My Doc says my numbers are good-But are they?

[Broken Bob]

I am using a Philips Respironics system one w/humidifier in BiFlex AutoB mode. IPAP set to 25, EPAP set to 5. I am using a Mirage Quattro full face mask w/pad a cheek. I was diagnosed in 2011 and fought it till May 2013. During that time I went through numerous mask, two sleep studies, 2 minute meetings with the Doc ($95.00 per call--think I personally bought him his new Mercedes)(by the way-I am not going back to him). I could not sleep with the mask and I could not sleep without it. End of June 2013 had surgery for deviated septum and turbinate reduction--this really helped me breathe. Went back on the machine in September 2013 and here are my numbers taken from Sleepy Head which sort of agree with the Docs program. To me my AHI is excessive but not to the Doc. Also wondering if the leaks are an issue.

Most Recent Last 7 Days Last 30 Days Last 6 months Last Year
AHI 10.00 6.60 9.41 19.16 27.06
RERA Index 2.67 1.44 1.23 1.13 0.83
Flow Limit Index 0.67 0.84 0.60 0.27 0.11
Hours per Night 03:00 06:41 06:53 05:38 05:22
Min EPAP 5.00 5.00 5.00 4.00 0.00
95% EPAP 11.00 9.00 10.00 10.60 8.00
Max IPAP 13.00 14.00 16.00 19.90 19.90
95% IPAP 13.00 12.00 12.00 13.00 13.00
Average Total Leaks 40.75 34.75 39.63 39.76 27.61
95% Total Leaks 56.00 53.00 67.00 63.00 61.00

[SleepyToo2]

I know nothing about the machine you have, and nothing about the effects of the surgery you have had. However, if the target AHI is below 5, then you still have some work to do, although that may be much better than your last sleep study, so it is hard to comment. What was your initial AHI (before any treatment). My main question (for now) is why only 3 hours sleep last night? What is stopping you wearing the mask for longer? There are many reasons why people don't manage to keep up xPAP therapy, so there will be a lot of questions. What have you done to try to make it work? The more information you can share the more people here can help you.

[Pugsy]

Would need to see a sample detailed nightly report from last night to have a better idea what is going on. See my example below.
Sounds like you are using the same machine I am using. Go to Preferences..graphs tab and turn off the AHI graph as it is unneeded. The graphs can be resized to get the 4 main graphs on one screen shot.
Your leak...it's fine.
Your AHI.. at 10.0 is higher than I would want to see. Let's see the breakdown of the AHI before we start worrying too much though.
If it is primarily Clear Airway...maybe you are spending some time awake with mask on..we can talk about that later if that is what is going on
If it is primarily Obstructive Apnea and hyponea then you likely need just a little more EPAP starting pressure.
Let's see what is going on.
How to post images of your reports is explained here in this thread
viewtopic.php?f=1&t=81072&p=737779#p737779
It would help us if we could see what you are seeing...like this one below of mine. Not one of my better nights because of that one cluster of events. This is uncommon occurrence for me so I didn't really worry about it. Normally my AHI is below 2.0..I just happened to have this link handy.

[greatunclebill]

keep in mind that it all depends on the state of your health including any conditions and or meds that may affect these numbers. based on how the doctor sees you on paper (blood work, etc) your numbers may be good for you. not everyone can achieve 0.0 or even 5. you should sit down with your doctor and ask him why he thinks your numbers are good. doctors evaluated sleep apnea for years basing their thoughts only on how the patient felt. in the grand scheme of things numbers are a fairly new thing.

[Broken Bob]

Sleepy too 2--My pretreatment AHI was 36-I went on the machine last night around 1030pm--got up about 3am for a bathroom break back on the machine within 5 minutes and up at 6am. That may be why the most current was 3.0 hours. Since my surgery I been on the machine all night long and not having any problems as I did prior to the surgery. Oh yes-I have a paralyzed diaphragm and only have a partial left lung. Don't know what effect that might have.

[JDS74]

It looks as if your IPAP max could come down a litle as you never get anyway near to 25cm H2O.
But more importanly, your EPAP min is way too low at 5cm H2O with your 95% EPAP of about 11cm H2O.
If your machine is a 750, it may not be able to react fast enough to keep your numbers down. I don't have experience with the newer 760 in this regard.

In any event, could you post the apnea breakdowns? OSA, FL, HYP, CSA so we can see better what's going on.

[BlackSpinner]

Sleepy too 2--My pretreatment AHI was 36-I went on the machine last night around 1030pm--got up about 3am for a bathroom break back on the machine within 5 minutes and up at 6am. That may be why the most current was 3.0 hours. Since my surgery I been on the machine all night long and not having any problems as I did prior to the surgery. Oh yes-I have a paralyzed diaphragm and only have a partial left lung. Don't know what effect that might have.

Is your sleep doctor a pulmonologist? Because with those issues I would be working closely with him/her. Your current AHI on the machine is much too high, however with the lung damage and diaphragm issues it maybe the best of many evils. If your sleep doctor is not a pulmonologist I would insist on getting a referral to one who is.

