Newbie Question - High AHI

sintpa · Post by **sintpa** » Thu Mar 13, 2008 4:42 am

I've been enjoying reading these forums. The information provided has been extremely valuable in better understanding the OSA condition I have been recently diagnosed with. My sleep study showed an AHI of 29. It was a split study and they were only able to get me into REM for about 45 minutes. The sleep technician says she was able to titrate me at a pressure of 9.

I received my REMstar Auto M Series with A-Flex machine on Tuesday. The machine was set by the DME to a fixed CPAP with a pressure of 9. Using instructions provided outside of this forum, I enabled viewing of the AHI and Leak numbers. My concern is that over the two nights my averages are:

AHI: 35.2 (7 day average)
Leak: 33.4 L/min
13.8 hrs of use over 2 sessions

I recently reviewed a post showing that I can reset the AHI data each night so I plan to get a fresh reading this evening.

I'm concerned that my pressure is too low since my AHI is so high. Should I try Auto mode this evening to see if it helps?

I don't think I have any significant leaks with my Nasal Pillow system. Occasionally I am catching myself breathing out of my mouth (once last night).

I just purchased the SW and card reader to allow me to better understand what is happening but it will be a few more days before delivery.

Any suggestions are appreciated.

-Sin

cflame1 · Post by **cflame1** » Thu Mar 13, 2008 5:07 am

Give it a week before you try making any changes.

sintpa · Post by **sintpa** » Thu Mar 13, 2008 6:19 am

cflame1 wrote:Give it a week before you try making any changes.

I plan to call my ENT today to see how long he suggests I keep the current settings. I will post what he says.

Thanks again,
Sin

BarryKaraoke · Post by **BarryKaraoke** » Thu Mar 13, 2008 8:12 am

Your leak rate seems high, which could be skewing the numbers. I believe it should be much lower than that. Then again you specified Liters per minute whereas my machine data provides Liters per second so it might not be as bad as first glance. Check your manual or ask your DME if that number seems correct.

You also could be mouth breathing all night long and don't realize it.

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sintpa · Post by **sintpa** » Thu Mar 13, 2008 8:46 am

BarryKaraoke wrote:Your leak rate seems high, which could be skewing the numbers. It believe should be much lower than that. Then again you specified Liters per minute whereas my machine data provides Liters per second so it might not be as bad as first glance. Check your manual or ask your DME if that number seems correct.

You also could be mouth breathing all night long and don't realize it.

Barry,
From what I can tell Respironics reports Total Leak Rate which is the intentional leak rate + unintentional leak rate. Per http://www.internetage.com/cpapinfo/leak-rates-1.html my Swift Nasal Pillows have an intentional lead rate of approximately 31 at a pressure setting of 9. Therefore, it looks like my unintentional leak rate (33.4-31=2.4) is not that bad.
Thxs,
Sin

More details on respironics leak rates found here --> http://sleepapnea.com/PDF/LeakRate.pdf
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Wulfman · Post by **Wulfman** » Thu Mar 13, 2008 9:06 am

Your pressure is more than likely too low. Do you have a copy of your sleep study? If not, I would urge you to get one. Did your doctor mention whether you had any Central Apneas or why some other reason why they stopped at 9 cm.?

If you did NOT have any issues with Centrals and you wish to experiment, I'd go with a 9 - 15 APAP setting and see what shakes out. Or, you could just start moving up 1 or 2 cms. at a time and check the results that way.

Good luck.

Den

BarryKaraoke · Post by **BarryKaraoke** » Thu Mar 13, 2008 10:18 am

sintpa wrote:Barry,
From what I can tell Respironics reports Total Leak Rate which is the intentional leak rate + unintentional leak rate. Per http://www.internetage.com/cpapinfo/leak-rates-1.html my Swift Nasal Pillows have an intentional lead rate of approximately 31 at a pressure setting of 9. Therefore, it looks like my unintentional leak rate (33.4-31=2.4) is not that bad.
Thxs,
Sin

Gotcha!

ResMed says anything over 0.4L/s is bad so when I saw 33.4 it caught my attention. Just another example of how your mileage will vary widely between manufactures.

sintpa · Post by **sintpa** » Thu Mar 13, 2008 10:29 am

Wulfman wrote:Your pressure is more than likely too low. Do you have a copy of your sleep study? If not, I would urge you to get one. Did your doctor mention whether you had any Central Apneas or why some other reason why they stopped at 9 cm.?

If you did NOT have any issues with Centrals and you wish to experiment, I'd go with a 9 - 15 APAP setting and see what shakes out. Or, you could just start moving up 1 or 2 cms. at a time and check the results that way.

Good luck.

Den

Hi Den,

No. I didn't get a copy of the sleep study. It was a split study so I only had the CPAP for about 4 hrs. Per my Docs description, I was only asleep for 45 minutes. He said that they were able to stabilize at 9 cm. I already talked to the medical assistant this morning. I should hear back from the Dr. by the end of the day. I will ask them to fax me a copy of the sleep study. I may take your advice and try raising the pressure. An alternate option is to try the APAP mode which is available in my machine.

