Amara view fit exhalation vents issue and results validity

[Aemilian]

Hello,
this is my third day using a cpap (PR DreamStation) with an Amara View full face mask. I am 22 and was diagnosed with severe sleep apnea with an AHI of 35.6
During these days my AHI dropped to 12.7. Are these good results? Shouldn't it drop to less than 5?
While using the mask (normal breathing) i feel that the pressure inside the mask drops while the exhalation vents leak a lot of air. Is this normal?

PS: no major leaks, mask fit index is always 100%, min-max pressure = 7 to 15.

[WineTravelSleep]

Hi there. This isn't good. You should be able to have a better result on your AHI... and not have air rushing. Seems like you need to make sure your mask fits right or try another type of mask. My AHI drops from 57 to .6 Your index may show 100% but you said you feel a lot of air rushing. I'd check it out with your supplier... seems like you should be getting better results. How do you feel? Better using CPAP even at these numbers?

Please follow up and let us know what you find.

[Pugsy]

During these days my AHI dropped to 12.7. Are these good results?

While it is better than 35 per hour AHI of 12 isn't very good and there's a lot of room for improvement.
And yes, we like it to be below 5 per hour.

While using the mask (normal breathing) i feel that the pressure inside the mask drops while the exhalation vents leak a lot of air. Is this normal?

It's probably just normal venting. The amount of air that you feel being vented can seem to vary a bit depending on Flex relief setting and if you are exhaling or inhaling.

What to do about the AHI?
Don't know because we don't know what the AHI is made up of. You need to use the software so we can see more details than the machine offers on its LCD screen.

Information on software can be found here...it's free too.
https://sleep.tnet.com/equipment

Information on how to share the software images you have so we can see what you are seeing.
https://sleep.tnet.com/reference/tips/imgur

Information on what we like to see if you are going to be using SleepyHead
viewtopic/t103468/Need-help-with-screen-shots.html

and how to organize things...there's 3 pages
https://sleep.tnet.com/resources/sleepyhead/shorganize

[Aemilian]

Hi there. This isn't good. You should be able to have a better result on your AHI... and not have air rushing. Seems like you need to make sure your mask fits right or try another type of mask. My AHI drops from 57 to .6 Your index may show 100% but you said you feel a lot of air rushing. I'd check it out with your supplier... seems like you should be getting better results. How do you feel? Better using CPAP even at these numbers?

Please follow up and let us know what you find.

Thank you for your reply
Maybe it is a mask issue although i am a mouth breather. I guess i will try the nose one with a chin strap.

Concerning the improvement i felt very good these days. I was fresh and active. No sleepiness. My concentration was great, also i did not need to sleep during the day. But still I don't know if this is psychological or caused by the improvement. I need some time to figure it out.

Thanks for sharing knowledge

[Aemilian]

During these days my AHI dropped to 12.7. Are these good results?

While it is better than 35 per hour AHI of 12 isn't very good and there's a lot of room for improvement.
And yes, we like it to be below 5 per hour.

While using the mask (normal breathing) i feel that the pressure inside the mask drops while the exhalation vents leak a lot of air. Is this normal?

It's probably just normal venting. The amount of air that you feel being vented can seem to vary a bit depending on Flex relief setting and if you are exhaling or inhaling.

What to do about the AHI?
Don't know because we don't know what the AHI is made up of. You need to use the software so we can see more details than the machine offers on its LCD screen.

Information on software can be found here...it's free too.
https://sleep.tnet.com/equipment

Information on how to share the software images you have so we can see what you are seeing.
https://sleep.tnet.com/reference/tips/imgur

Information on what we like to see if you are going to be using SleepyHead
viewtopic/t103468/Need-help-with-screen-shots.html

and how to organize things...there's 3 pages
https://sleep.tnet.com/resources/sleepyhead/shorganize

Thank you I downloaded sleepyhead and got the last three days results.this is a copy of tuesday's results http://imgur.com/a/nJfu2

[Pugsy]

Next time omit the snore and respiration rate graphs. Snores are included on the top Events graph and we don't need respiration rate. That way the remaining graphs will be larger and easier to review.

Hide the calendar and turn off the pie chart (Preferences/Appearance tab and remove the check mark) so that the statistics below the AHI graphs will come into view.

Without the statistics and a better look at the pressure graph it's a bit difficult to come up with what you might be needing in terms of pressure because we can't see where it wants to be all that well.
But we know you need more minimum pressure and maybe more maximum pressure.
I am thinking maybe 10 minimum and 20 maximum and see where it wants to go and what happens.
Going from 7 cm minimum to 10 cm minimum might be a jump that is really uncomfortable and if that happens I would suggest going up slowly (like 1 cm increments) so that you can adjust more easily.

Either your medical care team or yourself needs to change that minimum pressure. It's not doing a good job holding the airway open and it isn't close enough to what is needed for the machine to get there in a timely manner to get the job done.

How did they come up with the 7 minimum and 15 maximum? Did you have an in lab sleep study while hooked up to a machine to find optimal pressures or were you given the apap with the range of pressures to find out the pressure needs at home and a change in pressure was to be made after a period of time once some data was collected?
I wouldn't wait...the current settings aren't getting the job done and so far from what is needed that there is no sense in giving these settings more time.

All the above thoughts are assuming that you are sleeping when all the stuff flagged on your reports happened. If you weren't asleep then you get a different discussion but since you didn't say "I can't sleep with this stuff" I am assuming that you were asleep for the bulk of the night.

