So what can I do to lower my AHI & HI numbers?

[lazyace]

I'm now a week into this, and it dawned on me this morning as I reviewed the nights results, that I have no idea how to lower my numbers. I've come to grips with having apnea, but isn't the machine supposed to make things better? Of course it's way too early to make any judgements, but once I turn the machine on, snug up the mask and tape my mouth shut, what can I do to lower my numbers?

I was given a ResMed S8 Autoset II, because the lab couldn't obtain an accurate titration during the study. I am to return to my doc in two weeks, with the card so they can look at the data. The unit is setup to operate at a pressure of 8-15. Here are the average results for the past week, as well as, last nights numbers:

Week

Pressure: 9.2
Leaks: 0.30
AHI: 12.5
AI: 2.8
HI: 8.6

Last Night

Pressure: 9.4
Leaks: 0.08
AHI: 15.0
AI: 4.0
HI: 11.0

[ricochetv1]

did they show you how to access the clinical menu? If not, someone here might be able to help with that.
I'd suggest switching to cpap mode and setting different pressures each night. Do a little self-titration. It seems like the machine isn't having to go much beyond 9 to solve problems, but it looks like you're having events VERY frequently. If you don't mind my asking, could you post the results of your first study w/out titration?

[jdm2857]

If you PM me with an email address, I can send you instructions for your machine.

[Muse-Inc]

If the mask is properly set in the ResMed, the leak shown in the LED is the real leak because the machine figure's the mask's venting (intentional leak) before reporting the number...leak seems high to me but I have a 'dumb' machine and am new to understanding these numbers. Hoping someone with more experience will chime in and give you some good suggestions during your long at-home titration; if it were me, I wouldn't change pressure as I'd want the docs to have the most amt of nightly data but again your decision. Because you are wearing a nasal pillow mask, you could be losing air thru lips or opening your mouth or leaking it thru your lips when asleep. The leak means that the air that is supposed to stent open your airway is going into the air not into your airways as it should. This is what happened to me and I ended up buying RespCare's Hybrid mask which covers mouth and has nasal pillows to stop my leak. ResMed has a similar mask called the Liberty. The Hybrid comes with 3 sizes or oral cushion and 3 sizes of pillows which can be adjusted to 2 heights making it pretty easy to a get a good fit for your facial anatomy.

Your post reflects improvement (less angst & more commitment to improved xPAP therapy) even if it doesn't seem apparent to you -- congrats!

[stanps]

...leak seems high to me

I recently called ResMed and talked to one of their techs. I was concerned because I am using a non-ResMed mask and wanted to find out if the leak rate was accurate. She told me anything below 0.4 L/s was good.

She was generally quite helpful and informative btw.

[Muse-Inc]

I recently called ResMed and talked to one of their techs. I was concerned because I am using a non-ResMed mask and wanted to find out if the leak rate was accurate. She told me anything below 0.4 L/s was good...

Thanks Stan! Good info for when I finally get a data capable machine

[lazyace]

did they show you how to access the clinical menu? If not, someone here might be able to help with that.
I'd suggest switching to cpap mode and setting different pressures each night. Do a little self-titration. It seems like the machine isn't having to go much beyond 9 to solve problems, but it looks like you're having events VERY frequently. If you don't mind my asking, could you post the results of your first study w/out titration?

Because I am scheduled to meet with the sleep doc to go over the data, they probably don't want me messing around with any settings (although I'd REALLY like to). I also don't yet have the study results. I have called the clinic twice to have them sent to me, but no one calls me back. Typical...

If the mask is properly set in the ResMed, the leak shown in the LED is the real leak because the machine figure's the mask's venting (intentional leak) before reporting the number...leak seems high to me but I have a 'dumb' machine and am new to understanding these numbers. Hoping someone with more experience will chime in and give you some good suggestions during your long at-home titration; if it were me, I wouldn't change pressure as I'd want the docs to have the most amt of nightly data but again your decision. Because you are wearing a nasal pillow mask, you could be losing air thru lips or opening your mouth or leaking it thru your lips when asleep. The leak means that the air that is supposed to stent open your airway is going into the air not into your airways as it should. This is what happened to me and I ended up buying RespCare's Hybrid mask which covers mouth and has nasal pillows to stop my leak. ResMed has a similar mask called the Liberty. The Hybrid comes with 3 sizes or oral cushion and 3 sizes of pillows which can be adjusted to 2 heights making it pretty easy to a get a good fit for your facial anatomy.

Your post reflects improvement (less angst & more commitment to improved xPAP therapy) even if it doesn't seem apparent to you -- congrats!

