Introduction... and my ongoing saga

[Paul56]

Hi folks,

I found this board a while back and so far been lurking... decided to join and partake in the fun.

I'm the following:

-51 year old male from Canada (Ottawa area)
-been recently diagnosed with sleep apnea: AHI 58
-no medical issues other than apnea, high blood pressure (under control with medication but who knows perhaps the apnea is the root cause), and being overweight... not morbidly so, but nevertheless overweight.

Sleep study:

-First time was a total disaster. I threw my back out 2 days before and the night of the study my back kept going into severe muscle spasms. Needless to say I was awake all night and called myself a "sleep failure".

-Second time... I did not think I had sleep all that much but apparently it was enough for them to collect some solid data.

-Third time was the titration. I went in sleep deprived and definitely slept during the night. They had me on a ComfortGel FFM and surprisingly given this my first time with a mask I was able to sleep. Recommendation was pressure setting of 8.

The ongoing saga since:

Went to the supplier and got a loaner system consisting of a Fisher-Paykel 604 and Quattro FFM. Unfortunately the week on that was pretty much a waste of time, except to get me used to the system, since that machine only records basic data.

Second week I was assigned a Resmed S8 Elite II... wow... nice system and I can read my own data from the screen. I am now on my second week with this system. AHI readings hover very close to 10. Therapist recommended an increase in pressure but leaving alone till I get my own machine next week. I adjusted the pressure on the machine myself up a notch to 9 and spent the first night battling leaks. That first night the AHI went down to 5.5. Second night with same pressure the leaks were better controlled but the AHI went back to 10. What the heck?

Anyways next Monday I'm picking up a Resmed S8 AutoSet II machine. From what I have read it seems I'm better to set that machine within a fairly narrow range rather than allowing it the full capacity range. I have no trouble with 8, so I may set that as the lower number... not sure where to go with the higher number right now. Perhaps leave that at the top end of the scale and adjust as the machine collects data?

My Doctor has been great through all this. Been treating my blood pressure issue for a while and finally have it under control with meds. I'm hoping with some weight loss and therapy with the machine that perhaps I can get off the meds completely eventually. The Doc first wrote a prescription for a CPAP set to 8 and noted at the bottom it was to be an automatic machine. Therapist at the supplier said that was not good enough. <sigh> Okay, back to the Doc who basically wrote another prescription for an APAP... ah yes that "A" is so important.

Well, that is my intro in a nutshell. I've discovered with my short time at this that tweaking & fiddling with it all seems to be a constant... at least at the outset. Thanks for reading!

[Slinky]

Just a thought: Try setting it 1 cm BELOW your titrated pressure of 8 to 7 cms and 3 cms above your 8 cms titrated pressure to 11 cms. That gives you a 4 cms spread or range.

[dsm]

Paul50

Welcome to the board - a fantastic resource place for us hoseheads .

What Slinky has suggested is an excellent setup for you & I think you were heading in that direction anyway.
A spread of 4 seems a very good approach.

Your AHI of 10 does seem highish & you should be able to get it down but one reality with the Resmed machines
is that they will score higher HI events than most other brands. This is a good thing in that it reflects the high
accuracy of the machine's sensing circuits but it does dismay some people who would rather the machine give
them a lower HI score just for the sake of it being lower and irrespective of what the machine is actually
detecting.

I regard an HI of 3.0 on any Resmed machine as being very normal and quite acceptable. Naturally, any AI
score is undesirable but AI scores of 0.2 thru to 1.0 are a pretty good nights sleep as regards apneas.

Just in case AI & HI & FL are not familiar terms, AI is a score of Apnea events & HI is a score of hypopnea events, FL is a
reduced airflow but not as much as a HI.
AI - being obstructions (usually preceded by snores & flow limitations & in worst case result in a short period of zero airflow)
HI - being indications of reduced airfow (typically 50% drop over 10 secs)
FL - Flow Limitations are like hypopneas but don't quite qualify to be scored as an HI events

Good luck with your therapy & you chaose a very good place to discuss it.

DSM

[gasp]

Welcome! I love this forum and received so much help as I see you also now have. Let us know how any changes you may make did for you.

