New Machine, Increased AHI

[F3adventure]

Hi all,

I recently received a new machine along with some new settings and have noticed a sharp climb in my AHI. Previously I was using a Resmed SV9 VPAP (it's my back up machine now) with an IPAP setting of 17 and an EPAP setting of 14. My AHI was always <2, but also with large leaks most of the night so maybe that data was not reliable?

I now have a Dreamstation auto Bipap that I have been using for the last seven nights. The DME set a wide pressure range (10 - 18). This is my first time using an auto machine, it looks like It has been choosing to operate at a lower pressures but the AHI has been averaging around 7 with the new machine. One thing I just noticed is that the the PS value changed from 4 to 0 between my first and second night of use. I may have unintentionally changed it when familiarizing myself with the new machine. I will change it back to 4 and see if that makes any difference.

I will try to post a graph. If it works, I'd appreciate any advice as to how I could improve my therapy. Thanks in advance!

http://imgur.com/a/vJl5f

[Pugsy]

First thing to do...make a little change in SleepyHead.
The red line threshold in SH defaults to the ResMed 24 L/min and that is wrong for a Respironics machine and it will totally mess up the time spent over the red line threshold.
Go to Preferences/CPAP tab and either remove the check mark to turn off that particular statistic or change the 24 L/min to something that is more in line with a Respironics red line (we aren't ever given an exact number because it can vary with mask and pressure) like 80 to 90 L/min.
The actual important thing to watch for large leaks is the events graph....see the LL on the events graph...that's large leak and if the machine senses a large leak it will be flagged up there.

Verify the PS setting...there is a minimum and maximum PS...make sure both have a value showing.
If you want 4 PS like you had with the S9...make the minimum and maximum both show 4

My AHI was always <2, but also with large leaks most of the night so maybe that data was not reliable?

If you spent a lot of time in large leak with the S9 it is very possible that the machine was unable to sense any apnea events that were happening and thus missed flagging those events.
The AHI data when large leaks are present for a prolonged time is unreliable....so if you spent half the night in large leak territory then it is very likely the low AHI was simply the machine not even knowing what is going on.

In terms of this therapy with the new machine...this report seems to reflect the PS of 0 so it complicates evaluation...but I think that minimum EPAP of 11 and PS of 4 and max IPAP of 20 might be a better choice to start with.

[F3adventure]

Great, thank you very much for the recommendations! I will give those adjustments a try and watch it for another week or so. I will also be getting a new mask sometime soon which may also help with the leaks. The DME said she felt I should switch to a medium instead of the large. Maybe that will help a little too. I'll report back after a week or so.

Thanks again, I really appreciate the advice!