Newbie - TONS of questions after 2 nights, HELP!!!

[Jayjonbeach]

Hello fellow Cpap'ers. I just completed night 2 with a rental machine and I have many questions.

First, just a little background, my sleep study was not very successful, I only had about 90 minutes of sleep that could be studied as I had trouble sleeping at the hospital. The doctor did call me back though saying that I did have a few apneas in that time and combined with my history of feeling tired for the last 15 years, recommended I try a machine on trial. I am not the type that will fall asleep at the wheel or standing up, but I NEVER wake up rested and generally feel tired ALL DAY LONG (grogy and clouded thinking, mostly mental but sometimes physical, heat makes it worse) which really sucks and makes work a living hell.

So my first night with the machine was not so good, pressure was too low (7 what doc prescribed thinking I am a somewhat mild case) and my wife said I was snoring with the mask ON. Thanks to a very useful website, I gained access to the Clinical menu and adjusted to 9 which seemed better, though some of my questions pertain to this. So here they are:

First what I am using:

Machine: S8 AutoSet™ II CPAP Machine (currently on 9 with NO EPR)
Mask: Mirage Quattro™ Full Face CPAP Mask with Headgear
Humidifier: Humidaire H3i™ Heated Humidifier
Software: Not sure

1. What is the difference between: AHI, AI and HI?

2. Might tie into 1., is there more than one type of Apnea (I seen central mentioned) and what is the difference?

3. Does a number of 14.3 for AHI mean I had 14 of those events in one night? Per hour? Minutes of disturbed sleep?

4. What is PROBABLY the most common/average pressure setting? (I know if differs largely on the person but I am just curious what people think the average is, just guess if you dont know, my guess is 10-11)

5. What is the difference between CPAP and APAP? One is constant and the other is Auto or Adjustable?

6. After two nights it would appear that my numbers are as follows: AHI=12.5, AI=2.5, HI=7.6 (I'm not totally confident the "technicain" that gave me the machine reset the numbers first, also the first night my nose was itchy and I had to let air leak a lot just to scratch it, wondering if this affected my numbers and I wonder if I should reset them and start over)

How do these stack up against others, new users or long time users? Fairly average?

7. How many people are using the EPR and at what setting?

When I had the pressure at 7 and EPR 3 (the way the technician set it for me) I think it was allowing me to have apneas as breathing was TOO EASY with the lower pressure combined with the highest EPR setting (which I think means the higher the setting, the easier it is to breathe "against" the flow of air [it adjusts down]). I think in general this is maybe why the S9 is probably superior (see 8 below) as it senses when you are not breathing and then adjusts by rushing air into the mask? Even at a pressure of 9, I wonder if it was enough to stop my apneas with the S8, maybe I should try 11 and an EPR of 1? (EPR 3 seems too easy to breathe out and I suspect doesnt keep air flowing enough of the time which would allow more apneas)

8. Is the S9 more or less considered to be the best machine available? I have seen many comments saying that it helps to reduce "Apneas" , presumingly due to the autoadjust feature? Does this mean my current S8 does not adjust at all or only to certain ones? Here is a piece of interesting info on the S9 I found:

Enhanced AutoSet™ Algorithm
The S9’s Enhanced AutoSet algorithm now differentiates between obstructive and central sleep apneas and responds appropriately. You can enjoy peace of mind because you'll know you’re always receiving optimal therapy at the lowest necessary pressure.


Thank you in advance for any detailed answers! Need all the help I can get right now, tired of being tired for sure.

[Emilia]

Hello fellow Cpap'ers. I just completed night 2 with a rental machine and I have many questions.

First, just a little background, my sleep study was not very successful, I only had about 90 minutes of sleep that could be studied as I had trouble sleeping at the hospital. The doctor did call me back though saying that I did have a few apneas in that time and combined with my history of feeling tired for the last 15 years, recommended I try a machine on trial. I am not the type that will fall asleep at the wheel or standing up, but I NEVER wake up rested and generally feel tired ALL DAY LONG (grogy and clouded thinking, mostly mental but sometimes physical, heat makes it worse) which really sucks and makes work a living hell.

So my first night with the machine was not so good, pressure was too low (7 what doc prescribed thinking I am a somewhat mild case) and my wife said I was snoring with the mask ON. Thanks to a very useful website, I gained access to the Clinical menu and adjusted to 9 which seemed better, though some of my questions pertain to this. So here they are:

First what I am using:

Machine: S8 AutoSet™ II CPAP Machine (currently on 9 with NO EPR)
Mask: Mirage Quattro™ Full Face CPAP Mask with Headgear
Humidifier: Humidaire H3i™ Heated Humidifier
Software: Not sure

1. What is the difference between: AHI, AI and HI? AI= Apnea Index; HI= Hypopnea Index; AHI is the average of the two per hour events.