Thxs,
Sin

sintpa · Post by **sintpa** » Thu Mar 13, 2008 2:47 pm

So I heard back from the Doc. He wants me to do another sleep study. This time all night with CPAP to verify the correct pressure for me. Seems like the conservative approach but I guess I can't argue with it.

Opinions welcome!

-Sin

Wulfman · Post by **Wulfman** » Thu Mar 13, 2008 2:54 pm

sintpa wrote:So I heard back from the Doc. He wants me to do another sleep study. This time all night with CPAP to verify the correct pressure for me. Seems like the conservative approach but I guess I can't argue with it.

Opinions welcome!

-Sin

Just a few questions.....

Didn't you have one before?

Is this one going to be a "freebie"......since they apparently didn't get the other one right?

Is it (pre) approved through your insurance? (if your insurance requires that type of thing)

WHY don't they just use the data from your "APAP/Auto" to find your proper pressure?
(one night in a sleep lab hardly equals every night in your own bed)

Conservative? I don't THINK so....... (he found a pocket to pick)

Den

Wulfman · Post by **Wulfman** » Thu Mar 13, 2008 2:59 pm

P.S. You can ALWAYS argue with them......they're working for YOU!!!
They're like a "contractor" you're paying them to do a job for you.

"The customer (that would be you) is always right". (well, usually)

Den

sintpa · Post by **sintpa** » Thu Mar 13, 2008 3:16 pm

Wulfman wrote:Just a few questions.....

Didn't you have one before?

Is this one going to be a "freebie"......since they apparently didn't get the other one right?

Is it (pre) approved through your insurance? (if your insurance requires that type of thing)

WHY don't they just use the data from your "APAP/Auto" to find your proper pressure?
(one night in a sleep lab hardly equals every night in your own bed)

Conservative? I don't THINK so....... (he found a pocket to pick)

Yes. I had a split study before with my time actually sleeping with the CPAP limited to about 45 minutes. I attempted to sleep for a lot longer (maybe 3.5-4 hrs), but I had trouble falling asleep with the realization that I had sleep apnea and a new gizmo attached to my face.

I'm not sure about the insurance but I think it would be fully covered. My co-insurance is 10% so I would be responsible for that portion of the cost.

I like the APAP/Auto idea and I probably will try it myself. I'm debating about just increasing the pressure a couple of points to see the results prior to switching to a full APAP/Auto setting.

I'm not sure about the motives of my ENT. Do you think he gets a kick-back from the sleep clinic? I hope not but I guess anything is possible.

Wulfman · Post by **Wulfman** » Thu Mar 13, 2008 4:07 pm

sintpa wrote:
Wulfman wrote:Just a few questions.....

Didn't you have one before?

Is this one going to be a "freebie"......since they apparently didn't get the other one right?

Is it (pre) approved through your insurance? (if your insurance requires that type of thing)

WHY don't they just use the data from your "APAP/Auto" to find your proper pressure?
(one night in a sleep lab hardly equals every night in your own bed)

Conservative? I don't THINK so....... (he found a pocket to pick)
Yes. I had a split study before with my time actually sleeping with the CPAP limited to about 45 minutes. I attempted to sleep for a lot longer (maybe 3.5-4 hrs), but I had trouble falling asleep with the realization that I had sleep apnea and a new gizmo attached to my face.

I'm not sure about the insurance but I think it would be fully covered. My co-insurance is 10% so I would be responsible for that portion of the cost.

I like the APAP/Auto idea and I probably will try it myself. I'm debating about just increasing the pressure a couple of points to see the results prior to switching to a full APAP/Auto setting.

I'm not sure about the motives of my ENT. Do you think he gets a kick-back from the sleep clinic? I hope not but I guess anything is possible.

If your insurance is like MY insurance, they like to hear about these things ahead of time......and I don't want any surprises if they're not going to pay for it, either.

Sounds silly and needless at this point to me......

I would think that if you COULDN'T find the right pressure with the APAP, then a sleep study might be necessary. (but that hardly ever happens)

Den

sintpa · Post by **sintpa** » Thu Mar 13, 2008 5:50 pm

Wulfman wrote: If your insurance is like MY insurance, they like to hear about these things ahead of time......and I don't want any surprises if they're not going to pay for it, either.

Sounds silly and needless at this point to me......

I would think that if you COULDN'T find the right pressure with the APAP, then a sleep study might be necessary. (but that hardly ever happens)

Den

Thanks Den. I believe the sleep clinic will confirm insurance prior to visit but I will double check. I'm going to try APAP this evening to see what happens.

Guest · Post by **Guest** » Thu Mar 13, 2008 7:57 pm

It's pretty obvious from your results that you suffer from sleep apnea. The question is...will you get a more accurate reading from one night at a sleep clinic for 2- 3000 dollars or by using apap for several months at home at no cost. I choose apap at home....but everyone has to make their own decisions.