New and need advice

Billyboy · Post by **Billyboy** » Mon Jan 14, 2008 7:10 pm

Hi, I have been lurking here for a while and thought it was time to post. I was diagnosed with sleep apena back in sept 07 . I have been trying to get use to xpaps scince then. My first machine was a m series cpap with cflex set on 19cm(titration `level). I could not tolerate the pressure. I was loaned a resmed malibu auto bilevel set at 8-19,ps = 8. I found this machine much more confortable and the Dr. ordered me one. During the time I had the loaner I found out how to access my data and found out that I was having an AHI in the range of 11-30 / night. The HI's were running about .6-4.0. My 95% pressure was around 12-16 and usually on the lower side of that range. I have had problems with mask leaks and have not been very consistant. I know have rescan and will soon show you all my charts when I figure out how. Anyway I took my new malibu back to the Dr. with a few weeks data showing the high HI and relitivly low avg. pressures and he did not know how to interpret the dat so changed nothing. He is supposed to talk to a resmed rep this week and has ordered an overnight o2 test at my home the DM hasn't got the machine to me yet. I have been feeling pretty tired and don't want to mess with the malibu settings so I have been playing with the m series cpap. I have been getting an AHI around 10 for the last 4 night with settings of 16,15, 14, and 16.5. I am feeling somewhat better (fewer mask leaks) but need to get more consistant fitting the quattro and get the AHI solved on the malibu. Sorry for the long post.

Slinky · Post by **Slinky** » Mon Jan 14, 2008 8:01 pm

Pressure Changes

http://www.cpap-supply.com/Articles.asp?ID=130

Mask Fitting Suggestions:

Red Ball at the top of this page w/the Question Mark in it. Scroll down to Mask Fitting suggestions or similar.

Billyboy · Post by **Billyboy** » Tue Jan 15, 2008 8:00 am

Thanks for the reply Slinky. I know how to change the settings on the two xpaps I have and am doing this cautiously. I averaged 3 wks of data from the nightly 95% average pressures(from the auto bilevel) to try to find a sweet spot(on the m series) where the AHI is below 5. I know that you are a resmed user and know how they report data. I just can't figure out why the HI's are so high and believe the Dr. will have to close up the range of auto 8-19 to reduce the HI number. I was just trying to do that with the m series cpap by setting it around the high end of the 95% numbers. While on the malibu the # of events did not seem to be tied to leaks(only pressure would increase about 1cm) but the machine seem to have problems chasing or eliminating events,mainly HI's. My malibu is set for a full face mask and would show leaks of 1 l/m to 15 l/m(not consistant). I am now using the microfoam tape on the bridge of my nose (more comfortable) and showing a leak rate of 37-39 l/m on @pressure 15-16.5 on the m series which I think is OK ? I know I'm rambeling so I'll quit and hope to come back to my senses soon. Thanks

rested gal · Post by **rested gal** » Tue Jan 15, 2008 9:13 am

Billy, I've used Respironics and resmed machines.

I found that the ResMed S8 machines consistently reported a higher Hypopnea Index (HI) number for me than did the Respironics machines.

That doesn't mean one is right and the other is wrong. Nor does it mean we're having "more hypopneas" with one brand vs another. It's simply a matter of "definitions." It's the way each manufacturer defines a "hypopnea" (which IS a limited amount of air flow) vs a "flow limitation" in their own machines.

Each manufacturer designs their own machines to call it a "hypopnea" if the amount of flow limitation the machine sees meets THAT manufacturer's definition of "hypopnea."

There's no need to worry when you see a higher AHI because of the higher HI when using a ResMed S8 machine than when using a Respironics machine at the same settings. Nor does it mean you need to change settings in one manufacturers' machines to try to match what you've seen from another brand. You'd be trying to compare apples to oranges when it comes to each manufacturers' definition of "when a flow limitation gets marked as a hypopnea."

Mentally, I always just cut the reported HI in half when I used a ResMed S8 machine. They always reported double or more HI for me than my Respironics machines do. Doesn't mean I was having more, or less, hypopneas with one brand or the other. It's just the definition of "hypopnea" each manufacturer uses.

I think of flow limitation as a baby hypopnea. Someone once called it a hypopnea wannabe.

In a sleep lab PSG there are definite requirements before a flow limitation is categorized as an "hypopnea." Things like a certain percentage drop in O2 (4% drop, for example.)

But the machines we use are not measuring SpO2. Our machines go by whatever definition of "hypopnea" their own manufacturers built into them.

Respironics and ResMed and Puritan Bennett, for that matter -- any autopap manufacturer -- simply have different definitions of when a flow limitation has become "limited enough" to be marked as an hypopnea.

Again, that doesn't mean one brand is reporting "hypopneas" more accurately than the other. Or even that you are really having more hypopneas with one brand than another.

You'd have to be hooked up to PSG equipment in a sleep lab to know if it really is a hypopnea. And even then, it would depend on the lab and the scoring tech to call "this" an hypopnea, and "that" still a flow limitation. Labs usually go by Medicare's definition, I believe.

The HI report is always going to be different from one brand to another. That will cause the overall AHI to appear higher or lower than the other. I wouldn't worry about the difference in the Hypopnea Index reported by one brand vs the other.

If I felt the same results either way, I'd use the machine that I liked best for other reasons -- whatever's important to you, be it exhalation comfort, size, sound, software design, machine's outside design, etc.

My edit: Added "S8" to all my references to ResMed machines in this old post, since the definition of hypopnea was changed by ResMed in the later S9 series machines.

rested gal · Post by **rested gal** » Tue Jan 15, 2008 9:24 am

Billyboy wrote:I am now using the microfoam tape on the bridge of my nose (more comfortable) and showing a leak rate of 37-39 l/m on @pressure 15-16.5 on the m series which I think is OK ?

Yes, that's a nice low leak rate for that pressure with a Respironics machine. Glad to hear you've found a solution to make your mask more comfortable.