2. Might tie into 1., is there more than one type of Apnea (I seen central mentioned) and what is the difference? Yes, there are obstructive apneas; central apneas, hypopneas, mixed apneas Go to this link for definitions: wiki/index.php/Category:CPAP_Definitions

3. Does a number of 14.3 for AHI mean I had 14 of those events in one night? Per hour? Minutes of disturbed sleep? No, thus 14.3 events in an hour. That would be in the mild category---almost moderate.

4. What is PROBABLY the most common/average pressure setting? (I know if differs largely on the person but I am just curious what people think the average is, just guess if you dont know, my guess is 10-11) There is no common/aver setting. It is based on your sleep study results and the titration study is used to find the right pressure for you.

5. What is the difference between CPAP and APAP? One is constant and the other is Auto or Adjustable? CPAP is a set pressure setting; APAP is auto set with a range of pressures, high and low that machine detects and auto sets to your needs.

6. After two nights it would appear that my numbers are as follows: AHI=12.5, AI=2.5, HI=7.6 (I'm not totally confident the "technicain" that gave me the machine reset the numbers first, also the first night my nose was itchy and I had to let air leak a lot just to scratch it, wondering if this affected my numbers and I wonder if I should reset them and start over) Not sure about this. Those who use your machine can better help you with this one.... but I believe you need to have more than 2 nights to get a good picture.

How do these stack up against others, new users or long time users? Fairly average?

7. How many people are using the EPR and at what setting?

When I had the pressure at 7 and EPR 3 (the way the technician set it for me) I think it was allowing me to have apneas as breathing was TOO EASY with the lower pressure combined with the highest EPR setting (which I think means the higher the setting, the easier it is to breathe "against" the flow of air [it adjusts down]). I think in general this is maybe why the S9 is probably superior (see 8 below) as it senses when you are not breathing and then adjusts by rushing air into the mask? Even at a pressure of 9, I wonder if it was enough to stop my apneas with the S8, maybe I should try 11 and an EPR of 1? (EPR 3 seems too easy to breathe out and I suspect doesnt keep air flowing enough of the time which would allow more apneas)

8. Is the S9 more or less considered to be the best machine available? I have seen many comments saying that it helps to reduce "Apneas" , presumingly due to the autoadjust feature? Does this mean my current S8 does not adjust at all or only to certain ones? Here is a piece of interesting info on the S9 I found:

Enhanced AutoSet™ Algorithm
The S9’s Enhanced AutoSet algorithm now differentiates between obstructive and central sleep apneas and responds appropriately. You can enjoy peace of mind because you'll know you’re always receiving optimal therapy at the lowest necessary pressure.


Thank you in advance for any detailed answers! Need all the help I can get right now, tired of being tired for sure.

Generally, all I can tell you is that you need educate yourself by reading, reading, and reading some more on this form. Use the yellow lightbulb icon at the top of the page to go to the wiki and read that, too. I have only been on this forum for a few weeks, and I have learned tons. I am still waiting for my equipment to get started so I am learning as much as I can to be prepared.

Best of luck to you! Other, more veteran cpapers, will be by shortly to give you their learned advice. Do take a few minutes to register and fill in your profile with all pertinent info on your equipment so it will show up in every post.

[elena88]

OMG, I just answered every question too! Emelia, thank goodness for you, as when I clicked preview, I LOST THE WHOLE THING!
thank you! that would have been funny to see our emails in tandem!

[brazospearl]

Welcome, Jayjon! You are a fortunate man, because your doctor realized you might benefit from cpap therapy (many wouldn't have!) and you found this site. Emilia gave you some good responses, here's my 2 cents.

EPR = reduced pressure when you exhale. This feature lessens the pressure by 1 for every number it's "on." That doesn't make much sense, so think of it this way. With a pressure of 10 and EPR at 3 the exhale pressure = 4. This feature is useful for those sensitive to having to 'breathe against the pressure," especially at higher pressures. If you feel the EPR 3 isn't working for you, change it.

There is no correlation between the number of apneas an untreated person has and the pressure needed to prevent them. For instance, a person might have 30 events an hour and need a pressure of 9 to control them, another might only have 2 events but need a pressure of 18 to control them. Without an accurate titration, your doctor was guessing at which pressure might be best, and it's completely possible that his guess was wrong. You did well by upping your pressure to 9. There is also no "average" pressure, although, anecdotally, it seems many people begin in the 10-to-12 range.

