First 200 Hours with Autoset - need advise please !

[ifrimmel]

Hi Folks !

I've spent sometime trying to educate myself on this new hobby. After many years of poor sleep I finally went to a sleep lab and got prescribed a CPAP.

Feeling terrible( "walking dead" ) all the time I thought I would just not waste my time with insurance and I plunged in buying all the stuff myself - subsequently filing with insurance. I thought the APAP would give me the flexibility to find out what my optimum setting are and basically allow me to manage my own health - getting faster optimal results. I'm now at the point where experience comes in handy .. that's where y'all come in.

I had ALOT of issues in the beginning with leaks - BIG leaks - total failures with the mask - i.e. the machine would push so hard that it would destroy the pressure seal and force me to "reset" everything - at least 5-8 times a night - about 2 weeks ago- I got fed up with it - and put it into CPAP mode at 14 with EPR off and I find this leaking problem has become MUCH better - it leaks - but I can adjust the mask and the leak goes away - far less disruptive. Also using the Mirage Ultra (which I love) vs the Quattro seems to improve my results - but it is built so badly that I have managed to break both the head support and the little swivel pipe on the mask - wish I could have the quality of the Quattro with the comfort of the Ultra. I am MUCH better after the 200hours but I still think there is room for more optimization?

I have a few questions based on the data below which I would really appreciate your help on:
1) Is 14 to low ? I picked it because that seemed to be the range the APAP was ranging "around".
2) Should I leave it in APAP mode and just restrict it to a tighter range?
2) I have no apnea events - but a AHI of : 5 - I seem to have alot of hypopnea ? What does this mean ?





This is detailed data from when it was in APAP autoranging ( note all the leaks! )


This is last night's data - a very typical night - now set at 14.


THANKS!
Ivan.

[ifrimmel]

bump. If no one replies by tomorrow I will drop it.

[KatieW]

Don't be offended that no one has answered yet. It's the weekend, and things do get quiet here then.

I have the same xpap as you, and am in my 4th month of therapy. I started out on apap, but found that I did better on cpap--better numbers, and felt more rested. It's an individual thing, but it looks like you are finding that also.

If you are having no apneas, and an HI of 5, that's very good. Hypopneas by Resmed"s definition from the Clinical Guide)..."a 50 to 75% drop in ventilation. The AutoSet algorithm does not respond to hypopneas, but rather to the associated snore or flow limitation."

So, if you are feeling well rested, you could leave the pressure at 14. If you raise it, your hypopneas might decrease, but then your leaks might increase. The only way to know is to try it and see what happens.

[AirBreather]

Hi Folks !
I have a few questions based on the data below which I would really appreciate your help on:
1) Is 14 to low ? I picked it because that seemed to be the range the APAP was ranging "around".
2) Should I leave it in APAP mode and just restrict it to a tighter range?
2) I have no apnea events - but a AHI of : 5 - I seem to have alot of hypopnea ? What does this mean ?

A) 14 cmH2O is not too low, because you are not having obstructive apneas at that pressure.

B) If you can switch to Auto mode and find settings that will achieve zero apneas like you have now, you likely will have a lower average pressure which should reduce your leak and sleep disturbance problems. However, if you are unable to achieve zero apneas in Auto mode, you probably should leave the present fixed pressure setting and try to reduce the leaks some other way.

C) Hypopnea literally means underbreathing or in other words, breathing that is shallower or slower than normal. The Resmed S8 is unable to treat hypopneas, so there is no reason to increase the pressure to try to reduce them and, in fact, increasing the pressure might actually make them worse.

D) An AHI of 5 or less is generally considered normal by the medical community, so I don't think that level is anything to worry about.

I am not a physician and am not intending to give medical advice. I have made these comments merely from the perspective of a fellow S8 user.

[Muse-Inc]

Welcome aboard Ivan! Don't think folks are ignoring you -- remember, the Olympics are on...I am listening & reading, then turning & watching each event. I can see how challenging leak must have been and still is -- maybe some of our more experienced FFM wearers might have some suggestions...I wear the RespCare Hybrid FFM but just since July '09 and my leak is pretty much what I expect (vent rate is higher than any ResMed mask). Did you ever get titrated? The sleep study report reveals issues other than obstructed airways that may be preventing restful sleep. Knowing your oxygen desaturation numbers and arousals are helpful. Like many of us, you've discovered that an APAP allows us to home titration...a great start to getting restful start!

