Dream Station not Fully Eliminating my Apneas

I recently purchased the Philips Dreamstation with humidifier and heated hose. I use this machine with the ResMed Mirage Quattro full face mask. I have been using this machine for about two weeks and am generally quite happy with it. I am baffled by my nightly reports. Despite usually having 100% mask fit, the unit indicates that my AHI is still in the 4-7 range. Why is this machine not reducing my AHI more into the 0-1 range? Are there settings that I can adjust to help lower my AHI further?

jweiner@wi.rr.com wrote:I recently purchased the Philips Dreamstation with humidifier and heated hose. I use this machine with the ResMed Mirage Quattro full face mask. I have been using this machine for about two weeks and am generally quite happy with it. I am baffled by my nightly reports. Despite usually having 100% mask fit, the unit indicates that my AHI is still in the 4-7 range. Why is this machine not reducing my AHI more into the 0-1 range? Are there settings that I can adjust to help lower my AHI further?

Yes, in most cases there are settings that can improve your therapy.
Please register, list all of your equipment. Download Sleepyhead software and post some charts so we can see your data.

Use the software to determine exactly what category of event is being flagged.
This is something you can't see on the machine's LCD screen.

3 event categories.

Clear Airway/Central Apnea....if your AHI is primarily this category more pressure won't necessarily fix it and need to maybe see the software reports to get an idea if we need to worry about them or not. If you are spending a lot of time awake with mask and machine on it is possible these aren't real and if not real we don't worry about them. The airway is open...just no air is moving and more pressure can't fix it.

Obstructive Apnea

Hyponea

If your AHI is primarily Obstructive Apnea or Hyponea these are related to airway tissues collapsing and a little more pressure is likely needed.

Exactly which model Dreamstation??
If it is the DSX200(with 3 letters after it) then that machine won't tell you the event categories...it's a half assed brick.
You need DSX400(with 3 letters) or higher to be able to see the event categories along with other useful data like potential clustering of events along with snores and flow limitation which also indicate a need for more pressure since they relate to obstructive issues.

If you don't have the DSX200
get the software here
https://sleep.tnet.com/equipment

Get the clinical/provider manual and you can see how to change the settings (should you want to). You can request it here.
http://www.apneaboard.com/adjust-cpap-p ... tup-manual

I registered on Friday. I am just waiting to be approved but thought I'd go ahead and ask my question.

Pugsy - - I have the DSX500T11. Here is a screen shot of my AHI over the last week (from the Philips Dream Mapper app). You can see that it is always in the 4-7 range. My machine is an autopap unit. I didn't think that I had to do any adjusting of pressures.

jweiner@wi.rr.com wrote: I didn't think that I had to do any adjusting of pressures

Wrong thought and especially with apap range of 4 to 7. Not enough room to roam and starting point is too low most likely if it is obstructive events and you are maxed out at 7 all night.

Can't see screen shot until you can insert image link.

With your Dream Mapper.....how many clear airways, OAs and hyponeas over the night and how many hours?
The pressure number on DreamMapper is what we call a 90% pressure...you were at or below that number for 90% of the night. The "or below" part is often not known or forgotten.

Get SleepyHead...much better details.

First we have to decided if the events need more pressure...if they are mainly clear airway then more pressure won't help.

Pugsy - - the 4 - 7 is my residual AHI on treatment. The APAP pressures go from 4 - 20. My 90% pressure is about 9.0cm H20. My data from last night shows 8 total clear airway apneas and 4 total obstructive apneas. However, the night before, my total clear airway apneas were 3 and total obstructive apneas were 14 and my residual AHI was 7. Sorry, but I can't seem to figure out how to upload a picture.

jweiner@wi.rr.com wrote: My machine is an autopap unit. I didn't think that I had to do any adjusting of pressures.