[Aemilian]

Next time omit the snore and respiration rate graphs. Snores are included on the top Events graph and we don't need respiration rate. That way the remaining graphs will be larger and easier to review.

Hide the calendar and turn off the pie chart (Preferences/Appearance tab and remove the check mark) so that the statistics below the AHI graphs will come into view.

Without the statistics and a better look at the pressure graph it's a bit difficult to come up with what you might be needing in terms of pressure because we can't see where it wants to be all that well.
But we know you need more minimum pressure and maybe more maximum pressure.
I am thinking maybe 10 minimum and 20 maximum and see where it wants to go and what happens.
Going from 7 cm minimum to 10 cm minimum might be a jump that is really uncomfortable and if that happens I would suggest going up slowly (like 1 cm increments) so that you can adjust more easily.

Either your medical care team or yourself needs to change that minimum pressure. It's not doing a good job holding the airway open and it isn't close enough to what is needed for the machine to get there in a timely manner to get the job done.

How did they come up with the 7 minimum and 15 maximum? Did you have an in lab sleep study while hooked up to a machine to find optimal pressures or were you given the apap with the range of pressures to find out the pressure needs at home and a change in pressure was to be made after a period of time once some data was collected?
I wouldn't wait...the current settings aren't getting the job done and so far from what is needed that there is no sense in giving these settings more time.

All the above thoughts are assuming that you are sleeping when all the stuff flagged on your reports happened. If you weren't asleep then you get a different discussion but since you didn't say "I can't sleep with this stuff" I am assuming that you were asleep for the bulk of the night.

Thank you for your reply. It really helped me.

I edited the report as you suggested and this is the link: http://imgur.com/a/3kJUP

As you said I cannot wait on such results I also changed the auto pressures to 8 - 18. Will increase it in small increments as you suggested till my numbers are normal. It is evident that the problem is not mask related.

The rep in my country puts the same pressure interval for all the patients. My medical doctor suggested 5 - 15 interval as a start. No lab tests were done.

You're right, I am sleeping well but I wake up occasionally.

[Aemilian]

Thanks buddies :* I appreciate your help. You are a major support power. Much love and appreciation

[Pugsy]

Bear in mind that it is the minimum pressure that is the most critical setting and not necessarily the maximum. These machines take some time to respond to the apnea events or their warning signs and if the minimum is too low then it simply takes too long for the machine to get to where it needs to be to prevent the apnea event from occurring.

In your situation I wouldn't spend an awfully long time at each setting change because you have quite a ways to go in terms of getting that AHI down to acceptable levels. Normally we suggest people make a change and wait a week...see how it goes and then make another change and wait another week.
In your situation I wouldn't wait the week unless you need it to get comfortable with the increase in minimum.

Remember...the Clear Airway/Central apnea (the airway is open and you just stop breathing briefly) events aren't something we treat with pressure using your type of machine. I am hoping they will reduce on their own once the chance of having an arousal from all the obstructive events gets reduced. If they don't we will take about them at that time.

Right now we try to fix what obviously needs fixing and that is the obstructive apneas and hyponeas (which are obstructive also) with more pressure to hold the airway open.
I think you are likely going to end up needing at least 10 cm but it might be more if we go by the median average. The thing is that often when the minimum is more optimal that the maximum pressures will come down because it's easier to prevent the apneas in the first place than it is to try to fix things afterwards.
It hurts nothing to go up slowly with that minimum though...making a big jump can make it difficult to adjust to and be comfortable and fall asleep...and you have to be able to go to sleep easily and quickly first and foremost.
Besides, sometimes we get lucky and don't need as much pressure as I might initially have thought would be needed.

Good luck and keep us posted. Once you get your AHI down to around 4 or 5 then we can do smaller and finer tweaking with more time devoted to the setting changes.

[Aemilian]

Today i will try the 8 as a minimum. Tomorrow i will jump to 10 according to the morning's AHI.

Many thanks <3

[Pugsy]

Oh...a word about the leak line....the leak graph will show an increase in that top line as your pressure increases because that top line includes the mask's expected intentional vent rate. More pressure equals more venting. So when pressures change that top line will change so don't worry when you see it fluctuate.

Also, SleepyHead "% of time over red line threshold" statistic defaults to a ResMed leak data point which won't work with your Respironics machine. It will tell you that you have large leak times when you didn't.
I suggest that you change that data point or just turn it off so that SH doesn't scare you with a large leak warning when their wasn't a large leak.
Go to Preferences...CPAP tab and on the right change the 24 L/min red line number to around 75 L/min (that still has some cushion built in) or remove the check mark to turn that feature off.

If you have a Large Leak that is the real deal it will be flagged by your machine and will show up on the Events graph...see the LL on the left? That's large leak and if you don't see it flagged up there you didn't have any large leaks.
If you do see an occasional LL flag...don't panic. We all have them from time to time and they really aren't that big of a problem unless they wake you up a lot or they are prolonged.
Example...5 to 10 minutes in large leak out of 7 or 8 hours of sleep isn't a big deal...now 50 minutes in large leak could impact therapy effectiveness and/or machine's ability to sense, respond and record what is going on.

[palerider]

Hi there. This isn't good. ... and not have air rushing. Seems like you need to make sure your mask fits right or try another type of mask.

Note to OP, just ignore all this.

Pugsy gives *excellent* advice.