Leaks, AHI... what is acceptable?

My mask leaks continually, usually just a little but but constantly. Sometimes the leaks are pretty bad though. My averaged nightly AHI stays under 10 (I know 5 is ideal) but some nights my AHI runs up to 25 or 30 over the course of an hour or so. Hitting 25 or 30 seems pretty bad, even if the averages look ok.

This data is with the Forma FFM. Generally speaking I wake up feeling happy using the Forma, with very little edema in my ankles. When I use my Mirage SoftGel nasal, I get AHI below 3 and almost no leaking at all, but I wake up miserable and with moderate to bad edema.

My fit problems with FFMs are consistent across brands. If the mask is the right width, it is always too long and leaks at the chin or eyes. I don't know if I will ever find a better fit than I have with the Forma. Should I keep looking , or is this data acceptable? I am going to try a mask liner, an anti-leak strap and gel cushions in turn to see if any one of these items can reduce/stop the leaking.

Opinions are very welcome.

Any leak no matter how small that causes frequent awakenings messing with the mask needs to be worked on just from the sleep standpoint.

If I am sleeping well. Don't wake up from the leaks and generally don't even notice them till I see a report and they aren't anywhere near large leak territory (around 90 L/min for Respironics machines) for a prolonged length of time I don't sweat the ups and downs of the leak line.

You mention your AHI but I did not see a leak number being reported.
If you look at your reports...what is the worst it gets?

Looking at one night where my AHI hit 30 twice, the leak rate fluctuates between 25 and 60 looking at the brown line, and 0 ad 30 looking at the purple line, using sleepyhead. There doesn't appear to be any correlation between leak rates and AHI. (Huh?) If some one could tell me how, I will post my data.

The top leak line is the Total Leak line so it is the mask vent rate and any excess leak. If the worst you see is occasionally 60 L/min...the leak should not be enough to impact the scoring of the events and the machine should be able to compensate for it. Do you see lower AHI on the nights when the top leak line (total leak) is much less? How much of your AHI is normally Clear Airway Index?

I use screen shots to post my reports.
Here's how I do it.
Open the image to full size so it is easily read.
I use Vista snipping tool to create a screen shot and crop the image at the same time.
Prt/scr key will also take a screen shot if using XP. If laptop is used sometimes the Fn key has to be pushed at the same time as the prt/scr key
I think windows 7 Home Premium has the snipping tool, Basic may not.
Once the screen shot is created save it in jpg format.
Upload the image to a host site. I use Photobucket it is free, there are others.
Once the image is uploaded then copy the ENTIRE IMG address. Be sure to include the opening and closing IMG in brackets. Paste that copied address into a post here.
Use the preview button. If you can't see the image try again because if you can't see it we can't.

Thank you for the precise directions, Pugsy.

I am sorry it is so small, I couldn't figure out how to make it bigger.

It seems to me with the leak rate high during a period of low AHI (3am to 5am) and the leak rate relatively lower during the period of high AHI (7am to 9am)... there is no correlation between leak and AHI, which really confuses me.



And the ideal AHI with the nasal mask produces misery and increased edema and the really high AHI produces happiness and very little edema... this also confuses me.

Can anyone shed any light on this? I am thoroughly puzzled and do not know which of the two masks I have I should use. Or should I look for a new mask altogether? I have been on CPAP for more than a year and a half and I still haven't found the right mask. It is a bit discouraging.

Your leak goes up as your pressure goes up but of course we see some events at the same time so kinda difficult to know who came first..and there are snores and the machine will also respond to snores with more pressure. More pressure increase chances for more leaks. And I see lots of RERAs...are you waking often..fiddling with mask or for some other reason?

What happens if you increase the minimum pressure? Have you tried that? Maybe just 0.5 cm?

Your leak...isn't horrible at its worst as far as impacting therapy but the leak might be impacting the quality of your sleep. If your sleep is fragmented...those events being flagged may be "awake" events and not real.

The leaking is definitely impacting my sleep. I do wake up frequently to adjust the mask. Annoying.

I can try raising the pressure a tad. I am not secure in doing anything more drastic than 0.5 or 1 cm, but I feel comfortable making a small adjustment like that.

But there might be relief in sight! I got really frustrated last night and made a make-shift anti-leak strap which STOPPED the leaking. So I will be ordering one from padacheek asap and use my make-shift one until then. I will be so happy if I can get this mask to work. I feel like I have tried 3 million masks without any success. So keep your fingers crossed for me.

Work on the leaks...consider a minor pressure adjustment...if those events are real..you are having enough of them that they also could be causing some wake ups. Anything that wakes us up is unwanted..even a minor leak. I only ignore leaks if they don't disrupt sleep and aren't in the large leak territory for very long.

snuginarug,

My take on your leaks is that they're probably right at the edge of being serious enough to affect the efficacy of your therapy and they are clearly large enough to affect the quality of your sleep.

Unlike Pugsy, I've got a bit stricter of a standard for when I start to worry about leaks on my PR System One BiPAP: Since it appears nearly impossible for my leaks to be flagged as "Large Leaks" by the Encore software (I've had 1 or 2 minute long Large Leaks in 15 months of using a PR), I tend to use the Resmed RedLine standard: If I see substantial amounts of time with my unintentional leak at or above 24 L/min, I start doing trouble shooting. By this standard, you've got some leak problems.

You write:

It seems to me with the leak rate high during a period of low AHI (3am to 5am) and the leak rate relatively lower during the period of high AHI (7am to 9am)... there is no correlation between leak and AHI, which really confuses me.

