My First week on CPAP

[harwich]

Just finished my first week on APAP. First night was a disaster but got a little better after that. Didn’t have a WOW morning were I woke up and said “I feel great” but on several days I did feel better. Today I feel tired. I wake up after six hours and can't go back to sleep. Here are my numbers for the week, what do you think? The Pressure and Leak rates are: Median; 95%: Max

Date AHI/Ai
12/6 .7/.4
12/7 .3/.2
12/8 .8/.8
12/9 .2/.2
12/10 .9/.7
12/11 .1/.2
12/12 .6/.6


Pressure
12/6.....7.6/ 10.4/ 12.4
12/7.....8.4/ 9.8/ 10.6
12/8.....7.9/ 10/ 12.7
12/9.....7.7/ 9.8/ 11.6
12/10....7.9/ 11.4/ 14.2
12/11....8.9/ 10.6/ 11.6
12/12....8.5/ 11.3/ 12.6

Leak
12/6.....1.2/ 21.6/ 43.2
12/7.....0/ 7.2/ 30
12/8.....0/ 12/ 30
12/9.....0/ 3.6/ 33.6
12/10....3.6/ 26.4/ 34.9
12/11....4.8/22.8/32.4
12/12....3.8/ 19.2/ 27.6

Thanks,
Mike

[robysue]

First, congratulations on finishing that first week of CPAP. Long journeys start with a single step, and you've started your long journey.

Second, while some folks are lucky enough to have a WOW morning very early on, many (most?) of us don't. A few of us, including myself, go for months without getting to experience a WOW morning---I'm still waiting after 12 weeks of therapy. The fact that you have felt better on several days is another cause to celebrate! [I'm still waiting on that too ] You will have ups and downs and so one or two tired days in a row is nothing to worry about.

Your AHI/AI numbers look fantastic! Clearly your therapy is effectively treating the apneas. And it sounds like it is also beginning to allieviate some of your daytime symptoms as well.

Pressure numbers are pretty much individual to the patient. How much pressure is needed to effectively manage a person's apnea depends on the person's anatomy more than the degree of severity of the apnea. There's no point in trying to compare your pressure numbers to some "norm". The reality check, so-to-speak is whether the 95% number is somewhere close to your titrated pressure and whether the pressure range is controlling the apneas, which your current pressure range is certainly doing.

Leak rate numbers, on the other hand, depend on the mask and the machine. Since you're using an S9, if the "mask setting" is correct for your mask, the leak rates the machine reports are the leaks above the intended exhaust flow/leak designed by the mask's maker. Hence an ideal leak rate on the S9 is 0.0/0.0/0.0, which would indicate NO unintended leaks all night long. Such ideal leak rates are NOT the norm, even for those of us with no leak problems: If the S9 samples the leak rate just at the point where you're adjusting the mask to scratch your nose, the max leak rate can wind up being pretty large even if both the median and 95% leak rates are both 0.0.

Your leak rates:

• Leak
  12/6.....1.2/ 21.6/ 43.2
  12/7.....0/ 7.2/ 30
  12/8.....0/ 12/ 30
  12/9.....0/ 3.6/ 33.6
  12/10....3.6/ 26.4/ 34.9
  12/11....4.8/22.8/32.4
  12/12....3.8/ 19.2/ 27.6

seem to indicate that you are having a bit of a problem with leaks. You may even have gotten the dreaded Red Frowny face on 12/10. The ResMed S9 information indicates that it's designers believe that leaks AT or ABOVE 24 L/min are enough to compromise the integrity of the data recorded, interfere with the auto-algorithm's ability to respond to events, and compromise the effectiveness of the therapy. Now it's one thing if you have one short lived really bad leak and it's another thing if you have leaking at this rate for longer periods of time. That's why the Red Frowny is designed to come on if your 75% leak rate is AT or ABOVE 24 L/min---at that point, you've got big leaks for an average of 15 minutes out of every hour and that's the point where the ResMed engineers decided things are bad enough where your therapy is very likely being compromised.

