need to see the sleepyhead logs to determine that?

as long as leaks aren't waking you up at night, you may not want to futz with it at all.

you COULD post some charts, just to be on the safe side.

babydinosnoreless · Post by **babydinosnoreless** » Thu Jul 18, 2019 2:10 pm

I wear the N-20 get a good seal and my husband says my mouth does not open at all at night. My leak rates are similar to what you report. I've never had it report a leak free night. I don't get any weird loud tooting noises like I did with with the dreamwear ff mask. So I just ignore it.

Edited: just out of curiosity. I pulled my data for the last night.
I don't pay much attention anymore other than to look at the ahi number in the morning.

It shows the large leaks all happening this morning while I was laying awake after hubbys alarm went off. I know for a fact it wasn't leaking at that point. How weird is that ?

Ograx · Post by **Ograx** » Thu Jul 18, 2019 3:24 pm

I’m thinking mine might have the same skewed numbers because when I wake up to pee I press the stop button while taking mask off and get blast of air. Maybe throwing my numbers off but I’ll have to check. I assume the way to figure out if the leak is waking you up is to see if your flow rate shows signs of waking up right near the leak rate jumping?

Pugsy · Post by **Pugsy** » Thu Jul 18, 2019 3:39 pm

Actually if a leak wakes me up I pretty much will already know about it and don't need to evaluate the flow rate graph.

Now sometimes leaks just cause arousals that we may or may not remember but usually we know it.

If you aren't waking having to fiddle with the mask to stop a leak...probably not waking you up.

Generally if a leak doesn't wake me up and I look at the graphs and I don't spend an enormous amount of time in large leak...I shrug my shoulders and move on.

If you are still seeing Mr Smiley on the machine for leak management AND you don't remember many leaks....I wouldn't worry about it with the numbers you are reporting.
Off the machine the number is what we call a 95% number anyway and all it means is you were AT OR BELOW that number for 95% of the night. The "or below" part is often forgotten or misunderstood. We can have some pretty ugly 95% numbers with maybe only 30 minutes of large leak.

The brief time the machine runs when you aren't attached...won't really impact the leak numbers because the machine will quickly switch over to "breathing not detected" if it doesn't turn itself off...and any numbers that might occur with BND...don't factor into anything.

These machines can compensate for quite a bit of leak no matter what the cause so I don't worry about leaks
1...unless they wake me up often
2...I spend a gynormous amount of time deep into large leak territory (over 45 L/min).

Ograx · Post by **Ograx** » Thu Jul 18, 2019 3:47 pm

You know pugsy I do feel quite a bit better which I hope isn’t all in my head but I’m still waking up 6-10 times a night. My AHI has been 1 and lower for the last week or so.

Pugsy · Post by **Pugsy** » Thu Jul 18, 2019 3:59 pm

Take any medications that might be a factor in the wake ups?

Or maybe just the brain wanting to alert you to the alien on your face? My brain did that for about 3 months...just woke up me for no good reason. Eventually it quit doing that.

Ograx · Post by **Ograx** » Thu Jul 18, 2019 4:37 pm

No medications other than 1 cup of coffee at 6 am and I go to bed at 930 PM. ( I do consider caffeine a drug)

I am going to attach some Oscar data and just to make it clear I experienced this amount of wakeups before CPAP and I had thought and the doctor said they were probably related to the apneas but looking at my oscar data they dont seem to happen near leaks except maybe 1 or 2 over the 3 nights and are kinda all over the place.

What are your thoughts on caffeine ? ( Sorry to jump topics) I was originally thinking before my diagnosis that it was too much caffeine that was causing issues and cut down from 6 to 1 cup and probably just going to give up altogether and see what happens.

Anyways here is the data and let me know if you need zoomed in on anything.

Thanks!

zonker · Post by **zonker** » Thu Jul 18, 2019 4:44 pm

Ograx wrote: ↑
Thu Jul 18, 2019 4:37 pm

What are your thoughts on caffeine ? ( Sorry to jump topics) I was originally thinking before my diagnosis that it was too much caffeine that was causing issues and cut down from 6 to 1 cup and probably just going to give up altogether and see what happens.
Thanks!

google "sleep hygiene". but i think your intake of caffeine has been down-sized dramatically.

good job!

