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bbmiller
 
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Can somebody help me read my ResMed S9 report?

Postby bbmiller on Tue Dec 21, 2010 3:57 am

Hello
I have ResMed S9 auto CPAP machine. I think my mask has been leaking a lot and consequently am trying a different one today as I a sleep during the day. So I pull a report from S9 software for yesterday which I believe pretty good day as far as leakage go's, but need some help reading the report as I am not used to reading these reports at all. First the text summary of the report.

12/19/2010 - 12/19/2010
Device Settings
Therapy Mode: AutoSet EPR: Full_Time EPR Level: 2.0 cmH2O Minimum Pressure: 7.0 cmH2O Maximum Pressure: 13.0 cmH2O
Pressure - cmH2O
Median: 10.3 95th Percentile: 12.7 Maximum: 12.9
Leak - L/min
Median: 0.0 95th Percentile: 13.2 Maximum: 22.8
AHI & AI - Events/hr
Apnea index: 0.6 AHI: 1.8 Obstructive: 0.6
Central: 0.0 Unknown: 0.0 Hypopnea index: 1.2
Usage

Used Days >= 4:15 hrs: 1 Used Days < 4:15 hrs: 0
% Used Days >= 4:15 hrs:
100
Days not used: 0 Total days: 1 Median daily usage: 4:58
Total hours used: 4:58 Average daily usage: 4:58



OK the lines that say "Leak - L/min Median: 0.0 95th Percentile: 13.2 Maximum: 22.8" well what does that mean? Does that mean 13.2 minutes and 22.8 minute or what? I do not understand.


Also some explanation of the two images below would be appreciated too.

Image

Image

I know these are very basic questions, but I am a complete newbie in regard to reading these reports. So please be kind.

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Dimples
 
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Re: Can somebody help me read my ResMed S9 report?

Postby Dimples on Tue Dec 21, 2010 6:23 am

Hi bbmiller. I'm a newbie here too, and have learnt so much from reading this forum.

I'm no expert, but from what I've learnt here your leak rate is expressed in litres per minute (L/min)

The "95th percentile 13.2" means that for 95% of the time your leak rate was 13.2 litres per minute or lower, and for 5% of the time it was 13.2litres per minute or higher.
"13.2 Maximum: 22" means that the most it leaked was 22 litres a minute.

You can see on your graph, that the blue line goes up and down a lot around 9.00am and 10.30 am. That's when the leaks occurred, and the height of the line on the graph shows how much it was leaking, and for how long. My sleep specialist told me that leaks below 25 are OK. and you can see a red line on the graph at 25, and all your leaks shown here were below that 25 line.
The green graph gives a quick overview of each nights leak, showing the 95th percentile and maximum rate. From your graph you can see that you had lots of leaks on 23rd November, and that they are gradually decreasing.

Also
EPR ("expiratory pressure relief" I think) means the amount that your machine 'relaxes' the pressure every time you breathe out.

Minimum and Maximum pressure, is the lowest (7.0) and highest (13.0) pressures set by your technician, and your machine will continually vary the pressure between these values according to what you need. The figures that follow are the pressures your machine used for that time period.

AHI Is the apnea hypopnea index, that shows how many 'events' you had per hour (how many times you stopped breathing). 1.8 is really good. Anything less than 5 is acceptable. Of the 1.8 events per hour, 0.6 were obstructive apneas, 0.0 were centrals, and 1.2 were hypopneas.

The rest is about how long you used the machine.

Hope that helps you understand it a bit better. As I said, I'm not an expert, and someone out there can probably give you much more information, and correct any wrong information I may have given you here, but read the posts on this forum, and you'll get to know what all these terms and abbreviations mean.

Learn all you can, ask lots of questions, and you'll understand your treatment better, and be able to help yourself and make adjustments as you see that you need them.
Hope you have a good sleep today.
Dimples

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robysue
 
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Re: Can somebody help me read my ResMed S9 report?