[Paul56]

Thanks for the tips folks! Below are readings for the last five days off the LCD on the Resmed S8 Elite II/Quattro FFM combo I'm using this week:

Usage: 7.29 hours
Press: 8
Leak: 0.22 L/s
AHI: 7.70
AI: 0.40
HI: 7.30

Usage: 7.29 hours
Press: 9 <--- pressure bump to 9
Leak: 0.74 L/s <--- spend good chunk of time battling leaks
AHI: 5.50 <--- perhaps not sleeping as much due to leaks thus reason AHI is down?
AI: 0.10
HI: 5.40

Usage: 8.50 hours
Press: 9 <--- pressure bump to 9
Leak: 0.30 L/s
AHI: 10.50 <--- this reading despite the pressure being raised a notch <sigh>
AI: 0.70
HI: 9.80

Usage: 9.08 hours
Press: 8 <--- back to 8
Leak: 0.12 L/s
AHI: 9.60
AI: 0.50
HI: 9.10

Usage: 7.44 hours
Press: 8
Leak: 0.20 L/s
AHI: 9.30
AI: 0.70
HI: 8.60

The apnea's are under control, just those hypopneas that keep the AHI high.

BTW, maybe I'm odd... but I remove the mask from the hose each morning and cover up the hose end with a small plastic bag and elastic to keep bugs and what not out of the hose. Not that the place is overrun with bugs, quite the contrary, but lets face it... bugs and spiders often get into houses. I don't like the idea of perhaps a spider crawling down the hose and making a home inside the machine... or worse getting blasted in the face with the critters.

[Slinky]

You're changing your pressure too often. Slow down. Pick a pressure where you felt you slept well and stay w/it for a week. THEN decide on what pressure to try next. And STAY at that setting for a week.

[Paul56]

Ah okay, no quick pressure adjustments... and perhaps they should be in .5 increments rather than 1 full notch.

I've been on a machine now for 3 weeks. I adjusted to the pressure right away the first night... the instant the machine started I knew I was breathing better and getting more oxygen so it felt right.

I'm concerned about the automatic machine and getting this mask adjusted so it doesn't leak at the higher pressures it could potentially go to... even with the narrow range.

I'm going to discuss with the supplier about the Quattro mask on Monday. She fitted me with the large size, yet the online measurement guide suggests a medium will fit me. Perhaps my measurements were off. <shrug> I will do the measurements again over the weekend to confirm those results. Perhaps I could try a medium to see if there is any difference. When I mentioned the first time about trying different masks she was not too receptive. She lowered her head to think for a bit and then responded "give this mask a week and lets talk about it again next week".

I seem to get most of my leaks around the nose area... which also happens to be the area where I get red marks. I usually have one on the bridge of my nose and two more faint ones on either side of my nose. There seems to be no happy medium with the forehead piece adjustment... too loose and it leaks, tighten up just so the leaks stop and I have the red marks. Same with the lower strap adjustment.

Anyway, she wants me to purchase the machine and 2 of these masks on Monday... I have no problem purchasing the machine but I'm not quite ready to settle on this mask & size just yet.

[bap40]

Agree with above post. Too many changes too fast will just leave you feeling dizzy... one small change at a time and leave it alone for a full week. Then you can make another change and stay at it for another week. Too much too fast and you end up with no clue as to what works and what is not working.

Good Luck!

[gasp]

Ah okay, no quick pressure adjustments... and perhaps they should be in .5 increments rather than 1 full notch.

I've been on a machine now for 3 weeks. I adjusted to the pressure right away the first night... the instant the machine started I knew I was breathing better and getting more oxygen so it felt right.

I'm concerned about the automatic machine and getting this mask adjusted so it doesn't leak at the higher pressures it could potentially go to... even with the narrow range.

I'm going to discuss with the supplier about the Quattro mask on Monday. She fitted me with the large size, yet the online measurement guide suggests a medium will fit me. Perhaps my measurements were off. <shrug> I will do the measurements again over the weekend to confirm those results. Perhaps I could try a medium to see if there is any difference. When I mentioned the first time about trying different masks she was not too receptive. She lowered her head to think for a bit and then responded "give this mask a week and lets talk about it again next week".

I seem to get most of my leaks around the nose area... which also happens to be the area where I get red marks. I usually have one on the bridge of my nose and two more faint ones on either side of my nose. There seems to be no happy medium with the forehead piece adjustment... too loose and it leaks, tighten up just so the leaks stop and I have the red marks. Same with the lower strap adjustment.

