New to nasal pillows; is this leak rate acceptable?

I posted previously about having trouble with a full face mask, my first (and second) masks after starting treatment. I asked my equipment supplier to try out the new ResMed p30i and have found it very unobtrusive (though a bit noisy through the supply tubes in the frame). The headgear/strap doesn't always hold the frame in place; a couple of times a week, I wake with the pillows not properly positioned. But overall, I find this much easier to use, and my AHI has averaged in the 1.0-2.0 range, sometimes <1.0.

The problem is that I definitely am opening my mouth many times each night while asleep. My leak rate averages in the mid-20 L/m range, and as the attached SleepyHead graphs show, I've got leaks throughout the night with occasionally very large leaks. (I have no trouble keeping my mouth shut when awake. Well, only with a CPAP mask on....)

The large leaks tend to be less than 10% of the night. My AHI seems tolerable. Should I be concerned that I'm not getting the therapy I should because of the leaks? I have jaw/headache issues (for the past 20 years), so I'm reticent to try a chinstrap, and taping would be a big Nope.

As always, thank you for any wisdom from the group!

It is my understanding that Resmed machines leak rate upper limit is 24 lpm.
Palerider a member on here (very tech savvy) feels that therapy is essentially unaffected to 30 lpm.
Still probably ok to 40 lpm.
After that the machine begins to have trouble keeping up.
Not recognizing events. Generally losing effectiveness.

If I am wrong he will correct me and I will continue to learn with you.
JPB

jimbud wrote: ↑

Sun Jul 07, 2019 8:04 pm

It is my understanding that Resmed machines leak rate upper limit is 24 lpm.
Palerider a member on here (very tech savvy) feels that therapy is essentially unaffected to 30 lpm.
Still probably ok to 40 lpm.
After that the machine begins to have trouble keeping up.
Not recognizing events. Generally losing effectiveness.

If I am wrong he will correct me and I will continue to learn with you.
JPB

The further the leak gets over (probably) 30 or so, the more the machine starts to have trouble differentiating what kind of event you're having... then when it gets really bad, it starts having trouble maintaining therapy pressure (somewhere past 70lpm for that).

The OPs leak rate isn't *good*, but it's not terrible either.

Yes, I think that your leaks are keeping you from getting good therapy from your cpap. A good indicator is the LL line, that stands for "Large Leak"...if you're getting those, your machine isn't able to tell what's going on with you when you get large leaks like that. You don't have long periods of them, but still, I wouldn't be satisfied with that kind of leak line.

Not sure what to suggest if you're having problems with mouth breathing at night, and can't use a chinstrap or tape. You could try training yourself to keep your tongue on the roof of your mouth, with the tip just behind (not pushing on) your front teeth. Try that with your mask on, position your tongue that way and open your mouth. You shouldn't have any leakage at that point with your mouth open. If you can do that at night while you're sleeping, that will prevent mouth leaks. By training, I mean doing that during the day as much as possible, and being sure to position your tongue when going to sleep.

Of course, there are other kinds of masks that are more tolerant of mouth breathing, like full face and some hybrid masks. One that I'm okay with is the AirTouch F20...the memory foam is pretty forgiving and not uncomfortable. Takes some getting used to, but a lot of people use them.

Good luck, hang in there. You'll find your way soon.

If your jaw is dropping, you might want to try a neck collar.

Your leaks aren't "holy crap bad," but in the context of it not going past a pressure of 7, the leaks are indeed bad. It's possible that a more effective min pressure will prevent your mouth from opening as much...only one way to find out

Are the leaks waking you up or disturbing your sleep quality?
Or are you sleeping soundly and feeling quite decent????

It's not a real pretty leak line for sure but it's not horribly ugly either. I have let worse slide as long as I slept decently and felt decent.

Is the ugly bad enough ugly to negatively impact the therapy itself though??? Not likely IMHO
The machine is decently accurate even at 40 L/min if something is happening....meaning if something happened and it had a problem figuring it out...might get a UA flag or something.

10% of the night over 24 L/min and rarely over 35....If I was sleeping good and feeling good I would shrug my shoulders and move on to something else. My leak lines have rarely been pretty until I started using the Bleep.
I used to think that all my ugly leak stuff was mouth breathing too but I have found out that I used to have a lot more mask movement leaks than I ever thought I had. You might be having some mask movement ugliness as well.


But for negatively impacting therapy itself...a maybe but only for the times when leak was above 35 L/min or so. Those times were very short lived...
We don't get extra credit for "pretty".....if that were my leak graph and I was sleeping soundly and feeling decent....I would accept it and not spend much time worrying about it being a bit ugly.

Pugsy wrote: ↑

Mon Jul 08, 2019 6:43 am

Are the leaks waking you up or disturbing your sleep quality?
Or are you sleeping soundly and feeling quite decent????

+1 on what Pugsy said...
My .02 --
Leaks of the level you are getting would wake me up several times a night and I would not be happy/satisfied. Higher leaks also means higher pressure, which causes other problems for me, such as dry eyes and dry mouth, which would also wake me up.

Are you waking up at all?

Are the pillows the right size for you?

Thanks to all of you who gave me feedback. I'm going to continue with the P30i for now and see how I feel after a month or two. Although a couple of you disagree, it looks like several voices of experience don't think that leak rate is necessarily causing a complete loss of therapy. I do find the headgear strap to be somewhat problematic on this mask, as the single strap rides up the back of my head occasionally. When this goes too far, then I get a large leak at the nose and wake up. But this happens maybe once a night at most. When awake when first in bed, the seal at the nose seems great, so I think the pillow size is appropriate. Other than the leaks, this has been the most comfortable mask I've tried so far. I wish I could find a way to make the rear strap fit better or add something to it. If anyone has modified theirs, I'd love to hear about it.

Again, I appreciate the effort to respond to my question!