Help me please, new user, new to message board

[TylersDad]

Well guys, tonight is my first night on my "loaner auto" cpap machine.

What are the chances that I feel better tomorrow?

My AHI has been around 30 every night since I started so I am hoping and praying for a better number tonight.

My AI number is not that high usually, but my HI is always high. Hopefully this machine will improve my HI.

[Wulfman]

Well guys, tonight is my first night on my "loaner auto" cpap machine.

What are the chances that I feel better tomorrow?

My AHI has been around 30 every night since I started so I am hoping and praying for a better number tonight.

My AI number is not that high usually, but my HI is always high. Hopefully this machine will improve my HI.

How is it configured? (pressure settings and others)

If it's set wide open (4 - 20), my answer would be "slim to none".
But, we'll await YOUR "verdict".
Good luck.

Den

[TylersDad]

It is set for a range of 8 to 20.

My original presssure was 8.

Why does the wider range mean less chance of success?

[Wulfman]

It is set for a range of 8 to 20.

My original presssure was 8.

Why does the wider range mean less chance of success?

Maybe you've got a chance......the minimum pressure will at least be higher to start with. Another factor might be the EPR setting (if it's a ResMed and they configured EPR). Anyway, give it a try tonight and let us know how it went.


Den

[TylersDad]

Thanks for the words of encouragement.

I got the EPR set on one since you guys recommended that the other day and I have not had any issues with that.

[TylersDad]

Well, after my first night with my loaner auto machine, here where my numbers:

Pressure 9.6 (What does this number mean? This was what the average for the night settled out at)

Leak .06

AHI 22.8

AI 4.5

HI 18.3

I will work tonight on trying to improve the leaks, but based on past experience that does not move my numbers down very far.

So what do these numbers tell us other than my case is a lost cause, even the automachine cant help me!

[Hawthorne]

It does NOT tell you that your case is a lost cause and not even an auto can help!

Your average pressure (9.6 cm) tells me that you spend most of the night at that pressure even though you have the minimum set at 8 cm.

The leak rate is a little high, I think. I don't have a Resmed but I think those who do would call this high. You do have some work to do on leaks.

The AHI is high but (as with all Resmeds, most of it is Hypopneas). Some say, with Resmeds you should cut the HI (since they are more sensitive to Hypopneas) so your HI would then be about 9. You AI, at 4.5 is not too bad at all. This would put your AHI at about 13.5 or 14. You said you were hoping for an AHI better than 30 last night. You got it, even before the consideration of extra Hypopneas! If you take into account that Resmeds count more Hypopneas, you were even better!

One night is not enough to base anything on. You need to leave it at those setting for about 4 nights anyway (maybe a week) and then compare the data for each night. After that, some adjustment may help more.

You are on the right track!

[DoriC]

You can't tell much from one night, they say to give each setting a few nights to see what the trend is unless you're really uncomfortable. I'm not the expert here but I think they might be suggesting you increase the minimum pressure a bit. Good Luck. Dori

[Pugsy]

.06 L/sec as reported on the ResMed screen really isn't that bad at all. I believe that ResMed says that anything up to .20 L/sec is within the machine's ability to compensate for. I am with you, even if you could get the leak rate at 0.0, I don't see that working miracles with your numbers.

One night doesn't make a trend so give it some more time and see what happens. I am a bit surprised that the average isn't any higher than it is but then what do I know???

[TylersDad]

Pugsy, maybe you are right.

After the second night the numbers where:

Pressure 10.0

Leak .14

AHI 23.7

AI 4.5

HI 18.5

[Pugsy]

Pugsy, maybe you are right.
After the second night the numbers where:
Pressure 10.0
Leak .14
AHI 23.7
AI 4.5
HI 18.5

Is your minimum still 8 cm?

If it is and you still have these high hypopnea numbers after a few more nights, then I would consider raising the minimum 1 cm and see what happens. I personally don't have a lot of patience and with my own therapy I wasn't afraid to be fairly aggressive early on. Sometimes 1 cm of pressure will make a considerable difference, sometimes not but your numbers as they are now are too high and not being effective. While your leak rate isn't perfect, it is far from awful and I don't think the leak is the most significant factor.

I am still surprised that the auto unit doesn't want to go above 10 very much.

I haven't gone back and read your whole thread again so forgive me if I mention something that has already been covered but do you think part of this might be positional?? It is common to be worse on our backs. Do you sleep on your back a lot? If so you might try staying on your side and see if the numbers improve. If not, then the only variable left is pressure.....

