AHI - should I be doing something about it?

[Pugsy]

Please fill out your equipment information in your user profile so we can help you better.

Huh?

You are the only person in this thread who doesn't have their equipment showing in their profile.
Maybe you should heed your own advice.

[palerider]

Please fill out your equipment information in your user profile so we can help you better.

Huh?

You are the only person in this thread who doesn't have their equipment showing in their profile.
Maybe you should heed your own advice.

I tell ya, these people looking in the mirror while posting

[Pugsy]

I tell ya, these people looking in the mirror while posting

Yeah. Probably a fly by nighter just having some fun. First post on this forum and they just copied what we tell people all the time.
Not very imaginative though. Registering just to do that is a lot of work.
A lot of ID 10 error people around here lately.

[torontoCPAPguy]

No intention to slight ANYONE and if my hasty remarks were taken as such I apologize. My point was simply that regardless of blower, regardless of mask, there is a "baseline" from which we must work. The baseline for 'leaks' takes into consideration the vent flow rate based on pressure presented to the mask. As an example, on the Mirage Quattro full face mask, at 16 cmH2O pressure presented, one would expect a baseline 'leak' rate due to the mask vent, of approximately 48 L/Min. While this is, in fact, 'leak', it must be accounted for in calculating the overall and correct leak rate of the system. So, we would deduct 48L/Min from the flow in order to arrive at the "net flow rate" and determine what, if any, the leak rate is. My comment was simply to suggest that the very first objective suggested in most all of the patient literature is simply to get the undesired leakage down as close to zero as possible.... from which point, the other empirical data becomes more valid and useful. If one's system is leaking like a busted balloon much of the data is made less relevant as continuous positive airway pressure is absolutely compromised. I think that you would have to agree with this, no? So my comment, again, was simply to state that one must have a solid starting point from which to work and that once accomplished, there are going to be all sorts of OTHER compromising factors one will need to consider if one is titrating their own pressures, etc. For instance, one reached a point of 'no leakage' (taking into account the designed leakage of the system vent(s), etc.) and the titrated the pressure upwards from, say, 10 to 14 cmH2O. The result of which was an increase in designed vent flow (or leakage) or perhaps the mask seal being lost several times while in use during the night. All of these factors need to be taken into consideration when attemptingto achieve optimal performance, as I am sure you will agree. All I can tell you is that it was like trying to juggle multiple rubber balls, even after reaching a net zero leakage rate. And even then, the determination of centrals versus OSA events is difficult at best, even in a sleep lab supervised by a qualified physician. Some of us get lucky, some don't. I think a lot of it is a matter of perserverence and how much you are willing to do and endure in order to resolve the problem. In MY case, I was quite fortunate. Starting from this baseline where my leakage was close to zero most of the time (extranious factors considered and accounted for) it took some time for me to get all of my ducks lined up. And I did so with the input and help of many members of this board whom I don't seem to see around any more.

Again, if I offended, I apologize. We cannot afford to be offending one another. Nor is anyone on the board really able to hand out a solution on a silver platter if you think about it. My resolution, as I say, took some time experimenting (tsk. tsk. Not supposed to do that, right?) I had an issue, just as a matter of interest, shared by several members of the forum, whereby when I approached and entered REM sleep my breathing became so shallow that my SpO2 or more appropriately my CO2 caused me to arouse in order to bring my blood oxygen up. One of the members of our little group designed and built a device that read SpO2 from a pulse oximeter and opened or closed a valve from an oxygen concentrator until SpO2 was up around 93-94%'ish. Fortunately, in my case, I kept turning down the flow rate from my oxygen concentrator and am now OFF oxygen at night (am about to sell the Everflo Q-5 I think). At the time it was unheard of but by sharing thoughts and experiences we helped one another through the situation.

Anyway, nuff said here. Sorry I was not clear in my first post and sorry if I offended. We need to speak freely and help one another. This is NOT a popularity contest but a mixing pot of knowledge from which we should all feel free to dip.... but once dipping, need to validate information, digest information and make an informed decision. THIS IS WHAT makes this forum such an amazing place - and never a place to speak in harsh terms in while angry.

From one hose head to another. Be well.

With all due respect, LEAKS are the #1 issue and make no mistake about it. When I refer to leaks I include things like mouth breathing. Anything that does not fit into the bill of "CONTINUOUS POSITIVE AIRWAY PRESSURE". Everything else is secondary but requires addressing as well. If you have a mask leak you are not getting a constant positive airway pressure and the gear is not NOT doing its job.

