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Leak Graph Interpretation
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PaytonA Offline
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Post: #1
Leak Graph Interpretation
[attachment=712]
This is a topic that came up in another thread but was a little off the subject so I am starting a new thread. I asked the question if one could tell whether or not leakage was mouth leakage from the data. The initial answer from robysue was that it was possible (I think I remember this correctly) if one had the leak graphs. Zonk gave me a link to the ResScan Clinician Manual. I looked at their graph and it does not look a lot like what I am seeing so I will post a screen shot of my most recent (last night).

Comments please.

PaytonA
(This post was last modified: 02-24-2014 01:47 PM by PaytonA.)
02-24-2014 01:43 PM
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herbm Offline

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Post: #2
RE: Leak Graph Interpretation
I am going to claim that is "mouth leak", but not directly from looking at SHAPE of the graph but rather the timing.

That much leak for hours at a time would be driving you CRAZY if it were escaping from the mask itself. 60+

Question: Does the Resmed VPAP Auto 25 use leak figures as the S9 does, i.e., not total leak but leak after subtracting the normal mask leak -- does it have a limit of 24 (or more like 60 as the Respironics do?)

If it's limit is 24 that is a LOT of leak. It's still too much even if the cutoff is 60.

How else would this volume of leak occur without you waking up to the mask whistling in your eye etc.?

Sweet Dreams,

HerbM
Sleep study AHI: 49 RDI: 60 -- APAP 10-11 w/AHI: 1.5 avg for 7-days (up due likely to hip replacement recovery)

"We can all breathe together or we will all suffocate alone."
02-24-2014 01:53 PM
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robysue Online
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Machine: PR Dreamstation BiPAP Auto
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Post: #3
RE: Leak Graph Interpretation
PaytonA,

You've got a LOT (and I mean a LOT) of leaking going on.

On a Resmed machine, you need the leak line to stay below the red line at 24 L/min and the further below that line the better.

Even during the periods where your leak is at its least it's flirting with the Red line all night long. Out of curiosity: What was your median leak rate for this night?

If you have an S9 VPAP, there's a mask fit feature: Did Mr. Red Frowny show up? (I can't imagine why he wouldn't have shown up on a night like this.

So---either you are doing a heck of a lot of mouth breathing (which is possible) or you've got some other serious problems causing the leaks (which is also possible) or both.

As bad as the peak (unintentional) leak rates are---up around 80 -100 L/min for what looks like an hour or more of total time in bed----the "base leak rate" of around 20 L/min for the first two hours of the night is also a concern. While technically under the 24 L/min threshold for "large leaks", the leaking during this period is still substantial enough to worry about. The only "decent" part of the leak graph is the 50 minute period between 2:40 and 3:10, when the leaks were at 10 L/min.

So ...

Are they mouth leaks? Well my guess is that breathing through the mouth is certainly contributing to your problem. I'd say that the periods where your leak rate is bouncing around up near 50 L/min or above are probably mouth leaks. The places where the leak rate is bouncing up and down are probably when you're opening your mouth for a few minutes of breathing and then closing the mouth back up to breath through your nose for a few minutes. The largest bump in terms of length and height---the bump at 90 L/min that lasts from 1:50 to 2:15 might be some extended mouth breathing or the mask might have been bumped to the point where it was partially ajar. You'll notice that during that particular period of excessively high leaking the machine is also recording a very low respiratory rate of 5 breaths per minute. Chances are the machine was having a very tough time detecting any breathing at all. (Out of curiosity: Is your VPAP an S9 VPAP or an S8 VPAP?)

But I don't think mouth breathing is your only problem. The fact that your unintentional leak rate is always relatively high points to the possibility of more than one potential problem.

