Help Interpreting CPAP Data

[dogbone]

After about six weeks on CPAP, I'm starting to get some sleep, but I have to take a PM, to get to sleep and an Ambien to get back to sleep after a bathroom visit. So, I'm looking at the day's data on my machine and I don't know what it all means. Here's what I see this morning (went to bed at 10pm and got up at 7am. I slept most of that time).

Here's the data: Efficacy: Leak 0.82 L/s; AHI 5.3; AI 0.3; HI 5.0.
It's this efficacy data that I need help interpreting. Also, what is good performance?

The set up is: :Mode, CPAP; Start CPAP 8.0; CPAP 12.0; Max RAMP 20 (I'm not using the ramp), Mask Activa, Tube 2m.

I went to a second doc a couple of days ago and he said my study shows that I have restless leg syndrome, big time. He gave me a sample of a medication to treat the RLS. He told me as long as I have RLS, I'll not get the full benefit of the CPAP. The first sleep doctor said nothing about my RLS. The sample medication I got is a 10-day dosing schedule. The brand is Mirapex (promipexole dihydrochloride). The listed side effects are a bit disturbing but so far I have had none.

[Babette]

There are several RLS sufferers on this board. Hopefully one of them will respond to you.

The target number you are looking for is AHI less than 5. That's the "magic number" that MD's consider to be the hallmark of "good therapy." Many people here think that's too high. Me, I'm happy enough to be consistently below 5 AHI.

I'm disturbed by the amount of sleep meds you're taking, but I'm not a doctor, and I can't say anything helpful. I take two generic "benadryl" every night to go to sleep. I get them very cheap at Costco - Walgreen's also has a cheap version of it. No Tylenol or Ibuprofen in them. If you don't have pain, don't take pain relievers. I do have pain, so I take the appropriate pain reliever in the dose I need. Sometimes I also have to take them for inflammation.

ANYWAY, mostly just bumping this up, so maybe someone with better info will respond.

Good luck!
Barbara

[BleepingBeauty]

After about six weeks on CPAP, I'm starting to get some sleep, but I have to take a PM, to get to sleep and an Ambien to get back to sleep after a bathroom visit. So, I'm looking at the day's data on my machine and I don't know what it all means. Here's what I see this morning (went to bed at 10pm and got up at 7am. I slept most of that time).

Here's the data: Efficacy: Leak 0.82 L/s; AHI 5.3; AI 0.3; HI 5.0.
It's this efficacy data that I need help interpreting. Also, what is good performance?

The set up is: :Mode, CPAP; Start CPAP 8.0; CPAP 12.0; Max RAMP 20 (I'm not using the ramp), Mask Activa, Tube 2m.

I went to a second doc a couple of days ago and he said my study shows that I have restless leg syndrome, big time. He gave me a sample of a medication to treat the RLS. He told me as long as I have RLS, I'll not get the full benefit of the CPAP. The first sleep doctor said nothing about my RLS. The sample medication I got is a 10-day dosing schedule. The brand is Mirapex (promipexole dihydrochloride). The listed side effects are a bit disturbing but so far I have had none.

Hi, dogbone.

Your leak is WAY high. On your machine, any reported leak over .4 L/S means your machine can't compensate for it, and you're not getting optimal therapy. Are you sure the Activa mask has been entered into the machine's menu correctly? Your machine factors in the intended flow rate (to expel Co2) for the mask that you program into it at your pressure setting. So the leak that's reported in the data is the amount of leak that's OVER AND ABOVE what it should be for that mask at that pressure setting. (If you were experiencing no leak at all, the reported leak would read as 0.0, so that's the goal.)

Since you're using a nasal mask, my first question is: Are you SURE you're not mouth-breathing or mouth-leaking? If you're not sure, but you think the mask is adjusted properly, I think you should consider switching to a full-face mask, where you'll still be getting therapy even if you do open your mouth. Or keep using the nasal mask but consider the addition of a chinstrap (or tape your mouth shut) to prevent losing therapy through your mouth.