The difference between cpap and apap is simple. In cpap your pressure is always the same. In apap you set the machine for a range, such as 10 to 13, and the machine adjusts the pressure up or down as it senses your breathing. Neither is "better" than the other. Some people are very sensitive to the pressure changes and prefer cpap, others are more sensitive to having a higher pressure (that they don't always need) and prefer apap.

The S9 is the newest Resmed machine, and it has a more sensitive algorithm. Many forum members have them and seem quite pleased. That said, there is nothing wrong with the machine you currently have. It will provide your excellent therapy and data.

Keep reading on this forum, and keep asking questions. We're glad to help!

[Janknitz]

It looks to me like they sent you home with an autoset machine to be titrated at home, and then put you on straight CPAP (the auto machine can be set to either CPAP --continuous pressure, or APAP--automatic pressure adjustment).

This makes no sense. You can be titrated at home by setting the machine on auto and looking at what happens to the pressures. But all you can tell with a straight CPAP setting is whether or not a particular pressure works.

(7 what doc prescribed thinking I am a somewhat mild case)

Is this a sleep doctor treating you???? Severity of apnea and pressure requirements don't have much to do with each other--some people with very mild SA need higher pressures than others with severe SA.

If you have software to take a detailed look at you data, you can set your machine to CPAP with a pressure range of say 9 to 13 and see what happens. If the pressures stay well within those parameters (as seen by pressure graphs that don't have you bumping against the top or bottom pressures too often) and your AHI comes down, you're on your way.

EPR is for comfort, but it should not adversely affect your AHI, so don't worry about that. You can turn it anywhere from 0 to 3 according to what's comfortable for you.

The Resmed S9 autoset is the top of the line machine nowadays, but the S8 is very good as well. The S9 will show central apneas (also known as "clear airway apneas), the S8's don't (I think).

[elena88]

that was what I had written too..

an at home titration, the autoset needs to be ON auto! not cpap..

somebody really really screwed up.. I know because I only slept an hour in my study, thus rental of a machine for one week, on auto ON auto, to see
where I landed..

you need to get that thing reset.. or you will never know what your pressure is.

[Jayjonbeach]

Hello Hosers and thanks for the replies!
(truly the expression "hosers" or aptly also noted as 'hoseheads' now takes on a new meaning for fellow Canadians with OSA)

I have done a whole bunch of reading and feel much more educated already, I still do have a few more questions though.

To answer one asked, the actual sleep specialist after my sleep study, recommended the pressure of 7-8. The thing is, there was no test with a CPAP so it is really a guess! Like I mentioned, my study was only partially useful too since I slept all of 90 minutes of measurable sleep. Later in her office, she said the *&#*&% government has now changed the rules so that people are only allowed ONE SLEEP STUDY in their LIFE!!! (Canada for ya) So it looks like I will be playing with the machine at home to find good pressures that work. To that end, here are some more questions:

1. What is the advantage of BIPAP and the difference from CPAP or APAP? I think I read that with some people CPAP CAUSES Central Apneas and this is why they need to go with BIPAP.

2. I have access to the Clinical menu and since a proper titration has never been done, I will do one myself by switching the S8 Autoset to Auto. What pressures should I start at? I am thinking 8 - 14?

3. The Mirage Quattro has many little holes located around the nose area and TONS of air leaks out through these(which has the negative effect of being noisy too), I suppose this is normal yes as air does need to escape?

4. I'm not sure if the unit I have has an SD card in it or not, viewing the results I can see usage, AHI, HI, AI, but that is about it, no sleep efficiency or anything else. Is there a way to get more data from the machine besides having software?

5. Where could someone RENT an oximeter? This is a big concern for me, I have a feeling my levels are way too low and this is why I feel exhausted most of the time, which leads to:

6. How would you hook up oxygen to the hose? I have a feeling I am not going to feel fully rested unless I also have oxygen therapy but I will let the oximeter tell the tale for that and be the definite answer. Maybe once I get the machine dialed in I will start to feel better but I also think that having even small amounts of oxygen would be largely beneficial.


Thanks again for your help. I have read some success stories and feel cautiously optimitic (have also seen some where it doesn't seem to help). I have been going to the doctors for 20 years and telling them I am WAY too tired and something isn't right, and that is no way to go through day to day activities.

[Emilia]

You still haven't registered on this site to put in your equipment as well as be able to receive private messages or participate in live chat. If you want help from the wonderful family here at cpaptalk, you need to be a registered member to access the best available help for your treatment.

1. Please utilize the CPAP Definitions page wiki/index.php/Category:CPAP_Definitions to answer some of your questions. BIPAP machines are usually not Rx'd until one fails at using a CPAP machine. They are very, very expensive.