So it is worth carefully checking your hose for pin-sized holes that can cause constant leaks. Also check the where the coupling and the hose are joined together. And make sure your humidifier is properly attached to the blower unit and that the lid is firmly down and latched. Also check the mask cushion for tears and holes and make sure all the mask parts are there and are properly assembled. If you can't find any leaks in the system, it's worth doing some daytime debugging: Put the machine together and the mask on, turn the machine on while you are lying down and do your best to get the best seal you can. When you think that there are no leaks at all (if that's possible), breath through your nose for at least 10-20 minutes while you're awake. Make sure you keep your mouth as tightly shut as you can and feel for leaks around the edge of the mask and also around your mouth---particularly the corners of your mouth. And then down load the data and see what the leak line looks like: If there are no noticeable leaks and you know you were not breathing through your mouth, your leak line should be pretty close to 0 L/min. If it's not, then a trip to the DME may be in order.

All that said, I will repeat this: the periods with the largest unintentional leaks do look like mouth breathing to me. But I don't think mouth breathing explains the unintentional leak rate of 20 L/min for the first two hours of the night.
02-24-2014 02:59 PM
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zonk Offline

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Machine: A10 AutoSet
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Post: #4
RE: Leak Graph Interpretation
Firstly ....... is your mouth feel dryish in the morning?
Secondly ... congrats sleeping right thru the night

Looks to me, some mouth leak is evident but would not dwell about the nature of leaks, its not easy with pressure as yours 16/20

Have you got a chinstrap, the other choice is full face mask but I cannot get it working with pressure above 10
02-24-2014 03:26 PM
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PaytonA Offline
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Machine: ResMed S9 VPAP Auto
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Mask Make & Model: Resmed Mirage Quattro
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CPAP Pressure: VAuto MinE14.0 MaxI 20.6 PS4.0
CPAP Software: ResScan SleepyHead

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Sex: Male
Location: Orange County,California

Post: #5
RE: Leak Graph Interpretation
(02-24-2014 02:59 PM)robysue Wrote:  PaytonA,

You've got a LOT (and I mean a LOT) of leaking going on.

On a Resmed machine, you need the leak line to stay below the red line at 24 L/min and the further below that line the better.

Even during the periods where your leak is at its least it's flirting with the Red line all night long. Out of curiosity: What was your median leak rate for this night?

If you have an S9 VPAP, there's a mask fit feature: Did Mr. Red Frowny show up? (I can't imagine why he wouldn't have shown up on a night like this.

So---either you are doing a heck of a lot of mouth breathing (which is possible) or you've got some other serious problems causing the leaks (which is also possible) or both.


All that said, I will repeat this: the periods with the largest unintentional leaks do look like mouth breathing to me. But I don't think mouth breathing explains the unintentional leak rate of 20 L/min for the first two hours of the night.

First, my machine is an S8 VPAP auto 25.
Second, I have just switched from bilevel to auto mode. Bilevel setting was IPAP-20, EPAP-16.
Third, I had a chin strap on although I am new to the chin strap and not completely sure that I am using it as effectively as possible.
Fourth, my median leak for this night was 22.8 L/min. This was neither the best nor the worst night I have had for leaks.
Fifth, to answer Zonk's question - yes my mouth is dry every morning. Some mornings it is worse than others and some mornings it is almost not bad at all.

The seals and cushion are no more than a week old. Is there some way to leak test the system using the built in pressure or flow sensors? I will do visual and manual checks again just to make sure and try the awake test. I imagine the mask setting in the machine might have some bearing on the calculation of the leak rates. I have it set for a Swift mask which has close to the same vent flow rate at 20 cm as the F&P Zest nasal mask that I am using. the machine came originally set for an Ultra mask.

I will post what I find out. Thanks!

PaytonA
02-24-2014 08:59 PM
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robysue Online
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Machine: PR Dreamstation BiPAP Auto
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Other Comments: Papping since September 2010

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Post: #6
RE: Leak Graph Interpretation
(02-24-2014 08:59 PM)PaytonA Wrote:  an S8 VPAP auto 25.
Drat. Does the S8 VPAP have any kind of mask fit feature???