Pugsy · Post by **Pugsy** » Thu Jul 18, 2019 4:46 pm

My thoughts on caffeine....it's another one of life's things that comes with a huge YMMV sticker.
I always...I mean always...have at least 2 cups of coffee in the morning. It is part of my life's requirements for me to consider good quality life.
I even have tea or soda in the afternoon....I try to avoid anything with caffeine after 6 PM though. I have learned that caffeine after 6 PM usually means I don't get sleepy until after midnight.

I doubt one cup of coffee in the morning is the cause of your insomnia (sleep maintenance insomnia) unless you are getting major doses of caffeine in something else.

Sleep maintenance insomnia...lots of things can cause it and while sleep apnea is a common cause...the list of potential culprits is miles long. You might google it along with sleep hygiene and see if anything else stands out as a potential culprit.

Might also want to read what RobySue wrote some time back and she references a couple of excellent books to read.
She had insomnia issues long before she ever started cpap so don't let the topic title put you off.
http://adventures-in-hosehead-land.blog ... er_19.html

Do you have any other health issues going on? Pain, arthritis, anything that might affect sleep?

Ograx · Post by **Ograx** » Thu Jul 18, 2019 5:04 pm

My doctor said I'm the healthiest 34 year old hes ever met. Low blood pressure,healthy ranges for all my blood tests. Other than this they found absolutely nothing in 2 years of testing for the fatigue and irritability I was experiencing.

I wouldn't say I have insomnia for the most part either. I sometimes wake up at 3-4 am and have trouble falling back asleep but I wake up on average 6 times a night. I can usually fall right back asleep after peeing or laying back down. I'm starting to think its maybe a learned nuance that I am just going to try and have to break by just not getting up and peeing. Im not usually peeing very much and I think its become more of a habit my body somehow learned but I think its been going on since I was a teen.

Going over that sleep hygiene checklist I would have to say mine is immaculate. Exercise 5 times a week lifting weights and cardio 3-4 days. Always same bedtime and never take naps.

I will do some more reading and see though to make sure its not something simple Im maybe not doing or doing.

How do those leak rates look??? Acceptable?

Pugsy · Post by **Pugsy** » Thu Jul 18, 2019 6:12 pm

Leak rates well within acceptable limits IMHO.
As long as they don't disturb sleep...I let a lot slide until I start seeing a lot of time over 35 L/min. Below that and the machine can pretty much function normally despite being over ResMed's 24 L/min line in the sand. That's an ultra conservative line in the sand...the machine doesn't immediately go in the toilet the second it hits 25 L/min...it's a progressive thing. The farther you go above 24 L/min the worse it gets but in my past experience the machine does reasonably well up to about 35 L/min and then it starts having trouble knowing what is going on. Might see a UA flagged instead of OA or hyponea. The really big leaks make it hard for the machine to know what's happening....so it knows something is happening but not what to call it.

Even when I might hit a really big leak...unless it lasts a long time I don't worry about it.
10 minutes at 45 L/min really isn't going to make that big of a deal over the entire night. Only the 10 minutes might be questionable and not the entire night.

I learned a long time ago that trying to get perfectly flat 0.0 leak lines often involved doing things that ended up messing with my sleep a whole lot more than the little bit of time in large leak messed with my sleep.

And I know you don't like to use the insomnia word....but that's what you have. Waking often during the night for no apparent reason...even if you go immediately back to sleep...that's still sleep maintenance insomnia.
Sounds like you are like my friend Vivian was...she had the same problem and until the day she died she hated using the insomnia word.
No shame it it....accept it and move on.
And lots of people share the same problem....that's why fixing sleep problems is a multi billion dollar industry.
I have it myself...but in my case I know the problem but it's still not something that is easy to fix even when you know the cause.

Ograx · Post by **Ograx** » Fri Jul 19, 2019 3:15 pm

Thanks for all the helpful knowledge Pugsy you are one of a kind!

One last question!

My minimum pressure is 6.2 right now, can you tell from those charts if I should maybe reduce it ?

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