Fix that leak issue to start with. You need to be seeing an almost immediate response bringing your AHI below 5 before you begin to make the minor changes to aim for zero.....

With all due respect you need to understand that different machines report leaks differently and the OP here has a machine that reports leaks differently than your machine.

Perhaps you should understand the differences before you go telling someone to fix a leak that can't be fixed and telling them that the leak is the cause of the high AHI because in this case....it isn't.

Your S9 machine reports excess leak only.....the Respironics machines report total leak which is the mask's vent rate plus any excess leak. It's impossible to have 0.0 total leak number from a Respironics machine.

So maybe you need to understand what you are talking about a little better instead of blasting me...huh???

[Pugsy]

My comment was simply to suggest that the very first objective suggested in most all of the patient literature is simply to get the undesired leakage down as close to zero as possible.... from which point, the other empirical data becomes more valid and useful.

Trust me if someone is having leaks of the magnitude that the data reported is suspect....I will mention it.
I see no need to go into elaborate detail as to why if a person isn't coming anywhere near large leak territory.
Besides....if leaks were bad with the PR S1 the AHI would be more likely to show nothing going on instead of the high numbers this OP is having.

I try to keep things as simple as possible for newbies. I figure they have enough to try to absorb as it is.
The way you worded things and quoted what I said made it sound like the leaks were massive and I was pooh poohing them off and that wasn't the case.

this advice

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Fix that leak issue to start with. You need to be seeing an almost immediate response bringing your AHI below 5 before you begin to make the minor changes to aim for zero.....

was totally off the mark in this situation. There were no leak issues to fix.

[palerider]

No intention to slight ANYONE and if my hasty remarks were taken as such I apologize. My point was simply that regardless of blower, regardless of mask, there is a "baseline" from which we must work. The baseline for 'leaks' takes into consideration the vent flow rate based on pressure presented to the mask.

oh, nobody was slighted... some poeple are however quite annoyed by your ignorance, and habit of passing out bad, or at best, erroneous information.

what you, in your ignorance, fail to grasp is that some machines (not yours, of course) report the total leak, not the excess leak, as yours does.

ergo, a 40lpm leak indication on their machine may mean everything is perfectly fine, while on your machine, it's a big problem.

your blanket, and incorrect information, would cause someone who didn't know better to spend a lot of time, and frustration, trying to fix something that was never a problem in their specific case.

[jenk]

Thank you everyone for your responses. There's an awful lot to learn, the machine, mask, SleepyHead, etc. If I'm understanding right, maybe I should be using a different mask? Because there's no way I can see to help the leak rate on this one, I am using the M pillows, tried the S & L and felt a lot of leakage. Someone mentioned leakage as also relating to open mouth breathing while sleeping - for me that is where it could be coming from (snoring?). Maybe I need a full face mask?

Maybe I should print out the SleepyHead reports and see the sleep doc before the 1 month check up if possible? I thought it could just be a matter of adjusting the pressure but seems to be more involved.

Pugsy, just for the heck of it, I will get those screenprints for you. I figured out how to use paint to capture them, then save in photobucket & will do that tomorrow. Thanks for all your help!

[Pugsy]

Based on the leak numbers you reported.....there is no need to worry about changing masks at this time if you are otherwise happy with your mask in terms of comfort.
I need to see the reports to make sure but if the worst leak you ever saw was 40 L/min...that's about half of what it takes to get to large leak territory with your machine.
I could go into a long detailed explanation but there's no sense in adding more confusion right now.
You would need leaks up around 70 or 80 L/min for the bulk of the night for leaks or mouth breathing issues to be a problem.
It is not the cause of your high AHI.
Right now I don't know what the cause is...but you may be one of the small percentage of people who develop centrals just from the cpap pressure itself.

The follow up next month...is it with the doctor or just the DME for follow up?

The AHI being high isn't from snores or mouth breathing or leaks anything like that. It's likely going to be more complicated than that.

Did you ever answer the question about the home study.....did you wear a belt around your chest or was it just a little finger tip pulse ox test?

[palerider]

Thank you everyone for your responses. There's an awful lot to learn, the machine, mask, SleepyHead, etc. If I'm understanding right, maybe I should be using a different mask? Because there's no way I can see to help the leak rate on this one, I am using the M pillows, tried the S & L and felt a lot of leakage.

please just ignore torontocpapguy... is ignorance confuses the issue. while the comments about lleaks are generically good, it's not applicable to your case.

