AHI - should I be doing something about it?

[jenk]

Pugsy, I use the machine during the day when I take naps. The lady at the dr. office told me I should use it during naps. Yesterday I forgot to use it on the biggest nap of the day, but still used it a couple of times in the evening before I actually went to bed. I take lots of naps, am very fatigued all the time. I thought the machine would help with that. For now I'm also taking nuvigil but that's not helping 100% either. I went to bed and I think only turned the machine off once briefly to use the restroom. Otherwise, I was asleep or starting to go to sleep. I think my sleep was as good as any, last night. I think it was just the one trip to the restroom, then maybe one other awakening, just the normal tossing & turning.

[Pugsy]

Can you zoom in on a cluster that shows CAs and hyponeas?
While on the events tab click on one of the CA events that has both CAs and hyponeas real close together.
A little past the 3:00 mark would be good. Would like to see the breathing pattern associated with the CAs and hyponeas up close.

[jenk]

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[torontoCPAPguy]

leak rate had a spike up to 42 for ~1/2 hour then around 15'ish the remainder.

Fairly typical for a PR System One machine at your pressure. Large leak territory is up around 70 to 80 L/min with your mask at your pressure.
Leaks aren't an issue unless they are waking you up a lot.

With all due respect, LEAKS are the #1 issue and make no mistake about it.

with all due respect (and, for you, that's decreasing with every post you make) Pugsy knows more about counseling newbies with cpap issues than you ever will.

a leak indication of 15-40 on a PR machine means the leaks ARE under control...

so, why don't you quit displaying your ignorance.

Palerider and Pugsy, I am baffled at your comments and responses. I have apologized should I have said something that offended - and that apology was heartfelt as none of us is on here to "trash" one another, excepting it appears, palerider and perhaps pugsy? I am baffled.

Perhaps I am not clear in what I post these days - I had a serious accident on May 19 and am still recovering so perhaps my words are not coming across with the message that I want to convey.

Let me state for the record that it is MY OWN PERSONAL OPINION based on experience that LEAKAGE must be the very first thing that we address when looking at the data we are receiving from our respective blowers, regardless of the mask we are using, regardless of the software we are using and regardless of any other extraneious data. LEAKAGE is prime. I fully understand that different machines have different means of measuring leakage and have different means of presenting the data. And that different masks have different vent rates (which may be directly related to leak rate). But, if we are not seeing a constant leak rate, regardless of what that leak rate may be, the other data being presented may be flawed or misinterpreted.

What I am trying to say, perhaps poorly, is simply that when looking at other data being garnered from one's blower and presented in one's software, one needs to relate same to leak rate at any given moment. So, if one is looking at another bit of information, such as an "event", one should also be looking at the leak rate at that given moment as compared to the somewhat constant leak rate through the night, in order to take the leak rate into account in translating the event at that particular moment in time. And if one is concerned about the overall efficacy of their system (i.e. blower, mask, hoseing and seal of that system) then one must also look at the leak rate at that particular moment in time, regardless of what it is. It should become apparent if there was a momentary increase in leak rate by looking at the graph.

What I was trying to say was that, in my experience with my S8 Auto and the S9 Auto and the graphs the software was presenting, one could see a variety of values that related directly to the efficacy of the system, the primary one being whether or not the system was maintaining a seal and therefore Continuous Positive Airway Pressure and along with other data, together, a determination of whether or not the system was doing what it was supposed to be doing, in other words, keeping one's airway open. Diagnosis of centrals is very difficult if not impossible to establish without even further information/data (EEG, etc.), but surely one can see if the system is sealed and at least trying to do the job it was intended to do.

I hope that my babbling on here at least puts forth a little more light on what I was trying to get across. If I was unclear or if I continue to be unclear as to what I am trying to get across please feel free to say so. THAT criticism I am humbly appreciative of and take it as such. What I find difficult to accept is being unjustifiably hit from behind.

It has been some time since I have been active on this board and I am afraid it will probably be some time before I am again active on this board - frankly, I can understand the offense taken by Pugsy by my comments in hindsight (and who has done a wonderful job of gathering information and posting it and for which I am sure we are all thankful) but not Palerider (who one could justifiably suspect of having more than just OSA issues).

