Hi I'm new, have newbie questions...

[ghoundgirl]

First the basics: I got my machine two weeks ago today...it's a ResMed Elite ll. I am using an F & P 431 full face mask. It's my second mask in two weeks; I was initially given the Swift FX nasal pillow style mask, which, although I like the idea of it compared to a full face mask, won't work for me since I'm a mouth breather. It also tore up my nose, leaked moisture all over me, and wouldn't stay in place no matter how it was adjusted. I do like the 431, inasmuch as you can "like" an octopus strapped to your face. I don't have much of a problem with leaks, it stays in place when I move, and is reasonable comfortable. Oh, my pressure is 8.

I found out today how to access the Efficacy Menu on the machine. Data for the last week: AI .7, HI 7.5, AHI 8.6, leaks 0.22 L/s. Does that look normal/expected for first week of therapy (I'm not counting the first week, with the Swift, since it got thrown across the room on more than one night)?

I'm not feeling any different or better yet. I've done a lot of reading and know everyone's different in how quickly they respond to therapy, but it's hard not to be a little discouraged. I've had OSA symptoms since I was a child, along with all the fun side effects (head aches, irritability, falling asleep at inopportune moments, etc.) and was really hopeful that this would make a real difference in my life. I'm confident (trying to be confident) that it will, with time and perseverance. I'm determined!

I am having two problems: swallowing air and drooling. I've read about aerophagia, but am wondering is this common at first, and will it go away? I noticed when I was in the settings menu that epr is off. I read that turning it on may help with aerophagia--true? Can I just turn it on, or do I need the RT to do it? As far as the drooling, it didn't happen with the Swift; it started the first night I used the 431. I thought initially that it may be rainout, but I wrapped the tubing in fleece, and it still happens, and also, I have the humidity set really low (less than 1--I don't like it!).

Any hints, tips, and/or encouragement appreciated!

-laurie

[ephskiing377]

Hi ghoundgirl,
You might try the ResMed Mirage Liberty full face mask. It has nasal pillows and a mouth cushion that covers your mouth, so us mouth breathers can have the option of a nasal pillow mask. It is very comfortable and it dose not cover your whole face like other full face masks do. Also, no air leaks into our eyes, which is a big plus. I hope you the best with your treatment. Take care and sleep well.

Sincerely,
Chad
(ephskiing377)

[jweeks]

Laurie,

Welcome to the world of CPAP. Using the machine is never a cookie-cutter type of thing. It sometimes takes a lot of problem solving, and it sometimes takes a lot of patience. Still, I bet it felt good to throw the mask across the room. I wanted to do that more than a few times at first.

Do you find water droplets in your hose in the morning? If so, then you probably are having some rainout. A hose cover was a good first step. Also, make sure that your machine is below the level of your bed. That way, the water will run back into the machine rather than into your mask. That still isn't enough to stop rainout in some cases. The goal should be to let you run at a level of 2 or 3 on the humidifier without having water problems. A fan in your room can sometimes help.

The AI number doesn't look too bad. The HI is a little higher than one would hope for, but ResMed machines tend to score them higher, so it isn't all that out of whack. The goal to shoot for is 5 or less for AHI.

I never had the aerophagia issue, so I cannot help there.

EPR is something that you should be able to set on your own. The settings are typically 1, 2, or 3. One is a little pressure relief, 3 is a lot. Use what you are comfortable with. Some folks don't react well to the higher levels, but others find the higher level very helpful.

While I know just as little about this as the rest of the folks who are on CPAP, I do get the impression that you are not responding as well as you could be to the machine. Do you have a follow-up appointment scheduled? One option is to let things go as they are, and let the doctor read the data when the time comes. That will give you some time to adjust and get past some of your built up sleep debt. If you don't have an appointment, or it is a long way off, then I'd be tempted to do a little tweaking after you get another week or so of data. That is going to require reading you data on your computer to get the full charts. The line of reasoning that I am suggesting is that some folks are really sensitive to even the smallest number of events. You might need a little more pressure to go after the events that you are having. I wish you had an APAP or auto PAP machine. They are often very good at self-adjusting in these cases.

For me, it took just 1 CM of pressure increase to go from an AHI in the 6 to 9 range down to a consistent 1 to 2 range. I often feel great if I have a night with an AHI less than 1.5. But if I have a 2.5 night, I feel like I am in the ozone the next day.

I'd suggest building another week or two of history data, then see your sleep doc. If that doesn't help out, then let the arm chair engineers take a look at your data plots.

-john-

[rested gal]

I found out today how to access the Efficacy Menu on the machine. Data for the last week: AI .7, HI 7.5, AHI 8.6, leaks 0.22 L/s. Does that look normal/expected for first week of therapy (I'm not counting the first week, with the Swift, since it got thrown across the room on more than one night)?

You're right not to count the troublesome week you had with the Swift. Your numbers look very, very good. You're using a ResMed S8 machine, so what jweeks mentioned about the Hypopnea Index is what's making your AHI be above 5.0. jweeks uses a Respironics machine, which uses a different definition for when a flow limitation will be called "hypopnea."

