Remaining Apenas with Resmed Elite S8

Pierre · Post by **Pierre** » Sat Dec 22, 2007 12:42 pm

Hello,

2 months ago, I started using a Resmed S8 Elite machine for sleeping apneas (I have been monitored with 13 IA, and apnea average duration of 33 sec).

The technician let the min pressure at 4 and the max at 20.
After 2 weeks where I could feel a lot of improvement, he came back, and decided, seing the results, to set the max pressure at 12.
After this, I had 3 very bad nights and called him. He asked me to reset the pressure max at 20, and it came back better.

2 months after begining of the treatment, he came back, and analysed the results. In term of what I feel, I can say that 4 out of 7 nights are good, and 3 are average to bad.
From the analysis, he found out that my "not good" nights corresponds to an IA of 2 to 5 and a IH of 3 to 7. Also half of the apnea last more than 30 second, and up to 1 min. The max pressure reached is at 14.
He was kind of lost, and actually didn't change anything to the settings.

I read that there is no link between Pressure and Apnea severity, but I really wonder why the machine shows a max pressure reached of 14 (max pressure being set at 20), and I have an apnea of 1 min. I would imagine that the machine would go to its maximum pressure, for such a long apnea.

I would really appreciate to get some guidance from the memebers here.
I am also very interested in understanding how CPAP machine works, when encountering apnea, within the set pressure range.

Thanks,

Pierre

Slinky · Post by **Slinky** » Sat Dec 22, 2007 1:58 pm

Well, the pressure range is set way too wide open IF you are using an autoPAP. With a starting pressure of 4 cms it can take a long time for the pressure to creep up to where it is needed.

BUT - the Resmed S8 Elite is NOT an autoPAP so your pressure settings mentioned are more than a bit confusing.

It sounds like maybe you were started out on a Resmed S8 AutoSet Vantage w/a pressure range of 4 cms to 20 cms and based on the downloaded data you were then given the Elite w/the pressure set at 12 cms. Then set at 14 cms.

I'd be inclined to ask to see the printouts from the data downloads. Are we to understand that you didn't undergo a formal titration at a sleep clinic? I would want the full data summary reports (about 5-7 pages, with graphs,each) of any sleep evaluation and/or sleep titration study I went thru as well as the dictated reports for them (about 1-2 pages each).

Now the Elite does have the Ramp feature which can be set for a specific time period selected on the basis of how long it "usually" takes you to go to sleep. Ramp starts out at a lower set pressure and then over the specified time period "ramps" up to your "set" pressure. During the night if you waken you can hit the button and restart Ramp all over again in order to get back to sleep if you need to. BUT that affects that pressure data by reducing the reported pressure.

The Elite also has an EPR setting of 1, 2 or 3 cms. If used it can provide 1,2 or 3 cms less pressure on exhalation from the set pressure. Use of EPR can also affect the pressure data. It reduces the reported pressure.

Take a look at the top of your Resmed S8 and see WHICH S8 you REALLY have right now - the Elite or the AutoSet Vantage.

Keep in mind that the only pressure reported on the LCD screen is the pressure AT WHICH OR BELOW WHICH you spent 95% of the night. You need the data card downloaded to software to know the median (average) pressure and the highest pressure attained during that time period you are checking.

You also need to keep in mind that your mask fit and the leaks you encounter affect your pressure needs. These machines compensate quite well for mask leaks and that can affect your reported pressure by raising it to compensate for the leaks.

IF you do have a Resmed S8 AutoSet Vantage then the pressure range would better be set by setting the low range at or 1-2 cms below your titrated pressure and about 2 cms above your titrated pressure for a pressure range of 4-6 cms between upper and lower settings. That way the machine can run up the pressure faster to the pressure needed when you experience an apnea to stop it. Knowing the best lower pressure is the most important to set. Until you're sure you can leave the upper pressure at 20 cms if it appears you really do need a high pressure. But you need to bring the lower pressure up to where you can sleep most comfortably during the night on expiration. It really is the most important setting.

