Leak Rates

Newbie here that just started treatment on 9/30/2011. As you can see in my equipment listing, I have a ResMed Autoset S9 with the H5i Heated Humidifier and the ClimateLine tubing. I've been very pleased with the machine itself. From 9/30 to 10/18, I was using a ResMed Swift FX nasal pillows mask which I found to be very comfortable. My AHI (0.4) and AI (0.4) results were excellent, however my leak rates concerned me a bit with 30.0 L/min (95th percentile), 45.6 L/min (maximum) and 1.2 L/min (median) for this entire time period. I determined that my leaks were coming from my mouth, not from inhaling through my mouth, but opening my mouth and having air escape out of it. Towards the end of that period, I also added a chin strap and was able to reduce my leak rates to 18.0 (95th percentile), 36.6 (maximum) and 0.0 (median). I guess my mouth must not be opening as much, but my lips must be opening and letting a smaller amount of air out. I find wearing a chin strap to be a bit uncomfortable though. According to the way ResMed measures leak rates, I believe the goal is to stay below 24.0 L/min.

With ResMed and my DME, I was allowed 1 free mask exchange in the first 30 days, so on 10/19 I switched to a ResMed Mirage Liberty hybrid mask thinking that a full face mask might reduce my leak rates since my mouth would be covered. The DME is holding the Swift FX mask until 10/28 when I'll have to decide which mask I want to keep. Since the switch, for the past 4 days, my leak rates are 11.4 (95th percentile), 16.8 (maximum) and 4.2 (median). My AHI (0.8) and AI (0.3) scores have remained virtually the same. With the Mirage Liberty, I think I'm getting a small amount of leakage from around the mask portion that covers the mouth and occasionally from the nasal pillows which are a little trickier to seal versus the Swift FX.

In looking at my detail graphs using the ResScan software and comparing the scores, I'm finding that with the Swift FX mask, I had longer periods of zero of very low leak rates with occasional spikes near or above the 24 L/min line. Whereas with the Mirage Liberty hybrid mask, I have a somewhat continuous amount of very low leakage (not as much 0 leakage), but the spread between low and high leakage is much more compressed with the maximum staying below the 24 L/min line.

Like I say, I need to determine by the 28th which mask I want to go with. Is the leak rate pattern I'm seeing with the Swift FX (lower median but higher maximum, 18.0 at 95th percentile) or the Mirage Liberty hybrid (higher median but lower maximum, 11.4 at 95th percentile) more desireable? Or are my leak rate results close enough between the two masks that it's not really much of an issue? As a newbie, I'd appreciate any thoughts or comments from more experienced CPAP users. Thanks in advance!

Everyone is different, but for me, I'd go with the lower overall leak.

There's lots of folks who can help with taming the Liberty, so reducing leaks on that mask should get the numbers down even further.

More importantly than anything else, are the leaks waking you up? If you're sleeping through the leaks, and they're staying below 24 L/min, it may be something you can just fiddle with over time =)

Occasional leak spikes of short duration near that 24 L/min red line or even short spikes past that line, may not impact therapy that much. While it is nice to see a perfect zero leak line it is not a critical issue. The machines can do a very decent job of compensating for leaks.

If the leaks wake you...that is a problem though. If they don't wake you, use the mask that you seem to sleep more comfortably with. The one that gives you the best rest.

I don't go by the leak numbers so much. I go by that leak line itself. It gives a truer image as to whether the leak is large enough and more importantly prolonged enough to possibly impact therapy.

I have used nasal pillow mask my entire 2 1/2 years of therapy. I have tried other mask types.
Mouth breathing or opening? I did that for about 2 months when I first started therapy. I opted to tape my mouth.
So taped for 2 months, got lazy and started to "forget" to tape and found out that I don't need to anymore. Mouth pretty much stays closed now. I still may get an occasional blip of some size on my leak reports but it is rare that it might be large enough and long enough to hurt things. For me the overall comfort of the nasal pillows far outweighs the occasional leak that "might" impact therapy and more importantly....I sleep so much better with it than I did when I tried the other mask types (and I have tried many)

Too bad DME wants to "hold" the Swift FX and forces you to choose. They can't do anything with it anyway.
Should you wish to keep the Liberty (it is very expensive) there is a way to build your own Swift FX...Ebay.
Sellers sell the replacement parts. So put together what you need and you have one. Someone a couple of weeks ago got the Headgear and short hose..new for $35 plus $4 shipping and the seller included one nasal pillow on the side.
Deals are there just have to watch closely. Some sellers price things way too high.

b360155,

I'm asking an obvious question here: When you switched to the FFM from the pillows mask, did you or the DME change the mask setting on the S9 Autoset? That mask setting is what controls what the machine subtracts off the leak rate to get the unintentional leak rate. If you're using a FFM with the mask setting set on pillows, the machine will report leak that is simply not there because the expected leak rate for the FFM is greater than that of the pillows mask.

