Restating my question and hoping for input

[stages3n4]

After two weeks, my AHI is 4.8

In theory, with all else being equal, if I increase my (inhale) pressure from 12 to 14, should this lower my AHI ???

My thanks to track for answering in a previous post!

Have I offended people? Why can I not seem to get answers to this question?

Am I being blackballed because I admitted to using the ramp
feature

I'm doing good, but want to do better. But before I start messing with settings, I was hoping to see if the logic I'm using concerning the relationship of the variables is even close to being right.

[DreamStalker]

The reason you may not have gotten many answers is because relatively few of us use your machine. I cannot help you myself either.

Also, making adjustments to your settings requires that you first collect some data (at least a week's worth maybe more). Do you have leak rates, AI, HI values?

Collect the data post summary (you may also need to post details), be patient, and some of the more knowledgeable and experienced will try to answer.

Best of luck!

[Snoredog]

[quote="stages3n4"]After two weeks, my AHI is 4.8

In theory, with all else being equal, if I increase my (inhale) pressure from 12 to 14, should this lower my AHI ???

My thanks to track for answering in a previous post!

Have I offended people? Why can I not seem to get answers to this question?

Am I being blackballed because I admitted to using the ramp
feature

I'm doing good, but want to do better. But before I start messing with settings, I was hoping to see if the logic I'm using concerning the relationship of the variables is even close to being right.

[stages3n4]

Thank you for the replies:

Leak 21 L
AI 1.1
HI 3.7

(it doesn't list HI seperately, but if AHI is 4.8 and AI is 1.1, math would make HI 3.7 wouldn't it?)

Dreamstalker, I understand we use different machines, my brand seems to be a minority when it comes to usage, but I'm really just checking to see if correlations I'm using (assumptions I'm jumping to) are on target or not. The same theories and relations between the numbers and settings would be same regardless of brand wouldn't they?

Snoredog, I will certainly base what I do on how I feel as opposed to just numbers. My setting are based on one night is a sleep lab, where like most people probably, I slept absolutely horrible. I'm just looking to tweak things to get the best therapy I can. After all, if we're going to put with this, it may as well be the best it can be, right?

[Snoredog]

Thank you for the replies:

Leak 21 L
AI 1.1
HI 3.7

(it doesn't list HI seperately, but if AHI is 4.8 and AI is 1.1, math would make HI 3.7 wouldn't it?)

That is correct. If that AHI stays consistent or increases, to kill that last AI of 1.1 you would need to increase EPAP pressure, to kill the HI's increase IPAP pressure. So increase both by 1cm and look for improvement.

[cohodependent]

The other thing to keep in mind is that you have only been on the Cpap for a very short time. The biggest thing I would tell you is to give it at least a month. You are still adjusting to every thing. None the less, you are doing really well!

[christinequilts]

Dreamstalker, I understand we use different machines, my brand seems to be a minority when it comes to usage, but I'm really just checking to see if correlations I'm using (assumptions I'm jumping to) are on target or not. The same theories and relations between the numbers and settings would be same regardless of brand wouldn't they?

Its not so much brand of your machine, but that its a BiLevel-PAP, or BiPAP. Its not as easy to tweak 2 pressures as it is one with CPAP. Plus BiPAPs are often used when there are other issues, in addition to OSA, so that complicates matters even more. You can't adjust just the IPAP pressure without considering the EPAP pressure without risking other problems, which may not show up in your AHI but still affect your sleep.

Theories and numbers are great, until you throw in the one big unknown- the human body. Apnea isn't a math problem, there are a lot of complex issues involved and higher pressure doesn't always equal lower AHI; just as severity of apnea or AHI doesn't correlate with the amount of pressure needed to treat it.

It sounds like you are pretty new- I didn't go back to see how long you've been on your VPAP III, but an AHI of 4.8 is good. Give it some time, as your body is adjusting to sleeping with a mask, having a mini-hurricane blowing at you and the added issue of changing pressure with BiLevelPAP. What was your pre-treatment AHI? And is the AHI of 4.8 for one night or an average since you started using your machine?

