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High Leak, Low AHI - is it working or not?
#1
Gross 
Hello!

I am using Resmed Airsense 10 and have 2 masks - pillow type p10 and nasal type Mirage FX.

As I was prescribed pressure 10 by my doctor, I am using

RAMP 20min,(starting from 5)
EPR 2 (RAMP only)

and full time pressure 10 during my sleep, with no EPR.
I am using the Mirage, as I found the pillow type somewhat uncomfortable at the pressure of 10.

As I have experienced some leaks since my CPAP experience, i am currently sleeping with my mouth taped, with slight side vents.

Last night I had lowest AHI ever, but the High leak percentage worries me.

Last Night statistics:
AHI 1.3 (Apnea Index Obstructive 0.2 Central 0.4 Unknown 0.6 / Hypopnea Index 0.0)
Leak Median 33.6 95th Percentile: 42.0 Maximum 56.4


What actions should I take? any suggestions?


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#2
Your leaks are much to high to be able to rely on the data being delivered. I suggest you may need a chin strap or else consider getting a hybrid mask that will cover your mouth and have nose pillows as well.

Dude
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#3
chinstrap, plus try to form the habit of doing the Tongue Suck thing (my sig)
هههههه هههههه هههههه هههههه هههههه هههههه هههههه هههههه هههههه هههههه هههههه هههههه هههههه هههههه
Tongue Suck Technique for prevention of mouth breathing:
  • Place your tongue behind your front teeth on the roof of your mouth
  • let your tongue fill the space between the upper molars
  • gently suck to form a light vacuum
Practising during the day can help you to keep it at night

هههههه هههههه هههههه هههههه هههههه هههههه هههههه هههههه هههههه هههههه هههههه هههههه هههههه هههههه
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#4
I agree with the others you have almost continuous high leaks. During that time the machine can't compensate for the leaks and the low AHI reading is meaningless. As suggested you could try a chinstrap and the "tongue suck" but you might be better served going to a full-face mask like the Quattro Air, F10 or Simplus. (Or maybe a hybrid mask as Dude suggested).

In any case, you must get the leaks under control, as you're not getting any meaningful therapy with leaks like that.
DeepBreathing
Apnea Board Moderator
www.ApneaBoard.com


Bed

INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#5
Daria knows what she is talking about. She even knows the definition of guck. Big Grin Big Grin

Seriously, the tongue seal is very important and the right chin strap can help to remind your tongue to maintain the seal. Daria's advice is excellent.

Best Regards,

PaytonA
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#6
I've used that tongue technique since I started CPAP. Also had to use a chin strap at first.

Once I mastered the tongue technique, I was able to toss the chin strap. Dreaming

Agree that your priority has to be to get the leak rate down. It's easy to be duped into thinking that the leak rate is ok if the AHI reading is low, but that's not always true. If your leak rate is over the threshold, the machine may not be able to reach the pressure needed to "catch" an apnea.
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#7
(03-05-2016, 10:52 PM)DariaVader Wrote: chinstrap, plus try to form the habit of doing the Tongue Suck thing (my sig)

Thank you, I will try to practice the tongue suck.
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#8
(03-06-2016, 08:52 AM)OpalRose Wrote: I've used that tongue technique since I started CPAP. Also had to use a chin strap at first.

Once I mastered the tongue technique, I was able to toss the chin strap. Dreaming

Agree that your priority has to be to get the leak rate down. It's easy to be duped into thinking that the leak rate is ok if the AHI reading is low, but that's not always true. If your leak rate is over the threshold, the machine may not be able to reach the pressure needed to "catch" an apnea.



Thank you all, for sharing your opinions.
I should focus on trying to lower the Leak results.

Just want to make sure one thing though -
if the leak rate is between 24~30, is it safe to trust the AHI?
or does the leak rate HAVE to be lower than 24L/MIN to trust the AHI?
(24L/MIN is the red line across the graph)


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#9
I think that if the majority of your events are outside the large leak areas, then the AHI will be reasonably accurate. If you have a lot of events during times of large leakage, then the exact kind of event may not be accurate, but the machine did detect something, so the numerical value of AHI may be approximately correct, but the treatment can't be known until the leak rates and durations are brought down.

Does this make sense Huhsign
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#10
Hi Pholynik. I think the problem here is that the leak is above the red line continuously from 04:15 through to 08:15 with only the occasional brief downward spike below the line. Personally I wouldn't trust any figures during that period. If the leak is all mouth leakage then it will be hard for the machine to detect anything reliably - a lot of air is going in the nose and out the mouth without troubling the airway into the lungs.
DeepBreathing
Apnea Board Moderator
www.ApneaBoard.com


Bed

INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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