Slinky · Post by **Slinky** » Sat Dec 22, 2007 2:02 pm

Pierre, I am also going to suggest that you register as a member here and fill in your profile. It would help if you would include which xPAP you really are using, the mask that you are using, what your current pressure setting is, whether you are using Ramp and/or EPR and if so at what settings as well as enable PMing so that members can send you a private message if necessary. Its also nice to know what state or country you are in but isn't necessary.

Pierre · Post by **Pierre** » Sat Dec 22, 2007 3:20 pm

Thanks for your detailled answer.

First of all, I apologize. I wrote my post after reading some others, and messed the name of my machine :
it is a S8 Autoset spirit (French name), and looking to resmed site, it seems to correspond to the S8 Autoset Vantage (US).

I went to the clinic for a night of monitoring, before having the machine. But I don't have the conclusion papers with me. I will look to them as soon as I am back (end of next week).

So you are right : I started with a 4-20 pressure range.
After 2 weeks, the technician came back, dowloaded the results, and told me that the max pressure reached was below 12. He set the max pressure at 12 and let the min at 4.
3 nights later, I called hil telling him my nights were terrible, and he asked me to reset the max pressure at 20.
This week, he came again, and decided not to change anything to the pressure range (I understood that he was thinking of lowering the max pressure, but was scared of the former experience).

But I am sure that he never talked about raising the low pressure which seems to be the most important!

Just one question : since I am now spending all my complete nights with the machine, and that I support it very well, how can I understand the fact that 30% of my nights are still bad :
-it is something that may disapear with time?
-it is a problem of tuning the settings on the machine?
-could be something else (like Central apneas behing obstructive ones)?
-other ideas?

Thanks again

Pierre

NB : my profile is now created

LavenderMist · Post by **LavenderMist** » Sat Dec 22, 2007 4:46 pm

More than likely it is the fact that your bottom pressure on the auto is set at 4. It needs to be much closer to your treatment range of 12-14. For example, my titrated pressure was 11 and I have my auto set from 10-15. That way it is right there in range to catch most events and I have leeway at the upper end in case I need more pressure to deal with an event that my normal pressure doesn't take care of. I'm sure others can speak more to an ideal range and other thoughts. I hope this helps.

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CPAPopedia Keywords Contained In This Post (Click For Definition): auto

billbolton · Post by **billbolton** » Sat Dec 22, 2007 4:51 pm

Pierre wrote:I would imagine that the machine would go to its maximum pressure, for such a long apnea.

That is not the way that Auto PAPs generally work.

The monitor your autonomous sleep breathing and will make maximum flow rate change relatively slowly over time to minimse the number of apneas, but will not respond to apneas with instant flow rate changes.

Quick flow rate changes can create more problems than they solve. Non-trivial numbers of patients have a tendency to experience central apneas as flow rates increase, so increasing flow rate unnecessarily is not not a good treatment strategy.

Also note that the xPAP treatment strategies are not to eliminate apneas, though sometimes this will be an outcome, but rather to minimise the time spent in apnea and basically to get the AHI down below a reading of 5 for the entire night.

Pierre wrote:Just one question : since I am now spending all my complete nights with the machine, and that I support it very well, how can I understand the fact that 30% of my nights are still bad :
-it is something that may disapear with time?
-it is a problem of tuning the settings on the machine?
-could be something else (like Central apneas behing obstructive ones)?
-other ideas?

Your questions are reasonable, but there is nowhere near enough information provided in your messages so far to enable any sensible answer to your question.

Perhaps you could start from the begining and describe the process you have gone through in terms in diagnosis, sleep study (if any) and obtaining your S8 Autoset. It will probably be somewaht different to the experience of most users here, as you are in a quite different healthcare system than that which operates in the US, and understanding what you have been through do so far is important in terms of shaping advice on what you might do next.

Cheers,

Bill

Slinky · Post by **Slinky** » Sat Dec 22, 2007 5:06 pm

Ah, yes, Pierre. That helps a lot and explains a lot. Now we are on the right track.

But those full reports and the data from your sleep study would help too. I'd be inclined, since we are working a bit blindly here to set the lower pressure at 6 cms for the time being. Unless it is too uncomfortable turn the Ramp off for the time being so we can get more accurate data. If it is too uncomfortable w/o it, then leave it on, its not that big a deal.

