Reporting Leaks: My Air v.s. Sleepyhead

[Comfortably Numb]

I stopped using My Air after swapping out a defective Airsense 10 unit last week. "Mask Seal" in L/min is really the only feature of the My Air report that I miss. Each day, it was so simple and reassuring (possibly falsely?) to see that my "Mask Seal" was always below the My Air limit of 24 L/min.

Now that I'm using Sleepy Head for that purpose, things are a bit more complicated. As most of you know, Sleepyhead reports things such as Large Leak (%); Average Leak Rate; 90% Leak Rate; and % of Time Above Leak Rate Threshold. They also use phrases like "Major Mask Leakage" to further complicate things. Can someone please explain which of these Sleepyhead readings, if any, correlates to the My Air limit of 24 L/min? I have already accepted that I will have a lot of leakage through the mouth. This has little if anything to do with my "Mask Seal."

I'm not looking to over-analyze my leaks. I'm sleeping comfortably, my AHI is very low, and I accept that mouth leaks will always be there. Basically I'm looking for one of the Sleepyhead readings to focus on that has some relationship to the only measurement I've become familiar with (i.e., 24 L/min maximum).

[Pugsy]

ResMed machines and MyAir report the 95% leak number so in SleepyHead it would be the 95% number.

You can change SleepyHead so it shows 95% instead of 90% if you wish.

Preferences/CPAP tab and on the lower right "change upper percentile".

[Okie bipap]

The large leak flag says your leak rate was over 24 liter per minute. When you exceed the 24 liter limit, you will see the graph shaded gray. The 90% leak number is the leak rate you were at or under 90% of the time. The max leak rate is the maximum leakage you had for the night. The major mask leakage message will show up when your leak rate was over 24 liters per minute for a certain portion of the night. I think that number is 1/4 of the night. I never look at My Air any more. I use sleepyhead to monitor both of our therapies. I hope this clears up your questions.

[Comfortably Numb]

Thank you for your replies. This is still kind of confusing. In all of my time looking at the My Air "Mask Seal" data, I never even approached 24 L/min. However on Sleepyhead, I consistently see the phrase "Major Leakage." Also, my LL graph typically shows many gray shaded areas. Last night I had 18 gray shaded bars for a total of 26 minutes at that level. So Okie, unless I've misunderstood you, I was over the 24 L/min. rate for 26 minutes last night, not 1/4 of the night: ("leak rate was over 24 liters per minute for a certain portion of the night. I think that number is 1/4 of the night"). Maybe you were referring to My Air and not Sleepyhead. I assumed you were referring to Sleephead since you initially mentioned the gray shaded bars visible on Sleepyhead.

I will change my settings as Pugsy suggested. But I still need to come to terms with how the recipient of numerous Gold My Air Badges appears to be a Major Leaker on Sleepyhead. And, what is the most important number or range to focus on.

[Pugsy]

I don't know why your MyAir 95% number is less than 24 and SleepyHead is showing major leaks.
Care to share an image and tell us what MyAir said?

ResMed will give you a Mr Smiley for leak management as long as you don't stay in large leak (over 24) for more than 30% of the night.

MyAir gives "scores" for various aspects of treatment...are you confusing the leak "score" with the 95% number by chance?

If SleepyHead is showing gray areas of large leak...it's only reporting what the machine is flagging so they are real. As to why MyAir isn't dinging you for the large leaks....dunno why.

[Comfortably Numb]

Pugsy, there's no doubt that I'm confusing almost all of this. I'll pick out a typical recent night when I still used My Air to show a comparison. On Oct. 16th, My Air and Sleepyhead agreed that my AHI was 1.24. My Air gave me a score of 18/20 for "Mask Seal," and the actual bar graph showed a "leak" of about 17 L/min. My overall My Air score was 98/100. On the same night, Sleepyhead said I had "significant periods of major mask leakage," and my 95% leak rate was 22.8. Other than the AHI being equal, these values and comments don't appear to refer to the same person. I feel great when I look at the My Air data for that particular night. But extrapolating from what Okie said, I was at or under 22.8 L/min 95% of the night. That's not an encouraging view of the same person/same night.

[TASmart]

Myair does a calculation based on a "secret" formula that considers large, medium and small leak rates, as well the type of mask. It's not any kind of actual value. The leak rate in the myair graph is some odd thing, not a 95% number. Myair is not designed as nor usable as a quantitative tool to determine the details of what is going on with your therapy. That's why they have Resscan. Its numbers will look pretty much like sleepyheads.

