MANY Questions, need answers!

[mallen4258]

Hello!!

I have been a lurker for several months and Thanks for all the information, it HELPED. I researched OSA and CPAP's to death while planning for the study and getting the prescription and equipment (a process that took over a month from first visit to getting equipment). I was prepared when I went to the DME and knew what I wanted, with much thanks to this forum. I am fairly new to xPAP use (about 5 weeks) and I have a few questions. Most of the questions that I have, I have been able to find answers on the forum. I guess I am lucky as I have had improvement in sleep and comfort from the first night of CPAP use, of course with adjustment that comes with something new. But I would like some specific help.

My sleep study indicated a AHI of 65.1 and REM AHI of 101.9.
lowest O2 sat was 75%
recommended pressure was 8 cm H20

I have been using the Respironics Remstar M auto w/aflex set as auto with pressure range 8-12 after using it as a straight CPAP set at 8 with the humidifier set at 2 (water lasts all night with some left). I get better numbers with auto and range of 8-12. Currently my AHI ranges between 2.1-7.5 for the most part with an mean average around 5.1. I have found I don't like Aflex and run with Cflex set at 3. Before use of the CPAP I would get up to go to the bathroom 4 or more times a night, now once a night (small bladder syndrome comes with age, 55 lol). My average leak is around 32 using the Activa LT, and a little lower with the Swift LT. I seem to breath easier with the Activa LT than the Swift LT. The leak line is fairly straight with a few bumps here and there.

The questions for now are:
What is Flow Limitation and how does it affect the numbers?
How can I get better consistency in the numbers/quality of sleep?
What is the difference in comfort/fit between the Activa and Activa LT?
What is a suggested FF mask? I tried the Fisher Paykel 431 and while a nice mask, it leaked very badly around the eyes for me and I sent it back.
I see that some users have an Oximeter, does the information it provides help?

I sleep MUCH better now with the CPAP than before, and I am still trying to tweak everything to improve my results. I can tell that how I feel each morning corresponds fairly well to the numbers that i get from the equipment. I recently bumped my range from 8-12 to 8-13, but it is too early to tell how that will work. I do bump up against the higher pressure even at 8-13, but average pressure is around 10. I have not tried lower Cflex yet, as I like the comfort that Cflex 3 provides. Due to my job and education, I am an equipment and techno geek so any suggestions would be appreciated.


Here is to sleeping better, and breathing better!!!!!!

[DreamStalker]

It does take a little time to optimize treatment ... even for the technically endowed such as yourself.

The oximeter helps to verify how well your treatment is working ... since the main objective is to make sure you maintain a proper level of oxygen during sleep. CPAP treatment of OSA is too often attributed to improving daytime sleepiness or mitigating snoring when it is the apnea (lack of oxygen) that is dangerously fatal. So the oximeter allows you to quantify and validate CPAP efficacy. I suppose it also helps you to understand your body a little better too. I started taking a beta blocker last fall and with the oximeter I was able to monitor effects on my heart while asleep. And if you have loved ones or friends suspect with OSA, the oximeter can help to diagnose or at least guide a potential OSA victim to a sleep study.

Re: exhalation relief (AFLEX/CFLEX) ... try turning both off. May feel weird at first but you will get used to it relatively quickly.

I'll let others chime in on the other questions as I don't have answers for most.

[alnhwrd]

Mal,

Actually, it sounds like you are doing terrific, especially with controlling leaks. You have done lots of things right, so good for you! Just like a Hypopnea is a "wanna be" apnea, think of a Flow Limitation as a "wanna be" Hypopnea. Its a reduction of your air flow, but not enough to qualify it as a Hypopnea. Since your mean AHI is right at the threshold for being successfully treated, I would make any changes slowly, one at a time, and wait a week between making any other changes. For reasons I cannot explain at about three months my AHI went from the 4.5-6.0 range to a 3.0 to 4.5 range. I don't know why, it just did. I would agree with DS's suggestion of trying it without the exhalation relief. I used mine at first but now have it off and don't notice. Keep up the good work!

