Trying to understand flow rate and leak graph

[Tech Guy]

I've been looking at the sticky's and have a few questions. Here is last night's data. How do you read the flow rate and leak graphs? Noticed the spikes and the leak staying between 26 and 52. What is considered an acceptable value for leaks or does it matter that much? What is a normal flow rate. Had a little more challenging night with tossing and turning for whatever reason and wondered what exactly am I looking at. Should I raise the minimum to 6.5? Currently at 6.

[kwikwater]

I look forward to other responses to your question. I'm really looking at mine and having a tough time correlating leaks, flow rates, AHI and well, all of it, let alone I'm seeing 10-15 minute episodes of blood ox levels hitting 75-80% 2-3 times per night.

I didn't see your equipment notes on your profile. It's good to know the stated vent rate on your mask to interpret your leaks.

Here's to figuring it out and a better night's sleep!!!

Kelvin

[Tech Guy]

Hey Kelvin, yeah I've been through the sticky's and Pugsy has done a wonderful job explaining things. Trying to figure out how important the leak rate is and weather the pressure I'm using is sufficient to sustain itself to correct the issues it's trying to help. Guess the goal is to have a stable flow rate with low leak rate to be proficient. Using a PR One with Mirage Liberty mask. Not sure if all the tossing and turning is causing the leaks and given the system one 95%, trying to figure out if the average leak rate of 25 to 30 lpm is acceptable or not, or if its interfering with the treatment. The ahi isn't bad but the peaks and valleys of the flow rate does raise the question whether to move my minimum setting of 6.0 to 6.5 or move it a bit closer to try to stabilize the flow rate. Just started treatment less than a week ago and understand it's going to take time to sort out.

[kwikwater]

Hey Kelvin, yeah I've been through the sticky's and Pugsy has done a wonderful job explaining things. Trying to figure out how important the leak rate is and weather the pressure I'm using is sufficient to sustain itself to correct the issues it's trying to help. Guess the goal is to have a stable flow rate with low leak rate to be proficient. Using a PR One with Mirage Liberty mask. Not sure if all the tossing and turning is causing the leaks and given the system one 95%, trying to figure out if the average leak rate of 25 to 30 lpm is acceptable or not, or if its interfering with the treatment. The ahi isn't bad but the peaks and valleys of the flow rate does raise the question whether to move my minimum setting of 6.0 to 6.5 or move it a bit closer to try to stabilize the flow rate. Just started treatment less than a week ago and understand it's going to take time to sort out.

Thanks Tech Guy. Ya, it's because I've read all those references and I'm in 3 weeks into developing a picture of any patterns. I'm picking up a DME's pulse/ox tomorrow to verify my data and will be ready for more formal guidance. I'm betting talking to my GP doc, I'll be right back here!!!! I'm not sure my local docs can even recommend anybody that could sit down and review what gets discussed here daily!!!

[Pugsy]

trying to figure out if the average leak rate of 25 to 30 lpm is acceptable or not,

Totally acceptable...actually quite decent. Remember your machine reports total leak which is the mask vent rate plus any excess leak. At 25 to 30 L/min that's mainly vent rate.
Large leak territory on a PR S1 machine depends on pressure and machine but probably not until around 80 L/min.
Unless your leaks are disturbing your sleep...they are quite acceptable in terms of not being a negative impact to your therapy.

Flow rate...we don't measure the flow rate itself. The flow rate graph is highly compressed individual breaths and you have to zoom i to see the individual breaths. Of course the apnea events are flagged on the flow rate graph but we don't monitor the flow rate graph in its compressed state other then to see the pattern for the apnea events that get flagged.

Clear Airway events....we don't treat those with more pressure because the airway is already open.

We do treat obstructive apneas, hyponeas, flow limitations and snores with pressure.
When you say you had a rather challenging night last night I assume that you didn't sleep so great. That first cluster of events after the first therapy break around 12:30 I suspect are awake/semi awake events getting flagged by mistake.
If you remember being awake a lot last night and tossing and turning then some of the other events you see flagged may also we awake breathing getting flagged by mistake. The machine doesn't know if you are awake or asleep and it can and will flag awake breathing irregularities.

Your pressure line from the report above is showing 5.5 minimum pressure and not 6.0.
Are you sure it is 6.0??? If you are sure then the pressure graph is whacko...so go to Preferences/Appearance tab and remove the check mark from "use pixmap caching" and see if the pressure line shows as it is supposed to.

You can try increasing the minimum pressure again if you wish but just remember if you have a lot of time awake tossing and turning then what you see flagged as apnea events may be awake breathing and increasing the pressure won't help.
Of course if those are real hyponeas you are seeing then they can of course also impact sleep quality...it's difficult to know which came first.

[Tech Guy]

Thanks Pugsy! Yes, the minimum is 6.0. Unchecked "use pixmap caching." I do sort of prime the night getting the mask on and spending time before falling asleep. Appreciate explaining the leak and flow rate. Finding myself waking up every few hours changing positions. Guess I've always done that, but now have to be a bit more alert wearing a mask. Tried the nasal pillows the other night in another mask. The air coming in wanted to keep my mouth open. A chin strap or tape won't work! Will have to experiment a bit more and see how to keep my mouth closed. Do find myself waking up with a dry mouth using the hybrid full face indicating an open mouth for part of the night. So far the hybrid full face is reasonably comfortable but find myself fidgeting with the nasal pillows a bit.

[Pugsy]

wiki/index.php/Hybrid_Mask_Modifications

You might try Rooster's pantyhose/tights trick for stabiliziing the nasal pillows. See above. Just about anything with a bit of elastic could be used.

Try to make a conscious effort during the day to train the tongue to stay in the roof of the mouth. This will prevent the air from entering the nasal passageway (when using just the nasal pillow mask that you tried) and trying to prematurely exit the airway via the mouth. The tongue acts like a door and blocks the air from entering the mouth causing it to inflate (we call that chipmunk cheeks) and eventually forcing the mouth open.