2. I am pretty sure I read that when in Auto, the pressure range should reflect 2 below and 2-3 above the prescribed pressure. Since you were told 7-8, I'd set it at 6-10 or 6-11 to start.

3. The rest of your questions I have no idea how to answer.... but you can be sure others will be by soon to help!

Now.... go and register and fill in your profile!

[DoriC]

An AHI of <5 is considered satisfactory therapy but most people feel better once they get it lower than that. If your AHI is 12.5 and you're snoring I would think your pressure needs to be raised and the purpose of an auto is to do a titration to see what your optimal pressure is over several nights. A common setting might be 8-12cms but that's just my thought. I don't use the machine myself(I assist my husband) but I understand that a too low pressure can feel suffocating. Good luck and keep us posted.

[brazospearl]

The holes in your mask are normal, they are there to let out the air you exhale, and if your machine in set with the correct mask that has no impact on your leak rate or therapy.

Your S8 has the capacity for a data card; look on the back sort of next to the filter. If the card is there you'll need a special card reader and program to get the data off it, or you can take it to your DME for them to read it. Some people manage just fine without the details from the card, but since you're trying to gather info that might have been noticed in a titration it would be VERY helpful for you to have this info.

The pressure range of 8 - 14 is a bit wide for regular use, but since you have no titrated starting point it's as good a place as any to start. Whichever range you choose, leave it there for about a week to see results long term, as everybody's sleep varies from night to night.

Bipaps are used for some complicated situations and conditions, and it isn't likely that you'd be in a position to have one provided now because there just isn't enough data to justify it at this point.

Am I correct that you are in Canada? It seems the regulations about what is generally available there vary by province. One of our Canadian folks will be by soon to direct you to a place where you could acquire an oximeter. Please register and fill out your profile so we can be more help.

[elena88]

Hello Hosers and thanks for the replies!
(truly the expression "hosers" or aptly also noted as 'hoseheads' now takes on a new meaning for fellow Canadians with OSA)
If you are Canadian, you can call yourself an "apnean"! Well, some of us yanks do it too..

I have done a whole bunch of reading and feel much more educated already, I still do have a few more questions though.

To answer one asked, the actual sleep specialist after my sleep study, recommended the pressure of 7-8. The thing is, there was no test with a CPAP so it is really a guess! Like I mentioned, my study was only partially useful too since I slept all of 90 minutes of measurable sleep. Later in her office, she said the *&#*&% government has now changed the rules so that people are only allowed ONE SLEEP STUDY in their LIFE!!! (Canada for ya) So it looks like I will be playing with the machine at home to find good pressures that work. To that end, here are some more questions:

You cant guess at a pressure, that is why I suppose ALL Canadians are going to need auto paps the rest of their life.

1. What is the advantage of BIPAP and the difference from CPAP or APAP? I think I read that with some people CPAP CAUSES Central Apneas and this is why they need to go with BIPAP.

You are getting ahead of yourself here.. I think.. first they try to start off on cpap a constant pressure, if you are lucky and persistant, you
ask for an autopap off the bat, if THAT fails to work, or you have a lung ailment or trouble breathing against the pressure, they MIGHT give you
a bipap.. a bipap or vpap has two differnt pressure settings.. one on inhale and one on exhale, then there is an auto bipap which adjusts automatically
with two pressures on inhale on exhale.. I
Most people do fine with an apap which automatically finds the right pressure for you.. and it CAN be run as a cpap too.. so no use
buying a cpap these days.. A few centrals are normal, and happen to many people when they roll over.. an s9 autoset will pick up centrals you
are having, but it does not treat them.. you need a very specfic machine if you have central apnea

2. I have access to the Clinical menu and since a proper titration has never been done, I will do one myself by switching the S8 Autoset to Auto. What pressures should I start at? I am thinking 8 - 14?
about two below and two above.. thats good if you were a ten/eleven.

3. The Mirage Quattro has many little holes located around the nose area and TONS of air leaks out through these(which has the negative effect of being noisy too), I suppose this is normal yes as air does need to escape?
If there air was not venting out of their at a brisk pace, you would be rebreathing c02, a big no no.. so that is good.. you can put a pillow between
you and your pet or partner if it bugs them..

4. I'm not sure if the unit I have has an SD card in it or not, viewing the results I can see usage, AHI, HI, AI, but that is about it, no sleep efficiency or anything else. Is there a way to get more data from the machine besides having software?
You need the software for all the goodies, but its not that hard to find, does the rescan 3.11 work on the s8 you guys?

