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High Leak, Low AHI - is it working or not?
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hs8738 Offline

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Machine: Philips Dreamstation Auto CPAP
Mask Type: Nasal mask
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CPAP Pressure: 10
CPAP Software: Not using software

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Sex: Male
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Post: #1
Gross High Leak, Low AHI - is it working or not?
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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(This post was last modified: 03-05-2016 10:10 PM by hs8738.)
03-05-2016 09:58 PM
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surferdude2 Offline

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Machine: ResMed S9 AutoSet
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CPAP Pressure: 12 ~ 20 & 11 ~12 if nasal mask
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Other Comments: Late stage 2 emphysema

Sex: Male
Location: Mousetown, Southern Illinois

Post: #2
RE: High Leak, Low AHI - is it working or not?
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
03-05-2016 10:15 PM
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DariaVader Offline
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Machine: Resmed S9 AutoSet
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Location: Oregon

Post: #3
RE: High Leak, Low AHI - is it working or not?
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
03-05-2016 10:52 PM
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DeepBreathing Offline
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Machine: Resmed S9 VPAP Adapt
Mask Type: Full face mask
Mask Make & Model: F&P Simplus
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CPAP Pressure: EPAP: 9 - 15 PS: 3 - 10
CPAP Software: ResScan SleepyHead

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Sex: Male
Location: Perth, Western Australia

Post: #4
RE: High Leak, Low AHI - is it working or not?
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
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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.
03-05-2016 11:37 PM
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PaytonA Offline
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Machine: ResMed S9 VPAP Auto
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Post: #5
RE: High Leak, Low AHI - is it working or not?
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
03-05-2016 11:42 PM
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OpalRose Offline

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Sex: Female
Location: Northeast Ohio, USA

Post: #6
RE: High Leak, Low AHI - is it working or not?
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.

OpalRose
(This post was last modified: 03-06-2016 08:54 AM by OpalRose.)
03-06-2016 08:52 AM
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hs8738 Offline

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Posts: 13
Joined: Feb 2016

Machine: Philips Dreamstation Auto CPAP
Mask Type: Nasal mask
Mask Make & Model: Wisp/Dreamwear
Humidifier: Philips Dreamstation
CPAP Pressure: 10
CPAP Software: Not using software

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Sex: Male
Location:

Post: #7
RE: High Leak, Low AHI - is it working or not?
(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.
03-06-2016 04:53 PM
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hs8738 Offline

Members

Posts: 13
Joined: Feb 2016

Machine: Philips Dreamstation Auto CPAP
Mask Type: Nasal mask
Mask Make & Model: Wisp/Dreamwear
Humidifier: Philips Dreamstation
CPAP Pressure: 10
CPAP Software: Not using software

Other Comments:

Sex: Male
Location:

Post: #8
RE: High Leak, Low AHI - is it working or not?
(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)
(This post was last modified: 03-06-2016 04:59 PM by hs8738.)
03-06-2016 04:57 PM
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pholynyk Online

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Location: Ontario, Canada

Post: #9
RE: High Leak, Low AHI - is it working or not?
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
03-06-2016 05:45 PM
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DeepBreathing Offline
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Machine: Resmed S9 VPAP Adapt
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Post: #10
RE: High Leak, Low AHI - is it working or not?
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
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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.
03-06-2016 06:02 PM
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