leak rate...too high??

Can you help me interpret? Looking at my AHI and snore rate, I had an amazing and best ever night. My question is about the leaks...As you can see I had three sessions last night...each time I woke up, it sounded like the Pacific Ocean waves were running through my Pilairo mask. Should I be concerned about my total leak rate? According to the chart for my mask at my CPAP 15 pressure, the flow rate is 40. I must admit that although I have read all the information about the charts, I do not know what a "normal" reading should look like. What are the normal parameters for leaks?
I appreciate your input
Linda

Your "normal" should be what you see around the 03:00 time mark. That short little level line (top line) right around 3 AM. Hard to see exactly what number it would be but I think very much midway in between the 38 and 57 shown. That is going to be pretty much your baseline I think. Mask vent rates shown in the literature have a + or - 5 or 6 L/min anyway. What you see at the beginning of the night once the pressure increases past ramp time to where it stays stable is probably also very close to baseline.
That line is generally level.

When you start getting above 60 L/min you are starting to get close to large leak territory. If you used Encore it would tell you if those leaks in the 70s and 80s meet large leak criteria. SleepyHead doesn't but Encore will specifically flag large leak times.
I have seen some reports where large leak was flagged at 75 L/min and I have seen reports where large leak was not flagged at 85 L/min. We aren't ever told exactly where large leak territory is. Me personally I have never seen a large leak flagged until I hit 90 L/min.

Maybe what I need is an education. Am I suppose to be looking at the purple line or the green line as the leak line? In addition if my AHI is so low, do I even need to worry about the leak line. This may be even a dummer question...if my mask feels totally sealed, where are the leaks coming from?

Top line is the green line and that is the total leak number (vent rate plus excess leak). The bottom leak line would be the approximate excess leak only line. Some SleepyHead versions will still show that line (yours does) but it doesn't always seem to show up. I used to see it with my PR S1 machines and then it stopped. Since most people when they talk about Respironics machines leak rate will be talking total leak then that is what I talk about. Mark hasn't perfected the bottom excess leak only number.

You can trust the AHI data as long as you don't go way above large leak territory for prolong periods of time. Since you really didn't likely hit large leak territory (got close) then I would count the data as valid. Should you happen to go into large leak only the possible data during the large leak time would be suspect. In large leak territory the machine may not sense the events properly and might miss scoring some events possibly giving a false low AHI. This is a maybe because it sort of depends on how high the leak goes. I have had leaks up to right at 100 L/min and the worst thing that happened was during that time I actually had more events scored and I assume they happened because the leak caused the therapy pressure to drop below the level needed to adequately prevent the events. I have seen a couple of reports (not mine) where leaks were into the 120 range and they were from APAP machines and the machine's pressure line was flat lined making it look like a cpap pressure. This meant that the machine didn't know what to do at those leak levels. It didn't know to increase the pressure for sure. Those large leak numbers are very rare.

If your AHI is low and you stay below large leak territory and the leaks never wake you up to bother your sleep quality then you don't really need to put the leak line under the microscope.

The baseline leak number line...that comes from the vent on the mask. That is recorded as leak but it is the intentional leak.
When you see the increases above the sort of baseline...like that increase around 4 AM...that is excess leak for sure. Where is it coming from? Unknown really. Could be the mask slides around a bit losing the seal when turning over in bed or whatever or if using a nasal mask it could be from a bit of mouth breathing. Even if you do have some leak getting real close to or above large leak territory it isn't the end of the world unless it is prolonged. It looks like the large leak may have caused you to wake up around 5:15. If that is what woke you up then the fact that it disrupted your sleep is probably more important than possible loss of therapy at that time you see above 76 L/min. I don't know for sure that this would be large leak territory for you. Like I said...sometimes Encore reports will flag it at 75 and sometimes 90. So without Encore in this situation I don't know if you crossed the line or not.
Even if you did it was for around an hour or so. If the leak had been massive during that time it still only affects that time frame. The rest of the night the leak was well within acceptable limits. So an hour of bad leak (if yours would be called bad) certainly doesn't negate the rest of the night. Now if things were reversed and you only had 1 hour of sleep with well controlled leak then we would be having a different discussion.

If this report is a fluke and you rarely see stuff like this and you rarely wake up because of leaks...then I wouldn't do anything more than shrug my shoulders if I saw this report. Heck, I know I cross into large leak territory sometimes but rarely lasts more than a few minutes, doesn't wake me up so I don't worry about it. I don't freak out if my leak line is less than perfect zero.
I care more about my quality of sleep. 10 minutes in large leak territory isn't the end of the world. If I wanted to make sure I got a perfect zero leak number I could crank the mask down much tighter, add a tight chin strap and/or tape my mouth but doing that isn't so comfortable and I likely wouldn't sleep so great. I choose comfort first.
All I ever do is eyeball the leak line for time spent really close to or above large leak territory. Unless I spend a lot of time above large leak line....I don't even bother to look at the numbers.

Pugsy,
I really appreciate the time you are spending with me explaining leaks. I downloaded the same info for the same night using Encore. If I am reading the info correctly, large leaks for me do not begin until 120. Is that correct?

yulcdn wrote: If I am reading the info correctly, large leaks for me do not begin until 120. Is that correct?

No...that is just as high as it will go and they just stuck the LL above that number. That's the way all graphs show up in Encore.
Though I can see where it might appear that we can go up to 120. We can't. In fact at about 110 your machine will throw up its little arms and quit. I saw an APAP report where the pressures didn't vary at all at 110. It simply couldn't sense anything and didn't know what to do so it did nothing but straight cpap pressure. The person thought the APAP was broken because it wasn't varying the pressures. The leak was so huge for the entire night that it did look like straight cpap pressure. Fixed the leak and the machine started doing the normal stuff APAP does.

It is possible to have Large leak flagged at 90, or 80 L/min.

What we can tell by this graph is that at the highest point of your leaks the machine did not flag them. I suspect your large leak flags would show up around 90 L/min. It is obvious that they aren't flagged now at the 85 L/min highest it ever got. I bet if you ever manage to hit 90 or just a little above 90 that you will see a large leak section be flagged.

Thank you for your help Pugsy. I am beginning to get the idea of the graphs. I appreciate that you are so willing to give of your time and expertise.