[Julie]

Umm... he did apologize...

[jenk]

Thanks again Pugsy for taking such an interest in helping me. I'm sorry I didn't answer all questions, there was a lot of info going around.

In regards to the sleep study, I had a little clip on my finger, a belt-type thing around my chest (with some sort of little machine attached) and a thing in my nose. As I said, I really think the study was flawed, as they only got 2.5 hours of study out of the first 2 nights. When I used the set-up the 2nd weekend, they only got 1 night study out of 2 nights using it.

My follow up appointment Oct. 22 is with the sleep doc for insurance compliance. I'm supposed to take the memory card to the DME the day before so they can print out reports for the doc to have for the appt. I asked to have info to access the data/reports on my own, the DME did not give me that access. From what I read, SleepyHead reports are more detailed anyway.

Honestly, I'm not sure how the compliance is going to work if I wait to see him till then, as the paper says they must show that I am benefitting from the machine. How can I be benefitting if the AHI is out of whack?

When I wake up a little later I will print some report info for you! Last night the AHI was 17.2, the night before it was 38-something, and the night before it was 50-something. Maybe it is going down for some reason? I tightened the mask straps way down - the mask was fitting quite tight last night.

[Pugsy]

It's possible that the centrals are more related to arousals (awakenings that you may or may not remember) and as you sleep better they will decrease. That may explain the reduction in AHI that you are seeing.
When you feel like it I would like to see last night's report in detail though.

It's also possible that the centrals are post arousal from the obstructive apnea events and if those are better controlled then the centrals will come down.

It's also possible that you have developed the centrals in response to cpap pressure itself.

Lots of possibles....and maybe with a bit of time things will clear up but we need to keep an eye on things.

Compliance has nothing to do with effectiveness per se...it's all about using the machine for at least 4 hours a night more than is it working like it is supposed to. Obviously we feel that if we are going to have to use this machine all night we want the best possible results out of it.

If you had a chest belt for the home study that is supposed to measure effort to breathe....and maybe help identify centrals.
It's still limited in accuracy because without the EEG for brain wave activity we don't know if you were asleep or not and you have already said that it was difficult to sleep. Home sleep studies are good screening tools and often enough to establish a diagnosis and work from it. As with anything in life though...there are always exceptions that may need additional tools used.

No mask should be tightened to the point of pain. If pain or discomfort causes lack of sleep then it sort of defeats the purpose of cpap therapy.
You are using a nasal pillow mask if I remember right. They shouldn't cause pain or sores or abrasions and if they do then something is wrong with either the fit or the size of the nasal pillow used.
The most common leak issue with nasal pillow masks is the mouth. It flops open and the air pressure can escape out the mouth instead of going down the airway to hold it open.
Mouth leaks are easy to spot on the leak report though...a leak is a leak.
The machine can compensate for a little leak.
If you don't have any large leak flags on your reports then leaks aren't your problem unless they wake you up. Anything that wakes us up is unwanted because the goal is to get good solid sleep.
Brief excursions into large leak territory from mouth breathing or other leaks aren't the end of the world though. It all depends on how far a person goes into large leak territory and how long they stay there.
15 minutes in large leak territory out of 6 or more hours of sleep...not that big of a deal. Now 2 or 3 hours spent there...that's a problem.

I use a nasal pillow mask and yes I know that sometimes my mouth falls open and I do a little bit of mouth breathing. I see it on the leak graphs but it's never for very long and most of the time I don't reach large leak territory and I sleep well so I don't really care. I am not going to go to extraordinary measures that would likely impact my sleep a lot more than 15 minutes of big leak impacts my therapy.
So before worrying about leaks (which if the worst you see is 40 L/min is not big leak at all) let's look at the leak reports in greater detail to make sure they are worth worrying about.

[jenk]

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Pugsy: I think this is kind of messed up (my file save & print) but hopefully you can see it. I have 3 more photos to load. This is from last night, the lowest AHI I have seen in a week.

[jenk]

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[Pugsy]

The AHI graph is not needed and neither is the events tab image showing the total number of events in each category.

How was your sleep last night? I see at least 3 breaks in therapy with one that lasted a little bit.
Did you have a lot more awake times but didn't turn the machine off?