Please review my numbers!

[Jack356]

Hi all. I am using Respironics System 1, Model 560 and a Mirage Quattro ffm. Can you comment on how I am doing and what I SHOULD be doing please?

I only recently have learned to change settings to my machine and locate the info area. It is set on Auto and the max pressure setting has changed on the dates shown:

Date Max pressure setting
3/11 13 (lowered by me)
3/10 14 (lowered by me)
2/20 17 (by DME with Dr OK)
2/5 20 (Starting max pressure)

The initial pressure rangs set was a low of 4 and a high of 20. I have raised that lower setting to 5.5 and raised the ramp time from :20 to :10 minutes.

The pressure for 90% shows;
1 Day, 14.0
7 dats, 13.6
30 days, 16.0

The AHI reading from the machine shows:
1 Day, 7.2
7 days, 7.8
30 days,12.5

Is this per hour, per session or what? Does this mean that the lower the max pressure, the fewer the AHIs? Does this mean I should lower the max pressure even more? So confusing to me.

From the sleep study; "The AHI pre-treatment was 59.4. After treatment with CPAP the patient's AHI was 38. During REM sleep the AHI was 11.7 / hour and during NREM sleep the AHI was 52.8 / hour."

I have Other numbers from the machine but won't post everything. The above numbers seem to be the most germane to me with my limited knowledge. I am getting 7-8 therapy hours a night which seems good. I have ordered the new software but don't have it yet. I meet with my sleep doc from the hospital whi H havent met yet. I don't have a clue as to what to ask her.

To top everything off yesterday my family physician said that my climbing PSA numbers indicate Prostate cancer since I just finished a course of antibotics that ruled an infection as the reason for the higher PSA. Pre meds the PSA was 7.5 and post it was 9 so he has referred me to a uroligist. I am 74 in excellent health until last Feb now it's sleep apnia and not this latest news. Thank God I am resiliant and mentally strong.

Thanks for your insight---Jack Crosby, Hot Springs, AR

[fredr500]

I'm sure others will pipe in with more information and interpretation, but I can tell you about AHI.

AHI is calculated by the number of (all types of) apneas/total hours on treatment.

So if you turn on your machine and read or watch TV for an hour, that impacts your AHI. If you have 100 OAs and 0 CAs or 0 OAs and 100 CAs, the AHI will be the same.

It's a nice number to look at, and if your AHI is below 5 it really doesn't matter what the mix is, but once you get above 5 you should really dig in to the different types of apneas to understand what is going on.

Mask leaks can also effect apnea recording as high leaks cover up apneas and they won't necessarily get recorded, giving you a lower AHI than actual.

[Pugsy]

1 Day, 7.2 with max pressure being 14.0 for 90%

The AHI is an overall average per hour based on the total hours you used the machine during a 24 hour period.

90% pressure means for 90% of the time you were at OR below that pressure. To really see how the pressure trended you need the software pressure graphs.

That AHI is a little elevated but without knowing the breakdown into the 3 categories of events (available with the software reports) I can't comment on whether anything needs to be done about it at this point. It's common for newbies to spend a lot of time awake (trying to get to sleep) using the machine and often the machine flags Clear Airway events (centrals) during awake time and those centrals are included in the AHI and can make the AHI look worse than it really is.
We like to see AHI below 5.0...you are close and if the bulk of that AHI is indeed related to some awake stuff getting flagged well then it probably is not a problem.
We really need to see the reports to comment in depth about the AHI and whether it needs real work or not.

The other number on your machine's LCD screen is % of time in large leak...if that has anything other than 0.0 showing then you are having some time spent in large leak territory (for your machine around 75 to 80 L/min if you were looking at the software reports) and it can make the data unreliable if you spent much time in large leak.

Without seeing the AHI event category breakdown we can't really comment on what you need to do with the pressures.
If it is mainly obstructive in nature...probably the minimum needs to be adjusted and the maximum only needs adjusted if you are spending a lot of time at the maximum. It is the minimum pressure that is the most critical pressure though.
Have the minimum pressure set optimally and the maximum pressure might stabilize. Again..need to see the reports because there are a lot of things to consider when evaluating pressure needs.

[khauser]

Date Max pressure setting
3/11 13 (lowered by me)
3/10 14 (lowered by me)
2/20 17 (by DME with Dr OK)
2/5 20 (Starting max pressure)

The initial pressure rangs set was a low of 4 and a high of 20. I have raised that lower setting to 5.5 and raised the ramp time from :20 to :10 minutes.

The pressure for 90% shows;
1 Day, 14.0
7 dats, 13.6
30 days, 16.0

So FYI, LOWERING the pressure didn't matter really ... why did you choose to do so? I would leave the max @ 20 and RAISE the minimum closer to your 90%. I suggest 14. The only reason I know of to LOWER the max is if you are having CA events, which we can't tell without charts from SleepyHead or Encore.

-Kevin

[Guest]

Thanks Fred & Pugsy.