AHI isn't bad. (FYI, ResMed machines tend to report more hypopneas than others, and some forum members mentally cut the HI figure in half and then add it to the reported AI; in your case, that would produce an AHI of 2.8.)

Generally speaking, "good performance" means an acceptable leak rate, an AHI below 5.0, and feeling more rested.

Hope that helps, and welcome aboard.

P.S. I can't speak to your RLS issues (nor your need for sleep meds), but others here can (and, I'm sure, will).

[Muse-Inc]

I'm with BB on this:

...Leak 0.82 L/s

Seems to me that it'd be a good idea to get leak as low as possible and get some restful sleep, THEN review numbers again. Could be your other issues might improve with restful sleep.

[dogbone]

Thanks for all your fast responses. I use a chin strap which I have to make quite tight to keep my mouth closed. My mouth gets very, very dry which suggests that I'm opening my mouth even with a tight chin strap. I put it on before putting on the mask. I've tried it the other way but it makes the mask feel too tight. I had my therapist out last evening to try a hybrid mask which didn't work. She couldn't get it to stop leaking. When I put on the Activa mask I always test it for leaking and I get an "excellent" reading but when I lay down the mask must start leaking. I sleep on my side. I'll have to do some more adjusting for the fit and I'll double check the machine setting for the Activa.

I'd like to get off the sleep aids. Actually, I have not used PM's until I got the CPAP. I'll try benadryl tabs. The first MD, said that the CPAP would eliminate the need for sleep aids. So, I tried going without and laid awake all night.

If I can't get the ACTIVA mask working right, then I may try a full mask. When I got my machine I was sent home it a nasal billows. I really prefer that set up because it has minimal strapping, but it tends to make my nose sore. I had cancer removed from the tip of my nose, so I may have lost some cartilage. I'm not sure my insurance will cover a third mask.

[BleepingBeauty]

Thanks for all your fast responses. I use a chin strap which I have to make quite tight to keep my mouth closed. My mouth gets very, very dry which suggests that I'm opening my mouth even with a tight chin strap. I put it on before putting on the mask. I've tried it the other way but it makes the mask feel too tight. I had my therapist out last evening to try a hybrid mask which didn't work. She couldn't get it to stop leaking. When I put on the Activa mask I always test it for leaking and I get an "excellent" reading but when I lay down the mask must start leaking. I sleep on my side. I'll have to do some more adjusting for the fit and I'll double check the machine setting for the Activa.

Yes, it does. A FFM is the way to go, IMO, unless you want to try taping your mouth shut. (Many do that every night; I tried it for awhile but didn't like it much, so I now use a FFM.)

There are two masks on the market that are considered "hybrids": The RespCare Hybrid and the ResMed Liberty. Some people can use either one, and others find that one works very well and the other is not a good fit. Of the two, the Hybrid offers more sizing options (and therefore, more good fit possibilities) than the Liberty.

If I can't get the ACTIVA mask working right, then I may try a full mask. When I got my machine I was sent home it a nasal billows. I really prefer that set up because it has minimal strapping, but it tends to make my nose sore. I had cancer removed from the tip of my nose, so I may have lost some cartilage. I'm not sure my insurance will cover a third mask.

FYI re: nasal pillows and nose soreness: When I was first fitted (by the RT) with the Swift II, I kept waking up all night with terrible soreness between my nostrils. He had the top strap way too tight, effectively pulling up hard on the nasal pillows and mashing them into my nose. Once that was fixed, the mask was comfortable.

Re: insurance coverage for masks: Most DMEs will let you exchange masks within the first 30 days, as the major manufacturers offer them a 30-day return policy. Otherwise, you can find good deals on CraigsList or http://www.cpapauction.com. I've had great luck with equipment purchases on both sites.

[KatieW]

I use the Activa LT, and find that it may fit perfectly before I lie down, but then things shift. Sometimes it's the head pillow (I use a PAPillow), or the hose pulls on it. You might try readjusting once you are lying down, then when turning to your side, make sure the mask is hanging off the edge of your pillow. Also, that way, the vents are not obstructed. I use a hose hanger, but if the tension isn't just right, the weight of the hose pulls on the mask and breaks the mask seal.