Postby robysue on Tue Dec 21, 2010 10:03 am

bbmiller wrote:Hello
I have ResMed S9 auto CPAP machine. I think my mask has been leaking a lot and consequently am trying a different one today as I a sleep during the day. So I pull a report from S9 software for yesterday which I believe pretty good day as far as leakage go's, but need some help reading the report as I am not used to reading these reports at all. First the text summary of the report.

Here's a primer for helping you understand things line by line. Hope it helps.

12/19/2010 - 12/19/2010
Device Settings
Therapy Mode: AutoSet EPR: Full_Time EPR Level: 2.0 cmH2O Minimum Pressure: 7.0 cmH2O Maximum Pressure: 13.0 cmH2O

Your machine is running in AutoSet mode with a pressure range from 7cm (on the low end) to 13cm (on the high end) with a full time EPR of 2 cm. The pressure starts at 7cm and the machine adjusts the pressure in response to apneas, hypopneas, snoring, and flow limitations. Also the full time EPR setting means that the pressure is temporarily reduced by 2cm during the initial part of your exhale and as you finish the exhale, the pressure then naturally goes back up to the current pressure.

Pressure - cmH2O
Median: 10.3 95th Percentile: 12.7 Maximum: 12.9

For the noon to noon period your data is from, your median pressure was 10.3 cm, your 95% pressure level was 12.7 cm, and your maximum pressure was 12.9 cm.

The median pressure = 10.3 means that for 50% of the time the S9 was on, your pressure was LESS THAN or EQUAL TO 10.3cm. And so for 50% of the night, your leak rate was also GREATER THAN or EQUAL TO 10.3cm. So in the 4:58 hours:minutes (roughly 5 hours) you had the mask on with the machine running, for 2 1/2 hours (2 hours and 29 minutes) you had a pressure of LESS THAN or EQUAL TO 10.3cm. [By the way, I can tell you had the mask on with the machine running for just under 5 hours because of the numbers in the Usage part of the data you posted.]

The 95% pressure = 12.7 means that for 95% percent of the night, the S9 was running at a pressure that was LESS THAN or EQUAL TO 12.7 cm. And so for 5% of the night, the S9 was running at a pressure that was GREATER THAN or EQUAL to 12.7cm. It's useful to realize that 5% of ONE hour is THREE minutes. Since your machine was running for just under 5 hours for the night, this means that your pressure was AT or GREATER than 12.7 for a total of (3 minutes)*(5 hours) = 15 minutes for the whole night.

The max pressure = 12.9 means that at some point(s) during the night, the S9 reached a pressure of 12.9cm. You know (for sure) from the 95% data that the S9 was running at a pressure of 12.9 for less than about 15 minutes out of the night since 15 minutes is 5% of the night that this data was gathered on.

For Pressure, many people focus on the 95% pressure figure as the important one: The usual rationale for looking at the 95% number is that it is theoretically high enough to prevent most of your apneas and hypopneas. And most people seem to tolerate this pressure rather well. But for auto-titrations, they usually want the 95% number over several nights in a row so they can see what pressure the S9 tends to settle at. During my week or so of auto-titration, the individual 95% numbers ranged from something like 7.4 (on the low end) to 8.2 on the high end. The whole week came in at something like 7.8 or so. So my straight titrated pressure is about 8cm. Folks around here seem to have several ideas on how to set the min and max ranges for an APAP range. But there does seem to be a consensus that the max needs to be set ABOVE the 95% and that the min needs to be set not much lower than that 95% number. But your mileage may vary.

Leak - L/min
Median: 0.0 95th Percentile: 13.2 Maximum: 22.8

Your median leak rate = 0.0 L/min means that for 50% of the time the S9 was on, your leak rate was LESS THAN or EQUAL TO 0.0 L/min. And so for 50% of the night, your leak rate was also GREATER THAN or EQUAL TO 0.0 L/min. So in the 5 hours you slept with the machine, for 2 1/5 hours you had no detectable leaks---so there's evidence that you're making some real progress on addressing the real leak problems you're dealing with!