It could be that those periods with very high unintentional leak rates and low AHI have leak rates that are high enough to call the accuracy of the data into question. Once the leak rate is too high, the machine can have a bit of a tough time detecting the subtle differences in the wave form and it can fail to score some events.

The other things that I noticed about the data you posted are:

1) That big gap between 5:00 and 7:00. Did you just take the mask off and sleep without it?

2) During both the nap and the period after 7:00, there are a huge number of CAs scored. Were you very restless during these times? If so, that might explain the high number of CAs (and they might not all be "real CAs" in the sense of occurring when you were asleep). But if you frequently see this kind of pattern in your SH data, it's well worth going back to review the sleep studies to find out if they mention any problem with central apneas. And it may be worth mentioning to the doc that you are having really large numbers of CAs show up on your machine's efficacy data.

3) There's a fair amount of snoring going on during this night. Do you catch yourself snoring at times?

Finally you write:

But there might be relief in sight! I got really frustrated last night and made a make-shift anti-leak strap which STOPPED the leaking. So I will be ordering one from padacheek asap and use my make-shift one until then. I will be so happy if I can get this mask to work. I feel like I have tried 3 million masks without any success. So keep your fingers crossed for me.

Here's hoping that an anti-leak strap does indeed work wonders for you!

We can't use 24 L/min line standard for Respironics reports. That 24 Line is all excess leak in ResMeds.
Respironics report the vent rate in its numbers. Someone using a very low pressure is going to have a low vent rate and the total leak number is likely going to be low and very possibly under 24 L/min but one can can have a flat zero leak line on a Respironics report and the leak line itself be above 24 L/min.

My normal vent rate for my mask at my pressure is roughly 30 L/min. On a Respironics machine it is pretty much a physical impossibility to get a less than 24 L/min leak number when looking at the Total Leak number.

So I understand why Robysue likes to use a different standard and that is fine but if a Respironics machine user comes here and their vent rate is 40 L/min and they think that they shouldn't have above 24 L/min they are going to be in a panic.

To utilize the 24 L/min standard Respironics users need to add the 24 L/min to their mask vent rate and then they can have perhaps a different standard that they want to go by.
So using my 30 L/min vent rate as an example...I add 24 L/min to that and that would give me a 54 L/min line to watch.

If I saw someone with a consistent leak line between 60 and the "large leak territory number of 90"...and there vent rate pointed to something like my 54 L/min line if I was using ResMed standards and they reported not feeling so great...yeah...do something about the leak.
Short excursions to that area near "large leak" that don't wake a person up and they are feeling great with good numbers...I wouldn't worry about.

Now Encore Pro users have a choice...they can set the reports to show only excess leak like the ResMed machines do...then they can't use the 24 L/min line easily if they wish...
I mention this so that newbies who read this and are using SleepyHead or a version of Encore that doesn't allow leak reporting change to unintentional/excess leak...it is reporting total leak which is vent rate plus excess leak and you can't use the 24 L/min line as the guide because most of you are going to have pressures and masks with vent rates that exceed the 24 L/min line anyway.
So make sure you are comparing apples to apples.
Full face masks normally have a higher vent rate anyway.

robysue wrote:1) That big gap between 5:00 and 7:00. Did you just take the mask off and sleep without it?

No. I have terrible insomnia and frequently wake around 4 or 5, get up for a few hours, then go back to sleep. Lying down = mask. No mask = no bed.

robysue wrote:During both the nap and the period after 7:00, there are a huge number of CAs scored. Were you very restless during these times?

Yes. The leaks are small, but drive me crazy. The reason I am not just chucking the thing in the corner and searching for a new mask is two fold: one, I feel great when I wake up after using this mask, unlike all other masks I have tried and two, I have been searching for so long now, and this is the one FFM that, so far, has come the closest to fitting properly. I am asking for input to try to determine if I need to throw this mask on the pile of rejects and start again, or if this mask is good enough. I really feel great when I wake up, and it reduces my edema greatly.

I don't catch myself snoring, and I don't have a bed partner who can report what they witness. So maybe I am , maybe I am not.

robysue wrote:Here's hoping that an anti-leak strap does indeed work wonders for you!

Thank you so much for your kind wishes. You guys are a huge support to me.

Thanks. Pugsy, for explaining the difference between the data reporting of the two machines. I was quite worried when I first started my CPAP journey until someone explained the way Respironics machines report leakage.

snuginarug wrote:I am asking for input to try to determine if I need to throw this mask on the pile of rejects and start again, or if this mask is good enough. I really feel great when I wake up, and it reduces my edema greatly.

Feeling better....most important thing IMHO.
Your leaks aren't horrible...not real pretty but pretty doesn't guarantee feeling great. Some of the time you are getting awfully close to large leak territory but even crossing large leak territory doesn't mean that things are a total disaster and totally worthless for the entire sleep period.

I am a bit concerned with the arousals (RERAs) and the overall higher events but some of them may be the machine recording things happening when you are semi awake. So I don't know if they are the "real deal" and warrant concern especially since you are reporting feeling great.
The one and only "miracle" night I had about 3 months into my therapy was the next day after an AHI of 10.2. Go figure that one.

Up to you if you want to try a wee bit of a bump in that minimum pressure....I would do it if it were me but I am not you and I don't have the fragile sleep that you have. So.....just offering that one idea.
Keep it on the back burner...after getting the anti leak strap to see if taming the leaks themselves will reduce whatever is causing those events.