Not a "happy camper" Anymore....Ideas?? PLEASE

bap40 · Post by **bap40** » Wed Mar 26, 2008 7:49 am

After starting out so well, with low leaks and low AHI's, ALL has changed and I don't know why. ???????

For the past 4 days or I should say nights, my every number has gotten consistantly higher. Leaks up, AHI up and so on. The only 2 things I can think of, are I took entire mask (comfort gel) apart to really clean it. I did mark the headgear to set the straps where they were beforehand. The other thing is that I am pretty sure I am moving around more at night! I just can't figure out what is going on!!!!

Last night:

AHI was 11!
Mask leak, acutally down a little at 31

I would really love to have some input and maybe some solutions to try.
Please????

I just thought of another thing I did. I set my auto for a min of 10, the pressure I was given to start with, instead of the 9 doc said to start with and the upper pressure I did not change which is a 13.
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CPAPopedia Keywords Contained In This Post (Click For Definition): AHI, clean

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CPAPopedia Keywords Contained In This Post (Click For Definition): AHI, auto, clean

Goofproof · Post by **Goofproof** » Wed Mar 26, 2008 8:35 am

Probably mouthbreathing, you need the software and reader so you can tell whats up. Jim

Wulfman · Post by **Wulfman** » Wed Mar 26, 2008 9:07 am

You're mouth-leaking, like Jim said.
Your leak rate should be in the mid-upper 20's for your pressure.

http://www.internetage.com/cpapinfo/leak-rates-1.html

Den

Country4ever · Post by **Country4ever** » Wed Mar 26, 2008 9:20 am

When we leak at all, we just can't trust any of the other numbers.

dieselgal · Post by **dieselgal** » Wed Mar 26, 2008 9:59 am

Bap40 Didn't you just get a new M- series Auto?

mindy · Post by **mindy** » Wed Mar 26, 2008 10:25 am

IMHO, not all leaks result in problems with the numbers. All masks leak! One of the important things about seeing the data is that you can tell if the leak is a relatively smooth line or if it looks like a jagged mountain chain skyline. The machines are supposed to compensate for some amount of leaking (though not large leaks).

Mindy

Snoredog · Post by **Snoredog** » Wed Mar 26, 2008 11:00 am

I would:

Set Auto:Min = 8.0
Set Auto:Max =14.0
Set AFlex = 2

When you bump up the Minimum pressure on the autopap especially to 10 cm pressure, you completely wipe out the circuit or machine's ability to detect and respond to certain type of events as it basis its decisions on current delivery pressure and the event seen.

If that pressure is set lower than 10 cm, then the machine will be "allowed" to respond appropriately.

It is obvious that as you increased the Minimum that things took a turn for the worse, machine gets louder, leaks increase, AHI goes up not to mention the higher pressure is more difficult to tolerate when falling asleep.

If you go one direction and it doesn't work, you go the opposite and compare.

bap40 · Post by **bap40** » Wed Mar 26, 2008 12:00 pm

Thanks to all of your input. I do tape my mouth shut during the night, even though I don't think I am mouth breathing. I do that just "because" I want to keep that ruled out.

Snoredog, I didn't know that about the auto machines funtioning with the min number of 10! I was originally set for pressure range of 9-13 and you are saying 8-14. I will do that tonight and see how I respond.

By the way, I am in the process of getting my software downloaded to the computer and am waiting for Two Factors to replenish their stock of card readers. They have been out for a few weeks now. So, as soon as that pans out I will be able to and plan on reading my data daily.

I can't tell you all how much I appreciate the feedback from you when I have a problem and or question.

Thanks, Brooke[/i]

dieselgal · Post by **dieselgal** » Wed Mar 26, 2008 12:51 pm

So Brooke has the problem started just since you got the new machine and if so do you think it is just a matter of getting the settings right?

rested gal · Post by **rested gal** » Wed Mar 26, 2008 1:05 pm

Snoredog wrote:When you bump up the Minimum pressure on the autopap especially to 10 cm pressure, you completely wipe out the circuit or machine's ability to detect and respond to certain type of events as it basis its decisions on current delivery pressure and the event seen.

I don't agree.

Snoredog wrote:If that pressure is set lower than 10 cm, then the machine will be "allowed" to respond appropriately.

I think the machine will also be "allowed" to respond appropriately for most people even if the minimum pressure is set at 10, or above. Not that most people would actually need a minimum higher than 10 to be set for an autopap's range.