Your 95% leak rate = 13.2 L/min means that for 95% of the time the S9 was on, your leak rate was LESS THAN or EQUAL TO 13.2 L/min. And so for 5% of the night, your leak rate was GREATER THAN or EQUAL TO 13.2 L/min. Now it's important to realize that 5% of one hour is equal to three minutes. Since you slept for 5 hours, that means your leak rate was GREATER THAN or EQUAL TO 13.2 L/min for a grand total of (3 minutes)*(5 hours)=15 minutes. That 15 minutes of "high leak rates" might be in one giant half hour leak or it could be in several smaller leaks---the only way to know is that to look at the detailed graphs in ResScan. [More about this later.]

Your max leak rate=22.8L/min indicates that at some point when the S9 was sampling leak data, it detected a leak that was as large as 22.8L/min. It may have been a very short lived thing---when you broke the seal to scratch your nose for example. Or it could be that on one or two of the big leaks that you had, the leak pretty quickly went from in the neighborhood of 22.8 L/min to 22.8 L/min and stayed there. But you know for sure that you could not have leaked at a rate of 22.8L/min for more than about 15 minutes because of the 95% leak rate number and the time the machine was on.

Now you provided us with the detailed leak data graph:
Image
and when I look at it, sure enough, there are 3 really short lived leaks---one at noon the first day, one at around 9:00 am, and one right before you took the mask off at noon the next day---where the leak rate is clearly above 13.2 L/min. The detailed leak graph shows that you had the mask on and the machine running for about an hour between noon and 1:00 pm. Then you put the mask on for a very short period right around 1:00 am and took it off for the rest of the night. And then you put the mask on around 8:30 AM the next morning and kept it on until noon. The detailed leak data shows that while you're leaks on this day are not high enough to trigger the dreaded Red Frowny face, they probably are enough to be bothering you in the sense of making you uncomfortable. [More about this later.]

Interpreting the leak rate data is also important:

First, on the Short Sleep Quality menu, if you see a Red Frowny face, that indicates your 75% leak rate is AT or ABOVE 24 L/min and Resmed's litertature indicates that you are leaking AT or ABOVE a rate of 24 L/min for 25% of the night. And at that point, the ResMed engineers believe that your therapy can and probably is being compromised.

Many people take the 95% Leak Rate to be the key stat Leak data. But it is worth looking at the median leak rate as well, in my opinion. The reason I look at both is that the median leak rate tells me whether I was leaking off and one all night long or not, where the 95% leak rate tells me if my worst leaks were bad ones or not. To illustrate what I mean, let's look at two examples:

Person A sleeps for 7.5 hours and is leaking off and on all night at a rate of 5.5 L/M and for about 25 minutes during the night, the leak rate actually is between 7 and 10 L/min. So A's leak numbers look like this:

median=5.5, 95%=7.0, and max=10.0

Now suppose Person B sleeps for 7.5 hours and has NO leaks at all for most of the night, but has ONE 25 minute leak where the leak rates are from 8 to 10 L/min during this leak. B's leak numbers look like this:

median=0.0, 95%=8.0, and max=10.0

Neither person's leak rates are grate enough to trigger the Red Frowny face in the short Sleep Quality menu on the LCD. But Person A is likely to be having more significant problems with comfort due to leaking all night long.

Obviously, the closer to 0 your leak rate data is, the better obviously. But the information from Resmed seems to indicate that leaks above 24 L/min (the RED LINE in ResScan's detailed graphs) are enough to cause problems with the algorithms the S9 uses in order to detect and respond to apneas, hypopneas, flow limitations, and snores. So in any case you really want your 95% leak rate under 24 L/min to insure that you're getting some kind of meaningful therapy. But comfort is as a much of an issue as therapy is in my opinion: Nasty leaks cause most people real discomfort and they frequently cause people to wake up multiple times during the night to fiddle with the mask even when the leak is well below 24 L/min. For me, I don't worry at all if my 95% leak rate is below 10 L/min unless I had to fiddle with my mask more than once in the night. And if I wake up multiple times needing to fiddle with my mask because of leaks, then the leak rate IS a problem regardless of how low the 95% leak rate is.

