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What leak rate is OK for restful sleep?
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Carbon Offline

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Machine: Resmed Airsense 10
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Other Comments: EPR 3cm, Autoramp from 8cm

Sex: Male
Location: Australia

Post: #1
What leak rate is OK for restful sleep?
I think I mouth leak maybe every second night for 10 min or so, but find a chin strap (tried most of them now) gives me terrible sleep in combination with my nasal pillows. With the chin strap, my pressures go up about 2 points, I'm very restless, and fatigue gets worse, though the mouth leaks seem to stop. The mouth leaks don't really bother me that much, though I usually get up for a few minutes to rinse my dry mouth.

Even with the chinstrap my other leaks continue (side-sleeping x pillows) - I'm wondering if they are at OK levels? I imagine if I got a full face mask to fix the mouth leaks, general leaks would probably worsen anyway? I wouldn't care about them except to date I'm still quite fatigued despite 3 months AHI's <1, and this is one of the possibilities I'm looking at.

Last week, no chin strap -
average leak 2.1L/min
90% 6.0 L/min
Large leak Min 0.01%, Med 0.5%, Max 0.8%
03-27-2016 10:12 PM
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palerider Offline

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Post: #2
RE: What leak rate is OK for restful sleep?
whatever leak rate doesn't bother you.

as long as it's under 24lpm, the machine can compensate.
03-27-2016 11:08 PM
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Carbon Offline

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Machine: Resmed Airsense 10
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Other Comments: EPR 3cm, Autoramp from 8cm

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Post: #3
RE: What leak rate is OK for restful sleep?
Whether it is bothering me is what's what I can't work out - trying to figure contributing factors to ongoing fatigue
03-28-2016 01:41 AM
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PaytonA Online
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Machine: ResMed S9 VPAP Auto
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Post: #4
RE: What leak rate is OK for restful sleep?
Your leak rate data seems quite good. I would not worry about leaks unless they are waking you up.

Best Regards,

PaytonA
03-28-2016 12:08 PM
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robysue Online
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Post: #5
RE: What leak rate is OK for restful sleep?
(03-27-2016 10:12 PM)Carbon Wrote:  I think I mouth leak maybe every second night for 10 min or so, but find a chin strap (tried most of them now) gives me terrible sleep in combination with my nasal pillows. With the chin strap, my pressures go up about 2 points, I'm very restless, and fatigue gets worse, though the mouth leaks seem to stop. The mouth leaks don't really bother me that much, though I usually get up for a few minutes to rinse my dry mouth. (emphasis added)

Personally I would choose comfort over pursuing a great leak line graph here. Even if the mouth breathing results in an official Large Leak for 10 minutes or so every couple of nights, that's not enough time in Large Leak territory to seriously affect the quality of your therapy.

But you've got lots of evidence that wearing the chin strap does adversely affect the quality of your sleep and the mouth leaks are both rare enough and short enough that they're not really an issue anyway. Without a chin strap your leak numbers are quite acceptable:
Quote:Last week, no chin strap -
average leak 2.1L/min
90% 6.0 L/min
Large leak Min 0.01%, Med 0.5%, Max 0.8%

So my advice is ditch the chin strap (for comfort reasons) and ignore the minor mouth breathing leaks as long as they really are in the 10-15 minutes range every couple of nights or so.


Quote:Even with the chinstrap my other leaks continue (side-sleeping x pillows) - I'm wondering if they are at OK levels?

In terms of leaks there are two things to worry about:

1) Official Large Leaks that go on long enough to adversely affect your therapy and the accuracy of the data.

2) Smaller leaks that disrupt your sleep.

Official Large Leaks
In terms of #1, there's a lot of debate around here about how long is too long. Resmed's materials suggest that if the leaks are less than 24 L/min for at least 70% of the night, that's good enough. (Resmed defines an official Large Leak as an excess leak rate >= 24 L/min. Resmed only records the excess leak rate.)

So that's a starting point: If your official Large Leaks last less than 30% of the night and you're feeling pretty good, you might decide that's good enough. For a lot of people around here though, the idea of having Large Leaks for 20-30% of the night is still problematic enough to decide what to do about them.

I personally don't have too many problems with official Large Leaks. I see the occasional largish leak that's just shy of official Large Leak territory a lot more often than I see official Large Leaks. As a general rule, I don't typically worry about the largest of my largish leaks unless they make up more than 20% of the night or so. If I see an official Large Leak that lasts for 10 minutes (out of 5-6 hours of usage), I'm going to just ignore it as long as there's solid evidence that I slept through the leak without any problem.

Smaller leaks
My own philosophy is that any leak that disturbs your ability to get to sleep, get back to sleep after waking up, or routinely wakes you up multiple times a night is a leak that has to be dealt with---even if its size is well below the official definition of Large Leak for your machine's manufacturer.

The name of the game is to get a good night's sleep. If you're waking up every 30-60 minutes to fiddle with the mask because there's a small leak that's blowing air into your eyes, you're not going to get a good night's sleep no matter how low the AHI is.

Which brings us to:
Quote:I imagine if I got a full face mask to fix the mouth leaks, general leaks would probably worsen anyway? I wouldn't care about them except to date I'm still quite fatigued despite 3 months AHI's <1, and this is one of the possibilities I'm looking at.
Getting a FFM may or may not increase your general leaks even though it would fix the (very small) problem with a 10-minute mouth breathing leak that happens every other night.

The question is whether the smaller leaks are what's causing you to feel unrested. Without actually seeing some leak lines from the nights where you feel at your best (however "bad" that might be) and at your worst the next day, there's really no way to objectively tell you that leaks are or are not the cause of your on-going problems.

Questions about SleepyHead?
See my Guide to SleepyHead
03-28-2016 12:57 PM
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Carbon Offline

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Posts: 53
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Machine: Resmed Airsense 10
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CPAP Software: SleepyHead

Other Comments: EPR 3cm, Autoramp from 8cm

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Post: #6
RE: What leak rate is OK for restful sleep?
Thanks robysue for all that detail!

I have looked through a months data and there appears to be no relationship between my 95% leak rates and AHI. If anything AHI is a bit better with more leaks (large leaks usually <1%). So leaks do not appear to be my issue regarding fatigue, and I now am confident in managing leaks just by whether they are waking me or not. Another box ticked! Just pressures (still working minimum up to my 90%) and PLMD (seeing physician) to sort out.
03-28-2016 03:42 PM
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Mosquitobait Offline

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Post: #7
RE: What leak rate is OK for restful sleep?
(03-28-2016 01:41 AM)Carbon Wrote:  Whether it is bothering me is what's what I can't work out - trying to figure contributing factors to ongoing fatigue

There are a lot of causes of ongoing fatigue. You could have RLS (Restless Leg Syndrome) that wasn't caught during your study. You could have low iron. There could be another illness involved. On another forum, unrelated to this one, there were a couple of posters whose thyroid function was barely into normal. Medication resolved the problem. Also, look at your study for other clues.
03-29-2016 08:59 AM
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