Quote:Second, I have just switched from bilevel to auto mode. Bilevel setting was IPAP-20, EPAP-16.
Third, I had a chin strap on although I am new to the chin strap and not completely sure that I am using it as effectively as possible.
High pressures do make it harder to get a good seal, but on a Resmed machine, the leak that is reported is unintentional leak, and so regardless of the pressure settings, the goal is to keep the leak rate below 24 L/min all night and as close to 0 as possible.

Quote:Fourth, my median leak for this night was 22.8 L/min. This was neither the best nor the worst night I have had for leaks.
That indicates that you were leaking AT or ABOVE 22.8 L/min for 50% of the night. That's way, way too much time above or near the Large Leak line in my opinion. You want to try to get that median leak rate way down.

Quote:Fifth, to answer Zonk's question - yes my mouth is dry every morning. Some mornings it is worse than others and some mornings it is almost not bad at all.
Start tracking this. If the amount of dryness is proportional to the size of the worst leaks or the median leaks rate, then you know that mouth breathing is the main culpret.

Quote:The seals and cushion are no more than a week old. Is there some way to leak test the system using the built in pressure or flow sensors? I will do visual and manual checks again just to make sure and try the awake test. I imagine the mask setting in the machine might have some bearing on the calculation of the leak rates. I have it set for a Swift mask which has close to the same vent flow rate at 20 cm as the F&P Zest nasal mask that I am using. the machine came originally set for an Ultra mask.
For the hose, I attach one end to the faucet in my bathroom and turn the water on as high as possible and put my thumb over the other end of the hose just enough to build up some water pressure. If there's a leak, it's easy to spot because of spray.

Overall, however, I would recomend that you take everything apart and put it back together carefully. And then use the machine while awake for 20 minutes or so while you KNOW your mouth is closed. If the leak line for that 20 minutes is still in the teens, you will know there's something else going on in addition to the mouth leaks.
02-25-2014 09:20 AM
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PaytonA Offline
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Machine: ResMed S9 VPAP Auto
Mask Type: Full face mask
Mask Make & Model: Resmed Mirage Quattro
Humidifier: H5i(distilled-top up)
CPAP Pressure: VAuto MinE14.0 MaxI 20.6 PS4.0
CPAP Software: ResScan SleepyHead

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Post: #7
RE: Leak Graph Interpretation
(02-25-2014 09:20 AM)robysue Wrote:  
(02-24-2014 08:59 PM)PaytonA Wrote:  an S8 VPAP auto 25.
Drat. Does the S8 VPAP have any kind of mask fit feature???

Quote:Fifth, to answer Zonk's question - yes my mouth is dry every morning. Some mornings it is worse than others and some mornings it is almost not bad at all.
Start tracking this. If the amount of dryness is proportional to the size of the worst leaks or the median leaks rate, then you know that mouth breathing is the main culpret.


For the hose, I attach one end to the faucet in my bathroom and turn the water on as high as possible and put my thumb over the other end of the hose just enough to build up some water pressure. If there's a leak, it's easy to spot because of spray.

Overall, however, I would recomend that you take everything apart and put it back together carefully. And then use the machine while awake for 20 minutes or so while you KNOW your mouth is closed. If the leak line for that 20 minutes is still in the teens, you will know there's something else going on in addition to the mouth leaks.

S8 has a mask fit feature that when activated runs for 2 minutes prior to ramp or settle. It gives a 0-5 star leakage display. It does not do much good for me since my mask has the forehead stabilizer and I can not read the display without my glasses.

I changed one thing yesterday. I changed the mask setting to Ultra. This seems to have dropped the whole recording by about 10 cm. which makes sense. I have a 20 minute settle. Last night I made sure that I stayed awake for about 45 minutes after starting VPAP. My leak rate stayed at around 10 L/min for 2.5 hours before it started all of the blast offs. I think it would have been around 20 L/min with the old mask setting. Every time during the night that the leak rate was in the good area it was around 10 L/min.

I did a little manual checking while I was awake and I think that I identified a leak in the mask. I think that it is leaking around the swivel joint where the elbow goes into the mask shell. It is hard to be certain because it is so close to the mask vent area.