[nomoore]

I have an Activa mask and I recent tried the Activa LT cushion on it. I haven't tried the whole Activa LT mask though (the cushions are interchangeable). I will say that the LT cushion feels just a tad smaller to me. It also doesn't soak up as much movement as the regular Activa cushion. On the other hand the LT cushion doesn't stick out as far on the sides so I find I don't have to sleep on the edge of my pillow.

I've read about the differences in the masks:
The vent diffuses the air differently in the LT and is supposedly quieter.
I think the piece that touches the forehead is narrower.
The angle of the forehead piece on the LT mask is more finely adjustable.

[Hose_Head]

What is the difference in comfort/fit between the Activa and Activa LT?

I have both of these masks.

The Activa mask is slightly smaller, and it's lighter because it doesn't have the 18" extension piece for the hose (no difference in weight once you connect the hose to the LT).

The LT's forehead bridge is micro-adjustable and it seems a little sturdier. But I'd judge it no better than the Activa.

As another poster has noted, the LT seems not to handle movement quite as well.

I've found the LT a little hard to adjust to prevent leaks, but only slightly so.

The LT has a different and slightly improved air discharge system. It diffuses the air rather than trying to direct it.

Biggest negative for the LT is that the harder inner plastic of the mask is more likely to contact your face when sleeping. This can leave some minor marks that take an hour or two to disappear.

Biggest plus for the LT is that it's a little easier to clean (because there is no attached hose).

Overall, I prefer the Activa classic. I like its headgear better and I think it's more comfortable. It seems to leak less (although my numbers don't confirm this). I think Resmed could have done a little better with the LT.

Masks are highly personal. As they say, YMMV.

[ww]

Hi mallen.

Thank goodness you educated yourself and have an excellent setup to start with! I would advise you to learn how to post your results on the web and let others make comments on them, particularly the leak line, as this may easily invalidate your AHI results. This thread has quite a bit of description of the differences that leak lines can have on your therapy: Data worse with APAP treatment after one week? viewtopic.php?f=1&t=29565&p=254533#p254533

Most people would benefit from buying a ResMed Ultra Mirage Full Face Mask. The problem is getting the right one as there are six sizes. ResMed has a 3D fitting template that you can obtain with a phone call to them or be sure your DME uses that exact 3D tool to fit you. It is absolutely important that the mask is not too large or it will leak into your eyes. The smallest size that will fit is much better. There should be very little leak with a high quality full face mask, but you have to shave before bedtime, scrub your mask sealing surface, and your face with a warm washrag. This applies to any nasal or full face mask and can't be over emphasized how important these steps are in addition to fitting the mask correctly.

Think of flow limitations as almost a hypopnea and hypopneas as almost an apnea!!!

I don't think you should settle for the AHI range you are getting now, but it will take a little time to fix the leaks and get the range set properly on the machine. Do NOT make adjustments any more often than once a week or so as there is too much variability to not select a methodical approach to the problem. The 90% pressure point calculated from an auto gives you a quick determination of your lower point for the auto, PROVIDED your leaks are under control. Keep up the good work and post some data to the board. It is fairly simple to do.

[gerrymoorerrtdotcom]

I think you are doing just great, choice of mask would be comfort, but please do not go to the FFM if you do not need too. The numbers look great on both masks compared to what you were off cpap. As per flow limitation I was looking around for an article that I read a while ago about it and wanted to refresh my memory more before I commented. Gerry

[mallen4258]

Wow, thanks for the replies!! I have lowered the CFlex to 1 and with the Auto set to 8-13. My max 90% pressure has been 11 with average around 9 with decent AHI. Still room for improvement, I think this will come with time, mask selection, and setup. Again, THANKS to all.

Any suggetions on a recording Oximeter (brand, model, usefulness).