Unless it is way too uncomfortable to deal with try to leave the pressure range at 6 cms to 14 cms for a full week. Write down each night's data from the LED screen and then after 7 days write down the averages for that week. And we want them all: 95% pressure, 95% Leak, AHI, AI, HI, number of hours used that night and that week. Also during that week don't try to change masks. It is best to make ONE change at a time and observe the results for ONE FULL WEEK before making ONE other change if changes still need to be made.

You could then try changing the lower pressure to 7 cms - unless the data suggests otherwise. Or maybe even start w/the lower pressure at 7 cms and then a week later changing that lower pressure to 8 cms if it seems you still need a change.

Yes, this will improve w/time - and some tinkering w/pressures and mask(s).

Most likely, yes, at least one of your problems is that you haven't found that "right" pressure or pressure range for you. And also very likely are any leaks you are encountering w/your mask.

We have no way of knowing if you encountered any central apneas during your sleep study, or periodic leg movements or other sleep disorder so any thing else would be pure unfounded speculation on our parts. And, too high a pressure "can" induce central apneas but neither the autoPAP (nor a straight CPAP) can tell us that.

MOST likely its a matter of "fine tuning" your pressure or pressure range and ensuring you have a comfortable, good fitting mask. They are the two KEYS to successful xPAP therapy.

track · Post by **track** » Sun Dec 23, 2007 12:15 am

If you are like me those bad nights with the long apneas are those nights when you roll over on your back. I have the same machine as you and my 95% pressure is about the same typically. Also I was having an occassional apnea that lasted close to 60 seconds too. Changing pressure didn't seem to do much so I went to side sleeping...putting something on my back or against my back to prevent me from sleeping on my back. The few apneas I have now are never over 10-15 seconds.You might try it.

Pierre · Post by **Pierre** » Sun Dec 23, 2007 1:51 am

Thanks for all the replies. I will increase the min pressure for one week and keep track of Press, Leaks, AIH, AI and AH (I am actually doing so since 10 days).
Tonight (france time), I decided (before reading slinky advise), to increase min pressure at 8.
I feel in good shape, and the results are :
Press = 11,2 / Leask = 0,14 / AI = 1,9 / AH = 3,2 / 8 hours

I do not draw any conclusion there and I will stay on these for one week, since past showed me changing results froim night to night.

I would be interested in purchasing the SW and the cable or card readers, and my parents are in Manahattan for holidays until 27th Dec. Any address where to purchase this?

I will let you know more about the medical process I have been thru, as soon as I can have to the conclusion papers of the nights in the clinic.

Regards to all,
Pierre

rested gal · Post by **rested gal** » Sun Dec 23, 2007 2:40 am

Pierre wrote:He was kind of lost

Yes, the technician was very lost if he kept leaving your minimum pressure at 4 despite looking at your data more than once.

You've gotten very good advice from the others here about raising the minimum pressure setting. Bet you'll start seeing much better results now.

Good luck, Pierre, and welcome to the message board!

Pierre · Post by **Pierre** » Sat Dec 29, 2007 1:17 am

Hello to all,

I hope you all had wonderful Christmas with families.

I have been applying your advises of increasing the low pressure from 4 (where the technician left it) to 8, and removing the ramp, for one week now.
I also tried to apply Track advises to sleep on side, but I am not sure I really apply it.

To make it short, the average results on 1 week are :
Press//Leaks//IAH//IA//IH
11,4//0,16//3,7//0,9//3

It is the first time since I monitor results that for 6 days in a row, the IAH remained below 5, the IA remained below 1.3 and IH remained below 3.8.

In term of what I feel : much more stable situation, feeling in good shape, even if I kind of feel still some room for improvements.

I am now calling again on your experiences, in order to understand if there are some other levers I could use to optimize (like Slinky last improvements on settings)

Thank to all of you for advices, and for results I got!!

