What can i do to get my numbers better?

I am using an autoset Cpap with the range of 14-19. My numbers seem to stay pretty much the same except my pressure goes from 16.8 to 18.
Leak is 0.16ls
Ahi is 13.8
Ai is 0.6
Hi is 13.2

Are my numbers so off that I cant get rested? are they a mask issue or a machine issue?

I usually only get 4 hours before the pressure wakes me up or starts leaking. I really dont have trouble breathing against the autoset. I am on my 3rd FF mask. Nothing seems to fit just rite. I tried the Mole skin and havent had much luck. Is there any other machine that would help me more or is it just the matter of finding the corect mask first? The day time sleepiness is out of control! Thanks for the Help, Blair

I can't help much, as I am a Remstar user, but I think the use of software is the only way to go, Remstar's shows where and when problems occure, so we can change what needs to change, without taking a shot in the dark.

Do you have your machine set to the mask you are using, Remstar doesn't require this. Are you using settling to only measure your sleeping numbers, Remstar doesn't require this either. Jim

your numbers actually look okay, HI is a tad high but always is on that machine, leak is only 9.6L/m, doubt you can get much better than that at that high a pressure.

as for comfort and ability to sleep, you would probably do better on a Bi-Pap auto, certinly would offer you some exhale relief over what you have now.

So I take it you wake up and it is blowing at the Max. pressure? Then you hit Settling to get back to sleep?

When an arousal wakes you up all the way back to the wake state like that, I suspect a central apnea was what woke you as those are notorious for doing that. Then at your high pressure you could be at risk for them. You would have to consult your last PSG and see if any CA's or MA's where noted on the study, if none are noted, you are probably okay.

If it were me, I would LOWER the Max. pressure from 19cm to 18cm and see what that does to your overall OA index. it may not change it at all, but it might limit the machine from the pressure that has been awakening you. If numbers don't change after a night or two, I would even drop the Max. to 17cm or until I see the AI index goes up.

By limiting the Max. pressure, should the machine climb higher it will stop at that pressure just like if you were on straight cpap. If it doesn't wake you increasing to the Max, you should sleep right through it. It is when the pressure increases does it sometimes wake you.

There is nothing wrong with a AI index of 3 if you can drop your Max. pressure by 4cm. Use how you feel the next day as the best indicator, if you start feeling worse then take the Max. back up.

smockb wrote:I am using an autoset Cpap with the range of 14-19. My numbers seem to stay pretty much the same except my pressure goes from 16.8 to 18.
Leak is 0.16ls
Ahi is 13.8
Ai is 0.6
Hi is 13.2

Leak rate looks fine. Any leak rate no higher than 0.40 l/s is considered ok with that company's machines.

I personally would not be happy at all with an AHI of 13.8. AHI below 5.0 is considered "normal" with cpap or autopap treatment.

AI of 0.6 looks fine.

HI of 13.2 would bother me.

I always got almost double the AHI when using that company's autopap, compared with the lower AHI I got using a Puritan Bennett autopap or a Respironics autopap. However, I felt equally good each morning after using any of the those three major manufacturers' machines. The resmed autopap probably was interpreting and reporting hypopneas (flow limitations) a little higher than the others for my breathing. No big deal, as long as you know to possibly expect that. But 13 would be way too high an AHI to suit me, no matter what.

All that said, a person could be getting nice low AHI's yet still suffer from excessive daytime sleepiness. OSA isn't the only thing that can disrupt "sleep". PLMD (Periodic Limb Movement Disorder) could be the culprit, unless that was not shown to be a problem in your sleep study -- they'd have seen that in the study. Or any number of other underlying health issues or sleep hygiene issues could interfere with restful sleep even when cpap treatment was doing its part of the job fine.

If I were using the kind of pressure range you are, smockb, I'd probably want to give the Respironics BiPAP Auto with Bi-Flex a try. The kind of complete exhalation relief bipaps can give, coupled with the auto-titrating ability of that particular machine (two machines in one, in effect) might make your treatment more comfortable to sleep with in general.

