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Does CPAP machine work effectively with Large Leak?
#1
Does CPAP machine work effectively with Large Leak?
My father-in-law's CPAP machine shows a Large Leak for 49% of the nightYet, his AHI is only 4.33.  Does that mean that the machine is successfully compensating for the Large Leak OR does the Large Leak mean the machine can't get a good reading on his AHI?  It seems to me that his machine can't possibly be treating his sleep apnea very well, if there is a Large Leak for half the night.  Yet, I would have expected his AHI to be very high, if the machine wasn't able to treat his sleep apnea effectively.  Also, I would have expected the machine to start pumping very high pressures, to make up for the Large Leak.  But, his Average Pressure is only 7.19 and his pressure is 12.16 for 95% of the time.  

The doctor didn't seem concerned about the Large Leak.  I've been trying to convince my father-in-law that he cannot use the nasal pillows (ResMed AirFit P10) because he often opens his mouth while he sleeps (and the air from the machine goes out his mouth, and never reaches his throat to fix his Obstructive Sleep Apnea OSA).  But, my father-in-law hates wearing any kind of full face mask.  We tried various devices (like chin straps and mouth tape) but when the pressure reaches 14 or 16, the air breaks through his lips anyway.  

Also, he doesn't even wear the nasal pillows tight enough.  Sometimes air leaks from his nostrils (because the seal is inadequate).

I tried to get the doctor to tell my father-in-law that he needs to wear a full face mask, otherwise the machine is useless.  But, the doctor said "the Large Leak must not be a problem because his AHI is low, and that's all that counts".  Is that true?  Is that accurate?  

Why would the manufacturer say that the leak must be below 24 liters per minute, if it doesn't matter if the leak is larger than 24 and lasts for a long time?

I'm attaching a screenshot from Oscar showing his leak and other numbers.  I'm also attaching a graph view from one of his nights.

He has an AirSense 11 AutoSet.  

Any opinions or insights would be greatly appreciated.  I don't know if I should be arguing with the doctor, searching for a new doctor, or believing the doctor.

   
   
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#2
RE: Does CPAP machine work effectively with Large Leak?
You may want to include the detailed daily chart from OSCAR as well. However, here's the reality about leaks. ResMed redline for leaks is that 24 L/Min, but as it approaches this line, it will get less accurate. When it does go over, it'll be even worse.

Here's my car analogy, your left rear tire has a 2 inch gaping hole in the sidewall. There's likely no air compressor that can keep up with that, and the pressure gauge will not indicate accurately.

The statistics you indicate are it only had large leaks at about 50%, but it also says the range of leaks averages 32.95, with a 95 percentile at 120.

Y'all gotta get this under some semblance of control. As is, I suspect all the rest of the therapy data to be unreliable in accuracy. It's not possible to have any usable therapy with this very high leakage. This tells us you're correct, the mouth leak is basically an unattached open circuit.

The doctor is absolutely wrong.

You may need to strongly suggest switching to the full face mask, or have the FIL tape his mouth to stop the leaks.
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Positional Apnea

Attach OSCAR, etc.

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