I am saddened to say that it appears that the forum has lost something very valuable and that is simply the comfort members should feel in sharing their personal experience(s) and suggestions in dealing with Apnea problems.

As to freely giving out erroneous information en masse, I find it hard to be accused of this as I have probably made no more than a dozen posts on the board IN TOTAL IN THE PAST YEAR. And from the private personal messages that I have been receiving over the past weeks I am afraid that I am going to have to concede that this forum has indeed lost some of its heart and soul and is not what it used to be - such a huge attraction in past years and the free sharing of thoughts and suggestions which permitted me and many of the early members of the forum to deal with and correct our Apnea issues years ago - and now return to make some payback of that effort and experience. With some 28,000 (28 thousand?) posts I have to commend Pugsy on her level of participation and dedication and (yet again) no offense was intended. I was just hoping to share my own personal experience regarding 'leakage' but obviously screwed it up and I again apologize if any offense was given. To Palerider..... I am at a loss as to what to say without offending but suffice it to say that your reaction is so totally out of the ballpark it leaves me scratching my head. But to YOU as well, if I said something that gave YOU offense I give my heartfelt apologies. My intention was good. I was obviously not clear in what I was trying to say.

I will leave it to others, should anyone care to give it a shot, to explain why an actual quantitative base number for LEAKAGE is not all that urgent. BUT that an instantaneous leakage number or deviation could be helpful when being compared to an event of some kind, perhaps adding some enlightenment to what is going on at that instant. And ergo, lowering leakage is an important element in one's data library for a given time.

[PlinkerCraig]

Hmm. I'm no expert. But my diagnosis is that your low setting on the machine of 7cmH20 isn't doing the job. Don't listen to me since I'm a newbie to this also. Wait for more seasoned experts here or see your Dr.

I'm trying to figure out what "Clear Airway Apneas" mean. All glossaries I find make no mention of this and until now I though it meant the machine witnessed me coughing which did make sense to me and I have about 3 of those in a night, not 55 like you do.

[Julie]

Clear airway aps are also called central apneas, but do not necessarily always indicate the same problems as centrals do.

[PlinkerCraig]

Julie, many thanks. Can you point me to some references so I can read more about it. I'm in the "enthusiastic adopter" stage of CPAP therapy at this point, mentally awake and getting back in control.

[palerider]

Umm... he did apologize...

he apologized for "offending", but did not, as far as I could tell, even acknowledge that his long winded rants about leak rates were ignorant, wrong and misleading, and the kind of thing that would confuse people. as witnessed by the person he responded to saying that they'd have to change masks to follow his advice to "get leaks under control".

now, if the person had a S9, or their leaks were up around 90lpm, then sure, "get your leaks under control first!" would be the right advice. but, not in this case.

[torontoCPAPguy]

Umm... he did apologize...

he apologized for "offending", but did not, as far as I could tell, even acknowledge that his long winded rants about leak rates were ignorant, wrong and misleading, and the kind of thing that would confuse people. as witnessed by the person he responded to saying that they'd have to change masks to follow his advice to "get leaks under control".

now, if the person had a S9, or their leaks were up around 90lpm, then sure, "get your leaks under control first!" would be the right advice. but, not in this case.

To be clear, I apologized if I offended. I make no apologies for the information that I provided, believing the information to be correct and factual. If someone believes the information to be incorrect they need to speak up and provide correct information that can be digested by the person taking in the information.

FWIW, inconsistent mask leakage negates the treatment and I am wondering if you believe otherwise? CPAP stands for Continuous Positive Airway Pressure which is used to maintain an airway open. If there is excessive or fluctuating pressure being provided to the airway and the airway is collapsing is the therapy not being pretty much negated, or am I out to lunch here? The actual extent of the loss of pressurization may not really even be of consequence as long as it is constant so that your blower can adjust for it. When you set a blower for 12 cmH2O does it really matter (on most machines) if the mask has a vent loss of 8 or even 10 cmH2O (I am being facetious on purpose here) as long as the blower compensates for the vent or leakage loss and brings the pressure being presented to the airway back to 12cmH2O? Therefore, my belief is that leaks are of critical importance if therapy is to be consistent. One may have leakage, as we do with, for example, the Mirage Quattro FFM, but it is vent leakage and is constant which the blower can deal with. It is when we have inconsistent leakage or leakage of such an extent that the blower cannot deal with it that therapy is affected.