Also, I'm with pugsy: If the leaks are not bothering you and they stay well below that RedLine for the vast majority of the night with only occasional upward blips now and then, I wouldn't get overly worried about chasing a perfect leak line. Now, if the leaks are waking you up, that's a different thing altogether: Any leaks that disturb your comfort need to be dealt with.

robysue wrote:b360155,

I'm asking an obvious question here: When you switched to the FFM from the pillows mask, did you or the DME change the mask setting on the S9 Autoset? That mask setting is what controls what the machine subtracts off the leak rate to get the unintentional leak rate. If you're using a FFM with the mask setting set on pillows, the machine will report leak that is simply not there because the expected leak rate for the FFM is greater than that of the pillows mask.

Also, I'm with pugsy: If the leaks are not bothering you and they stay well below that RedLine for the vast majority of the night with only occasional upward blips now and then, I wouldn't get overly worried about chasing a perfect leak line. Now, if the leaks are waking you up, that's a different thing altogether: Any leaks that disturb your comfort need to be dealt with.

Yes, I read through the manual and it said with the Liberty to set it to the FFM setting, so I did change it when I changed masks. With both masks, the first night or two I haven't slept very well, just getting accustomed to the new contraption on my face, I guess. Then, I've had a few nights where I'll wake up once or twice during the night...I guess due to the leaks (one very loud thunderstorm one evening though with the Liberty). And with both masks, I've had nights where I've slept all the way through the night after the first few days break in period. So, I think from that perspective, either mask should provide similar sleep quality. Sometimes I get too wrapped up in the numbers as I've read several posts in searches about leak rates that say that as long as you're not seeing prolonged periods with leaks above the line, sleep quality is the most important determining factor.

Thanks for the comments and advice!

Pugsy wrote:Occasional leak spikes of short duration near that 24 L/min red line or even short spikes past that line, may not impact therapy that much. While it is nice to see a perfect zero leak line it is not a critical issue. The machines can do a very decent job of compensating for leaks.

If the leaks wake you...that is a problem though. If they don't wake you, use the mask that you seem to sleep more comfortably with. The one that gives you the best rest.

I don't go by the leak numbers so much. I go by that leak line itself. It gives a truer image as to whether the leak is large enough and more importantly prolonged enough to possibly impact therapy.

I have used nasal pillow mask my entire 2 1/2 years of therapy. I have tried other mask types.
Mouth breathing or opening? I did that for about 2 months when I first started therapy. I opted to tape my mouth.
So taped for 2 months, got lazy and started to "forget" to tape and found out that I don't need to anymore. Mouth pretty much stays closed now. I still may get an occasional blip of some size on my leak reports but it is rare that it might be large enough and long enough to hurt things. For me the overall comfort of the nasal pillows far outweighs the occasional leak that "might" impact therapy and more importantly....I sleep so much better with it than I did when I tried the other mask types (and I have tried many)

Too bad DME wants to "hold" the Swift FX and forces you to choose. They can't do anything with it anyway.
Should you wish to keep the Liberty (it is very expensive) there is a way to build your own Swift FX...Ebay.


Sellers sell the replacement parts. So put together what you need and you have one. Someone a couple of weeks ago got the Headgear and short hose..new for $35 plus $4 shipping and the seller included one nasal pillow on the side.
Deals are there just have to watch closely. Some sellers price things way too high.

Thank you Pugsy and Talon NYC for your replies!

I don't know about taping my mouth, that idea doesn't thrill me too much, but it did seem that the longer I used the chin strap with the Swift FX, the lower my leak rates were getting. I've read posts where people have said that you can "learn" to keep your mouth closed and/or keep your tongue pressed against the roof of your mouth. I'm not sure how you train yourself to do that, but I guess it must be possible. Actually, my girlfriend was waking up and hearing some of the air leakage when my mouth would open so that contributed to my experiment with the Liberty and she sleeps better when I use the Liberty.

I offered to purchase the Swift FX from the DME that I'd used thinking that maybe I could get a good price from them and have it to use in case I decided the Liberty wasn't going to work out. They said that they have to return it to the manufacturer though to get credit for the mask under the 30-day free exchange deal. I did notice that the Liberty was one of the higher priced masks out there though, so if I had any inkling of using the Liberty long term (wish the test period could be a little longer), I thought I'd keep the Liberty and maybe purchase the less expensive Swift FX from the host site outside of my insurance plan. Never even thought about buying CPAP masks on eBay, but I do purchase a lot of stuff on eBay so I checked it out and see quite a few listings. I guess by law they can't sell the complete mask, but by purchasing the components as replacement parts, they can get around that law and it appears I may be able to indeed put together a Swift FX for less money, so thanks for that suggestion!

b360155 wrote:I don't know about taping my mouth, that idea doesn't thrill me too much, but it did seem that the longer I used the chin strap with the Swift FX, the lower my leak rates were getting.

When I first started cpap therapy I read about "taping" and thought OMG, how horrible, no way would I do that.
But I did. I did some experiments first to alleviate my concerns, the main one being could I easily break that seal IF power went off and there was minimal air movement. Using the blue painters tape I discovered it is really quite easy to break the seal. Minimal effort really. A yawn will do it. It is NOT like cementing your lips shut.