As for the large leak numbers they are;

1 Day, 0%
7 days, 2%
30days, 2%

That seems low to me compared to what I have been experiencing but those are the #s.

From what yousay, the AHI numbers are a vast improvement over the sleep study numbers---right?

Would the DME have the ability to print out a graph from the software they have so I can take it to the doc?

Thanks a million!----Jackl

[Guest]

Thanks, Khauser--I appreciate your comments.

Why did I change the pressure? When it was set at 20 on the high end I was having huge problems in the middle of the night with all of a sudden, the pressure blowing out of the seal between my mask and my face. It felt like the machine was better suited to blowing up car tires than CPAP use! It was a huge problem for me.

The first month I was on therapy, the DME read that the 90% number was like 16 so I had her call the Doc and get the ok to lower that max pressure. They were very reluctant to do it though, which I don't iunderstand----but they lowered it to 17. That didn't help much in fact the number for large leaks was 2% at a 20 max and 2% after lowering to 17. Last night it was zero. So it helped in the leak department.

The only thing that kept me from sleeping soundly all night from the start was mask leaks. I'm ok with every other issue with the therapy but the leaks were keeping me from sleeping.


I envy folks who can use pressures like 10 or so. They shouldn't be at all troubled with leaks. IO am just trying to find the "sweet spot" between pressure and therapy. Am I on the right track, do you think?

Many thanks again!----Jack

[Pugsy]

From what yousay, the AHI numbers are a vast improvement over the sleep study numbers---right?

Yes, vast improvement and I wouldn't change the pressure until I knew what that AHI was made up of.

And yes, the DME can print off a report but make sure they print off more than the summary usage page.
You will want the detailed nightly graphs so you can see exactly what that AHI is made up of and when things were being flagged during the night.
For all we know right now 90% of the flags might even be occurring during the first hour of the night and likely while awake.
This is why we really have to see the nightly details that the software makes available.
To many "what ifs" when trying to evaluate a single AHI number.
Might have 8 hours of sleep and one hour of a truckload of stuff (while awake) but the other 7 hours might not have much of anything going on. But that 1 hour of maybe ugly stuff gets averaged in with the the other hours.

Are you the person that is afraid to download the software and do the reports yourself?
Or maybe think you lack the skill?

[khauser]

Thanks, Khauser--I appreciate your comments.

Why did I change the pressure? When it was set at 20 on the high end I was having huge problems in the middle of the night with all of a sudden, the pressure blowing out of the seal between my mask and my face. It felt like the machine was better suited to blowing up car tires than CPAP use! It was a huge problem for me.

The first month I was on therapy, the DME read that the 90% number was like 16 so I had her call the Doc and get the ok to lower that max pressure. They were very reluctant to do it though, which I don't iunderstand----but they lowered it to 17. That didn't help much in fact the number for large leaks was 2% at a 20 max and 2% after lowering to 17. Last night it was zero. So it helped in the leak department.

The only thing that kept me from sleeping soundly all night from the start was mask leaks. I'm ok with every other issue with the therapy but the leaks were keeping me from sleeping.


I envy folks who can use pressures like 10 or so. They shouldn't be at all troubled with leaks. IO am just trying to find the "sweet spot" between pressure and therapy. Am I on the right track, do you think?

Many thanks again!----Jack

If I understand correctly, you're lowering the pressure because you think the max is contributing to leaks. But there's little evidence to that (like Pugsy said, we need more data). The 90% numbers you gave weren't near 20, so the machine probably spent little to no time at the upper end anyway. It's mostly a "buffer" should you need it one day. That's why the doctor didn't want to reduce it.

Now leaks are a concern. My average pressure is 17 to 17.5, so I am talking from the point of view of a high pressure "customer". We need to work on those leaks. At my top end I still get minimal leakage. I sometimes can hear it, but it's not strong enough to disturb me otherwise (it still disturbs me, which is annoying because it's WELL below the machine's problem area).

I first used a nasal mask. That thing leaked like a sieve, so it rapidly found its way to the junk pile. Several attempts at nasal pillows later and I've found a set that have practically no leaks. So my advice is to keep trying different masks until you get a good one.

I think I remember you're using a Full Face Mask. Do we know you need it? Many DME's do a dis-service to their customers by assuming that high pressure means you MUST use a Full Face Mask. Many of them "Know Better Than You". These DMEs are causing problems. I'm not saying you have such a DME, and maybe you DO need a FFM, but be aware there are other options.

My ex-DME insisted nasal pillows wouldn't work at my pressure. "It'll blow your nose off!" (Really, she said that! She also said that if I changed the numbers I'd kill myself, and that she had another patient that gave themselves an air embolism by changing the numbers.) All very interesting, and a lot of BS.

[sleepstar]

Hahaha really Kevin?

It's so funny (and sad) how different places are. We use full face masks as a "last resort". Our doctors would much rather a patient on pillows or nasal mask, even at high pressures or with bi level.