Need Suggestion on Devilbiss Intellipap Auto setting

[shirleyAPAP]

I have two smart code reports.

7/1:FTMF-FCJ-5FQ9. AHI: 7; NRI: 9; EPI: 10
7/2:F0MF-FEJ-VAQ7. AHI: 6; NRI:9.25; EPI:31

My setting is:

7/1: Pressure is 10-16 with Delay set to start at 6.5 for 15 minutes
7/2: I bumped up the low pressure from 10 to 11. All other settings remain unchanged.

Compared to 7/1 report (smart code: FTMF-FCJ-5FQ9), the AHI is lowered from 7 to 6. But NRI is 9.25, which is .25 higher. EPI is way too higher, from 10 to 31.
According to Devilbiss, "If exhale puffs are present in significant numbers, the AutoAdjust algorithm will prevent the pressure from increasing because an increase in the pressure will create more exhale puff in a patient with obstructive sleep apnea." Do I need to lower the pressure a little bit to reduce the exhale puff? But it seems that higher pressure setting helps reduce the AHI from 7 to 6.
Any suggestions?

[shirleyAPAP]

Maybe I need to tape the mouth to reduce the exhale puff? But I do not want to do that Any good suggestion how to reduce breathing from the mouth?

[Emilia]

COPIED THIS REPLY FROM OTHER THREAD:

Exhale puffs are when your mum inhales via her hose but exhales through her mouth. As a result, some of her therapy is literally going out her mouth. Chin straps are not something I've ever used, but from what I've read on this forum, they work for some and not for others. Pressure probably won't do much to eliminate the puffs. Alternatives would be to get a FFM to work, move to a hybrid mask that uses a mouth piece plus nasal pillows, or try taping the mouth. Search for taping to read more about that. Some folks train themselves to keep their mouths closed by taping, and others find that training themselves to keep their tongue placed on the roof of their mouths just behind the ridge located behind the upper teeth helps greatly (this is what I did).

Remember that in Smart Codes, the NRI is a total of all kinds of issues, including the puffs so that is probably why it went up. Glad her AHI went down a bit even in light of the extra puffs. The good news is that no leaks were recorded for the 2nd night.

I suspect that if she can get rid of the puffs, everything else would fall into place. Leaks are now controlled, and the AHI is falling. Remember, also, that DeVilbiss contends that and AHI under 10 is considered good. I've never agreed with that because, for myself, I notice a discernable difference in how I feel if I even get an AHI of 3 vs. my usual 1.5.

The best guideline, in my opinion, is how does your mum feel? Is she feeling more rested and able to remain alert during the day?

The 90/95thtile is still up there at 15 so it is hard to recommend a lower starting pressure at this time. Theoretically, it ought to be bumped up more, but until the puffs are under control, I am not sure that is advisable. Generally one looks at the 90/95%tile to set the range by using 2 below and 2 above. In this case a range of 13-17. I don't see her handling that very well.

Work on the EPI issue and keep things where they are for another couple of nights.....