How am I doing

[computerguy2202]

Below are my results from Rescan 3.7, could you let me know how I'm doing and any suggestions. I do have leaks with this mask and the Swift LT using the small pillows with the mod done to it. After 12 masks these 2 seem the best so far.

Therepy Mode: CPAP
Set Pressure: 17.0 cmH2O
EPR Level: 3.0 cm
Days used: 34
Apnea Index: 2.4
% Time in Apnea: 0.8
Hypopnea index: 16.7
AHI: 19.0
Leak: 95th Percentile: 19.2 Maximum 37.8

[ttg]

Computerguy,

I have learned from the forum that the first question should be how do you feel? That is the most important aspect of therapy regardless of any numbers.

The following comments are based on my experiences with the same machine and masks after about 56 days...

AI seems a bit high (target should be < 1), but I suppose it is relative based upon where you started 34 days ago. What were the results of your sleep study? What is the severity level of your condition? HI also seems high but many on the forum will say that ResMed's report of hypopnea's is typically higher, perhaps 2x, than what they may really be. AHI is of course a combination of the two. Your first focus should be reduction of the AI's.

As you noted, you do have leakage. Do you have the Elite II set to mask type of SWIFT when using the Swift LT or ACTIVA when using the Mirage Activa LT? If not, you should set it accordingly so that the flow generator efficacy leak data will adjust for the standard leak levels of each mask. The reported leak rate may be higher if your mask type is not set to match your mask. If you do have the mask type already set according to the mask you are using on any particular night, you definitely need to continue to work on improving the leak rate, IMO.

I was titrated at 9 and have been trying some higher pressures to see if I can improve my numbers. I know that 17 is in the high range but with an EPR of 3, your average pressure will be effectively around 14. The EPR inhale rate (medium or fast) will also have a small bearing on the average effective pressure - medium yields slightly lower average pressure whereas fast will be more true to the target pressure since the machine will ramp up to the set CPAP pressure more quickly after each exhale.

Regarding pressure, 17 is on the higher end of CPAP mode. Others with experience with higher pressures on the forum could probably give you more feedback.

Lastly, if you are making adjustments to your pressure and EPR levels, you need to do so in a very controlled fashion. I can't stress this enough. Remember that the EPR level does have an impact on effective treatment pressure. Also, consider that if you are prone to have central apneas (check your sleep study results), higher pressures could make your results worse. I have learned this the hard way after trying several increases in pressure over the past few weeks and having mixed results. I, myself, did not consider the #1 question "how do you feel" with enough priority when assessing my results. When I took a step back and realized I was generally feeling worse at the higher pressures, I backed off on pressure and am starting to feel better now.

I hope this helps.

ttg

[computerguy2202]

Like any new user strugling with leaks causing waking up every 2-3 hours. Out of 12 masks still have not found one that fits properly, only close.

Still not feeling a little tired and memory/concentration not up to speed.

Yes I do change the settings of the mask when it's changed.

A little lip leak and chin straps haven't worked.

AHI was 53.4
SaO2 was 78....below 85% was 8.9
Arousals was 47.9 per hour
No REM sleep
Sleep Efficiency was 86.2%
Severe sleep apnea

[riverdreamer]

If you are having so much trouble with masks, you might want to look at some of the info on modifying the masks to work better. I have been fortunate to find one that works pretty well for me, but many, if not most, need small tweaks to make a mask work for them.

Check out Rested Gal's links. She has lots of info on many of the masks, and specific fixes for them.
viewtopic.php?t=17435

Once you have a comfortable mask, everything else will be easier. Yes, your numbers are a little high, but until you get a good mask, it isn't easy to make other changes. Once you have a mask that fits, and doesn't leak, then you can make any other changes that might help with improving your treatment.

Welcome to the board, I'm sure you will get lots of help!

[turbosnore]

While I'm not sure about the settings with that mask, it kind of feels like the
leak is high enough to mess up AI/HI/AHI numbers.

About the settings: is the "sleep turbo" calibrated for that mask? (Is it "excess"-leak?)
What are the leak rate units?

HI looks pretty high even if the machine is ResMed.

[alnhwrd]

Welcome! As stated, your leak rate is WAY too high, and must be addressed first. My nightly 95 percent leak rate is sometimes 0.0, and never above .20. Not your fault, 17 cm is getting up there in pressure. Make sure that when you are using the LT that you have selected it from the mask selection menu, and when you are using the Activa select "Standard". If you are leaking air out your mouth or it is coming open in the night then all of your pressure is being wasted and not doing you any good. I would try a chinstrap and/or some tape to hold your mouth shut or a full face mask. Once the leaks are controlled you should see those numbers come down.

[Uncle_Bob]

On top of the excellent advice already given I would recommend using the mask fit feature on your machine.
Fit your mask then turn on the feature and breath with it for a few minutes while maybe turning into a few different sleep positions.
Then go and have a look at the display to see your rating which is displayed in **** form.

I have the Swift LT and like some other found that the back strap slips up on the head causing pillow leaks in addition i was mouth leaking too. I found that the PapCap chin strap helped with both keeping the back strap securely in place and also reducing mouth leaks.