Newbie ?? Elite II and Hypops Still....

[twokatmew]

My DME gave me the Escape when I started CPAP this past Friday. On the advice of alnhwrd, however, I pressed them into upgrading my machine to a fully data capable one, so today I exchanged my Escape for the Elite II. I took a nap earlier, and the EPR makes a world of difference when I exhale. But ... I'd been having trouble getting to sleep, and then I'd wake up feeling "bug eyed" and headachy. I had little difficulty falling asleep today, but I awoke feeling that same headachy feeling. I see that I'm still getting hypops of 7.1. Leaks are only 0.06, and most of that is probably me reseating the mask. I don't see my doc for two months. Am I likely to need more pressure to get the AHI down? Other suggestions?

[Catnap]

There's been quite a bit of discussion on the forum about how Resmed machines score hypopneas, with the general thinking seeming to be that reductions in flow that some machines would classify as "flow limitation" get scored as hypopnea by the Resmed machines. It's not a good/bad thing, just a different way of defining events. Somewhere (can't find it now since I'd like to quote it, of course), I saw a posting from Rested Gal that suggested one could divide Resmed hypopnea scores by 2 for a better idea of actual HI if other scores are acceptable. Try doing a search on Resmed + hypopnea and you'll find a lot of thoughtful info on this.

[Pugsy]

I am too new to give suggestions but I can share what happened with me.

My titrated pressure was at 8 cm. At that pressure I was averaging 5 to 8 AHI with okay leak results BUT waking with a headache and feeling like crap every day. I increased the pressure from the 8 cm minimum to 10 cm minimum and the headaches disappeared and my AHI is averaging between 2-3 and I even had one night at 1.5. Most of the time now I seem to average between the 10 - 12 cm min. I had the advantage of using the software to see that despite the 5 AHI numbers which should be "okay", I was having large clusters of events within a short time frame. Enough to make me feel like crap but not enough to put a huge red flag on the LCD averages seen without the software.
Without software to see what is really going on you are at a disadvantage but things can be suggested by the long term pros here that will help.

Even if you had great results and still had headaches, it would warrant further detective work. Good numbers aren't worth much if we still feel bad.

[Slinky]

It is very seldom I would gainsay RestedGal, but having used 3 different Resmeds (S8 Elite, S8 AutoSet Vantage and now VPAP Auto) my experience is that altho the Resmeds most likely are more aggressive in scoring hypopneas I don't believe they are scoring twice as aggressively and think we would be fooling ourselves if we halved the reported HI.

That being said, since you are not using a Resmed mask, are you sure that the Mask Selection option is set to Standard? In the Standard setting, which is where it SHOULD BE, the Resmed have automatically SUBTRACTED 0.4 L/s (24 L/M) when reporting the 95th percentile Leak rate. So you have to ADD that 24 L/M to the reported Leak rate and know what the allowed vent rate is for the non-Resmed mask you are using at your set pressure to compare whether your Leak rate is acceptable.

[ttg]

First, I would give things a little time before you start to make any tweaks since you have been on CPAP for less than a week. Then, I would forget about the hypops for now and focus on the AI's first. Try adjusting your pressure up one AND down one in a controlled fashion, that is, keep everything else the same, adjust pressure and monitor for at least a few days. I was titrated at 9, had the support of my sleep doc to try increasing to improve my numbers and actually made things worse (probably with centrals) as I tried 10 and 11 for a few weeks. After frustration and feeling like crap again, I dropped down to 8 a few days ago and am having literally 2 apnea events for the entire night so far and feel much better.

Good luck!

[ttg]

Oh, also, my first several days on CPAP yielded headaches as well. Take the time to tweak humidity settings also. For me, I tried to use the highest humidity I could without having rain outs.

[Catnap]

It is very seldom I would gainsay RestedGal, but having used 3 different Resmeds (S8 Elite, S8 AutoSet Vantage and now VPAP Auto) my experience is that altho the Resmeds most likely are more aggressive in scoring hypopneas I don't believe they are scoring twice as aggressively and think we would be fooling ourselves if we halved the reported HI.

Just want to mention that I could very well have the info from Rested Gal skewed, since I couldn't find the actual quote I was looking for. And thanks for the info on setting mask for standard; I've wondered what setting I should use when I'm trying out my Nasal Aire II.

