Very large leak rates

boomba212 · Post by **boomba212** » Mon Aug 05, 2019 3:21 pm

Hello,

I've been a CPAP user since 2015 but never looked at my data myself until the last few days. I have a Philips System One and usually use a Fisher & Paykel Simplus full face mask. Looking at my data in both the Philips software and Oscar, I see that I have been having crazy large leaks all the way from 2016 and never knew until now (this graph is from Oct. 2015 - July 2019):

: everything.jpg (94.25 KiB) Viewed 1566 times

Here is the leak rate graph from one night a few nights ago:

: one night.jpg (77.25 KiB) Viewed 1566 times

Skimming through the data, I'd say I have an average of about 85% time in Large Leak.

So, I don't really know what to do. I know I am a huge mouth-breather. My first theory was that maybe I am opening my mouth outside the mask. Last night, I readjusted my mask to be lower on my face. This helped a little-- the Large Leak time dropped from 90% the night before to 64%. Tonight I will try to adjust the mask some more. Anyone have any ideas? Thanks so much.

Okie bipap · Post by **Okie bipap** » Mon Aug 05, 2019 3:29 pm

Many of us here on the forum use a firm, foam cervical collar to keep our mouths closed. You can also try using a chin strap. I tried three or four of them, but could not find one I could stand to use.

jimbud · Post by **jimbud** » Mon Aug 05, 2019 3:31 pm

Yah,
Fill out your equipment section in your profile.
Machine
Mask
Ect.

Will give the experts something to look at and save extra unnecessary questions.
JPB

boomba212 · Post by **boomba212** » Mon Aug 05, 2019 3:38 pm

jimbud wrote: ↑
Mon Aug 05, 2019 3:31 pm
Yah,
Fill out your equipment section in your profile.
Machine
Mask
Ect.

Will give the experts something to look at and save extra unnecessary questions.
JPB

Done, thanks. My machine was not in the list so I added it in the comment.

LSAT · Post by **LSAT** » Mon Aug 05, 2019 3:42 pm

Are you using the correct size Simplus? I am an occasional mouth breather and I have virtually 0 leaks with the Simplus.

zonker · Post by **zonker** » Mon Aug 05, 2019 5:10 pm

boomba212 wrote: ↑
Mon Aug 05, 2019 3:21 pm
Hello,

I've been a CPAP user since 2015 but never looked at my data myself until the last few days.

excuse what may be two dumb questions-

1. are these leaks waking you up or interfering with your sleep in any way?

2. are these leaks affecting your ahi?

i mean to say, it looks HORRIBLE to see it on the graph. but i'm thinking the data could be wrong, particularly if you are sleeping okay and aren't waking up tired.

boomba212 · Post by **boomba212** » Tue Aug 06, 2019 9:40 am

zonker wrote: ↑
Mon Aug 05, 2019 5:10 pm

boomba212 wrote: ↑
Mon Aug 05, 2019 3:21 pm
Hello,

I've been a CPAP user since 2015 but never looked at my data myself until the last few days.

excuse what may be two dumb questions-

1. are these leaks waking you up or interfering with your sleep in any way?

2. are these leaks affecting your ahi?

i mean to say, it looks HORRIBLE to see it on the graph. but i'm thinking the data could be wrong, particularly if you are sleeping okay and aren't waking up tired.

Sometimes I get dry mouth, but mainly I feel very tired and sleepy throughout the day. The AHI is fine but as I understand it, with so much leakage the AHI numbers aren't going to be accurate.

Pugsy · Post by **Pugsy** » Tue Aug 06, 2019 10:31 am

I would be interested in seeing a full detailed report showing the pressure graph lines along with Events and leak...just to see what the pressure is doing when face with such massive leaks if you are using auto adjusting pressure mode.
In the past when I have seen auto mode reports with leaks exceeding the 110 L/min area...the machine essentially throws up it's little arms and says "I quit" and there is no auto adjusting happening.

And your low AHI....extremely in question because when the machine throws up its little arms it usually can't sense much of anything.
We don't know if the machine just couldn't sense anything happening or nothing happened in terms of the airway collapsing.

Pugsy · Post by **Pugsy** » Tue Aug 06, 2019 10:35 am

Ooops...I just now realized you are showing a fixed pressure machine in your profile. That won't help me with my curiosity.

Pressure is fixed and can't auto adjust so I don't know if the big leaks are impacting that part of things.

No need to bother with the more detailed report.

boomba212 · Post by **boomba212** » Tue Aug 06, 2019 10:45 am

Pugsy wrote: ↑
Tue Aug 06, 2019 10:35 am
Ooops...I just now realized you are showing a fixed pressure machine in your profile. That won't help me with my curiosity.

