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High leaks with nasal pillows, but low AHI. what's that about?
#1
High leaks with nasal pillows, but low AHI. what's that about?
I started having issues with mouth leaks while wearing my P10 nasal pillows. However my AHI was always excellent--like a 0.6 average. One DME said the leaks were irrelevant if they didn't bother me; a second recommended a full face mask. I started with that and my leaks are now non existent, but my AHI is higher--still good, avg. 2.5

But the full mask bunches up my skin just below my normal puffy under eyes and is creating new bags. So last night I went back to my P10 and didn't experience the mouth leaks that had begun occurring even when awake. the mask was like it was for all those years with no issues. The smiley face on the Airsense showed in my mask seal area. But the online report showed a different story--my leaks went very high. But my AHI was back to being 0.7.
 
I thought that I was sleeping for longer periods with the full face mask but I slept just as well last night with the P10.

How can I have higher leakage and lower AHI? 

I tried that half mask which fits under your nose without much luck. that would address the eye bag problem if I could get it to work.

That's my story. I thought I had come to a resolution mask wise but the eye bags are bad. I don't think they're caused by leaks. Maybe the smaller full mask would fit lower on my face and not cause issues.
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#2
RE: High leaks with nasal pillows, but low AHI. what's that about?
If you post your nightly charts it would really help us to understand what is happening.

Leaks.  It depends.
'Large Leaks' are never good.  Leaks with higher AHI levels implies that the leaks are hindering the machine treating the events.  If the events are few, low AHI, your .5 qualifies, you can handle higher leaks.  The response to contain all leaks via a FFM was IMHO reactionary, a conditioned reflex in a response to ALL leaks are bad.
Fred Bonjour - Project Manager and Lead Tester for OSCAR - Open Source CPAP Analysis Reporter 
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#3
RE: High leaks with nasal pillows, but low AHI. what's that about?
Merci, monsieur Bonjour! I'll use the nasal pillows again tonight and see what happens. I really do prefer that mask to a full face mask. IF I can sleep for four or more hours at a time.
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#4
RE: High leaks with nasal pillows, but low AHI. what's that about?
So after three nights back on with my P10 nasal pillows, the same thing has happened. My leaks as measured on the Resmed site are at 40 leaks per minute; with the full face mask they're at 0 to 4, consistently.

and still my ahi score is lower with the nasal pillows: 0.5 with the pillows.

I'm wondering if my habit of taking off the mask without turning off the machine and letting it auto stop is actually registering as a major leak? It doesn't do this with my full face mask.

In the end I seem to be sleeping as well with either mask. 

I tried a chin guard to no avail. I may try taping once again to see if I can get used to that.
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#5
RE: High leaks with nasal pillows, but low AHI. what's that about?
I recently experienced this when I switched from nasal pillows to a full mask.  I could keep it on longer each night, but my AHI got considerably worse.  I looked at my pressure history and found that my machine was constantly bumping up against the upper APAP limit (7 in), suggesting to me that the machine thought it should go higher. 

I discuussed this with my Dr just this week and he said that the literature supports my observation - all things being equal, face masks seem to require higher pressure settings than nasal pillows to acheive the same result.  So he told me to change the setting to a range 5 to 12.  I did that, and the results look promising, though it has only been a couple of days.  The machine is adjusting up and down within that range over the night instead of hitting its head on the ceiling all the time.  And the average AHI went down.

I am still dealing with leaks around the face mask, but that is just a matter of tweaking the velcro buckles a bit each night to find the right amount of tightness.
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#6
RE: High leaks with nasal pillows, but low AHI. what's that about?
Without OSCAR data, this is only a guess. When the leaks go up, accuracy of flagging/tracking events on your machine goes down and the readout of AHI is artificially low. The reverse may also be true. When leaks go down, accuracy goes up and the real value of events appear.
Dave

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INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEBSITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#7
RE: High leaks with nasal pillows, but low AHI. what's that about?
Dave, what you say makes sense. I tend to feel better using a full face mask; and in fact I noticed that I was sleeping for longer periods wearing the face mask. also I was beginning to feel slightly oxygen deprived (or so it felt to me) in the mornings with my nasal pillows, which is a huge sign. However going back to the p10 for those three nights I felt fine. Hmmm.

I have no idea about how to post the on line resmed data and I'm pretty averse to all things computer, sooo

again, my chart starkly and consistently shows leaks in the 35 40 l/hr range with nasal pillows, as opposed to very low (often no) leaks with the full face mask; and an average 0.6 ahi with nasal pillows; 2.4 with face mask.
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#8
RE: High leaks with nasal pillows, but low AHI. what's that about?
OK that's important. If you feel better, more comfortable on full face, keep at it. Always do what gives you the highest comfort level you can obtain. Remember we were not born with a mask and air hose coming off our face.

FWIW a ResMed leak redline is 24 L/min, if you're under that, the machine has enough room to compensate, but accuracy would be a bit questionable in relation to higher leaks.

The best way to report usage data is via OSCAR from your PC. If it's not a workable thing for you, as in you may not have the PC, then so be it. If it's a matter of help to install it, that hurdle can be overcome.
Dave

OSCAR
Standard OSCAR Chart Order
Mask Primer
Dealing With A DME
Soft Cervical Collar Wiki
INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEBSITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#9
RE: High leaks with nasal pillows, but low AHI. what's that about?
My problem with eye bags and morning squashed face remains. I have far less of that with nasal pillows.

I may try the half mask again if I can find it. (fits under the nose and over the mouth). that might solve a lot if I can get it to work. Or maybe a different model.
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#10
RE: High leaks with nasal pillows, but low AHI. what's that about?
If we can assume that all masks have a 'general leak threshold' that the 'common' user will experience, the smaller sealing perimeter and inner volume on the nasal masks is much easier to deal with by the software and fan than it would be on the larger styles of masks.  All things being equal, the smaller mask, if it has leakage at, say, 15%, will be more easily corrected by the machine than it would be on, say, a full-face 'large' mask with the same leak rate.  But, one of those masks will have a higher efficacy, probably, by comparison, and that's why your AHI is still handily dealt with when you check your results each morning.
Serial Tapist
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