[JohnBFisher]

... There are several RLS sufferers on this board. Hopefully one of them will respond to you. ...

I shall in a moment, but wanted to comment on your note first ...

... I'm disturbed by the amount of sleep meds you're taking, but I'm not a doctor, and I can't say anything helpful. I take two generic "benadryl" every night to go to sleep. I get them very cheap at Costco - Walgreen's also has a cheap version of it. ...

You are aware, aren't you, that Benadryl acts as a central nervous system depressant and can increase obstructive sleep apnea? If you need help falling asleep a hypnotic might be a better choice. For example, Sonata is available in a generic form (or at least it was much cheaper than Lunesta) and helps you fall asleep quickly. There are also Lunesta and Ambien. Other medications can help you fall asleep, but tend to interfere with normal sleep architecture.

[DreamOn]

Welcome to the forum, dogbone! I agree with what the others have said. Because your leak rate is extremely high, your other numbers may not be accurate. Once you get the therapy air leaks (from mask and/or mouth) taken care of, you'll probably see those other numbers improve as well. They're not bad results, but it doesn't sound like your therapy's optimal.

You're probably sleeping right through the mask/mouth leaks, especially since you're taking the sleep medications. I don't take any sleep meds, but I was still unaware that therapy air was escaping from my mouth when I was deep asleep.

I use the Activa LT myself, and it's very important with that mask not to overtighten the straps. It can be worn with two fingers between the straps and face. You may have to play with the nose bridge adjustment dial too. It's also possible that yours may be the wrong sized cushion. Or, as others have said, you may need a full face mask if the main problem is mouth leaks/breathing and the chinstrap and mouth-taping don't prevent them.

Please let us know how you do! I hope you're feeling better during the day.

~ DreamOn

[JohnBFisher]

... After about six weeks on CPAP, I'm starting to get some sleep ...

It takes a while to get adjusting to using the machine. Not everyone adjusts instantly. But if you are starting to get better sleep that's the way to go.

... but I have to take a PM, to get to sleep and an Ambien to get back to sleep after a bathroom visit. ...

It takes a while to adjust to using the machine. I hope after you learn to sleep with the machine you will be able to drop at least the PM. It includes Benadryl, which actually increases obstructive sleep apnea. It acts as a central nervous system depressant, causing more obstructions. The therapy numbers show it's not too bad, but your numbers might be better wihtout it.

Of course, the Benedryl also helps decrease nasal congestion. You might have some rebound after you stop using it. You may need to switch to a nasal saline spray to help. And adjust your heated humidifier.

Additionally, once you get accustomed to using the machine you might be able to drop the Ambien.

... So, I'm looking at the day's data on my machine and I don't know what it all means. Here's what I see this morning (went to bed at 10pm and got up at 7am. I slept most of that time). ...

It appears (based on just the numbers) you have a ResMed unit. It measures the data by day (from noon to noon). Of course, that assumes the date and time were properly set on your machine.

... Here's the data: Efficacy: Leak 0.82 L/s; AHI 5.3; AI 0.3; HI 5.0.
It's this efficacy data that I need help interpreting. Also, what is good performance? ...

As Barbara noted an AHI below 5.0 is considered fairly normal. Since you just started the numbers are in fact excellent. As you adjust, it will probably improve. Of course the most important thing is this:

How do you feel? Better? If not, do consider the RLS medication. If yes, well, see how things progress.

... I went to a second doc a couple of days ago and he said my study shows that I have restless leg syndrome, big time. He gave me a sample of a medication to treat the RLS. He told me as long as I have RLS, I'll not get the full benefit of the CPAP. The first sleep doctor said nothing about my RLS. The sample medication I got is a 10-day dosing schedule. The brand is Mirapex (promipexole dihydrochloride). The listed side effects are a bit disturbing but so far I have had none. ...

