Results of changing my husbands range..

[Sam33]

Yesterday I received some excellent advice... Thank you..
I changed the range from 7-16to 10-17.5. He was avg. an AHI Of 52.1.. Last
Night with the change and range and sleeping on his side his AHI was 30.9. Much better but still way to high.. Here's the newest concern... When the ceiling was 16 he averaged 15.8 now the pressure ceiling is 17.5 and now he is using 17.2.. Nothing seems
Enough... And If he hits 20 we are in trouble right??
Will his pressure and AHI come down.. With the new range? Or
Is that it with the ceiling set at 17.5 his AHI will be around 30 which is better but still unacceptable.
Thank you all agian...
You have been wonderful!

[Mary Z]

Would that it be so simple as increasing the pressure... You want to look at trends- I suggest a weekly average. Sometimes a decrease in pressure is what is needed instead of an increase. If with a few adjustments you cannot get his AHI under 5 I think a visit to the doc is in order. His AHI is quite high. My personal experience is that a new type of machine was needed when I could not titrate my AHI down..
I did not see the original thread and don't know his general state of health.

How do you know his AHI with an Escape machine?

[Emilia]

You are moving in the right direction, but, boy.... those are still high numbers. I tend to think your hubby may need more help from the doctor.... it could be that he should be on a more sophisticated machine like a bipap (bi-level) machine. Trouble is that most insurance won't approve that until the patient has 'failed' at using cpap/apap. That said, I'd keep him at those settings a few more nights to see if he settles into it and the AHI comes down some more. If you adjust things again on your own, I'd consider ONLY bumping up the low end number by .5 at a time to see if that reins in things to a tighter pressure range. Keep good documentation on what you are doing so all can be discussed with his doctor should he need to move to a bi-level machine. The Escape isn't recording data to demonstrate this so you will need to journal it.

[hades161]

A person's nightly pressures can change A LOT depending on leaks, Sleep position, food ate before bed, acid reflux, Alcohol drank even a beer, cold meds, reflux meds, and if a sleep partner attaches oneself IE spooning. You need Data over a weeks time or more to get a good average.

My pressures are currently 14 - 18cmh2o my average and titrated rate is 16. for a time I was at a setting of 16-20 and I had peaked 20 a few nights but looking over a months worth of data I saw that it happened only 2 times. The most I normally hit is 17.5 so I cut it off at 18 and went 2 pressures lower then my average pressure or Time Most Spent at which was 16. MY AHI is normally under 2.0 and as low as 0.5 some nights.

No your not in trouble if you hit 20. You just need to work on it over a months time and tweak it weekly. The high AHI might be due to leaks as well so watch the leak rates, if the mask is leaking most of the night then the machine can not compensate for the OSA and the AHI will go nuts. If you have no leaking issue and have the ranges set as best as you can for the best numbers and are still way over an AHI of 5.0 then you need to go to a sleep doctor again and most likely will need a new PSG to see what's going on.

[robysue]

Sam33,

Can you check the machine listed in your signature? It's showing the machine as an S9 Escape, which is neither an Auto nor a machine that gives any data beyond usage hours.

Is hubby using an S9 AutoSet or an S9 Escape Auto? Can you fix the signature so we know which of the S9 APAPs he's using?

If he's using the Escape Auto, you only have that generic, unbroken down AHI to work with, and it is still too high. But neither you, nor we, nor his doctor can definitively tell what kind of events are causing the continuing problems. And hence the best anybody can do is make an educated guess as to whether he needs more pressure or less pressure. And without the actual leak data, neither we nor the doc can do anything but make an educated guess as to whether excess leaks might be a problem. Since you are present at night when hubby is using the machine, you might be able to determine if he's got a leak problem if the leak is loud enough to wake you up. But many leaks aren't really all that loud even if they are large, long leaks that interfere with therapy.

If he's using the S9 AutoSet, you can get a breakdown of how many of the events are OAs, CAs, and Hs. And you get the leak data as well. And all that would be really useful to know. Because whether hubby needs more pressure or less pressure or simply a bit of time to work the kinks out of the mask leaks and start sleeping more soundly all depends on what the breakdown of the AHI actually is and what the leak data is.