[RMinOntario]

Hi there,
After 2+ weeks on the Escape with the Swift LT nasal pillows which felt comfortable, I reported that I had head-aches every morning. So I was put on a 7 day APAP study. The pressure on the Escape had been set to 8. Now after 7 days on the APAP, I got results today showing my pressure should be nearly doubled. I no longer get the head-aches, but am pretty freaked out at the difference in the results. I'd follow up because of the head-aches. WIth an adjusted pressure, your AHI will probably settle down too. Good luck.
Rosemary

[twokatmew]

First, I would give things a little time before you start to make any tweaks since you have been on CPAP for less than a week. Then, I would forget about the hypops for now and focus on the AI's first. Try adjusting your pressure up one AND down one in a controlled fashion, that is, keep everything else the same, adjust pressure and monitor for at least a few days. I was titrated at 9, had the support of my sleep doc to try increasing to improve my numbers and actually made things worse (probably with centrals) as I tried 10 and 11 for a few weeks. After frustration and feeling like crap again, I dropped down to 8 a few days ago and am having literally 2 apnea events for the entire night so far and feel much better.

Good luck!

Interestingly enough, at my diagnostic sleep study, I had only one *central* apnea with the rest hypops, for an AHI of 15.6. In today's 3.5-hour sample, I had no apneas and 7.1 hypops. So I guess I'll have to focus on hypops. It does make sense to let things "settle" before I mess around too much though.

I had to turn the humidifier down to 2 (manual said start at 3), because I was getting so much moisture in the mask, and then it would whistle. (Water in the nose was waking me up, too.) Today I got a hose wrap, and between that and the new machine with EPR, the mask is almost silent in comparison. So perhaps I can turn the humidifier up a little. Eventually I'll get the card reader and software, but I need to hold off spending any more $$ right now and also want to concentrate mainly on getting used to CPAP and feeling better before I dig too much into the numbers analysis!

Thanks everyone for your suggestions thus far!

[twokatmew]

... snip.... That being said, since you are not using a Resmed mask, are you sure that the Mask Selection option is set to Standard? In the Standard setting, which is where it SHOULD BE, the Resmed have automatically SUBTRACTED 0.4 L/s (24 L/M) when reporting the 95th percentile Leak rate. So you have to ADD that 24 L/M to the reported Leak rate and know what the allowed vent rate is for the non-Resmed mask you are using at your set pressure to compare whether your Leak rate is acceptable.

Yes, mask is set to "standard." I'll check the F&P site for the mask stats you mention. Thx!

[twokatmew]

Hi there,
After 2+ weeks on the Escape with the Swift LT nasal pillows which felt comfortable, I reported that I had head-aches every morning. So I was put on a 7 day APAP study. The pressure on the Escape had been set to 8. Now after 7 days on the APAP, I got results today showing my pressure should be nearly doubled. I no longer get the head-aches, but am pretty freaked out at the difference in the results. I'd follow up because of the head-aches. WIth an adjusted pressure, your AHI will probably settle down too. Good luck.
Rosemary

Hi Rosemary, I'd be pretty freaked out too, if my pressure more than doubled like that. I was thinking I'd try the Swift LT for Her mask, but I think I'll stick with the mask I've got till I get my pressure figured out. I don't want to change too much at once, and I don't want to be left with a mask I can't wear if I require more pressure.

[ozij]

According to your profile, you have a pulse oxymeter. How do its results correlate with your headachy feeling?
Some of us find we need pressures different from those prescribed - we sleep deeper at home than in the lab, and therefore have more events.
I wouldn't use "Rested Gal's Resmed hypops rule of thumb" automatically - certainly not if I felt bad - and definitely not if I had a pulse oxymeter.
Brenda's points about the data are very valid.
I have never used any Resmed machine -- but I think Slinky is right. We should be very careful when deciding ignoring the Resmed hypops -- that's is only warranted when everything else is fine. Certainly unwarranted when you're still not feeling well.

O.

[twokatmew]

According to your profile, you have a pulse oxymeter. How do its results correlate with your headachy feeling?
Some of us find we need pressures different from those prescribed - we sleep deeper at home than in the lab, and therefore have more events.
I wouldn't use "Rested Gal's Resmed hypops rule of thumb" automatically - certainly not if I felt bad - and definitely not if I had a pulse oxymeter.
Brenda's points about the data are very valid.
I have never used any Resmed machine -- but I think Slinky is right. We should be very careful when deciding ignoring the Resmed hypops -- that's is only warranted when everything else is fine. Certainly unwarranted when you're still not feeling well.

O.

Heheh, you caught me! My new oximeter is scheduled to be delivered tomorrow, so I have no data ... yet. I was wishing myself earlier, that I'd had the oximeter while I was napping today. Currently I have an oximeter that's just for periodic checks, so I'll be glad to get the new one -- and the data from it.

[ozij]

By the way, don't take any AHI nap data to heart too much -- the short time we (usually) nap skews the AHI.

O.