Large Leaks

[ginzo]

Good Morning,

I'm still a newb but am catching on pretty fast. I appreciate all the help I have gotten so far and hope to contribute soon.

As the title says, I have/had a LL issue. With a chin strap and 2 kinds of nasal pillows, I seem to be getting a handle on it, (somewhat).

I'm very fortunate, as with therapy, this is my only battle. All else seems to be within parameters.

Here are 2 screen shots from SL software. 1 from my 1st day, and the 2nd is just last night.

Can someone PLEASE, in plain English, (explain it like I'm stupid), tell me what would be a target on LL's, what median, maximum and 90 (or 95 in ResScan) percentile means.

I think I can mudle through (so far) the rest of the data, but this is making my head spin. And when I finally get it, I'm going to go

Regards,
Chuck

P.S. I'm still working on getting the images in thread correctly. Please forgive me, as I add it to my "to do" list here.

[img]1st Day 7-17-2015 by Chuck Cangialosi, on Flickr[/img]

[img]Today 8-16-2015 by Chuck Cangialosi, on Flickr[/img]

[AlanE]

Morning Chuck.

ResMEd uses a leak rate of 24 liters per min (L/min) and above as a large leak. Your target leak rate is 0.

All masks have a 'leak'. The vents on your mask intentionally vent air. This allows Co2 you exhale to be vented to the room. This is considered normal and the machine expects this and should not record it as a leak.

A leaking seal and/or mouth leaks are not good. With a pillow mask, like the P10, you can have air entering your nose and escaping out of your mouth or you could be bypassing CPAP all together and breathing in and out of your nose. Not likely with pressurized air but could happen. The other type of a leak would be equipment malfunctions. A hole in the hose, or a hose connection.

Looking at your chart it looks like you are losing a seal at the end of your ramp time when you reach your set pressure. You might want to tighten up your mask a little bit more (not too tight) or wear a chin strap depending on where the leak is (seal or mouth). Having the mask too tight is just as bad. One of the things we fight with is trying to find that sweet spot and that changes frequently. You have a fixed pressure so you are at an advantage.

As for what median, maximum and 90/95 percentile means:

Median is 50%. 50% of the time you were at this level or below and 50% of the time you were at this level or above. Referring to your first chart, 50% of the time you had your mask on your leak rate was at 31 or less (0 to 31 liters per min) and also 31 or higher (31 to maximum).

95% means you were at that level or less than that level and 5% of the time you were at that level or higher. 95% of the time you had a leak rate of 73.20 or below (no leak to 73.2 liters of air per minute excess flow) and 5% of the time you were at that level or higher 73.2 to maximum).

Maximum is the maximum recorded leak rate. Hard to read your chart but it looks like 91.20 L/m. Obviously you have a major leak issue.

Your AHI numbers are fantastic but events may not be recorded accurately because of your leaks. Work on getting the seal fixed and you should feel even better.

Let me know if that helped or just made it more confusing.

Alan

[MobileBasset]

Hi Chuck,
As you said, you have made some progress with the leaks and your second chart shows that. Have you determined where the leaks are originating from? I know you have been trying chins straps and you may not be as sensitive as I am because I awaken when air leaks from my mouth and I would notice it, especially if I was wearing a chin strap and the air had to force itself out around it. I don't suspect a hose leak because your recent data shows a median value of zero and I would expect a non-zero median with the hose leaking.

When I first used my chin strap I wore it very snug to make sure no leaks would escape and then loosened it a little at a time to find the best adjustment. This allowed me to rule out mouth leaks while I addressed the mask leaks that remained. Are you mastering the tongue placement against the roof of your mouth? Suck it gently against the roof and train it to stay there. That really helps.

I found that having a clean mask to face interface really made a difference with mask leaking. Since you are using pillows, that might include the fresh application of a little lanolin on the nostril interface.
That's all I got. Congratulations on the great AHI numbers.

[AshSF]

Chuck: The flat tops in the leak rate chart are typically due to mouth leaks. You can work on that by tweaking your chinstrap settings and mastering the tongue seal trick.

Another thing To look into here will be to eliminate the ramp gradually. Also try to use the mask+machine while awake with no ramp, and see how the air pressure work and how the tongue seal hold under pressure.

The zig zag peaks are typically due to leaks at the nasal pillow/nostril interface. A typical reason for this is the hose and the little mask tube pulling your mask off your nose when you move around in your sleep. A strategy that has worked for me is to anchor the hose in a clip on the headboard of my bed. And the little hose of the mask is routed over my head to connect with the hose anchored on the headboard. This eliminates the problem of mask getting pulled off. Something you may want to try.

[ginzo]

Just a quick update, working on all of your suggestions. Trying different things. Slow process, I'm gonna get it yet!

[PaytonA]

Some of the large spikey leaks are not actual leaks but can be caused by a large rapid change in breathing.

[Seabird]

I second the suggestion to turn off the ramp, even just to test the mask fitting. I was having a lot of leaks for a while as well. I found that seating the mask correctly with full pressure helps you set it up correctly. I think your machine has a mask test mode which is helpful.

The other thing that helped me is that I eventually taught myself to keep my mouth closed while I am sleeping. It took a while but it did happen. That does look like a mask leak to me rather than a mouth leak.

[ginzo]

Good afternoon all,

I have made the following adjustments:
Tightened chin strap somewhat, using the P-10 system exclusively (med pillow), and during the session last night, (ignore the lag where I couldn't go back to sleep), here are the last 2 nights results.

During the lull, I have adjusted the ramp from auto, to 5 minutes, but have left the pressure from start at 5cmH2O, and max at 14cmH2O
EPR @ 3 is being reduced to 1.

My old machine (S-8) was at 8-15 ( I set it to 15) EPR @ 1, ramp 5 minutes.

Tonight will be the 1st full night at these settings, 5 minute ramp, EPR-1, 5cm-14cm


I got this from my Sleepy Head notes:

The question, of course is how much time in Large Leak territory is too much? Resmed provides a guideline for its users: Mr. Red Frowny face shows up on the Sleep Quality Report if your leaks are above the Redline for at least 30% of the night. When the Large Leaks last that long, Resmed's engineers believe both efficacy of the PAP therapy and the accuracy of the recorded data can be adversely affected. We will assume that 30% of the night in Large Leak territory is clearly bad news for users of any PAP machine. But many people may find that their therapy begins to be compromised by the time Large Leaks make up 20% of the night.

So with this being said, am I showing any improvement?

I feel well and rested. Am I trying to find something that isn't going to make a difference, it is fun and frustrating at the same time. At least at this point, my S-10 is giving me a "thumbs up" every morning as compared to all the frownie faces before I started the chinstrap.


Thanks All,
Chuck

[img]screenshot-Weds 2015-08-19 by Chuck Cangialosi, on Flickr[/img]

[img]screenshot-Thurs 2015-08-20 by Chuck Cangialosi, on Flickr[/img]

[img]screenshot-20150821-133849 by Chuck Cangialosi, on Flickr[/img]

[AlanE]

If I had numbers that low and felt refreshed in the morning I'd be doing a happy dance.

[MobileBasset]

gonzo,
The following question is not meant to imply that you should change your settings in any way as your event numbers are very good and I am not qualified to recommend changes.

I notice you are using your autoset machine in CPAP mode at 14 cmH2O rather than autoset mode. Why is that?

I ask because higher pressures are more prone to leaks and the autoset mode might find a lower but still effective pressure.