I will include a screen shot of last night's graph

[attachment=713]

PaytonA
02-25-2014 11:49 AM
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zonk Offline

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Post: #8
RE: Leak Graph Interpretation
(02-24-2014 08:59 PM)PaytonA Wrote:  Third, I had a chin strap on although I am new to the chin strap and not completely sure that I am using it as effectively as possible.
Fourth, my median leak for this night was 22.8 L/min. This was neither the best nor the worst night I have had for leaks.
Fifth, to answer Zonk's question - yes my mouth is dry every morning. Some mornings it is worse than others and some mornings it is almost not bad at all.
chinstrap cannot stop air escaping thru the mouth if the air is not going where suppose to go
The other question, does your nose get stuffy, the stuffier the nose ... the more you mouth breathe
I've found this ebook by Steven Y. Park, M.D very helpful
http://www.apneaboard.com/forums/Thread-Un-stuffing-Your-Stuffy-Nose

and "Nasal Breathing Video Series".... see commercial posts for the link

I've used Zest in the sleep study but have found Activa LT works better for me (Activa LT and SoftGel cushions fit on the same frame) ymmv
(This post was last modified: 02-25-2014 01:59 PM by zonk.)
02-25-2014 01:28 PM
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PaytonA Offline
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Machine: ResMed S9 VPAP Auto
Mask Type: Full face mask
Mask Make & Model: Resmed Mirage Quattro
Humidifier: H5i(distilled-top up)
CPAP Pressure: VAuto MinE14.0 MaxI 20.6 PS4.0
CPAP Software: ResScan SleepyHead

Other Comments:

Sex: Male
Location: Orange County,California

Post: #9
RE: Leak Graph Interpretation
(02-25-2014 01:28 PM)zonk Wrote:  
(02-24-2014 08:59 PM)PaytonA Wrote:  Third, I had a chin strap on although I am new to the chin strap and not completely sure that I am using it as effectively as possible.
Fourth, my median leak for this night was 22.8 L/min. This was neither the best nor the worst night I have had for leaks.
Fifth, to answer Zonk's question - yes my mouth is dry every morning. Some mornings it is worse than others and some mornings it is almost not bad at all.
chinstrap cannot stop air escaping thru the mouth if the air is not going where suppose to go
The other question, does your nose get stuffy, the stuffier the nose ... the more you mouth breathe
I've found this ebook by Steven Y. Park, M.D very helpful
http://www.apneaboard.com/forums/Thread-Un-stuffing-Your-Stuffy-Nose

and "Nasal Breathing Video Series".... see commercial posts for the link

I've used Zest in the sleep study but have found Activa LT works better for me (Activa LT and SoftGel cushions fit on the same frame) ymmv

I am not a chronic mouth breather and do not suffer unduly from stuffy nose. I do not mouth breathe while awake but I can not say for sure that I do not do so while asleep. What I can say is that I do not wake up at any time breathing through my mouth. I have awakened with my mouth closed and a bubble of air escaping through my lips at times. It takes a while after the first escape for the pressure in my mouth to build up for another bubble to escape. This happens when my mouth is dry and apparently it is too dry to make a complete seal with my tongue.

Best Regards,

PaytonA
02-25-2014 05:08 PM
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zonk Offline

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Post: #10
RE: Leak Graph Interpretation
From S8 manual: Star ratings for the mask-fit and patient Smart Data features
--------------------------- Indicative Leak Measure
Star rating --------------- (L/s) -------------- (L/min)

* * * * * (Excellent) ----- 0.00–0.18 -------- 0.0–10.8
* * * * _ (Very good) ---- 0.19–0.26 -------- 10.9–15.6
* * * _ _ (Good) --------- 0.27–0.34 -------- 15.7–20.4
* * _ _ _ (Adjust mask) -- 0.35–0.41 -------- 20.5–24.6
* _ _ _ _ (Adjust mask) --- 0.42–0.49 -------- 24.7–29.9
_ _ _ _ _ (Adjust mask) --- ≥ 0.50 ------------ ≥ 30
02-25-2014 05:49 PM
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