Overwhelmed - don't understand the data

[Jane Jetson]

I have been on the CPAP for several months. I have adjusted but I am not certain if I am maximizing my benefits. I still get tired some days and I wonder if I should be doing something more. I am using the Resmed program and can't understand some of the results.


Here are a few examples from the calendar. I think the AHI should be under 5 and that looks good but I don't understand the leak %.
Day 1
Therapy Hrs: 8.40
Leak 95th %: 18.00
AHI: 3.30

Day 2
Therapy Hrs: 6.83
Leak 95th %: 25.20
AHI: 0.20

Day 3
Therapy Hrs: 9.13
Leak 95th %: 36.00
AHI: 1.60

Any information you can share would be greatly appreciated. I don't want to get too caught up in the numbers but I want to be sure I am on the right path.

Thanks!!!

[dhoppe]

Seems like a lot of leak but I'm new too so I'll let someone else weigh in there.

I would certainly recommend getting the Sleepyhead software. I've been using it since I started my therapy just over a week ago and it has been quite insightful.

[Cardsfan]

That Leak 95th % 18 means that 95% of the time, your leak rate was at Or below 18 L/Min (Liters per minute). It does not tell you how much time you spent at 18.
Machines can make up for leaks to some point, I believe for Resmed it is 24L/min.

[yaconsult]

See here to understand about mask leak and why you need to have some: wiki/index.php/Mask_Leaks

[Jane Jetson]

Thanks everyone. Would it be fair to say the most important thing is to have the AHI below 5? I am trying to get more than 7 hours sleep. I presume that will help.

[palerider]

Thanks everyone. Would it be fair to say the most important thing is to have the AHI below 5? I am trying to get more than 7 hours sleep. I presume that will help.

5 is pretty crap, it's like being poked in the side every 12 minutes on average.

I feel worse if I'm not under 2.

[Jay Aitchsee]

Jane, it looks like your AHI is pretty good, about 1.7 average from what you've shown and, yes, you definitely want your AHI under 5. Under 2 would probably be a better number to shoot for. However, it is important to know the make up the AHI (AI, HI, CAI) before deciding how to optimize it.
It looks to me as if your leaks are a little high and could be disturbing. This might cause you to feel unrefreshed in the morning and could raise the number of CA's that you see. But this is just a guess.
If you were to download SleepyHead and upload some nightly graphic results, people could offer a little more informed advice. You can get SleepyHead and instrucions on what and how to post by going here.

[Cardsfan]

Agree. I want to be under 1.5 or I can feel it. Most nights I am under 1.
If you get Sleepyhead and post your results here, we can help you understand how to monitor your data and improve your therapy. AHI 5 and above is where you get diagnosed with apnea.
Anything below AHI 5 is considered treated. BUT- you want to get as low as possible. I'd feel like crap if someone woke me up 5 times every hour, all night long.

That's why you need to learn as much as possible. Take advantage of the good help you can get here.

**The "Most important thing" now is to educate yourself. Learn all the lingo and stick around. And monitor how you feel. Your AHI is is an acceptable range, but there can be improvements. Especially if you do not feel refreshed and rested. And, it takes a long time to undo all the damage that has been done. My sleep doc said it takes 6 months for the brain to recover. So don't be discouraged if you don't bounce back quickly.

[robysue]

Jane,

Your AHIs are excellent. Mine are mostly in the 1.5-2.5 range, and I'm mostly content with that. (The things that I have to do to get them to be consistently below 1.5 lead to other problems.)

As others have explained, the 95% leak rates indicate that your excess leak rate was AT or BELOW that number for 95% of the night. Resmed defines a Large Leak as 24 L/min. When the 95% leak rate is below 24 L/min, you know that Large Leaks were not much of a problem. When the 95% leak rate is above 24 L/min, there may or may not be a serious leak problem. You just can't tell from that one number, and here' why:

• Case 1: If your 95% Leak Rate is 30 L/min, you might have had a leak rate of 0.0 L/min for 90% of the night, a leak rate between 0.1 and 29 L/min for 3% of the night, and a leak rate AT or ABOVE 30 L/min for 7% of the night. In this case 95% of the leak data lies AT or BELOW 30 L/min, so the 95% leak rate is reported as 30 L/min.
  
  Case 2: If your 95% Leak Rate is 30 L/min, you might have had a leak rate of 0.0 L/min for 30% of the night, a leak rate between 0.1 and 29 L/min for 30% of the night, and a leak rate of 30 L/min for most of the remaining 40% of the night. In this case 95% of the leak data lies AT or BELOW 30 L/min, so the 95% leak rate is reported as 30 L/min.

