Acceptable Leak Rate

I'm using a mirage activa mask. My pressures are 21/16 and my leak rate is 36. Wondering what an acceptable leak rate would be with
these higher pressures that I have. My ahi last night was .8. Wondering if any events are slipping by? All of my leaks are mouth breathing.

Your signature shows you are using a Resmed S9 VPAP. Resmed machines report only the unintentional leaks, not the intentional ones. And Resmed defines any leak AT or ABOVE 24 L/min as a Large Leak.

While an occasional short lived leak above 24 L/min is not really a problem, you need to avoid prolonged leaking AT or ABOVE 24 L/min. On the short version of the on-board Sleep Quality Report, you can check for Mr. Green Smiley and Mr. Red Frowny each morning.

Mr. Red Frowny shows up when the leaks are AT or ABOVE 24 L/min for at least 30% of the night. At that point the Resmed engineers believe that the quality of your therapy is definitely being adversely affected by the prolonged Large Leaks.

But note: Mr Green Smiley will show up if you are leaking AT or ABOVE 24 L/min for 25% of the night. And that's enough leaking where it can be problematic for many people. Hence it's best to look at the leak line in either SleepyHead or ResScan to determine how much time you're spending in Large Leak territory.

You write:

my leak rate is 36

Without knowing more information, it's impossible to tell whether this leak rate is horribly unacceptable, moderately unacceptable, marginally acceptable, or perfectly fine.

If that number is coming off the machine's LCD, then it represents the so-called 95% leak rate. For 95% of the night you were leaking AT or BELOW 36 L/min and for 5% of the night, you were leaking AT or ABOVE 36 L/min.

It is possible that you were leaking AT or ABOVE 24 L/min for 60-70% (or more) of the night and have a 95% leak rate of 36 L/min. It's also possible that you were leaking at a rate of LESS than 5 L/min for 90% of the night and still have a 95% leak rate of 36 L/min. In the former case, the leaks are clearly unacceptable; in the latter case, they're actually very good.

So first question: Who shows up on the Sleep Quality Report each morning? Mr. Green Smiley or Mr. Red Frowny?

Second question: What does a typical leak graph look like in SleepyHead or ResScan?

http://s743.photobucket.com/user/Bennny ... sort=3&o=0

Here is my chart from last night. Disregard the first 30 minutes, I was checking my leaks while watching tv. This is a typical leak rate
for the last 4 weeks. I did raise my epap from 14 to 16 last night to see if my ahi or leaks would change. My leaks stayed the same and my
ahi went from an ave of 6 to .8. I originally lowered my pressures in an attempt to get my leaks under control (thanks to pugsy) so that is
why I raised my pressure back up. So I think I'm on the right path. Just wondering about the leak situation. I originally was using a ffm
with no success, Leaks were over a 100.I switched to a nasal mask about a month ago, and that lowered my leaks considerably. ( thanks to pugsy again). Chin strap didn't work for me. Not sure if I'm comfortable taping.

More history is here and before people tell him he is mouth breathing and needs a full face mask..leaks were worse with the full face mask. This is a much improved leak line considering what we were first dealing with..see this thread below for further details and more information.
viewtopic.php?f=1&t=95589&st=0&sk=t&sd=a

At times the leak is so big that the lack of events getting flagged we can't trust that nothing happened. Maybe nothing did and it wouldn't be impossible but also maybe the machine threw up it's little hands and said "I can't tell what's going on so I won't report nothing".
I don't see any green unknown apnea flags though so that makes me hopeful.
At least you are maxing out mostly near 35 L/min instead of 80 L/min like you were doing.
I know this is far from perfect but it is good compared to what we were seeing....he doesn't want to tape at all (even for one night to see if for sure this is mouth breathing leak) .....we have tested the equipment with a period of time of awake breathing to see if leaks are zero then..and they are so equipment damage isn't a reason..

Personally...if I got a Mr Green smiley face on the machine with last night's report...I would accept it for now.
I think you are mouth breathing but I can't prove it. I am not there in your bedroom and I can't see if the mask simply is fitting awful or you are mouth breathing.
That's why I suggested taping...even for just a couple of hours...only to try to figure out if we for sure are dealing with mouth breathing...so that maybe we had a better idea what we need to fix to make your leak graphs show not so much big leak.