Now the second graph you provide is the summary data of your leak rate data:
Image

You'll notice that each bar is split into three sub-bars.

The darkest green bar represents the median leak rate for the day's data. For the most part, your median leak rates are below the Red Line, but they are not ALWAYS below the Red Line. You need to get those median leak rates to be consistently below the Red Line because that Red Line is drawn at 24 L/min---the point where ResMed believes therapy is likely to be compromised. When your median leak rate is above the Red Line, the Red Frowny face should show up in the short Sleep Quality Report on the S9's LCD.

The medium green bar represents the 95% leak rate for the day's data. For the most part, your 95% leak rate is still above the Red Line. While it's possible for your 95% leak rate to be above the Red Line and to still get a Green Smilely face on the Sleep Quality Report, you'll be more comfortable if you can get that 95% leak rate to be consistently below the Red Line in my humble opinion.

The light green bar represents the maximum leak rate for the day's data. Your maximum leak rates are quite large on some days. But a large maximum leak rate can be triggered by the S9 sampling the leak rate at the wrong time---when you take the mask off to scratch your nose, for example. So if you get the median and 95% leak rates under control, then in my opinion, the max leak rate is largely meaningless.

Overall, your leak rate data indicates that you are fighting a pretty severe leak problem. What mask are you using? What kind of fitting tips have you used? Have you asked other users for help? Are you breathing through your mouth? Have you asked your DME for help? I strongly suspect that mask problems are making it very difficult for you to get used to CPAP at this point. So start working on fixing the mask problems!

AHI & AI - Events/hr
Apnea index: 0.6 AHI: 1.8 Obstructive: 0.6
Central: 0.0 Unknown: 0.0 Hypopnea index: 1.2

This is the data that shows how well the therapy is treating your apnea. However, given the severity of your leaks, this data may not be completely accurate!.

At any rate, here are the definitions: First the AHI, AI, CAI, OAI, and HI are all indices. They indicate how many events of the given type you had per hour on average during the time the machine was on. The machine computes each of these numbers by dividing the number of events (of the particular type) by the time the machine was running.

    AHI is the Apnea/Hypopnea Index and it is computed by the S9 by dividing the number of detected apneas and hypopneas by the time the machine is running.
    AI is the Apnea Index and it is computed by the S9 by dividing the number of detected apneas by the time the machine is running.
    HI is the Hypopnea Index and it is computed by the S9 by dividing the number of detected hypopneas by the time the machine is running.
    CAI is the Central Apnea Index and it is computed by the S9 by dividing the number of detected central apneas by the time the machine is running.
    OAI is the Obstructive Apnea Index and it is computed by the S9 by dividing the number of detected obstructive apneas by the time the machine is running.
    Unknown Index is computed by dividing the number of detected apneas of unknown type by the time the machine was running.
Now note that the S9's LCD's detailed Sleep Quality Report shows the AHI, the AI, and the CAI on it, but not the HI, the OAI or the Unknown Index.
But even though the OAI and HI are not shown on the S9's LCD, they're easy to get: the OAI = AI - CAI and the HI = AHI - AI.

Now from the data you posted, your S9's LCD most likely showed:

AHI = 1.8, AI = 0.6, CAI = 0.0

We can compute the number of events of each type without going into Rescan as follows:

(1.8 events per hour)x(5 hours) = 9 apneas and hypopneas, (note Resmed truncates the decimal, always round UP if there is a decimal part)
(0.6 apneas per hour)x(5 hours) = 3 apneas that day
(0.0 central apneas per hour)x(5 hours) = 0 central apneas that day

A bit more arithmetic shows that there were likely 6 hypopneas (9 events - 3 apneas = 6 hypopneas) and 3 obstructive apneas (3 apneas - 0 central apnea = 3 obstructive apneas)

Usage

Used Days >= 4:15 hrs: 1 Used Days < 4:15 hrs: 0
% Used Days >= 4:15 hrs:
100
Days not used: 0 Total days: 1 Median daily usage: 4:58
Total hours used: 4:58 Average daily usage: 4:58

This is the compliance data.