Leak 21 L
AI 1.1
HI 3.7

Can someone remind me if the VPAP III reports leaks above the expected for the selected mask or if its inclusive? ResMed played with my mind so much when they changed up how they normally report leaks on my Adapt from what's expected from ResMed machines, I can't remember what's 'normal' now-lol

[bearcatx16]

I was having AHI's >5 and <10 and tried adjusting my S8 up and down by 1cm, with no affect lowering the AHI. I was using a chin strip, ace bandage. I finally taped my mouth, don't like it, and reduced my AHI for 2 nights to less than 2. Third night I used my headband and concentrated on tongue placement and had a AHI of less than 3. I am convinced that my AHI's are leak related.

Best regards,

Fred

[rested gal]

I am convinced that my AHI's are leak related.

Mine too, Fred. Not always, but too often to be coincidence, my AHI numbers are higher on the few nights I've tried going without taping my mouth.

[rested gal]

Can someone remind me if the VPAP III reports leaks above the expected for the selected mask or if its inclusive?

When I used an S7 VPAP III and an S7 Spirit just to see what they were like, I often got leak rate of 0. Apparently resmed does factor in the expected normal leak from mask exhausts before presenting their leak data.

I think resmed says unintentional leak (like from around the mask cushion or from any source...mouth, hose connection, etc.) should not exceed .4 liters per second.

I don't have the VPAP III manual, but from the Clinician Manual for the S7 Spirit, resmed says:

Generally, a leak rate of more than 0.4 L/s (24 L/min) is associated with patient discomfort, disturbed sleep, and reduced efficacy of treatment

stages3n4, if you're getting a leak rate of 21 with a resmed machine, and you've not accidentally done like I often do (I've been known to miss sticking a decimal point in the right place, which might mean you are really looking at an "ok" leak rate of just .21).... then the leak rate you're getting is wayyyy too high. I'd doublecheck that.

If you really are getting a leak rate of 21 with a resmed machine (other than the ASV Christine is using which she says reports differently) I'd work on stopping the leaks first. I'd strongly suspect mouth air leaks or mouth breathing if you're not using a full face mask.

P.S. Excellent point, Christine:

Apnea isn't a math problem, there are a lot of complex issues involved and higher pressure doesn't always equal lower AHI; just as severity of apnea or AHI doesn't correlate with the amount of pressure needed to treat it.

Or as SAG often puts it... "better know what needs treating before trying to treat it." Or words to that effect. Spinnin' them dials ain't always the answer.

[christinequilts]

I don't have the VPAP III manual, but from the Clinician Manual for the S7 Spirit, resmed says:

Generally, a leak rate of more than 0.4 L/s (24 L/min) is associated with patient discomfort, disturbed sleep, and reduced efficacy of treatment

... if you're getting a leak rate of 21 with a resmed machine, and you've not accidentally done like I often do (I've been known to miss sticking a decimal point in the right place, which might mean you are really looking at an "ok" leak rate of just .21).... then the leak rate you're getting is wayyyy too high. I'd double check that.

If you really are getting a leak rate of 21 with a resmed machine (other than the ASV Christine is using which she says reports differently) I'd work on stopping the leaks first. I'd strongly suspect mouth air leaks or mouth breathing if you're not using a full face mask.

Its the whole L/sec vs L/min- I knew my Respironics always reported in L/min and thought ResMed reported at least live data leaks in l/sec, if not average on most machines. It took me a few times to figure out the Adapt never reports l/sec, only l/min...I kept trying to convert, sort of like I did with US prices when I came back from Ireland (covert to Irish pound, then back to US $-lol).

Average leak rate doesn't tell the whole story either- I get a 'report card' rating from my Adapt at the end of every session, rating my leak rate as: Excellent, Very Good, Good, Adjust Mask (aka- you failed the test ). Excellent is suppose to be if average leak is generally under 20, if I remember correctly. But I've had nights with less then 20 rate come up as Very Good and nights with higher then 20 as Excellent; I've had nights with the same average leak rate where it says 'Good' & others with 'Excellent'. I assume it's grading curve is based on how large of a leak, for how long, and at what pressures.

Remember 23+26+22+26+21+27 averages out to 24, as does 1+47+5+43+10+38...but a those extremely high leaks are going to cause more sleep disruptions, possible apneas, etc

(and yes, RG, I finally got to experience an occasional mouth leak with the Adapt...its hard not to when it suddenly goes from 'IPAP' of 12 to 19 in a matter of seconds...talk about 'wind gust'-lol...its no wonder they really want people to use a FFM with it...most of my leaks are mask related)