From my own personal experience with the S9 and big leak territory....around 30 L/min big leak I saw clusters of events pop up and the S9 flagged them as OAs...regular OAs...meaning it could still sense and flag them but obviously the pressure therapy was impaired or they wouldn't have happened...
Then at 35 L/min leak...I get green apneas...unknown apneas....likely they are obstructive but the machine can't tell for sure.
Then leaks above 40 L/min...big blank area on the reports...and since right before it at 35 L/min leak I got green apneas then I have to assume the machine just totally couldn't sense anything. I don't think they went away and weren't happening....but I can't prove it.
It took me a long time to have a period of large leak that it was bad enough that I could get all the above correlation of details and leaks and something to show up on the report...My OSA is worse in REM sleep...I just happened to have a big leak in REM stage sleep that lasted long enough to get some correlation as to how bad...bad is. It might be different for someone else but it will be close. Just because ResMed says 24 L/min is the beginning of large leak territory doesn't mean that things go to hell real quick once we go past that line. It goes to hell slowly and from what I can figure out...you are totally there at 40 L/min...getting close at 35 L/min....and still far enough away at 30 L/min not to get burned.

Here's Benny's last night image. It's ugly but it really is a big improvement over the others.

I'm going to second what Pugsy is saying in light of the history she reports for the OP.

So it looks like the leaks have improved with the nasal mask even though this is still a pretty ugly leak line. Seems like the prudent thing to do is to check for Mr. Green Smiley vs. Mr. Red Frowny every morning in addition to looking at the 95% leak number. If Mr. Red Frowny is showing up a lot, then it's clear the leaks still need to be dealt with sooner rather than later. If Mr. Green Smiley is showing up most of the time, then it may be that just need to be learning to live with the leaks is the way to go---as long as the leaks are not sky high, the way they were with the previous FFM.

http://s743.photobucket.com/user/Bennny ... l?sort=3&o

Here's my graph from last night. I checked my machine when I woke up this morning. Mr. red frowny face showed up. I've tried a few ffm
when I first started, and didn't have much success. I would prefer to sleep with a nasal mask, as it is much more comfortable. Not that a ffm
is out of the question. Any suggestions on how to lower the leaks? I'm pretty sure that this is all mouth breathing. My ahi is pretty good, so maybe I should just relax . My ahi is coming down cosintently as every day goes by. Quite honestly I changed the pressure to much and didn't
give any of them enough time.

It's hard to estimate how much time was actually spent in leaks over 24 L/min but it roughly looks like 50 % and probably maybe 25% of the time over 30 L/min.
The 30 L/min line would be my line in the sand that I would really, really like to avoid if it were me and I was in your shoes. It isn't an ideal goal but considering your situation...it might be the lesser of two evils.

Which is worse...the leaks you had with a full face mask or the leaks you have with a nasal mask and mouth breathing?
The full face mask leaks were much, much worse and effectively putting the entire night's worth of therapy in the toilet where with the nasal mask only part of the night is in the toilet. Plus you prefer the comfort of the nasal mask and likely are sleeping better with it.

For mouth breathing leaks...you have these choices
1...tape...which you aren't comfortable doing
2...chin strap...which you have tried and not had much success with but maybe you could try a different kind...there are many different models available and some work better than others for some people.
3...accept that things aren't perfect and hope the brain eventually figures out not to open the mouth. Some therapy is better than no therapy...and even imperfect therapy is better than no therapy.
4...your could try a different full face mask...they aren't all created equal but all present the challenge of greater real estate needing to seal and the extra challenge of maintaining a good seal at your pressures.

All this is assuming that the mouth breathing is NOT related to any nasal congestion issues and is more from habit and not a real need to breathe through mouth. If you are having nasal congestion issues...those need to be dealt with but I don't remember you ever really mentioning chronic or bad nasal congestion.

What are the advantages and disadvantages of taping. Could it be dangerous or life threatening?