Now as i pointed out, there's only one day here that you might have seen that Red Frowny face. So the real question to ask about leaks is how much are they bothering you? Data from 12/10 through 12/12 indicate that you were having some on-going small leaking for AT LEAST 50% of the time the machine was running. And you had pretty significant leaks (up close to the Red Line in ResScan) for 5% of the night on each of those nights as well. Note that 5% of one hour is three minutes. So if you slept for about 7 hours with the machine on 12/10, your leak rate was AT or ABOVE 26.4 L/min for

(3 minutes) * (7 hours) = 21 minutes for the whole night

Now that could be one really bad 21 minute-long leak. Or it could be a whole series of bad, but short-lived leaks. Only the detailed leak data graph can tell you which it was.

My guess is that you will have much more comfort (and hence better sleep) if you can get those median and 95% leak numbers closer to 0.0. And in fact, if you felt like you were fighting leaks off and on all night last night, that might explain part of your tiredness this morning.

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[harwich]

Thanks Robysue for your detailed answer. I was very surprised by my AHI/ HI. I’m glad my therapy is working. I was diagnosed with severe sleep apnea. When I went for my second sleep study to be titrated, I did not sleep well and could not be titrated.
Sleep Dr had two recommendations. First, CPAP at 4 for six weeks to get used to the mask, then a third study. That was not going to happen. I could’ent sleep for the first two study’s I know I wouldn’t do much better on my third.
Second, she recommended an auto titrating machine to help determine the correct pressure. That’s were the S9 Autoset comes in, as I knew a third study would be useless. The pressure on the machine is set 7 to 20. If my number stays the same, I’m sure the pressure will be raised. Any ideas on what they will be?
Leaks are a problem. I am going to ask my DME for another mask to try. My machine is set for the correct mask and I have never got that Red Frowny face. The controlled leak rate for this mask at a pressure of 10 is about 30(L/min). The mask does not feel comfortable. There is a silicone flap inside the mask that rubs against my nose a chin which causes an itch. I scratch it by putting my finger under the seal which momentarily causes a large leak. Several times a night I’m fighting off leaks not large leaks but annoying. Thanks again Robysue.

Mike

[robysue]

Mike,

I'm not a doctor, but I'd guess that your doctor will settle on recommending a straight pressure of either 10cm or 11cm or a APAP range of maybe something like 9cm-13cm or so.

My machine is set for the correct mask and I have never got that Red Frowny face. The controlled leak rate for this mask at a pressure of 10 is about 30(L/min). The mask does not feel comfortable. There is a silicone flap inside the mask that rubs against my nose a chin which causes an itch. I scratch it by putting my finger under the seal which momentarily causes a large leak. Several times a night I’m fighting off leaks not large leaks but annoying.

The leak numbers the S9 shows on the LCD as well as the leak numbers in ResScan already take into account the intentional (controlled) leak rate for the mask at the given pressure. In other words, the leak rate numbers are for leaks ABOVE the expected intentional, controlled leak rate. That's why you want to get those median and 95% leak numbers down close to zero if possible. The max leak rates are more than likely coming from when you're breaking the seal to scratch your nose. I'd ignore those numbers, but not the itchy nose. Maybe the DME can work with you to find a better fitting mask that triggers less itching of the nose. And I do understand the itchy nose problem: On my titration study, the tech could not even manage to turn the CPAP machine on with me in a nasal mask because every time she got the mask close to my face, either I'd start sneezing (like 6--12 times in a row) or the top of my nose started itching uncontrollably. She finally gave up and suggested the nasal pillows mask, which I was able to tolerate reasonably well. And I've had no trouble with the Swift FX pillows mask. But then again, I don't seem to have any mouth breathing at night.

[jweeks]

Hi,

Congrats on getting started. Based on your AHI, you are off to a great start. It may take your body a while to adjust, and it may take some time to pay back your sleep debt--especially if you are in the severe category. I think your doctor has a great plan of letting your run in auto mode for a while, and then recommending a final prescription. If you do end up changing machines, make sure you stay with a model that gives you this kind of data. Data is essential for you to track your progress over time and for problem solving (since everyone runs into a problem now and then).

-john-