If someone has an issue with this information I would really appreciate (serious here) hearing about it. I have a couple of hoses that I have set aside for return that have inconsistent leaks in them and have been told by a doctor of respirology specializing in OSA that they should be tossed. If you have a different theory I would be grateful to hear it instead of being called an idiot, which is simply a bad attitude.

[palerider]

I make no apologies for the information that I provided, ...

The actual extent of the loss of pressurization may not really even be of consequence as long as it is constant so that your blower can adjust for it. ... If you have a different theory I would be grateful to hear it instead of being called an idiot, which is simply a bad attitude.

I direct you to page 31 of the clinicians manual for the s9 autoset, autoset for her, elite, escape auto, escape combined manual.

thoughts?

[torontoCPAPguy]

The Clinician Manual that I have is
AutoSet™ & Elite™
POSITIVE AIRWAY PRESSURE DEVICES
H5i™
HEATED HUMIDIFIER
Clinical Guide
English

Page 31 refers to S9 Cautions; H5i Warnings and Air Tubing Warnings. Is this the page you are referring to? This being the page, we are cautioned against playing with ANY of the equipment or settings in the S9 Autoset or Elite series. If it is another manual I do not have that manual.

I make no apologies for the information that I provided, ...

The actual extent of the loss of pressurization may not really even be of consequence as long as it is constant so that your blower can adjust for it. ... If you have a different theory I would be grateful to hear it instead of being called an idiot, which is simply a bad attitude.

I direct you to page 31 of the clinicians manual for the s9 autoset, autoset for her, elite, escape auto, escape combined manual.

thoughts?

[Jay Aitchsee]

Julie, many thanks. Can you point me to some references so I can read more about it. I'm in the "enthusiastic adopter" stage of CPAP therapy at this point, mentally awake and getting back in control.

Here's a couple for you.
viewtopic/t62941/Clear-Airway-Apnea.html
http://www.resmed.com/us/en/consumer/di ... apnea.html

[PlinkerCraig]

Jay, many thanks,
Craig

[Pugsy]

Back to original issues here. OP had a home sleep study and no in lab titration.
Too many centrals...unsure if centrals were present before cpap therapy or just showed up after cpap therapy.
Best advice is to get with the sleep doctor ASAP. OP is going to try to get the Oct 22 appointment for follow up moved up sooner.
Might try more pressure to see if the hyponeas and OAs are causing post arousal centrals...it's long shot though. I have seen it happen only twice...so not totally impossible. One night with higher pressures (like 9 or 10) to see if the centrals increase or decrease. I don't advise a big APAP range in this situation but would like to see apap mode used so we can get any FL flags just to see if they are happening.

My gut tells me CompSA is what we are seeing here and that needs to be followed with a doctor until proven otherwise.
We aren't seeing big PB times though...so I am still scratching my head here. It's not following the usual pattern but then exceptions to the rules are common with cpap therapy.

So might fiddle with the settings a little just to see what happens while waiting for the doctor appointment but most definitely advise follow up with doc.
In the process of getting OP setup with Encore to show the sleep doc as he/she probably doesn't know about SleepyHead and might blame the centrals on SH and not the machine scoring.

[cathyf]

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.

Was this called an ApneaLink? I used one of these last spring. I'm quite sure that on the ApneaLink the belts are only to strap the sensor to your body -- it's battery operated, so you can get out of bed and walk around without having to disconnect anything, and the straps are just to keep you from getting entangled in the equipment when you move around while sleeping. I'm pretty sure that the ApneaLink also can't tell whether you are actually asleep. With mine I was awake for awhile until I finally gave up on going back to sleep and turned it off. My ApneaLink screening only showed an AHI of 8, while my sleep study showed 15. A big part of the difference is that the denominator on the AHI is the amount of time you are asleep, so if it overcounts sleep time, then it divides by too big a number to get the AHI and it looks lower than it really was.