Pressure is fixed and can't auto adjust so I don't know if the big leaks are impacting that part of things.

No need to bother with the more detailed report.

Here are graphs from a night when I had CFLEX on, which decreases the pressure when you exhale. I think that may not be what you mean by auto-adjust, but here is the data (and thanks so much for your help!):

: cflex on.png (118.53 KiB) Viewed 1489 times

zonker · Post by **zonker** » Tue Aug 06, 2019 10:49 am

boomba212 wrote: ↑
Tue Aug 06, 2019 9:40 am

Sometimes I get dry mouth, but mainly I feel very tired and sleepy throughout the day. The AHI is fine but as I understand it, with so much leakage the AHI numbers aren't going to be accurate.

okay, i'll bow out as pugsy is here and she has more knowledge than i.

i'll admit that your therapy needs tweaking if you are felling bad throughout the day.

good luck!

Pugsy · Post by **Pugsy** » Tue Aug 06, 2019 11:21 am

By auto adjust I mean the pressure itself...not the exhale relief (C Flex) portion. The top line of 15.
Your machine won't do it unless you happen to have some auto trial time remaining. Some of those System One machines had some limited trial in auto adjusting mode.
The Pro model Respironics is essentially a fixed pressure machine...15 cm is your fixed pressure. How much of that you are effectively getting in the face of the massive leaks (the ones above 100 L/min) is the dark horse here. We just don't have any way of gauging it.

At any rate...everyone knows that I probably let a little more large leak slide than most people will unless it wakes me up...but I couldn't let the amount of large leak you are having slide when seen on a consistent basis. Random ugly anything I toss out the window but when I see ugly consistently then I don't like it.
Unless you tell me that you never wake up during the night and you feel like superman/woman every day.

Maybe whatever pressure you are getting with those big leaks is still enough to keep the airway open and the airway just isn't closing up....wouldn't be impossible I suppose but I hate guessing as to whether that low AHI is because nothing happened or the machine was clueless the biggest part of the night. Now when you were below around 90 L/min total leak (the top leak line)...even if in large leak territory the machine was probably accurate enough with the sensing but when you get over 100 and especially 110 and above...it gets really iffy in terms of accuracy.

boomba212 · Post by **boomba212** » Tue Aug 06, 2019 12:20 pm

Pugsy wrote: ↑
Tue Aug 06, 2019 11:21 am
By auto adjust I mean the pressure itself...not the exhale relief (C Flex) portion. The top line of 15.
Your machine won't do it unless you happen to have some auto trial time remaining. Some of those System One machines had some limited trial in auto adjusting mode.
The Pro model Respironics is essentially a fixed pressure machine...15 cm is your fixed pressure. How much of that you are effectively getting in the face of the massive leaks (the ones above 100 L/min) is the dark horse here. We just don't have any way of gauging it.

At any rate...everyone knows that I probably let a little more large leak slide than most people will unless it wakes me up...but I couldn't let the amount of large leak you are having slide when seen on a consistent basis. Random ugly anything I toss out the window but when I see ugly consistently then I don't like it.
Unless you tell me that you never wake up during the night and you feel like superman/woman every day.

Maybe whatever pressure you are getting with those big leaks is still enough to keep the airway open and the airway just isn't closing up....wouldn't be impossible I suppose but I hate guessing as to whether that low AHI is because nothing happened or the machine was clueless the biggest part of the night. Now when you were below around 90 L/min total leak (the top leak line)...even if in large leak territory the machine was probably accurate enough with the sensing but when you get over 100 and especially 110 and above...it gets really iffy in terms of accuracy.

thanks for all the info. yeah, i'm not sure what's going on. i am going to my dme tomorrow to have my equipment looked at.

boomba212 · Post by **boomba212** » Thu Aug 08, 2019 9:17 am

Okie bipap wrote: ↑
Mon Aug 05, 2019 3:29 pm
Many of us here on the forum use a firm, foam cervical collar to keep our mouths closed. You can also try using a chin strap. I tried three or four of them, but could not find one I could stand to use.

Thanks-- do you happen to know if this is a good and comfy cervical collar (or do you have another one that you would recommend?):
https://www.cvs.com/shop/futuro-soft-ce ... id-1660037

Okie bipap · Post by **Okie bipap** » Thu Aug 08, 2019 7:31 pm

I use this collar. I use the four inch one and my wife uses the three inch collar.
https://www.amazon.com/gp/product/B000F ... UTF8&psc=1
I get about two months use out of each collar before my leak rate and AHI start going up. I set up an automatic delivery for every two months which makes them slightly cheaper, plus I don't have to remember to reorder them.

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