While I might give ResMed a little more leeway because they tend to score hypopneas a little more aggressively than other machines, I wouldn't give it this much leeway.

[TylersDad]

Pugsy,

1) Yes, the auto is set from 8 - 20 range. My original pressure is 8 cm.

2) I mainly sleep on my sides. The only reason usually I will turn from my sides might be to mix it up when my back hurts some, but I would say I am on my sides 90% of the night usually.

3) Are their any tricks for stopping leaks around the bridge of the nose that blow into the corners of your eye? I would say ALL of my leaks are at this spot on each side of the mask.

Is the normal process to turn up the bottom setting to match what the pressure (over a period of time) shows on the auto machine? Does THIS move normally help with HI numbers?

Thanks again for the help everyone.

[Pugsy]

3) Are their any tricks for stopping leaks around the bridge of the nose that blow into the corners of your eye? I would say ALL of my leaks are at this spot on each side of the mask.

Is the normal process to turn up the bottom setting to match what the pressure (over a period of time) shows on the auto machine? Does THIS move normally help with HI numbers?

Yes, it is normal to increase the minimum pressure. I was titrated to do best at 8 cm. Felt awful for a week, got the software that showed me why my AHI of 7-9 was likely causing me to feel bad. I am worse in REM stage sleep so I had several little groupings of events in cycles that correspond with REM stage. I did very well at 8 cm except when I went to REM stage and my pressure needs seemed to be in the 11-13 range for those times.
With the minimum at 8 cm the machine couldn't quite reach the needed pressure quickly enough to prevent the events. The machines do these increases in small increments. If it takes too long to catch the event, they don't get stopped.

What we ideally want is a minimum pressure that is comfortable yet will be close enough to what is needed that it will get to the higher pressure in time. Or in my case the minimum pressure handles the run of the mill events but my REM stage events seem to need higher pressures. I do much better with a minimum of 10 or 11 cm. As soon as I increased the minimum from 8 cm to 10 cm, I saw an immediate reduction in AHI to less than 3 and I felt better.
The machine can react more quickly and get to the 13 that I need from 10 cm. It couldn't react quickly enough when the minimum was 8 cm.

Your machine should be able to get from 8 to 10 quick enough but for some reason even 10 cm doesn't take care of your events. It would be really interesting to see software data if you had it but you don't so we have to speculate.. You may do better with a narrow range instead of wide open. You may do better with the minimum close to or at what appears to be your average. Only a little bit of experimentation will give you answers to those questions. With the numbers you have right now you are still having more events with therapy than some people have without, so your therapy is not effective as it stands right now.

So sorry but I cannot help with your mask leak issue. I use the nasal pillow system and can't use anything that goes over the bridge of my nose, so I have zero experience along those lines.

[Pugsy]

Wonder if it would be possible for you to try a different type or brand of mask? Sometimes therapy effectiveness is better with one mask than another even it the leak rate for the first one isn't all that bad.... Just a thought.

[ozij]

TD,
Do you have your PSG (sleep study) full report? Can you share your sleep study results with us?
Did you have a separate titration night, or did they come in and put a mask on you in the middle of the first? A split night study makes it more probable that you were under-titrated.

I am still surprised that the auto unit doesn't want to go above 10 very much.

This is less surprising than you may think, Pugys,since the ResMed auto needs snores or flow limitations to drive the pressure up once it goes above 10. If you happen to belong to the small group that have neither flow limitations nor snores above a pressure of 10, and you do have apneas or hypopneas above that pressure, then a ResMed will not raise the pressure appropriately for you, and you will be better off using either fixed pressure or an auto with a different algorithm.

This explains the Autoset's three lines of defence, apnea, snores and flow limitations:
http://www.resmed.com/au/clinicians/com ... nc=dealers

It looks like you don't have enough snores or flow limitations to drive the pressure above 10, TD.

If those were my results, depending on the PSG I would either: Try fixed 11 and EPR=3 (my personal preference at this point) or another auto,or else ask for a repeated, full night's titration study.

Fixed 11 with EPR=3 would ensure a minimum of 8 for exhaling, and give a chance for more pressure to take care of obstructive events. It would also keep the machine from dropping below 11 for inhales.
An improvement would indicate the events are obstructive and need more pressure.

I take it the doctor who recommended an Auto saw your PSG results, and wasn't too worried about pressures higher than 8.

O.
Typos (some?) edited...