Hope you find a mask that suits you well. That's usually the biggest piece of the puzzle to "get right." Good luck!

Rested Gal, why would you recommend a bi-PAP? Would you get more exhale releif with it at the higher pressures?

I would have asked if most of the HI are happening at 14 or 15 to raise the pressure to 15 or 16.

Also do you reach your maximum pressure set and still have Apneas or hypopneas?

The main issue with straight BiLevels is that in order to get the benefit of the two levels you need to set the inhale cms approx 4 above the exhale cms but if you follow the official guidelines, the exhale cms needs to be set to your titration cms.

Like so

TITRATION RECOMM 13 CMS
BiLevel EPAP = 13 CMS
BiLevel IPAP = 17 CMS

If compared to a CPAP machine, it would be on 13 CMS.

By using a BiPap Auto you get the chance to set EPAP lower than your titration and IPAP perhaps at your titration cms.

I have been using a BiLevel where I set the IPAP to my titration (13) and the EPAP to 10 (only 3 lower, and 3 under my titration recomm).

I realy like this set up - I have tried varying it up to 10/14, 11/14 etc: but immediately feel that my sleep deteriorates or the mask starts squeaking & waking me.

If I don't have the 3 or 4 Ipap to Epap gap plus the timed back-up, I seem to stop breathing during sleep. That plays havoc with my wife's sleep. I have no really clear indications that I can point to as to what it does to mine. The PB330 I have come to really love, doesn't provide *any* nightly data!.

I go along with Rested Gal re using a BiPap Auto (I have one but it is on loan). Rested Gal has used hers for a while now & I am sure has a good understanding of the results on her sleep.

DSM

If you're interested in more full face mask options, you might give the new Fisher & Paykel 432 a try. It's been getting rave reviews, and I think I'll be trying it next.

In my experience, the F&P 431 has far fewer problems than the UMFF.

Goofproof wrote:Are you using settling to only measure your sleeping numbers, Remstar doesn't require this either.

I'm curious how the REMstar knows how to calculate this corrently?
-James

They have smarter chips, and programers, and they haven't been resting on their hands the last three years. Jim

Really the Chipmonk that turns the blower, listens for when you relax into sleep, then while running at the correct speed, he reaches out his little paw, and presses the record button to the Smart Card.

Therefore he replaces the trained monkey in the Restmed unit. Jim

That must be why I have to feed my CPAP acorns every night.

Brian Hinther wrote:In my experience, the F&P 431 has far fewer problems than the UMFF.

Sorry, Brian, I don't mean to laugh - a lot of people like the 431, but that mask put me through HECK and back. The time it made my face bleed was a highlight. I found the UMFF to be a godsend for me - it fit sooo much better and didn't leave the deep crevices in my face that the 431 did.

Just had to put that out there.

SelfSeeker wrote:Rested Gal, why would you recommend a bi-PAP? Would you get more exhale releif with it at the higher pressures?

Yes. Pressure relief throughout the entire exhalation.

Bi-level machines in general can be extremely comfortable even if a person does not need particularly high pressures and even if a person does not have any particular difficulty breathing out against his/her prescribed pressure. A bi-level machine can feel more like "natural" breathing even if a person were prescribed what most of us would regard as moderate or even somewhat low pressure.

One specific bi-level machine -- the Respironics BiPAP Auto with Bi-Flex-- can give two types of relief, working as a bipap and as an autopap. Doing both at the same time. It's the most comfortable "cpap" machine I've ever used.

Some actually need the kind of exact exhalation pressure relief a bi-level machine can be set for. And some of us just prefer that kind of exhalation comfort....even if we don't absolutely need it. That's me. I don't need the BiPAP Auto vs a basic straight CPAP. But I sure do like the additional comfort and "natural breathing" feeling the BiPAP Auto gives me.

All that said, I want to stress this... a plain single pressure cpap machine can treat most people just fine.

Thank you for the info about the bi-cpap.