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[Random]

Hi Everyone,

Background: 24-Year-Old diagnosed with mild sleep apnea with an AHI of 18.

I've had a lot of troubles with my therapy in the past and I've always got good advice here and followed it to the best of my ability. The most recent advice was to get a data capable machine and keep track of my treatment. I've now got a Resmed S8 which is data capable and though I do not have the usb cord or the card & reader in order to access the more extensive data I have been keeping track of my leak rate and AHI over the past couple months.

So my problem is I've been using CPAP on a nightly basis for the past 7 months and I still feel like garbage, I have to struggle to make it through my days as I am so tired I can't even risk closing my eyes for a moment and my head feels as though its stuffed with cotton. I've tried to remain positive but its come to the point where it is causing me to be extremely depressed in addition to being constantly exhausted.

I have also tried a variety of masks which I was lucky enough to get for free with the used S8. I originally got the Mirage Activa LT with my first machine and it has been the most comfortable mask I've tried. After extensive problems with mouth breathing and struggling to find a full face mask that didn't leak like a hurricane I've settled for taping my mouth each night.

Over the past week I've also grown to like the Resmed Swift LT which allows me to sleep on my side much more comfortably and seems to have a lower leak rate. My AHI has come down and is seems to remain in the range of 2.4-5.1 and does not get any lower. However my leak rate is still 0.34 which is the lowest I've managed to get it as well. I'm not really sure how the Swift manages to leak with only two two nostril holes but I'd appreciate any advice I could get.

The problem I had with the Activa LT was the leak rate would usually be around 0.64 no matter how well I fit it and not only that but it would also cause my mouth tape to leak during the night where the Swift does not.

I've heard that my current AHI with my machine is considered to be normal, but why then am I not feeling any better and what else can I do about it?

[MAL]

Hello,
I was wondering if you put one of those things on your finger to see what your oxygen level was in the morning when you are feeling badly?
If it is normal, then go on to check something else (like a blood test for example) if below normal, then we know that you are still not being successful with your therapy.
I hope this helps.

[Wulfman]

You really haven't given us any information to use to offer any suggestions.
I would suggest that you list ALL of your machine settings here.......including the humidifier.


Den

[jdm2857]

Are you changing the mask setting on the machine when you switch masks?

[Random]

Hello,
I was wondering if you put one of those things on your finger to see what your oxygen level was in the morning when you are feeling badly?
If it is normal, then go on to check something else (like a blood test for example) if below normal, then we know that you are still not being successful with your therapy.
I hope this helps.

I've never heard of doing anything like this, would you mind giving me a little more information? If you're talking about a Oximeter, I cannot afford one of those at the moment so I have not tried.

You really haven't given us any information to use to offer any suggestions.
I would suggest that you list ALL of your machine settings here.......including the humidifier.

Den

I'm not sure what more you're after. I keep EPR on full-time on 3, my humidifier I usually keep fairly low at 2 or 3 otherwise the water builds up in the hose and makes a lot of noise.

My pressure is currently set at 9 since I did my titration sleep study about 5 months ago. I still haven't made it back to my sleep doctor since then as it takes almost six months to get an appointment

Are you changing the mask setting on the machine when you switch masks?

Yes, I've changed it each time though I've never noticed a difference.

[Emilia]

I would suggest increasing your pressure a tad -- maybe to 9.5 or 10 to see if that brings down your AHI and gives you more energy. I use an auto machine, but just upping my lower end pressure by 1 made a huge difference in my results. My AHI is around 1-1.5 all the time now. Having your EPR on 3 all the time may be limiting your therapy a bit, too. So increasing the pressure a bit to compensate for that may be the ticket.

If you need the clinician manual to get into the settings to adjust them, you can get them here: http://www.apneaboard.com/CPAP%20Adjustment.htm

I use the Swift LT for Her mask, and leaks can occur if the pillow(s) shift a bit.

Getting an overnight oximetry reading would be a great idea. They are a bit pricey, but worth it. I use the CMS 50E which I bought online for about $115.00 and it came with the software. If you know anyone who owns one, perhaps you can borrow it and then use their computer to read the results.

