2nd Night S8 Autoset II

[Liddelbrook]

(Since 10/5 with Autoset II)

date: 10/01/09 - 148 Total SpO2 Events - Time 59.4 - 1hr Index 18.4 - Time < 88% 9.3 - Events < 88% 44
date: 10/03/09 - 80 Total SpO2 Events - Time 38.4 - 1hr Index 10.6 - Time < 88% 11.9 - Events < 88% 37

date: 10/05/09 - 27 Total SpO2 Events - Time 12.4 - 1hr Index 3.2 - Time < 88% 1.3 - Events < 88% 6
date: 10/06/09 - 16 Total SpO2 Events - Time 7.4 - 1hr Index 20 - Time < 88% 1.2 - Events < 88% 4

S8 Autoset II : 10/05 Min presure 7.2 results: Pressure 16, Leak 0.08, AHI 17.3, AI 8.3, HI 9.0.
S8 Autoset II : 10/06 Min presure 10 Pressure 17.6, Leak 0.32, AHI 17.6, AI 10.3, HI 7.6.

Strangely you would expect better results from the Autoset II since the SpO2 looks better...

On 10-6 I used a chin strap under the Quattro FF. Kinda like it.

On 10-6 I woke up at around 3 with a hissing mask next to me. I guess I pressed the strap release by accident somehow?



Next night is raise min pressure to 11 (and use the data card with the right side up )

[Slinky]

Well, I usually experience "first night effect" when I make a change whether in pressure or mask or whatever. One night just does NOT the entire story tell even an in-lab titration much less w/an APAP. Unless the change makes sleep absolutely miserable and impossible you should make ONE change at a time and stay w/that change for ONE WEEK before using the data to make any next ONE change that may be indicated.

You mention minimum pressure but you don't mention maximum pressure. The S8s raised pressure in .2 cms increments. If the pressure range is too wide the xPAP doesn't have time to respond up to the pressure needed to prevent apneas.

[Liddelbrook]

I just tried 11 a bit, but it feels a bit much, will try 10.4

Max pressure is set a 20.

Do you say this setting it too high to respond to apneas ??

[Slinky]

Yes. Did you ever have an in-lab titration? Ideally if you had had one you would set your APAP pressure 1-2 cms below your titrated pressure and 1-2 cms or at most 2-4 cms above your titrated pressure.

If you didn't have an in-lab titration there are others here on the forum better able to suggest a pressure range. The high number of apneas COULD be pressure caused central apneas. The ideal is to concentrate on lowering your AI and not worry about the HI until your AI is running consistently below 1.0

There are those who suggest you halve the Resmed reported HIs as compared to Resprionics HIs due to the difference in the way the two brands respond to and score hypopneas. Whilst Resmeds are more aggressive at scoring hypopneas I don't hold w/their scoring twice as many.

[Liddelbrook]

No, no in-lab titration.

[Slinky]

Okay, then RestedGal is a good one to ask this question. Why not PM her??

[rested gal]

I'm just guesstimating! I'm not a doctor and I'm nothing in the health care field at all.

..."if it were me..." Depending on where I set EPR, I'd use one of these as the minimum pressure for at least 3 or 4 nights:

EPR off -- I'd set the minimum pressure at 10.
EPR 1 -- I'd set the minimum pressure at 11.
EPR 2 -- I'd set the minimum pressure at 12.
EPR 3 -- I'd set the minimum pressure at 13.

I'd keep the max pressure set at 20.

Your O2 while sleeping is much, much better now that you're using the Autoset. That's great!

If several nights at one of those minimum pressure numbers doesn't start producing a lower AI (Apnea Index) I'd probably try using the machine as a straight CPAP single pressure -- starting with the same pressures listed above, depending on which EPR I used. I'd keep on going up with the single straight pressure until I was using a straight pressure of 16 with EPR at 3.

If that didn't lower my AI, I'd say, "RG, what you said to try ain't helpin' !!"

P.S. Don't worry about the HI number right now, or the overall AHI number. Let's get just the AI number down to below 5 if we can.

Oh..and about this question you asked Slinky:

Max pressure is set a 20.

Do you say this setting it too high to respond to apneas ??

I don't think the maximum pressure will affect how long it takes the machine to move up in response to flow limitations. It's not going to respond to ANY full apneas when it's using a pressure of 10 or more. What it WILL respond to with ANY pressure setting (in auto mode) are flow limitations and snores. By responding with more pressure to those thing (flow limitations and snores), it is expected that a full apnea won't be able to happen.

It's the minimum pressure that is the important pressure to set right, when Slinky correctly says:

If the pressure range is too wide the xPAP doesn't have time to respond up to the pressure needed to prevent apneas.

"too wide", in my opinion, refers to setting the minimum pressure too low. I don't think it matters that the maximum pressure is set wide open at 20. It's the minimum pressure that needs to be up high enough that it doesn't take the machine too long to get the airway fully open with just a few increases when it senses trouble starting -- trouble being flow limitations and/or snores.

But that's only if the minimum pressure is set high enough to be pretty close to what it takes to keep your airway open. Without a sleep lab titration, you have to guess at that. Guess, set the minimum pressure, see what the AI is, set the minimum higher if the AI isn't under 5.0, and so on.

If raising the minimum pressure setting repeatedly -- up to as much as 16 cm H20 -- or if setting the machine as straight CPAP up to as much as 16 -- doesn't keep your airway open well enough to bring your AI down nicely (remember...for now look at only the AI, not the overall AHI or the HI), we'll go back to the drawing board!

It's true that since the machine cannot distinguish central apneas from obstructive apneas, the AI might consist of some or many central apneas. Additional pressure wouldn't help centrals. But until you see that more pressure (more minimum pressure or a straight pressure) and more and more and more doesn't help matters, I'd assume that you simply haven't found a high enough pressure to preemptively keep your airway well and truly open.

You've never been diagnosed with CHF (Congestive Heart Failure), have you?

Good luck. You're doing a really, really good job working on your own treatment, Liddelbrook!

[Liddelbrook]

CHF, OMG, noooo.. never had that.

Ok, will raise the minimum pressure slowly over time, and see where the AI goes.

Thanks guys (and gals)

Why do the days look so long now?