For over a year, I've set the pressure range at 10 - 20 on any auto-titrating machine I use:
Respironics REMstar Auto with C-flex (pre-M model)
Respironics REMstar Auto with A-flex M series
Puritan Bennett 420E autopap (with IFL1 turned off)
Respironics BiPAP Auto with Bi-flex (min EPAP 10, max IPAP 20)

According to the software data I consistently see from those machines, that minimum of 10 is "allowing" them to respond appropriately -- if ending up with very low AHI (even some zero AHI's) is any indication of appropriate machine responses and appropriate treatment. Not to mention, my subjective feeling of "very rested" each morning.

All that aside, bap40 would do well to get the Encore Viewer software and card reader, to get a better look at what's going on. Especially to get a better look at leak activity via the Daily Details graph.

There can be many, many reasons why a person's initially low AHI goes up. More often than not, imho, it's for reasons other than a pressure setting which had been working fine, or a one cm increase in the minimum pressure in an autopap's range. A one cm DECREASE would be more apt to cause an increase in AHI, but not a measly one cm increase, imho..not for most people.

Snoredog wrote:It is obvious that as you increased the Minimum that things took a turn for the worse

I don't think that's "obvious" at all. Increasing the minimum from 9 to 10 isn't necessarily the REASON things took a turn for the worse, imho.

There could be many other factors going on for bap40 that have nothing to do with the coincidence of having changed the minimum from 9 to 10. Could be something as simple as more leaks from an aging gel mask cushion, allergies acting up, more nasal congestion than usual that week; other health issues, med side effects... on and on.

Of course everyone is different, so the settings you suggested might be just the ticket for bap40, Snoredog. Even if not for the reason you stated:

Snoredog wrote:When you bump up the Minimum pressure on the autopap especially to 10 cm pressure, you completely wipe out the circuit or machine's ability to detect and respond to certain type of events

(bold emphasis mine)

I sure don't see that happening with my autopaps... or with those used by several other people near me that I've been helping and looking at their downloaded data...people with the minimum set at 10 or more.

Wulfman · Post by **Wulfman** » Wed Mar 26, 2008 1:14 pm

rested gal wrote:I sure don't see that happening with my autopaps... or with those used by several other people near me that I've been helping and looking at their downloaded data...people with the minimum set at 10 or more.

Me either. I used my Auto in a range of 10 - 15 and it responded to EVERYTHING......just not fast enough to give me an AHI lower than straight pressure.

Den

rested gal · Post by **rested gal** » Wed Mar 26, 2008 1:24 pm

bap40 wrote:Snoredog, I didn't know that about the auto machines funtioning with the min number of 10!

Just because something is "said" doesn't mean it's correct. (That goes for what I say, too!!! )

bap40 wrote:I was originally set for pressure range of 9-13 and you are saying 8-14. I will do that tonight and see how I respond.

That setting range will probably work fine for you -- just not necessarily for the reason Snoredog stated. Do remember you should go at least 5 days (preferably a whole week) with a new setting. And not be making changes to other things during that time, or you won't know what different factor did what. For that matter, when you switch to those settings, you're not going to know if raising the max from 13 to 14 was more important for you to do than dropping the min from 9 to 8. Or if raising the max was counterproductive, or what.

bap40 wrote:By the way, I am in the process of getting my software downloaded to the computer and am waiting for Two Factors to replenish their stock of card readers. They have been out for a few weeks now. So, as soon as that pans out I will be able to and plan on reading my data daily.

Excellent, Brooke! If you get tired of waiting for them to re-stock, here is another site where you can buy the correct reader. A little higher priced than at two-factor, but probably in stock:

http://www.securetech-corp.com/mako_dt.html

Or, Google for these words: Encore card reader cpap

You might come across an online cpap store than sells it fairly cheap. If you find a price less than what cpap.com has it listed for, contact cpap.com. They might be willing to price-match it. If you needed to order some other things and your total order is at least $100, you'd get free shipping from cpap.com.

Moby · Post by **Moby** » Wed Mar 26, 2008 5:32 pm

Because it happened after you took the whole mask apart to clean it, I would check that the mask is put together again correctly and not damaged, and that there are no "foreign bodies" eg water in a seal somewhere. Also check the tubing and connections.

regards

Di

Moby · Post by **Moby** » Wed Mar 26, 2008 5:36 pm

PS

It might be time to boil it again, and get it fitted to your face again.

Di

Gerald · Post by **Gerald** » Wed Mar 26, 2008 6:05 pm

My honey and I find that....especially for her....sinus drainage greatly affects the AHI score.

She also fights mask leaks because she can't wear nasal-pillow type masks.

Both of us mouth-tape at night.....and that's the only way I can keep my average to around 0.7 AHI.

You might also take a hard look at your mouth-taping technique to be sure you aren't suffering from "blow-outs" (tape leaking).

Don't give up....we all want to see you succeed.

Gerald

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