Anyway, she wants me to purchase the machine and 2 of these masks on Monday... I have no problem purchasing the machine but I'm not quite ready to settle on this mask & size just yet.

I'd be curious after she lowered her head, asking her what she was thinking. Your observation was a good one - go with it.

I have a Quattro and only use it when my nose gets too stuffy and I have to use a FF mask. It is a delicate balance with how tight or lose the mask is. It seems designed to have the (active membrane I think the company calls it) cushion puff out to provide the seal. If the mask is too tight then it flattens and doesn't provide a seal. If it's too loose it puffs out, but then it leaks. I don't think the mask shape is suited to every face. The next FF mask I get will have more adaptability to the curves of the face.

Oh, and I found when the cushion is a bit used it sealed better for me than when brand new.

[ozij]

Don't use a plastic bag at end of your hose - the hose needs a chance to dry out.

Use something more porous - a tissue or piece of stocking that will keep bugs out, the give the hose interior more of a chance to dry out.

O.

[One Tired Puppy]

BTW, maybe I'm odd... but I remove the mask from the hose each morning and cover up the hose end with a small plastic bag and elastic to keep bugs and what not out of the hose. Not that the place is overrun with bugs, quite the contrary, but lets face it... bugs and spiders often get into houses. I don't like the idea of perhaps a spider crawling down the hose and making a home inside the machine... or worse getting blasted in the face with the critters.



Yuck! Why did you have to say that? I hate spiders! I live on the 6th floor yet these spiders have daily family reunions that last all night, on my bedroom window.

I have an air-conditioner in the warm months and I need to tape every possible crack and between windows where they can enter. I have spider phobia and of all places, they should choose my bedroom window. Now, just the idea that if one gets in it could crawl into my hose and I might suck it up into my mask or up my nose, is so grose, yuck!!!

I am going to find a some knee-hi's to cover the hose ends, right now!

Anne

[rested gal]

Well, of course I can't resist posting THIS good old link ... LOL!!!

Aug 18, 2005 subject: Worst CPAP moment
viewtopic.php?t=4223

Welcome to the board and the funny fun-filled world of cpap, Paul.

[Paul56]

Hi folks...

Okay, so I'm not being paranoid about the bugs issue.

The past couple of nights I have switched from bringing the hose under the covers with me to draping it over the headboard. I have to say I like this positioning the best... less fussing.

Also the Quattro FFM has been fitting particularly well the last couple of nights. No battles with leaks. Unfortunately, I had to hand it in today when I purchased my equipment... so now I get to start all over with dialing in this new mask.

Today I purchased my new equipment:

-Resmed S8 Autoset II with Humidifier
-1 Quattro FFM
-Years supply of machine filters

All for $2,038 CDN. Insurance will reimburse $2,000 so not too bad of a deal. She wanted to provide me with 2 Quattros but I declined... may pickup another one along with a hose later for spares. They are looking into the software & card reader for me and will call later with the pricing. If they had these items in stock this morning I would have purchased them on the spot.

Despite having a good fitting mask the AHI has risen from ~10 to ~12 for the past couple of nights.

Tonight will be interesting... new mask and an automatic machine. The face cushion appears to be a little stiffer than the one I had on trial.

EDIT: I will be setting that range on the new machine as suggested... 7 to 11... and will see how it goes for at least a week.

[Paul56]

Results of first night with new equipment... S8 AutoSet II & Quattro FFM:

Range: 8 - 11
Usage: 8.07 hours
Press: 11
Leak: 0.16 L/s
AHI: 10.4
AI: 0.70
HI: 9.7

I decided to set the lower end of the range at 8 instead of 7... simply because I am very comfortable with 8. The upper max was set to the suggested 11.

That leak rate is my best number yet. It would seem I got the adjustment pretty close the first night... that and the combination of a new face cushion worked rather well. The other face cushion was not clear like this one so perhaps it was nearing the end of its life.

I woke up at 3am and noticed the pressure displaying on the LCD was reporting at 10.6. Looking at the above results it seems I spend most of the night at pressure 11... the max of the set range.

Should I leave these settings alone for the next week or would these results warrant immediately bumping up that max range setting?

Comments anyone?

[bdp522]

I think the data is telling you that you spend most of the night AT or BELOW the pressure of 11. I would still leave it where it is for a week. As your body adjusts the numbers may improve. Tweaking the mask a bit may be all that's needed at this point.

Brenda