The "fill-in" xPAP trainer setup the unit with a mask called "Ultra", which is obviously not the correct mask. Perhaps accessing the clinical menu would enable me to make that change? To combat the high leak rates, I taped my mouth shut (which is fun to remove with stubble) last night. As reflected in my numbers last night, it seemed to make a dramatic improvement. However, I noticed that several times throughout the night my mouth would be full of air, like I was inflating a balloon. Because my mouth was taped shut, I would wake up to peel the tape back to expel it. Makes me wonder if I need a mask that covers my mouth?

Less angst about xPAP, but want to get things dialed in so I can get my life back!

[lazyace]

...leak seems high to me

I recently called ResMed and talked to one of their techs. I was concerned because I am using a non-ResMed mask and wanted to find out if the leak rate was accurate. She told me anything below 0.4 L/s was good.

She was generally quite helpful and informative btw.

WOW! That shocks me, because everything I have read on this forum suggests that 0.4 would be way too high?! It seems like experienced Pap'rs recommend being below 0.1.

[Muse-Inc]

With a ResMed you can actually get a reported leak of 0.0 -- it'll be my goal when I get a data-capable machine.

[lazyace]

With a ResMed you can actually get a reported leak of 0.0 -- it'll be my goal when I get a data-capable machine.

BTW, how do you like the hybrid mask? The "intern" that set me up at the clinic indicated that most people don't like nasal pillows because they are painful and irritating. Of course, that exactly what I thought about her!

[ricochetv1]

With a ResMed you can actually get a reported leak of 0.0 -- it'll be my goal when I get a data-capable machine.

BTW, how do you like the hybrid mask? The "intern" that set me up at the clinic indicated that most people don't like nasal pillows because they are painful and irritating. Of course, that exactly what I thought about her!

I have a bit of soreness in my left nostril with the Liberty mask in the mornings. I rub it out in about 20 seconds and no problem the rest of the day.

[Muse-Inc]

BTW, how do you like the hybrid mask? The "intern" that set me up at the clinic indicated that most people don't like nasal pillows because they are painful and irritating. Of course, that exactly what I thought about her!

Idiotic statement. Most people like pillow masks because they don't cover the any part of the face! My former beloved OptiLife was a pillow mask...pillows, small support frame, and just enough headgear to ensure the pillows won't fall out -- most minimal of all the pillow masks. If the pillows fit and are placed at the end of the nares as they are supposed to be, they are extremely comfortable. I never had leaks with mine; it was an extremely good fit with my face shape. I wear the Hybrid which I like because I started losing therapy air thru my loose lips and the idea of taping totally freaks me out given my 30-40 yrs of allergy & sinus issues that periodically totally block my nose.

[Sleeprider]

You have said several things that suggest you are not a good candidate for nasal pillows. You are taping and get air pressure in your mouth that requires you to un-tape to relieve the pressure.

Those of us that use nasal therapy generally control the air with the back of the tongue against the roof of the mouth. With practice, we can control the pressure and even speak clearly. If you are prone to releasing air into your mouth, you are not a good candidate for nasal CPAP, and should be looking at a full-face. Taping can mitigate the effect and prevent pressure loss, but its kind of a band-aid approach when you really should be on a full face.

[ricochetv1]

You have said several things that suggest you are not a good candidate for nasal pillows. You are taping and get air pressure in your mouth that requires you to un-tape to relieve the pressure.

Those of us that use nasal therapy generally control the air with the back of the tongue against the roof of the mouth. With practice, we can control the pressure and even speak clearly. If you are prone to releasing air into your mouth, you are not a good candidate for nasal CPAP, and should be looking at a full-face. Taping can mitigate the effect and prevent pressure loss, but its kind of a band-aid approach when you really should be on a full face.

I don't like the idea of chin straps or tape when I'm sleeping. I assume that the reason we open our mouths at night is because we have trouble breathing nasally and therefore must use our gaping maw to tug in enough air to increase the O2 in our blood. Who am I to interrupt this?

[lazyace]

You have said several things that suggest you are not a good candidate for nasal pillows. You are taping and get air pressure in your mouth that requires you to un-tape to relieve the pressure.

Those of us that use nasal therapy generally control the air with the back of the tongue against the roof of the mouth. With practice, we can control the pressure and even speak clearly. If you are prone to releasing air into your mouth, you are not a good candidate for nasal CPAP, and should be looking at a full-face. Taping can mitigate the effect and prevent pressure loss, but its kind of a band-aid approach when you really should be on a full face.

When you say not a good candidate for nasal pillows, what about a hybrid that also covers my mouth? Is there any technical advantage to this over a full face mask? Or is it simply personal preference?