Sleep Score Question

Hello, I'm new to this forum and one week into CPAP therapy. I check my score every morning. I use a nasal mask. My sleep study AHI was 28. My overall sleep score on therapy has been between 86 and 92. The mask leak score is my lowest, usually 9/20. My AHI is between 1 and 2 on therapy. Question: How much should I worry about the mask leak score, as long as my AHI is 1 or 2? I dont want to get obsessed with the darn mask fit. Subjectively, I feel much more rested and energetic during the day (never really had daytime sleepiness). Thanks! Tracy

If your AHI is 1 to 2, you are good! Mask leaks will come down as you figure out best fitting size and adjustment issues. Your ResMed scores are more or less not all that useful.

Ok thank you. So if my AHI stays low like it is, do I need to try a chin strap and "fret" over getting a better mask leak score?

There are a number of factors to be looked at with mask fit. First, it depends on what type mask you use. If you have a full face mask and the cushion is the wrong size, this can be a bit of a problem. Some mask types tend to leak a bit. I started therapy using a Simplus which is a full face mask that fits over my mouth and nose and it took awhile to figure out they started me on the wrong size cushion. I learned to mitigate leaks that bled air into my eyes by using mask cushions. Once I started using a smaller cushion, the leaks were less but the mask still bled a bit of air into my eyes and I used mask pads which are essentially pieces of tee shirt material that are shaped the same as the cushion and sit between it and your skin. They are cut out just in the area that contacts your face. I also found that my jaw slackened during the night and dropped a bit and the mask lower side ended up in my mouth and leak rates were really high as a result. I began using a "boil and bite" mouth guard (still use it) which prevents my jaw from going slack.

This tamed my leak rates to a fairly acceptable number. I switched to an Amara View mask and after figuring out how to wear this mask on many nights have NO leaks. This process took a few years and some experimentation. Doesn't do much good to try and follow what others have done as the mask fit issue is kind of a personal one and what works for one person may not work for another. Good luck!

You say that, "Your ResMed scores are more or less not all that useful." would you please explain. I only ask as I have been receiving them for over three years now and thought they were useful.

What I mean is that the scores, like mask seal, are just numbers. The mask leak number is relevant but should not be a concern if AHI is low... by low I mean less than 5 events per hour and even that is not great. They take ONE point off if you remove your mask and then put it on. If you did this 5 times during the night I guess you would drop 5 points but sleeping 6 hours solid with no mask offs gets you a much less number of points. The results are worth thinking about in order you can self direct therapy but a high ResMed score isn't worth as much. You will get a great number of points if your AHI is over 5 and you sleep 10 hours compared to six hours of sound sleep with no AHI events. Getting your AHI down to near zero is the goal.

I pay attention to the mask seal score to give me a clue if I need to adjust something or replace the nose piece. I got my newest CPAP in February of 2015 and have logged every night's score since then. My most frequent score is 100, then 99, then 98. My most frequent AHI is .5, followed by .2. The scores may not seem relevant for any one night, but I use them to spot a change or a trend that I might want to pay attention to. When my AHI climbs unusually high for me, I usually need to make a mask adjustment. Too much leakage means less going through my nose and not enough pressure to keep my airways open. I love waking up feeling rested. My mind works better, I get more done, I remember things and can learn new things and can be creative and solve problems. All those attributes I had relied on were gone due to my apnea. It was the depression that came with this that made me see my doctor and explain what was happening. He knew I needed a sleep study. The sleep study indicated I had no deep sleep, which is why I could not learn anything new--long term memories are only formed in deep sleep and I had none. The depression came from lack of dreaming--I could not dream and the mind needs to do that. All the abilities I had counted on in work and life came back once I got my machine. Good luck with your efforts. It was literally a life saver for me.

When my leak rate goes up, that is a good indication the mask cushion needs to be swapped out. The Amara View mask cushions are very soft vinyl and I need to swap them every 3-4 months. The Simplus mask cushions I used previously were much more dense vinyl and seemed to last indefinitely.