Did either his diagnostic sleep study or his titration study mention anything about central apneas? And is there any evidence of mask leaks or mouth breathing?

Overall, I'd say give it a few more days, but if by next week his AHI is still in the double digits, it's time to call the doctor's office and insist on a QUICK appointment.

[Pugsy]

I am very short on time so can't comment much. Don't worry about the ceiling average right now. It will be what it will be. Worry about it later once you see what the final pressure needs are to deal with the events.

If it were me...I would increase the minimum again and this time to 13 or 14. See what it takes to get the AHI down and then worry about the maximum.

Leaving things at a minimum of 10 for a week is unlikely to make enough of a change from AHI of 30 to be worth waiting for. I know I usually say "wait" but this time I don't. When the AHI is down to single digits...then smaller increases and give it some time for trends to develop. We can "trend" all we want at minimum of 10 and it won't help.

I don't remember if he is using EPR or not but it likely is impacting things a bit because it is reducing the pressure. Not saying not to use it but it often is a factor in optimal pressure needs so we keep that thought on the back burner.

Folks...the machine is the S9 Escape Auto...all this person is getting is AHI and average pressure.
OP is aware of its limitations.

[Sam33]

The machine listed is correct... When you hold down two of the buttons you can get in and change the range of pressure and in there you get a small list of sleep data. How it determines is it
I have no idea.. I would imagine some average. I will give it a few more nights. But I am
Alson calling doctor get his take.. It's been so long since my husband has seen
Him ill have to look up his name.
Thank you all again. This is an amazing outlet

[Pugsy]

BTW... with any pressure increase...if you see the AHI go up and not down...it might be centrals which the S9 Escape won't show you (but a S9 AutoSet would) and you need to go back down in pressure and immediately call the doctor.

Some people (perhaps 10 to 15 %) develop centrals as a response to pressure when none showed up on the sleep studies. When this happens...time to talk to the doctor for sure.

[hades161]

I just read the original thread and the data you need is not available to you. I started out on a Plain old Cpap and self titrated by feel up to 16 which was months later confirmed by my purchase of an Auto adjusting machine or Apap. After I got my medicare and supplemental insurances I was able to get a sleep study done or PSG. 16 was my confirmed titrated pressure. SO I know a lil bit about shooting in the dark like you are.

Seeing you can't tell leaks via data his high pressures and high AHI and being only 4 months into using a Pap machine leaks are likely a big cause of the high AHI and the huge pressure variances. Ask your husband if when he has the mask on if his face gets cold or if his eyes get really dry and has big ol eye dust in the corners of his eyes waking up. If he does the mask is leaking into his eyes. If his face gets really cold its leaking around the seals on the cheeks. DO NOT cover the vent on the mask that's for normal exhaust of CO2 but you will need to address any other leaking. I have a Mirage Quatro which is like your husbands but mine has a forehead cushion (which I hate btw so I might try yours ) and those are the things I feel when my mask leaks. If the sealing lips on the mask are no longer sticky that too can cause a poor seal. Take the mask apart and soak the parts in 50/50 water and regular white vinegar, rinse well after 30 minutes and the plastic will be clean and then when dry the sealing parts will be sticky like new again. No it wont hurt the mask I been doing that for 7 years now and still have my first mask the Swift and it still seals but i just got to try the new version and liked it a lot.

Once the mask is clean and ready for use the next thing is fit. Put the mask on him and turn on the unit. The mask should seal and "float" on his face via the plastic cushions. If its tight any place loosen it. If he feels ANY small breeze on his face, bridge of his nose, forehead, or eyes you got a leak and tighten it up a lil. Once it's good in a seated position with no leaks have him lay down in bed like normal and again any cold spot means a leak and you need to tighten it up. The seated position is for general fit and laying down on the back/side is fine tuning the fit. The only other issue with the mask I have found is sometimes when I sleep on my side my pillow against the side of the mask it can become twist up a little and cause a leak if he favors a side then have him lay on that side and try to see if it creates a leak. If it does adjust it so it stops or more likely he will have to try a different pillow or position.

You can do it ! If I can start with a garbage picked mask from the hospital stay I had and a used data-less cpap you can 2. But really you should push for a data capable machine and don't let them tell you different!