Yup. I have RLS. You might want to try it. It definitely helps. Remember anything that causes you to arouse (your body jerking, you legs moving, you moving during the night, outside noises, etc) tend to distrub your normal sleep. RLS can make it very hard to fall asleep. Though it sometimes does not equate to Periodic Limb Movement (PLMD is Periodic Limb Movement Disorder). In otherwords, RLS might not interfere with your sleep once asleep. But it often does. Your new doctor is definitely on target there. Your first doctor might have wanted to wait until you got started with the CPAP. Sometimes RLS and PLMD is a result of obstructive apneas. Essentially they accompany your body's effort to arouse you during an obstruction.

So, If you continue to feel as if you are not resting as well as you could, consider the RLS medication. Another choice - if you want to research it - is Requip. It is also available in a generic form (or at least very inexpensive). The generic name is Ropinirole HCL.

Hope that helps.

[jules]

Your leak is WAY high.

Yep - get the software and look at the graph

Until leak issues are resolved nothing else matters.

[dogbone]

You all have given me a lot to chew on (or to sleep on). Tonight's a new night that I'm actually looking forward to. This whole CPAP experience is a challenge. My first objective is to close all the Activa leaks, if I can. As for sleep aids my wife picked up some genetic Benadryl this afternoon but now I'm not sure I should use it if it "acts as a central nervous system depressant." It can't be any worse for me then Excedrin PM. I guess I'll go with the Benadryl tonight to see how it works and check out Ropinirole HC, or just push myself through without a sleep aid. Until I got the CPAP Mesmed, I had no trouble falling to sleep when I got in bed, it was after I made a bathroom trip that I had trouble falling back to sleep. I think it's a mental thing.

By the way, I bought a white-noise machine which I read is suppose to help sleeping without sleep aids. I used it for the first time last night. The jury is still out on its effectiveness.

[jules]

check the active ingredients in the excedrin pm - and check the generic benedryl

[dogbone]

Here's an update. My leak rate is still high. I'm going to call the therapist and get a full face mask tomorrow. I haven't been able to lick the mouth breathing and I don't want to start taping my mouth. I didn't take a sleep aid last night and didn't get a lot of sleep (5:46 hours) and I'm going to stay clear of sleep aids, if I can. I do feel more refreshed today, or at least I'm not in a fog as I am after taking sleep aids.

I just looked on CPAPAuction and there appears to be some good buys there. What brand/kind of full mask do you suggest to go with my machine? I'll check with my therapist to see what here FFM would cost. I don't think I'll be covered by the 30-day free exchange.

[BleepingBeauty]

Here's an update. My leak rate is still high. I'm going to call the therapist and get a full face mask tomorrow. I haven't been able to lick the mouth breathing and I don't want to start taping my mouth. I didn't take a sleep aid last night and didn't get a lot of sleep (5:46 hours) and I'm going to stay clear of sleep aids, if I can. I do feel more refreshed today, or at least I'm not in a fog as I am after taking sleep aids.

Good move.

I just looked on CPAPAuction and there appears to be some good buys there. What brand/kind of full mask do you suggest to go with my machine? I'll check with my therapist to see what here FFM would cost. I don't think I'll be covered by the 30-day free exchange.

The right mask is a very individual thing, and which machine you're using it with is of no consequence. My advice: Go see your therapist and try on different FFMs there (with a machine running at your pressure). Hopefully, there's a place where you can lay down and turn from side to side (to mimic your sleep habits) and adjust the headgear so the mask fits well and doesn't leak. Once you have an idea of which mask(s) you prefer, note the exact name(s) and size(s) of the mask(s) and ask the therapist what each one will cost through the DME. Then smile, say "Thanks," hit the road, and check the auction or CraigsList for the mask(s) you want. (There's absolutely no doubt in my mind that the DME price will be much higher than what you'd pay for the mask out-of-pocket online, from any reputable dealer like our host. It's a given that it'd be cheaper still on the auction or on CL, especially if it's not brand new.)

Good luck!