If it were my post, I'd change the Subject to add "AutoSet" that way folks using the ResMed Model 8 AutoSet Series 11 will notice.

[ozij]

Don't be offended that no one has answered yet. It's the weekend, and things do get quiet here then.

The detailed data you posted, for Jan 26 is not very informative, since there was no pressure ranging on that night (see the summary) the ups and downs are all "mask on masl off" issues.

You picked 14 well: Your results at 14 look excellent -- and if you're feeling good, there's no need to change the pressure. Though leaks could use some improvement.
Are you aware of the effect hose management has on leaks? Sometime, routing the hose differently makes a big difference in mask seal.

What pressure range were you on during most of the nights?
Did you buy an APAP instead of having a titration study?

The ResMed auto algorithm does not respond to hypopneas because its designers thought hypopneas were often an indication of sighs, tossing in bed and the like -- changes in breathing that are not the result of obstrution, and therefore do not need additional pressure. There's not telling whether your residual hypopneas are obtructive in or origin or not -- and therefore, not telling whether additional pressure will resolve them. It may - it may not.

[mdintx]

The results you're getting are pretty good. I think that getting the major leaks under control should be a priority. Is there a particular reason you're going with a FFM?

[dtsm]

Thanks to everyone for this info - I've been in apap for 6 wks and slowly adjusting my range. One of my questions was failure for Hi to drop as my AHI and Hi were improving, with almost no leakage. I now understand better.

[ifrimmel]

THANKS to EVERYONE! All the suggestions are appreciated. Sorry for the bump I'm impatient by nature!

To answer a few questions - I spent time on here and the wiki after my sleep study early JAN ( it all happened really fast! ).
I did the sleep study 2 weekends in a row - First one was " yeah you have 129 apneas an hour " to the second with CPAP of basically 8 hours of SOLID sleep. Apparently I REM'd for 4 hours. Woke up feeling WONDERFUL! The sleep tech says she's never seen anyone REM that long. I called them on the Tuesday and asked for a prescription for a CPAP and threw cash at the problem. I decided on the APAP because I read on here that after treatment your numbers start moving around - and I wanted to stay ontop of those changes and not have to rely on anyone to change my therapy. The reason I went for full face is because the sleep tech ( who also has Apnea ) said she had the most success with the Quattro FF - it was also the mask I used during treatment - admittedly it didn't work VERY well .. but it was what I knew - and I couldn't imaging NOT breathing through my mouth ! OMG !! HOW AWEFUL ! I find myself pushing my tongue up against my front teeth even when I am awake - I think I have trained myself to do it instinctively during the last couple of weeks.

A few really good suggestions - that I am going to try! THANKS AGAIN!
1) Leak Management :
a) Moisturizer / Gel - ordered
b) Mirage Softgel Nasal Mask - ordered:
c) Hose Management !! - didn't think about that - I'll look into this some more - I am terrified of "rain" so I have been trying to keep the hose as short as possible - management would require a longer hose. Any simple suggestions ? I saw something about putting a hook above the bed?

2) More Data
Get full sleep study results - all I cared about at the time was a prescription to be ABLE to buy the kit

3) No/Less Alcohol before bed. I read somewhere that Alcohol and some drugs "look" like central apnea and hypopnea?

Point is I am feeling better! But NOWHERE near as good as I felt that first night - I know its a game of diminishing returns.. but still its made such a HUGE difference in my life - I would love to be able squeeze every little drop of improvement out of this thing.

As a matter of interest - would a VS or ST machine help ? If money was not an issue?

Ivan.

[bdp522]

Here are some links put together by RestedGal, all about hose management.

viewtopic.php?t=10640

Brenda

[ifrimmel]

Thanks Brenda!

[Muse-Inc]

...Point is I am feeling better! But NOWHERE near as good as I felt that first night - I know its a game of diminishing returns.. but still its made such a HUGE difference in my life

Ivan, have a little patience...it's gonna take your brain some time to learn how to deal with your new sleeping, ie, with equipment. Dimishing returns??? I continue to see improvements, small but still improvements, and I'm into my 3rd year! This isn't for sprinters, it's for ultra-long marathoners. Relish these improvments, more will comes as your brain learns...and ya can't speed that up at all!

[ifrimmel]

Thanks muse-inc. I appreciate you putting it into perspective. 3 years and still " working " on the issue. 200 hours is NOTHING.

I've seen there are a few folks here that are 20 years or more " on the hose ". Wow that just blows my mind!