It's "normal and expected" for Respironics users to see AHI below 5. With ResMed S8 (and older ResMeds) I think it's "normal and expected" to see an AHI approaching 10 -- made up mostly of the Hypopnea Index (the "HI" number.) If you want to compare your AHI to what you'd likely see if you were using a Respironics machine, ghoundgirl, I'd mentally cut in half the HI of 7.5. Think of that HI as being 3.2 or 3.3, then add that to your AI of .7....giving you an overall AHI of about 4. Doing that gives you a better comparison, imho, to what you'd have seen had you been using a Respironics machine. Both brands can give equally effective treatment even though they report the AHI differently...usually because of the "HI" (Hypopnea Index.) The two brands use different definitions of when to call a flow limitation a "hypopnea."

If the AI is very low (which your AI is) and it's the HI making up the bulk of the AHI, I would not worry for one moment about an AHI of 8.6 with a ResMed S8 machine. I'd regard any AHI that's below 10 (with a ResMed S8) to be essentially the same as an AHI under 5 with other brands of machines. The difference in identifying "events" and reporting them is not a matter of one brand has it right and another brand doesn't. Or that one brand catches things that another misses. Or that one brand "misidentifies things and another brand is accurate. The difference is purely a matter of an arbitrary "line in the sand" definition of when a flow limitation will be given the name "hypopnea." Each manuacturer uses their own definitions. Doesn't make one right and another wrong.

With the introduction of the newest ResMed models (the S9 machines) ResMed has apparently made some changes in their algorithms and reporting of events. It's "normal and expected" now for S9 users to see AHI below 5.

I'm not feeling any different or better yet. I've done a lot of reading and know everyone's different in how quickly they respond to therapy, but it's hard not to be a little discouraged. I've had OSA symptoms since I was a child, along with all the fun side effects (head aches, irritability, falling asleep at inopportune moments, etc.) and was really hopeful that this would make a real difference in my life. I'm confident (trying to be confident) that it will, with time and perseverance. I'm determined!

You have the right attitude!

I've read about aerophagia, but am wondering is this common at first, and will it go away?

For some who experience it, it eventually stops happening; but for others it can persist. Have you ever been diagnosed with GERD (acid reflux disease.) Very common in people who have had years of untreated OSA. Acid getting pushed up from the stomach can damage or weaken the esophageal sphincter, allowing acid even easier access to going up, and allowing cpap air to get pushed down the wrong way, into the stomach.

There's also such a thing as "Silent GERD" meaning you can have it but not have noticeable symptoms:
http://www.sciencedaily.com/releases/20 ... 080008.htm

"These are patients without significant heartburn symptoms, who are experiencing acid reflux during sleep," explained William C. Orr, Ph.D. of Lynn Health Science Institute in Oklahoma City, OK. "'Silent reflux' may be the cause of sleep disturbances in patients with unexplained sleep disorders."

"All patients with sleep apnea should be evaluated for gastroesophageal reflux," said J. Barry O'Connor, M.D., of Duke University Medical Center, one of the investigators.

I noticed when I was in the settings menu that epr is off. I read that turning it on may help with aerophagia--true?

Might help. Might not. The only way to know is try EPR and see. Could be very different for different people.

Can I just turn it on, or do I need the RT to do it?

If you know how to go into the clinical setup menu on your machine, you could turn it on. Otherwise, you'd have to take the machine back to the DME (home health supplies store) to have them do it...if they will. They might say they'd want an "ok" from your doctor to turn on EPR as that will lower the pressure you'd be receiving each time you exhale. Or they might regard EPR as purely a comfort setting and say, "Sure...bring it in."

My opinion about EPR and a person's prescribed pressure -- just an opinion, and I'm sure not a doctor:
January 2, 2010
viewtopic.php?p=436272#p436272

By the way, welcome to the message board, ghoundgirl!

I'm curious...does the "g" stand for greyhound? Perhaps you've given a sweet retired greyhound a good home?

[ghoundgirl]

Many thanks to all who replied! I'm so glad I found this forum.

John, thanks for the tip re: having the machine lower than the bed; currently I do not. Maybe I'm not drooling after all, and it is rainout.

rested gal, thanks for all the information regarding the difference in how the various brands of machines arrive at their numbers. Very interesting! Good to know I'm doing okay number-wise.

Last night was a pretty bad one--I woke up around 1am with my abdomen swollen and tight from all the air I'd swallowed (I looked 8 months pregnant at least; unfortunately, no exaggeration). Painful! I was afraid to put my mask back on, so I slept the rest of the night without it. I'm still uncomfortable, and it's now 2pm. I've never been diagnosed with gerd, but I have had symptoms-at times enough to wake me up at night-in the past. I'll give it a few more weeks and see if things get better. If they don't, I'll have a talk with my doctor. I have no follow up scheduled, but it looks like I may need one.

Thank you all so much for the help, information, and encouragement!

(and yes, the g stands for greyhound. i've had seven retired racers over the years. they do make wonderful pets!)