It says that for this time period (of one day) you used the machine for at least 4 1/4 hours 1 day (out of 1 day). That the average daily usage on that one day of use was 4 hours and 58 minutes. And that the actual time used on that one day was a total of 4 hours and 58 minutes. The S9's LCD probably would have said Usage = 5.

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Lizistired
 
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Re: Can somebody help me read my ResMed S9 report?

Postby Lizistired on Tue Dec 21, 2010 6:54 pm

Great Reply Robysue! Thanks, I've bookmarked it so I won't have to ask when I start messing with the stats.

_________________
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Humidifier: S9™ Series H5i™ Heated Humidifier with Climate Control
Additional Comments: Swift FX sometimes, CMS-50F, Cervical collar sometimes, White noise, Zeo... I'm not well, but I'm better.

bbmiller
 
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Re: Can somebody help me read my ResMed S9 report?

Postby bbmiller on Tue Dec 21, 2010 10:19 pm

robysue - thank you very much for taking all the time it must have taken you to give me such a detailed answer!

There are some things the report I posted can not tell you. I purchased my ResMed S9 CPAP machine from secondwindcpap because the health plan I purchased from Kaiser Permanente did not include any DME benefit and I pay for all CPAP equipment out of pocket. Consequently a slightly used CPAP machine was a good deal for me as the price was greatly reduce. Another thing the reports I posted does not tell is how it's been working from mid-Augus when I started my therapy . Prior to my purchase of my machine my health plan would lend me a machine usually a S8 ResMed without humidifier, but sometimes S8 auto to run tests on me. During that time I was also going back and forth between a ResMed Mirage Quattro Full Face mask in medium and large sizes. I settled on medium for my purchase. And during my early days in using the S8 and mask combination might mask would leak less I believe because the seal was new. I have been thinking of purchasing a new seal that have been procrastinating since I paid totally out of pocket and even in my early days I would have some leaking problems. During my early days occasionally my mouth would come out of the mask with my jaw-dropping. Then as now this would make my mouth very dry. I remember waking up recently with what felt like a hair dryer right against my throat totally drying out my mouth. I do not use a humidifier it wasn't available from secondwindcpap and also doesn't seem to be a problem as long as my mouth stays close. But if my mouth opens very widely the seal breaks and I havea very dry mouth.

I am presently borrowing a mask from the sleepnation trial program. In this program the mask list they are presently loaning out are these

Resmed Quattro

Respironics Fullife

Respironics Fitlife Small

Resmed Liberty

Innomed Hybrid

Fisher & Paykel Forma

Respironics Comfort Gel Full Face

Resmed Swift Fx

Resmed Swift LT

Resmed Softgel

Resmed Activa LT

Resmed Micro

Respironics Comfort gel Nasal

Respironics Easylife

Hans Rudolph Full Face Small

From this list I chose the"Fisher & Paykel Forma" and have been trying to get the medium-size to work but it seems that the medium-size will never work for me so I will have to contact the program again see if they have a larger size in this mask. What the medium-size does is leak profusely into my eyes by my nose bridge. I do not know if there is somebody here who has experience with this mask who can enlighten me if they think a larger size would fix the problem I am describing of profuse leaking into my eyes. Any other advice I'm getting the best mask for me would be appreciated. I could just try a new seal if that's what you think I should do. Somebody told me on these forums to use KY jelly with my mask seal and it will make them last a long time and seal better. It seems to work some, but I have not tried it with the new seal.


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