[Broken Bob]

Bear with me folks-I have been trying to follow Pugsy instruction about reducing the size of the graphs and getting a snap shot. Haven't had to much success. My sleepy head is full screen and I cannot get to the snipping tool. Been playing with snap shot but not to successful. I have all the right buttons but just cannot get them to work right. I will be back. I appreciated all of the information and am trying to provide he info requested.

[Pugsy]

What operating system is on your computer?
The snipping tool is available on most Windows Vista and new OS...except the most basic versions.
If you don't have it...try using ScreenHunter...it's free (though there is a paid for version with more bells and whistles that you don't need).

Otherwise if you don't have the snipping tool you have to use Windows screen print key and Paint and it's PITA.
Don't worry about full size...that's better than too small. We can figure it out.

Otherwise...
Just tell me what the AHI breakdown is
The index for what you see on that left side of the detailed nightly report.
How much is Clear airway Index?
How much is Hyponea Index?
How much is Obstructive APnea Index?
Then of course the total AHI.

[BlackSpinner]

Bear with me folks-I have been trying to follow Pugsy instruction about reducing the size of the graphs and getting a snap shot. Haven't had to much success. My sleepy head is full screen and I cannot get to the snipping tool. Been playing with snap shot but not to successful. I have all the right buttons but just cannot get them to work right. I will be back. I appreciated all of the information and am trying to provide he info requested.

It doesn't really matter. Just upload them to flikr or photo bucket and post a link (URL) rather then an image (Img) and people can follow the link and deal with the sizing.

[Broken Bob]

Pugsy I went through several nights and these figures seem to be about my average night:

AHIApnea / Hypopnea Index 8.64
HypopneaHypopnea 1.15
ObstructiveObstructive Apnea 4.61
Clear AirwayClear Airway Apnea 2.88
RERAResp. Effort Related Arousal 1.58
Flow LimitFlow Limitation 0.58
VSnoreVibratory Snore 0.86
PB/CSRPeriodic Breathing 0.54%

I am operating on Windows 7 Premium, my screen shot button is suppose to be F12 but nothing happens. I have the snip tool but I cannot make my sleepy head smaller than full screen which leaves me without any task bars. Haven't figured out how to pin it to sleepy head.

[Pugsy]

I have Windows 7 Home Premium too.
It's early...haven't had my morning coffee so can't think.
Can you lock your taskbar so that it will stay on top of the image?
If you go to your snipping tool in Accessories....right click on it and Pin to Start menu for quick easy access.
SleepyHead has a reduce size button upper right...just to the left of the X close out button. Though I have mine full size and I can access my taskbar.

Anyway. Your numbers help.
AHI 8.64
and 2.88 of that is Clear airway...how is your sleep quality..wake up often and spend much time on the machine while awake?
so that leaves roughly a little less than 6 per hour that is either OA or hyponea which are the obstructive components of the AHI.
The clear airway we sort of ignore because we don't treat it with pressure.
6 per hour obtructive component is just a little higher than we would like.

Since your AHI is mainly Obstructive apnea. If it were me I would look at a small increase in the EPAP starting pressure.
Your EPAP of 5 is too low to get to where it needs to be quickly enough. I don't think it needs to be hugely higher though..maybe 7.
What is your pressure support?
and which model Bipap do you have ? 750 or 760 (it's on the bottom of the blower).

[Broken Bob]

I have a 750--What do you mean by pressure support?

[Pugsy]

Pressure support is the difference between IPAP and EPAP.

On the 750 model..in Auto adjusting pressure mode...the default is 2 cm but you can set it higher like 4 or 5 cm or even higher up to 8 I think and the machine will auto adjust the pressure support between 2 and 5.

If using straight bilevel mode...it's simply the difference between EPAP and IPAP by default and there is no special setting.

Min EPAP 5.00 5.00 5.00 4.00 0.00
95% EPAP 11.00 9.00 10.00 10.60 8.00

These numbers along with the IPAP point to you being in auto mode because 95% EPAP is higher than minimum EPAP. EPAP is varying.
I can't see pressure support but I know it is at least 2 cm but might roam a bit up to the max pressure support.
You can see these settings in your clinical setup menu easily. Do you know how to get there.
I think EPAP minimum of 7 or maybe 8 might do a better job preventing the airway collapse but again without seeing the pressure graphs it's hard to form much of an opinion based on numbers only but your 95% number means you were at OR Below that number for 95 % of the time. For all we know you may have spent the bulk of the night at 9 or even 7...the or below part of the definition sometimes gets forgotten and people thing that 95% number means that's the setting you should use for EPAP...it might be and it might not be. This is where the actual graphs tell a more important story. I have seen 95% number inflated too easily to blindly accept that number as the "best" number without verification by report images.

[Broken Bob]

Pugsy
Been trying to get a geek in here to figure out why I cannot get a screen shot. If you mean by clinical setup menu are you referring to my machine? If so, I can get into that. If this menu is in Sleepy Head-I have no idea how to get into it. Set my Epap to 7 last night, left Ipap at 25--Slept from 1030 to 630. Not aware of waking during the night. Feel good this morning. Until I can get a screen shot I feel that I am wasting your time. I will be back when I can provide the information needed.