Just really sad I didn't know about this stuff 5 years ago - could have saved me tons of money - being a grumpy mean assh*le can cost big bucks - and generally ruins lives. CPAP is here to stay ..

[torontoCPAPguy]

I don't think I've even reached 200 hours yet in total but my hypoapnea is running 1.7 with ZERO events over the past week or so. Not one. My median cmH2O has been running at 9.0 (amazingly, exactly what the sleep clinic titrated me at) but it does drop below and it does head up to as high as 14.8 at times.

What I am thinking is that with the Autoset II and the lower (nil) number of apnea events I am sleeping better and when the machine detects an impending obstruction it raises the pressure to cover it then comes back down. The advantages include less inclination to mouth breathe, less apnea events, less air forced into my stomache causing billiousness, etc. I am thinking that hypoapnea at 1.7 is referring to impending apnea events and is a good number - someone please comment. The lower pressures make for a more restful sleep and a deeper sleep. I am now in the process of getting used to the mask and the whole business of CPAP/APAP, am dealing with severe lower back and hip pain (one from exacerbated chronic arthritis in one hip; the other the result of three crushed and protruding disks due to three rear end collisions and high school football and baseball.) I am awakened to take pain medication... that is to say, I awaken in pain and must take pain medication and wait 30 minutes to get back to sleep. The good news is that it is down to Tylenol from Oxycontin (look it up - it is 11 times more addictive than heroin with all of the same side effects - not for folks that aren't terminally ill - better to work with heavy duty tylenol). And working on the one pit stop during the night by not drinking within an hour or two of hitting the sack and making a visit just before retiring.

We are getting there. The hose management system? I have a portable job that CPAP.com sells that travels with me; otherwise I have a velcro loop with an alligator clip that clips to anything that will hold the hose up above the blower and my head and it works great. And have changed masks three times so far. Maybe four. I am using a Mirage Activa LT Large Wide. Why wide? Not so much to cover my shnozolla as it is to give the mask stability and avoid the creases beside my nose. As I said earlier, I use a number of holsters and find the best belt holsters to be the ones with the attachment points far apart for stability... figured the same would hold true of the mask and I was correct. The Activa is a "bellows" type mask that actually inflates to an extent - the blower has a mode whereby it will blow at full speed for three minutes and present a graph so you can adjust your mask for optimum fit. Hit the switch again and you enter 'nighty-night' mode with a mask that is set on your face right. And I clean the mask every morning with a citris wipe to remove any oils on it and other shmootz. Give my face a quick wash before bed when brushing teeth and the mask is a good fit and stays in place. The Activa LT also has a forehead rest so you don't wind up with a diot in the bridge of your nose... very comfy and I'm looking for anyhing that might be more comfy. Can't thnk of anything offhand and I have tried the Swift LT... what a waste and a gimmick Except maybe for back sleeperes. But as soon as you smoosh your nose into the pillow you are in trouble as the part of the Swift that enters your nares collapses and cuts the flow of air; the Autoset II gets confused by this I believe and thinks you are enering an APNEA event and cranks up the pressure which comes full blast out of the other hole and into one nare like a pressure washer.... unless you have a concrete nose you are awake until the air flow goes back down. So the Swift has gone into the drawer and I am on to the Mirage Activa LT Wide Narrow and am loving it. The bellows inflates and the contact with your face is generally that of a balloon; light as a feather.

And that's the word from here tonight. I'm off to practice being a hosehead for another night. Sweet dreams all. Don't forget to pay a visit before you hit the sack and make sure ALL the lights are out and the alarm is set, temperature turned down if your daughter is not home from university and the comforter is nice and fluffy on you with the dog snoring and farting in the corner of the bedroom as your early warning system (ours has earned his kibble twice). Fill the tank on the humidifier (what was I ever thinking when I tried the blower without a humidifier?) and the alarm clock is turned off if you are north of the 49th. because (eat your hearts out) tomorrow is FAMILY DAY and a holiday here in KANADA. We get to sleep in yet again. YAAAAAAAAAAY. Night night.

[ifrimmel]

I went and pulled out my prescription ..


Must admit I didn't know what I was looking at when I started with this - I thought the APAP would do "all the work" for me.

I seen now that I should have gotten a CPAP @ 17/21 and perhaps a BiPAP based on the 2nd sleep study. I haven't seen the results of the 2nd sleep study with regards to the Hypopneas. I have an appointment on Monday 22nd.

I was just in such a hurry to get everything so that I could start making some progress.

Any thoughts?
tx!
Ivan.