Take a stroll through all these threads
viewtopic.php?t=8011

The tape isn't like cement...depending on what tape is used it can be easily loosened with just a big yawn.
I tried it while awake just to see how easily it could be loosened or removed.
If your nose isn't stopped up...you can easily breathe through your mask using the vent holes.
The very first night I tried taping all night we had a thunderstorm and lost power. I woke up because of the silence and not from being in distress.

Last summer I woke up and power was out but I was breathing quite comfortably...decided to check to see just how long I had been without power so got up and checked clock and then the software report...20 minutes I was breathing using the vent.

Risks? Everything in life has risks.

I did tape for about 2 months when I first started therapy because my leak reports looked a lot like yours.
The tape could easily be loosened or removed...I used cheap old blue painters tape that I had tested while awake just to see how much force was needed to break the seal...minimal force.
After a couple of months I got lazy and quit taping and found out that my mouth had learned to stay shut for the most part.

Taping isn't for everyone though...gotta be comfortable doing it and some people just can't get comfortable with the idea.
Heck, I remember the first time I read about someone taping...I thought "no way in hell would I do that"...but I had a choice...full face mask or tape and full face mask was something I couldn't/wouldn't do for various reasons.
Chin straps moved around on my head and were more annoying than the tape was for me. Woke up a gazillion times with the chin straps.

Some people put little slits in the tape so they can get air through the tape if needed...the main idea with the tape is a gentle reminder to keep the mouth shut...it isn't meant to act as super glue.

How about a hybrid mask. Don't hear to much about them. Look like there are only 2 available.

Yes, only 2 of the hybrid mask types and if you haven't tried one...by all means try one.

I would suggest the Innomed/Respcare Hybrid over the ResMed Liberty though...the Innomed Hybrid comes with 3 sizes of cushions so potentially easier to figure out which size works best. The Liberty you have to decide on size when you buy it.

It's a SOB to get sealed initially (I tried it once and if I ever just HAD to use a FFM that would be what I would use) but once you get past that hurdle it isn't a bad mask and we have lots of forum members using hybrids quite successfully.

http://s743.photobucket.com/user/Bennny ... sort=3&o=0

I tried my new liberty last night. My leak is only 6.4. Wow best ever. I went to bed around 11 and woke at 2:30 decided to look at data, and
found out I forgot to put card in machine. Went back to bed. Here is last nights chart. My concern all along has been that I have not been
feeling better. So I have worked hard on controlling leaks. The problem is that I suspect that with the leaks being so big things are slipping
by. My overall AHI for the last 18 days has been 3.3 and my leaks have been around 38. I do have random nights where my AHI jumps up to
over 10. On those nights I have tons of centrals at the end of my sleep cycle. Just like the one I posted. Are my high pressures causing
the centrals? In my first sleep study it says that there were 140 central 12 obstructive and 7 hypopneas. in my tritration study it says that
I was tritrated bipap to a setting of 22/18. No mention of centrals. I know I had a very poor tritration study.

That leak line...I won't say anything but great job. Doing the happy dance for you.

Were you by any chance awake or not when that ugly bunch of centrals happened? If not...you need to be getting with your doctor. Sooner than later.

If you had centrals during the initial sleep study (before titration)..

Bennnyp wrote:first sleep study it says that there were 140 central 12 obstructive and 7 hypopneas.

the problem isn't pressures causing the centrals but centrals being present even without a machine and based on this information here...OSA would not be the primary diagnosis.. Central sleep apnea would be I would think. Not OSA.

http://s743.photobucket.com/user/Bennny ... b.jpg.html

Here's an example from March 2nd.

I wish you could somehow come to terms with the blue painters' tape. Could you just try using it while sitting in a chair for awhile? Then trying it while sitting in the chair with your machine on(with your mask), watching TV?
I am a very clostraphobic-type person and I got used to the tape. Do I like it? No! But it's the only way I can keep the air going down into my lungs. And in the mornings, I am thankful for it. For me, chinstraps still don't keep the air in.

I haven't read your history, but I would encourage you to try it again and slowly get used to it. Good luck!