Leaks are not much of a problem in Case 1. Leaks are a big problem in Case 2.

My advice is this: If you are frequently seeing 95% leak rates above 24 L/min on your Resmed CPAP, then you need to look at the full leak data in a program like SleepyHead. On the other hand, if your 95% leak rate is consistently below 24 L/min and you are sleeping well and feeling good, then it's ok to assume that leaks are not an issue.

[robysue]

I want to be under 1.5 or I can feel it. Most nights I am under 1.
...
Anything below AHI 5 is considered treated. BUT- you want to get as low as possible. I'd feel like crap if someone woke me up 5 times every hour, all night long.

Cardsfan (and others),

I'm sure that you may indeed feel much better with an AHI < 1 as opposed an AHI between 1.5 and 2.5, which is more or less where mine tends to stay, with some days getting as high as 3.0.

But it's important for newbies to remember that sometimes chasing the elusive "below 1.0 AHI" leads to more problems that it solves. In my case, I can only get to an artificial below 1.0 AHI target by doing things that lead to a worsening of my sleep and my daytime functioning in other ways. In particular, for me to consistently have an AHI < 1.0, I have to have more pressure than my stomach can handle. Which leads to more arousals and more pain. Which leads to me feeling really, really crappy in the daytime.

Sometimes there is a necessary trade off in CPAP therapy: If the measures that are needed to achieve a super low AHI lead to other problems with your sleep, you are probably better off concentrating on getting high quality sleep with a somewhat higher, but still acceptable AHI. If the measures that are needed to completely eliminate all excess leaks lead to other problems with your sleep, you are probably better off concentrating on getting high quality sleep with a less than perfect but still acceptable leak line.

[Jane Jetson]

Thanks so much. This is more complex than my doctor lead me to believe. I also didn't realize it was a balancing act. My number is 9, it starts at 4 and ramps up over 45 min. I feel so good learning there is room for improvement. I am now off to sleepyhead.

[Jay Aitchsee]

I'm sure that you may indeed feel much better with an AHI < 1 as opposed an AHI between 1.5 and 2.5, which is more or less where mine tends to stay, with some days getting as high as 3.0.

But it's important for newbies to remember that sometimes chasing the elusive "below 1.0 AHI" leads to more problems that it solves. In my case, I can only get to an artificial below 1.0 AHI target by doing things that lead to a worsening of my sleep and my daytime functioning in other ways. In particular, for me to consistently have an AHI < 1.0, I have to have more pressure than my stomach can handle. Which leads to more arousals and more pain. Which leads to me feeling really, really crappy in the daytime.

Sometimes there is a necessary trade off in CPAP therapy: If the measures that are needed to achieve a super low AHI lead to other problems with your sleep, you are probably better off concentrating on getting high quality sleep with a somewhat higher, but still acceptable AHI. If the measures that are needed to completely eliminate all excess leaks lead to other problems with your sleep, you are probably better off concentrating on getting high quality sleep with a less than perfect but still acceptable leak line.

Excellent point, Robysue. Perhaps this, or a variation, should be the first response to any post of a newbie. As SleepyHead becomes more and more commonly used, it seems (to me) we are seeing more and more people chasing the Holy Grail of a 0.00 AHI without regard to how they feel and without allowing sufficient time to adjust to any changes made (Dial Wingin') or even to the treatment itself. As you point out, a low AHI means little if ones sleep is not refreshing and restorative. Trading a little AHI for better sleep could be exactly what some people need to do. Optimizing the efficacy of treatment should be a slow, logical, deliberate, process carried out with an understanding of all the variables involved. And let's not forget Sleep Hygiene, often the last practice to be implemented, if ever, which should be the first. Just my 2 cents.

[Jane Jetson]

Thanks so much. I didn't even know 1 was a goal. My doctor and DME guy just basically told me to use it. It was all about the machine mechanics. No mention of leaking or how to know if I was benefitting. I have been reading all over the this site. Turns out my mac doesn't have an sd card slot. I am taking the card to work tomorrow and hopefully it will fit in my work lap top. If not, I will need to buy an adapter.

I have a new mask which should help stop the leaking. Can't wait to see my results tomorrow morning at the office.

[Cardsfan]

I agree RobySue.

[Julie]

Have you tried shortening the ramp time? You're not getting optimal treatment while it's taking its time getting to 9. Most of us stop using ramp very shortly after starting out, or at least shorten the time by quite a bit and 9 is not excessively high in terms of getting air-blasted.