Switch to P30i Mask - success but high leak rate - problem?

[C123C]

Hello from long time lurker who has gotten a ton out of this board.

I have a have a Resmed Aircurve 10 VAuto which is a bipap for me. I run decently high pressures (50+ events per hour in diagnosis test so fairly severe) which had me in a full face F&P Simplex and later Vitera which need to be super tight to my face to get good pressures without the mask blasting off or making super loud noise at the seal/skin.

I previously tried mouth tape (unsuccessful) but now have a chin strap that works so I've moved to a P30i nasal pillow mask. From a comfort and lines in face/tightness perspective it's game changer and I love it. From an apnea perspective I'm getting 1-2 events per hour - same or just slightly above the full face but this is totally fine and sleep is good.

The only area of potential concern, and not sure it is if events are super low - is the leakage. I have the resmed set to Nasal Pillows and pressures I'm using are the same as my old mask 23.2 and 17.2. "Seal" or leakage is 35-45 L/min. Note that this is all coming from the mask vent up top not from the nose or pillows. I've read in research that nasal pillows will have a higher expected leak rate with higher pressures like mine but thought the Resmed machine set to nasal pillows might compensate rather than throw the red flag and tell me something is wrong.

Any issue here or anything I should be doing like lowering pressures on machine? Otherwise this is a big/good change for me.

[Pugsy]

Where are you getting your leak numbers?
Off the machine's LCD screen or software like OSCAR?

With that amount of leak (over 35 L/min) your nice low AHI might be low because the machine is unable to sense or record or respond to any apnea events.

[C123C]

Where are you getting your leak numbers?
Off the machine's LCD screen or software like OSCAR?

With that amount of leak (over 35 L/min) your nice low AHI might be low because the machine is unable to sense or record or respond to any apnea events.

Resmed myAir application for the leak numbers. Haven't used OSCAR but maybe I should. I've been using the mast 2 weeks and feel fine/good, not dragging at all - not scientific and no measurement though.

I did find a chart - midway down the page is tech data and chart for the P10 with the level of "intentional" leak on various pressures and it states that Nasal Pillows leak more at pressures vs Full Face - which is what I'm experiencing. Even my pressures seem to match my leak rate (20ish and 40ish).
https://www.cpap.com/blogs/cpap-therapy/cpap-leak-rate

THAT SAID, I'm a novice here so I want to make sure I'm interpreting it correctly. The Aircurve has settings for Full Face, Pillows etc...so having set that I'm wondering if it's measuring the intentional or unintentional (the 2nd of which would be a problem).

Any guidance is useful. Happy to go the Oscar route if people think I should

[Pugsy]

ResMed machines report ONLY EXCESS leak. They remove the intentional leak from the calculations prior to reporting the leak. So all that leak you see reported is excess leak (above the intentional vent rate) and 24 L/min is ResMed's line in the sand for large leak territory.

I don't know for sure that your machine is missing flagging anything or not BUT it might be..... at least when it goes past 30 L/min.

Get OSCAR and let's see just how much time you spend with leaks over 30 L/min.
I am not sure what the MyAir leak number is but I think it is a 95 % number and all that means is you were at OR BELOW that number for 95 % of the night. If that is what it is then it may not be all that bad.

Here's and example of what happens with 95% numbers that look, on the face of it, alarming but over the entire night it really isn't that big of a deal.
viewtopic.php?f=1&t=108724&p=1036669&hi ... t#p1036669

[C123C]

Got it. Thank you both. Super busy but will get OSCAR, figure things out, and post back when I have that data if people could kindly help me review/think over results.

Much appreciated.

[C123C]

So I managed to solve this - at least adequately for my purposes. Got leak down into "good range" and events are still very low so at least for me the higher leak wasn't interfering with the event reading in any observable way based on my results.

What I realized is that the diameter of the nostril holes in the pillows on the mask - not just the pillows and placement of holes - differs by each size (S/M/L) with the large being the biggest holes. At higher pressures I, and potentially others, run this can restrict air or pressure getting into the nose and instead increase leak as more air is foreced out the top by the hose attachment.

While I don't have a particularly large nose I moved from the medium to the large attachment. Still fit my nose. Leak dropped substantially and events stayed the same (1.4 average with a 2-2.5 high maybe once a week, plenty of nights 1 or below). I have also been sleeping substantially better, anecdotal but can see some on my Whoop band) and deeper as I think I was getting pressure but not enough total air flow with the smaller holes which wasn't resulting in more "events" but didn't let me sleep as well. Putting on the small with my pressures not enough air for breathing is particularly noticeable.

I imagine if I needed pressures significantly higher I'd run into the same issue as with the medium and this mask wouldn't work for me at some point (would need the full face strapped tightly that I'm trying to move away from). Luckily, not my issue and this is doing the job.

Appreciate the help on this. Didn't need to go full data route as the large with bigger holes worked out find and I'm enjoying the mask and sleeping well.

[ChicagoGranny]

Didn't need to go full data route as the large with bigger holes worked out find and I'm enjoying the mask and sleeping well.

I'm big on data, but if you are sleeping well and feeling well during the day, then data schumata->

Thank you both.

Pugsy's so good, it does seem like there are multiples of her.