CPAP making AHI go up?

[Budleigh]

I'm using Philips Respironics remStar auto system one, and a ResMed Swift FX small mask. How do I go about posting the graph for that night? I have it as a part of a larger PDF file.

[jdm2857]

You don't appear to have a leak problem at all.

Respironics machines report the total leak (including the normal mask venting) as the leak. To interpret it, one has to determine the mask vent flow rate for the pressure being used and subtract it from the total leak reported to get the correctable or actual leak.

Here's a vent rate table and graph for ResMed masks:
http://www.resmed.com/us/assets/documen ... sa_eng.pdf

Take your night with a pressure of 11 and a leak rate of 30.9. Your Mirage SoftGel mask has a vent rate of 32 to 33 at a pressure of 11. Keeping in mind that the actual vent rate varies between different samples of the same mask, your leak of 30.9 is right in line with the expected mask venting. You're not leaking anything over and above the mask vent rate.

[Budleigh]

That is very interesting about the leak. Like I said there are 2-3 spikes on the graph that are also grouped with centrals and OA's. Here is the image of the report taken from the PDF:

http://i38.tinypic.com/2jeeb2b.jpg

[jdm2857]

I wish I could get my leak line to look so good. The flat line is what you want. And the couple of brief spikes, which are probably from when you shifted position, are nothing. What you have is about as good as it gets.

[Budleigh]

OK, leak is good. That's a relief. But what does that leave? If the majority of apneas are clear airway, it's probably pressure related?

Another part of the report I tried to share above is probably better served in its original format here:

http://i35.tinypic.com/21m7vo7.jpg

The difference in AHI's is striking. Is it statistically significant though? The time spent at 8 was an hour it seems.

[echo]

CA's can also be caused by waking up or when you're drifting off to sleep, and especially at first when you're not using to breathing out against the high pressure. A few CAs are normal, and will usually decrease over time as you get used to the therapy. If however they continue, there are other options (depending on how significant they are). Reducing your pressure is one way to go - based on that info you don't seem to need 11. Remember your own measurements at night, taken over some time, will eventually be more accurate than what they measure in the sleep lab (which is only ONE night, in strange conditions, the FIRST time you ever use CPAP). But if you start dial-winging, make only ONE change at a time and stick to it for ONE week. We sleep differently every night, and if you go making changes every single night then you won't be able to see a trend.

[GumbyCT]

OK, leak is good. That's a relief. But what does that leave? If the majority of apneas are clear airway, it's probably pressure related?

Another part of the report I tried to share above is probably better served in its original format here:

http://i35.tinypic.com/21m7vo7.jpg

The difference in AHI's is striking. Is it statistically significant though? The time spent at 8 was an hour it seems.

Yes much easier to read there. Hope you went to 8 last nite to get a better measure.

[BleepingBeauty]

Tonight I'll almost definitely set it to 8 and probably do a taping because of that leak of 30, which is quite clearly not 0. Open mouth or mask mis-fit. The leak seems totally constant throughout the night with one or two spikes to 5 or 10 more points.

Just so you know, shooting for a "zero" reported leak only applies to ResMed machines, which factor in the intended vent rate for the mask that's programmed into the machine. ResMed machines report leak that's over and above what it should be. Respironics machines report the entire leak rate, which needs to be compared to the intended leak rate for your mask at your pressure.

I don't have access to the Swift FX chart but, for comparison purposes, the Swift LT (very similar mask) should produce a leak rate of 32 lpm at 11 cms pressure and 28 lpm at 8 cms. Check the booklet that came with your FX and find the chart to determine exactly what the leak rate should be, and then compare that to what the data is reporting.

Hope that helps, and good luck!

[Budleigh]

So I think I've taken everyone on a journey orbiting the fact that my body is simply not used to breathing with CPAP. So my last question is - is it just a matter of using it every night, or is there something I can be actively doing to help my body adjust? I.e. Sleep aids - or do those just make it worse?

[GumbyCT]

So I think I've taken everyone on a journey orbiting the fact that my body is simply not used to breathing with CPAP. So my last question is - is it just a matter of using it every night, or is there something I can be actively doing to help my body adjust? I.e. Sleep aids - or do those just make it worse?

Just like anything else in life, the more you do it - the easier it becomes. So wearing it everytime you sleep is important. Or wearing it while watching TV or reading.

If using the machine is a problem but you can wear just the mask then do that.

[Budleigh]

Sticking with pressure 8 at least for a week, trying to wear my mask with the machine going during downtime at home so my body gets familiar with the breathing patterns and efforts. Here's last nights.

http://i35.tinypic.com/mcdvmh.jpg

[tattooyu]

All great pieces of advice posted prior to me. If it wasn't said in one of those posts, I'll say it now...

DON'T MAKE MORE THAN ONE CHANGE AT ONCE
KEEP THAT CHANGE FOR A WEEK IF YOU CAN (AT LEAST A FEW DAYS)!

That was the sage advice given to me over a year ago. It's true. Make one change and see if a new trend develops. One night does not a trend make!

All the best.

[Budleigh]

Last night was night 4 of the swift pillow/pressure 8 combo. I'm not giving up on that particular combo, but things aren't improving. I actually feel quite bad at the moment.

last night.
http://i33.tinypic.com/29mnbe9.jpg

summary of those 4 nights.
http://i38.tinypic.com/k11ld.jpg

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