The settings can be adjusted to fine-tune the therapy. If the settings are wide open (min 4, max 20), the machine may take longer to respond to your particular needs. Compare it to constantly having to run up and down stairs to retrieve things you need on another floor in the house, versus keeping things frequently needed closer by. You still get what you need, but without the lag in time and energy, so a more efficient process.

When Pugsy sees your charts, she may be able to suggest some modifications to the settings so that your therapy is optimized.

cheers,
Jean

[quote="jweiner@wi.rr.com" Sorry, but I can't seem to figure out how to upload a picture.[/quote]
That may be because you have recently registered as a user, and your registration is not yet confirmed. That takes a couple days. There are instructions in the pinned topics at the top of the page about Sleepyhead use and how to post charts.

Jean

Sorry...misread what you said...thought it was pressure and not AHI that was 4 to 7.

The 4 to 20 setting is wide open default from the factory and while those settings work fine if a person never needs more than 9 or 10 most of the time the machine needs a better head start to get to where it needs to be in a timely manner to better hold the airway open.

You have to mentally remove the ClearAirway/Central index from your evaluation of pressure needs...we can't fix those with more pressure unless they happen to be post arousal from an OA causing an arousal and if you prevent the OA then the arousal gets prevented.

When the machine senses the airway is closing (snores, flow limitations, hyponeas and OAs) it will increase the pressure but it takes a while to do it. It can't go 3 cm in the blink of an eye...it goes up in stages and can take several minutes to get there and by then the airway has closed and opened back up again.
The best defense against the airway closing is to simply hold the airway open better to start with.....more minimum pressure and probably since not all your AHI is obstructive maybe something like 7 cm minimum would do the trick and still be comfortable.

Is the jweiner@wi.rr.com an email address I could use to contact you? If so I can email you and then you can email me the screen shot of the report and I can see it that way. You won't be able to insert an image link until you are not only registered but logged in. Look at my Profile on the left of this message...I am logged in...look at yours...you aren't.

xxyzx wrote:

Pugsy wrote:

jweiner@wi.rr.com wrote: I didn't think that I had to do any adjusting of pressures

Wrong thought and especially with apap range of 4 to 7. Not enough room to roam and starting point is too low most likely if it is obstructive events and you are maxed out at 7 all night.

Can't see screen shot until you can insert image link.

With your Dream Mapper.....how many clear airways, OAs and hyponeas over the night and how many hours?
The pressure number on DreamMapper is what we call a 90% pressure...you were at or below that number for 90% of the night. The "or below" part is often not known or forgotten.

Get SleepyHead...much better details.

First we have to decided if the events need more pressure...if they are mainly clear airway then more pressure won't help.

======

never mentioned pressure

ahi was 4-7

and you all dis me when you think i goofed even when i am a right

You are very seldom right..go back and read the posts

The official "goal" of treatment is 5 or lower. There is no such thing as too low; zero is fine (but perhaps unrealistic).

I would try raising the minimum pressure to 7. If the centrals go up, you'll need to put it back where it was. If they go down, then you can assume that the central (or "clear airway") episodes are a by-product of your Obstructive Sleep Apnea. If they go up, the higher pressure might be responsible. If they stay about the same, ignore them for now.

In any case, keep a careful eye on your centrals.

BTW, you cannot set a pressue less that 4 on any current machine, as this is considered the minimum to safely clear the exhaled CO2 from the mask. Some very old machines might go as low as 3.

Pugsy has mr know it all on her foe list....not worth reading or responding to his posts. So I am neither agreeing or disagreeing with whatever he says or doesn't say.
I inadvertently have to see his posts when someone else quotes it but I quickly scan past then and move on to posts with more substance and worth.

Most of the time I see this and it suits me just fine.
I simply choose not to waste my time reading or responding to anything he says. It's like talking to a stump anyway.

Pugsy wrote: It's like talking to a stump anyway.

Stumps everywhere are insulted.

Pugsy - yes - that is my e-mail. Feel free to email me and I will gladly share my dream mapper screenshot with you. Does it usually take several days to get authorized once you register?