[Wulfman]

My pressure is currently set at 9 since I did my titration sleep study about 5 months ago. I still haven't made it back to my sleep doctor since then as it takes almost six months to get an appointment

Are you going to (or are you willing to) take charge of your own therapy or are you going to be dependent on your doctor?

If you're willing to take charge of your own therapy, I'd also suggest increasing your pressure by 1 cm. and set the EPR to "2" and see how that goes. Maybe reduce the humidifier setting by 1 number. You didn't mention whether you were using Ramp. If you're using Ramp, try turning it off. Your pressure isn't all that high to begin with.

Do you have a copy of your sleep study? Is there any mention of Central Apneas?

With regard to doing an overnight pulse-oximetry, you could get your doctor to send a prescription to a local DME and they will loan you one overnight and download the results to send to your doctor......you also will want a copy of it, too. The best part......it's FREE......or at least it should be, because there are no insurance reimbursement codes for the service.
Many reasonably knowledgeable sleep doctors will order one for their patients after they start therapy as part of the determination as to whether their therapy is working.


Den

[DoriC]

With the EPR set on "3", your pressure decreases to 6cms(1cm less for each setting) which is quite low and may be causing you to have apneas. Since you're having obvious high leaks and haven't been properly fitted for the right mask ,any data you are getting is unreliable. Your humidifier setting may need adjusting too, depending on your location and if you have allergies,etc. We don't use a humidifier, just fill with distilled water and use (0) setting in "passover mode". BTW, I believe an AHI=18 is considered moderate sleep apnea, below 15 is considered mild. I hope you've been doing a lot of reading here. Keep us updated.

[Random]

My pressure is currently set at 9 since I did my titration sleep study about 5 months ago. I still haven't made it back to my sleep doctor since then as it takes almost six months to get an appointment

Are you going to (or are you willing to) take charge of your own therapy or are you going to be dependent on your doctor?

If you're willing to take charge of your own therapy, I'd also suggest increasing your pressure by 1 cm. and set the EPR to "2" and see how that goes. Maybe reduce the humidifier setting by 1 number. You didn't mention whether you were using Ramp. If you're using Ramp, try turning it off. Your pressure isn't all that high to begin with.

Do you have a copy of your sleep study? Is there any mention of Central Apneas?

With regard to doing an overnight pulse-oximetry, you could get your doctor to send a prescription to a local DME and they will loan you one overnight and download the results to send to your doctor......you also will want a copy of it, too. The best part......it's FREE......or at least it should be, because there are no insurance reimbursement codes for the service.
Many reasonably knowledgeable sleep doctors will order one for their patients after they start therapy as part of the determination as to whether their therapy is working.

Den

My doctor has been less than helpful with suggesting anything to improve my condition which is why I've been trying to find some more tips on these boards. I do not use the ramp function as I have difficulty breathing at the lower pressure settings.

With the EPR set on "3", your pressure decreases to 6cms(1cm less for each setting) which is quite low and may be causing you to have apneas. Since you're having obvious high leaks and haven't been properly fitted for the right mask ,any data you are getting is unreliable. Your humidifier setting may need adjusting too, depending on your location and if you have allergies,etc. We don't use a humidifier, just fill with distilled water and use (0) setting in "passover mode". BTW, I believe an AHI=18 is considered moderate sleep apnea, below 15 is considered mild. I hope you've been doing a lot of reading here. Keep us updated.

I did not realize the EPR setting could be responsible for apneas. From what my DME told me it is just a function to make it easier to breathe. As for the AHI of 18 being moderate, that is what I'm told pretty much everywhere online I just went off what my doctor told me. Also, you have all mentioned the humidifier settings as though they were very important, how can they affect your therapy? I found that when I did not turn on the humidifier I woke up with an extremely sore throat and had difficulty speaking the following day.

For now I will try removing or lowering the EPR setting and increasing my pressure a tad.

Thanks!

[Emilia]

My sleep doc said my OSA was 'moderate' with AHI 17 from sleep study. He did say that Medicare guidelines begin 'moderate' at AHI 20 so I guess it depends on what coverage you have as to how it is categorized.