5. Where could someone RENT an oximeter? This is a big concern for me, I have a feeling my levels are way too low and this is why I feel exhausted most of the time, which leads to: \
In the usa, we can rent oximters from the docs office, you might be able to do that too, or ask the folks you got the machine from..
You can also buy them online..

6. How would you hook up oxygen to the hose? I have a feeling I am not going to feel fully rested unless I also have oxygen therapy but I will let the oximeter tell the tale for that and be the definite answer. Maybe once I get the machine dialed in I will start to feel better but I also think that having even small amounts of oxygen would be largely beneficial.
You are going to have to give the machine some time to do its job, the adjustment can take anywhere from a few days to months.. it depends on
the person.. See how you feel with the pressure range raised a few days.. if you have had OSA for years, your body is going to fight the feeling of
actaully get in oxygen again.. it takes time for it to adjust to accepting these changes..

Thanks again for your help. I have read some success stories and feel cautiously optimitic (have also seen some where it doesn't seem to help). I have been going to the doctors for 20 years and telling them I am WAY too tired and something isn't right, and that is no way to go through day to day activities.

It is very likely this was your problem, Ive had it since I was a kid, and not diagnosed until I was 53.. This therapy, WILL give you your life back,
the struggles are only mysteries to solve one by one..
Youll be okay!

elena
(now watch Emelia will post the exact same answers! ha!)

[sleepnationtv]

Here are a few videos that will help you with the machine choice and full face masks
http://www.sleepnation.tv/post/942170110/episode2
http://www.sleepnation.tv/post/808897740/episode1

Hope this helps

[ThatMaskedMan]

Hi Emilia,
In your post yesterday at 2:54, you said, "AHI is the average of the two [AI and HI]." Actually, it is the sum, not the average.

[Emilia]

MaskedMan: Thanks for the correction. I am still learning!!

[Jayjonbeach]

Hello all, 3rd night is in the books and my numbers appear to be improving. (and yes Emilia i registered just for you... )

So to anyone curious like other newbs, here is a run down of my numbers over the last 3 days.

Night one: CPAP mode, pressure 7, AHI 14.3, EPR=3. Night two: pressure 9, CPAP mode, AHI 12.5, EPR=off.

Night three: APAP mode, AHI 10 (AI 2.7, HI 8.3), Leaks 0.04, av pressure 11.2, EPR-off (thinking about putting this at 1).

I think I am on the right track here though I am still feeling somewhat tired and have some clouded thinking albeit MAYBE less, honestly its a little hard to tell, probably too soon not sure (and also being on the 17th floor in a condo in a very HOT summer I think makes things worse as the A/C is constantly on and the windows always closed which means air is pretty stale. I think I am less tired generally speaking in seasons other than summer for this reason since we can open windows and let air in)

Last night I ran the machine in Autoset mode with Min=8, Max=14. The doctor only guessed at the pressure I would need since no titration was done and appears to be off given my average last night and the fact that night two set on CPAP 9 was much better than night one CPAP 7 where I was snoring with the mask on (though I wonder if the low pressure combined with EPR=3 was a bad combo and allowed me to snore). Note on the Quattro, thank goodness someone pointed out that the dial needs to START fully extended in another thread, I did the opposite night one and two and had a whooping red mark with tiny blisters on bridge of nose, much better last night and virtually no leaks 98% of the time all 3 nights.

So, I do have a couple more questions.....

1. What is A-Flex, C-Flex and the difference?

2. Could leaks affect the AHI data? (I don't think so but would like clarification)

3. I wonder what is the advantage of CPAP over APAP if any? I did read a good thread/article on it somewhere but I would like to know what some long time users think. If APAP adjusts to your breathing, why even go back to CPAP? Will CPAP help reduce someone's AHI more than APAP?


I guess that is about it for now. One other thing I noticed last night, it seemed to me I was doing a lot of SHALLOW breathing, I wonder if I am one by nature and if this is also part of the reason I am always tired. I definitely want a copy of my sleep study to see what the numbers were (even if not fully meaningful because I only had 90 minutes of measurable sleep) and what my Oxygen Saturation level was. I am looking forward to renting an Oximeter to see where I stand now and where I will be in one month, I think Oxygen is critical to someone's well being and having OSA drops your levels which of course has the effect of making you horribly tired.

Overall I think I am adjusting well, my wife is not very keen about sleeping next to a "Machine" (yes she is poking fun and calling ME that) and truthfully I do feel a little like Darth (Luke, I am your father... ) but the mask is much more comfortable and much less obstructive to my sleep than I thought it would be.

Happy hosing to all of you out there.