Pierre

PS

My detailled results are below (starting the night where I set low pressure to 8 ) - The average quite stable nights duration is 7.5 hours.
Date //Press//Leaks//IAH//IA//IH
22-déc//11,2//0,16//5,1//1,9//3,2
23-déc//11,6//0,1//3,5//0,8//2,7
24-déc//11,2//0,16//3,1//0,8//2,3
25-déc //12//0,14//5, 1//1,3//3,8
26-déc//11,2//0,32//3,4//0,8//2,6
27-déc //11,2//0,16//3,9//1//2,9
28-déc//11,6//0,16//3,3//0,9//2,4

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CPAPopedia Keywords Contained In This Post (Click For Definition): Ramp

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CPAPopedia Keywords Contained In This Post (Click For Definition): Ramp

billbolton · Post by **billbolton** » Sat Dec 29, 2007 4:21 am

Pierre wrote:11,4//0,16//3,7//0,9//3

Those are good results!

Pierre wrote: even if I kind of feel still some room for improvements.

Its your call, but there is no clinical evidence that any particular set of results below an AHI of 5 will necessarily produce better outcomes than any other set of results below an AHI of 5.

Its easy to get caught up in a "numbers Olympics" chase to get the lowest possible "numbers" without actually seeing any practical difference in outcomes. You really should work on maintining the above results over a couple of months to experience the full impact of getting continual nights of good quality sleep.

After that you can consider whether there is likely to be any real benefit in trying for a different result.

Cheers,

Bill

rested gal · Post by **rested gal** » Sat Dec 29, 2007 4:31 am

billbolton wrote:Its your call, but there is no clinical evidence that any particular set of results below an AHI of 5 will necessarily produce better outcomes than any other set of results below an AHI of 5.

Its easy to get caught up in a "numbers Olympics" chase to get the lowest possible "numbers" without actually seeing any practical difference in outcomes. You really should work on maintining the above results over a couple of months to experience the full impact of getting continual nights of good quality sleep.

After that you can consider whether there is likely to be any real benefit in trying for a different result.

Cheers,

Bill

I agree absolutely with Bill.

Your numbers look fine right where you are, Pierre.

As Bill said, it's your call (your decision), but I'd probably just leave the settings the way you have them and not be a bit concerned about getting any lower numbers. You're well under 5.0 for your AHI.

Very good!!

ozij · Post by **ozij** » Sat Dec 29, 2007 7:04 am

Code: Select all

Date           Press    Leaks    IAH      IA       IH 
22-déc         11,2      0,16    5,1      1,9      3,2 
23-déc         11,6      0,1     3,5      0,8      2,7 
24-déc         11,2      0,16    3,1      0,8      2,3 
25-déc         12        0,14    5,1      1,3      3,8 
26-déc         11,2      0,32    3,4      0,8      2,6 
27-déc         11,2      0,16    3,9      1        2,9 
28-déc         11,6      0,16    3,3      0,9      2,4

Those results are very good, Pierre.

Some of us sleep better when the pressure range is narrower - and that might be a reason for you try and push the lower range a little higher, but it can wait.

Your apnea index (IA - AI in English...) is very low (very good!) and Resmed machines are well known to record more events as hypopneas than do other machines. I agree with the others, there's no reason for you to make any changes right now.

O.

P. S. I've just learned that the best way to post tabular data is by using the "code" button before and after the text. The way, the forum software doesn't drop the spaces... .

track · Post by **track** » Sat Dec 29, 2007 7:55 am

Nice work Pierre...you have made great progress as the others have said. Has the duration of the apnea's decreased?

I have been at this about a year and my numbers are similar to the numbers you have experienced the last week. Last night the backpack I wear slipped over to my side so I got on my back and my normal apnea(AI) rate of .5-.7 jumped to 1.7.....and most of them occured during that relatively short period when I was on my back. It's not the numbers that get me though as much as the duration of the apneas while on my back. They typically triple in length....so even though the number of apneas only doubles or triples the time in apnea is increased 6-9 fold.

Remaining Apenas with Resmed Elite S8

Remaining Apenas with Resmed Elite S8

Re: Remaining Apenas with Resmed Elite S8

Remaining Apenas with Resmed Elite S8

Re: Remaining Apenas with Resmed Elite S8

Re: Remaining Apenas with Resmed Elite S8

Machine	Mask

Additional Comments: Airmini, Medistrom Pilot 24, CMS 60C Pulse Oximeter, ResScan 6