Wouldn't you know it the first night I decided to tape we lost power due to a thunderstorm. I woke up to this strange quiet. I was breathing through my nose with my mouth still taped but other than minimal air flowing...it really was not that distressing. No feelings of suffocation or such. I realized power was out. So I just yawned to open mouth and break the seal. No big deal. There is air movement through the vent holes with power off, not a lot, but enough that I sure was not in any panic or distress. Vomiting? I wake up long before I ever throw up. Happened a couple of weeks ago when I had stomach bug. Of course I don't tape now but I woke up very early with the telltale upset stomach. Hubby says what are you doing getting up now.. "I just figured it would be better to puke in the toilet" Sure enough, about 30 minutes later it started. Lasted a couple of hours. I just dozed on the couch a little between running to the bathroom.

Taping or polygrip strips isn't for everyone. There is the potential for some very remote risks and if it bugs you too much, then don't do it. But if you are curious. Try it in the daytime and play with sealing just how easily the seal is broken.

Just found this forum. Curious, what do you mean by taping ? I seem to have alot of what I call 'face farts' and seem to have air leaking. How do you find out your leak rate. I did pull out the little card and inserted it in my computer, but it did not want to open anything ?

In addition, where can a person purchase the cushions for the Resmed Mirage Liberty, they are so expensive.

elsiesmom wrote:Curious, what do you mean by taping ?

This should get you started with explanation. Lots of reading.
viewtopic.php?t=8011

elsiesmom wrote: How do you find out your leak rate. I did pull out the little card and inserted it in my computer, but it did not want to open anything ?

Depends on your machine. There is software available for some machines that offer full data.
You need more than the little card. You need a machine that has the leak data AND software or at least a machine with full data on the LCD screen.

Please register here at the forum and then add your equipment so we can see if the machine you use even offers data.
Often they don't. Sometimes all the data that little SD card will show is how many hours you use the machine.
wiki/index.php/Registering_Equipment_in_User_Profile

Replacement cushions for the Liberty? Where have you looked for prices? DME? or online?
https://www.cpap.com/productpage/Mirage ... shion.html
If I have time I will poke around elsewhere.

Thank you so much for the information, I actually found on the screen that my leak rate is 30% ???? Guess I need to read up about that too.

I have the Philips Respronic System 1
Mask is the Resmed Liberty Mirage.

debralj wrote: I actually found on the screen that my leak rate is 30% ???? Guess I need to read up about that too.

On screen leak data is % of time spent in large leak. 30% of the time that you use the machine you are having horrible leaks.
For Respironics to call a leak LARGE.. it has to be humongous.

Do you have the software to use? Know about the software? If not, explained here.
viewtopic.php?f=1&t=64906&st=0&sk=t&sd= ... re+options

Pugsy wrote: Too bad DME wants to "hold" the Swift FX and forces you to choose. They can't do anything with it anyway.
Should you wish to keep the Liberty (it is very expensive) there is a way to build your own Swift FX...Ebay.
Sellers sell the replacement parts. So put together what you need and you have one. Someone a couple of weeks ago got the Headgear and short hose..new for $35 plus $4 shipping and the seller included one nasal pillow on the side.
Deals are there just have to watch closely. Some sellers price things way too high.

Thanks again for the suggestions Pugsy! I've made my decision and have followed your advice. I told the DME I'm going to keep the Mirage Liberty hybrid mask. I've been using it since 10/19 and since then my median leak rate is 1.2 L/min, the 95th percentile is 5.4 L/min and the maximum is 12.6 with an AHI of 0.6. The last 4 days have been even better since I switched from the medium to the large size nasal pillows in the Liberty mask with median of 0.0, 95th of 1.8 and max of 4.2 and AHI of 0.5. I'm ecstatic that I've been able to get these kinds of results in such a short amount of time! I really like the Liberty mask so far. It's all-in-one, I don't have to wear the separate chin strap, it's comfortable and quiet, it's not as big and bulky as the other full face masks, I'm getting excellent results and I'm starting to sleep through the nights.

I also have followed your advice on piecing together a Swift FX mask on eBay. In three separate auctions, I've been able to get the headgear, the short air supply hose and 2 nasal pillows...everything I need for $72 including shipping. Not too shabby! It'll give me some extra piece of mind to have a fallback mask.

One suggestion I haven't tried yet and maybe never will is the taping the mouth shut part. That just doesn't appeal to me very much. Two out of three ain't too bad though, don't you think? Thanks again!!!

b360155 wrote: One suggestion I haven't tried yet and maybe never will is the taping the mouth shut part. That just doesn't appeal to me very much. Two out of three ain't too bad though, don't you think?

No, 2 out of 3 is pretty good. I opted for tape when I felt like I needed because I simply could not/would not go for a full face mask. I do understand it isn't for everyone and I am sure okay with that. Besides archangle would come along and give you is dire speech and this way he saves his fingers.