[Comfortably Numb]

Thank you. I think this "secret" is the source of some of my confusion. Since I'm no longer going to use MyAir, I need to focus on a Sleepyhead value/range that indicates whether or not my excessive mouth leakage is high enough to interfere with treatment even though my AHI's always "appear" to be outstanding. Hopefully this can be as simple as using My Air with a lot more accuracy.

[Guest]

that is actually quite easy: as long as you have a big enough leak the machine can do nothing at all - not help you with the therapy and not estimate what your breathing pattern looks like. (the moment a leak starts measurement is out of the question and estimation starts)

depending on who you ask you get different opinions if leaks matter at all or are all always bad or at what range or value a leak becomes a 'problem'. That is more of a believe thing like which water to use in the humidifier or how often to clean the equipment.

[Goofproof]

that is actually quite easy: as long as you have a big enough leak the machine can do nothing at all - not help you with the therapy and not estimate what your breathing pattern looks like. (the moment a leak starts measurement is out of the question and estimation starts)

depending on who you ask you get different opinions if leaks matter at all or are all always bad or at what range or value a leak becomes a 'problem'. That is more of a believe thing like which water to use in the humidifier or how often to clean the equipment.

You are correct, my worry about leaks are allowable to maintain treatment good and counting on them to be low enough to let the machine still keep the data correct. Personally I use total leak a rate of 40 to 50 LPM as my mAX Allowed Marker, many here dispute that and say it's higher. I'd rather error on the Low Side!
It works for me! Jim

[Comfortably Numb]

When you say, "total leak a rate of 40 to 50 LPM as my mAX Allowed Marker," do you really mean Maximum Leak Rate? If so and if 40-50 is considered conservative, then I should be good in the 30-40's??

[Goofproof]

When you say, "total leak a rate of 40 to 50 LPM as my mAX Allowed Marker," do you really mean Maximum Leak Rate? If so and if 40-50 is considered conservative, then I should be good in the 30-40's??

Total leak rate is mask leak plus any other leak that can happen, My XPAP is a Remstar "Tank", they use the real leak method, if the XPAP pumps it, it records it. Jim

[Comfortably Numb]

OK, well I'm still looking for that value on the Sleepyhead data chart that indicates leaks are within an acceptable range for treatment. The longer I go the more I realize that it probably doesn't exist.

[Goofproof]

Your Brand of machine, only reads the leak minus the mask leak you set on your XPAP. I don't know if yours is set correctly, Resmed doesn't, and maybe you don't. Welcome to Resmed's World!

One of many reasons I won't be using Resmed Products. Jim

[Pugsy]

GoofProof uses a Respironics machine and it reports leaks totally different from your ResMed so ignore his personal guidelines. They don't apply to you at all.

As for SleepyHead saying "significant periods of large leak" warning...take it with a grain of salt. I have seen the same warning with 15 minutes over 24 L/min and the worst it went to was 27 L/min.
When Mark did the warning thing he put way too strict of a requirement on what was need to not get that warning.

Here's what I happened to have happen to me all in one night so that I could see what the machine did when presented with large leaks that got progressively worse...and what I pretty much live by in terms of what I look at for my ResMed leak.

Leaks over 24 and to 30 L/min...will get a large leak flag but I found that the machine seemed to respond and flag events normally.
Leaks between 30 and 35...I started seeing some unknown apnea flags. The machine knew something was going on but couldn't make up its mind as what to call it.
Leaks over 35 L/min...the machine quit flagging anything when 5 minutes before I was seeing unknown flags. Now I don't for one minute think that nothing happened when 5 minutes before a lot was happening. The leaks got so bad the machine didn't know anything was going on. It lost ability to sense, record and most likely respond when leaks went over 35 L/min.

For this reason I don't get all upset until I see leaks over 35 L/min and for a prolonged period of time. I don't sweat any large leak that just lasts 5 or 10 minutes as long as it doesn't wake me up.

So learn to eyeball the leak line graph and how much time is spent deep in large leak territory.
Things don't go totally in the toilet at 25 L/min..it's a gradual worsening of the situation and the further you go the worse it gets.
If 95% of the time you were at or below 24 L/min...I wouldn't give a second thought to what that other 5% went to as long as I slept through it.

Remember the definition of 95% numbers ....at OR BELOW for 95% of the night.
95/90% numbers are very easily skewed upwards by just a relatively short period of time at higher numbers so they aren't always something we want to put a lot of worry into when looking at short term numbers.