What's appropriate to ask of DME?

[Wulfman]

Hi Peggy,

It kinda depends on what pressures your machine is set to and what pressures it went to. The leak rate you mentioned for the Quattro doesn't sound all that bad. With mine, at a pressure of 12, I've seen leak rates between the low 30's and upper 30's. Before I did the "Teflon tape fix", it was in the upper 30's and after, it was in the lower 30's. Yes, removing the mask or reaching under it will skew the leak totals if the machine is still running when it's done.

One reason your AHI is high, may be because the minimum pressure is too low. If the data in the LCD screen gave you a 90% figure, it would probably be advantageous to move your minimum pressure upwards and near that figure.....then look at the numbers for the next few days to see if it's helping.

If you can get the software and card reader at some point, that would help greatly.


Den

[rested gal]

Well, I got into my menu today, and I'm thinking my four-day average is not that great. An average of 15 on the Apnea Index and 34.5 on the Leakage. Is that typical of a first week?

Just one question, did you really mean the Apnea Index or did you mean the Apnea/Hypopnea Index (AHI). An AHI of 15 may not be so bad, but an Apnea Index of 15 sounds terrible.

She meant AHI (Apnea/Hypopnea Index) since she's using a Respironics REMstar Auto with A-flex M series machine. The Respironics LCD data doesn't break it down into apneas and hypopneas. It gives the AHI. Even if most of it were hypopneas, a while-being-treated AHI of 15 is very bad, imho.

[NightHawkeye]

Even if most of it were hypopneas, a while-being-treated AHI of 15 is very bad, imho.

RG, I agree with you. Nevertheless, if her untreated AHI is 50 or higher, which is not uncommon, then she's still getting considerable improvement from treatment. It is far from optimum treatment, however.

Regards,
Bill

[pjwalman]

I don't have a 90% pressure number, I guess because I am not using the Auto feature, just straight CPAP, pressure of 11, ramp of 30 minutes starting at 5. Could it be all those apneas are occuring during the ramp period? Would it help if I bumped up the starting pressure of the ramp time?

Good to know that's not bad for leakage of the mask. I will try to quit fussing with it and see if that number improves. Seems like the darned things keeps slipping, though, so maybe I just need better headgear technique.

Oh. And, yeah, I messed up my terminology. It's the AHI index, not the AI index. Sorry! A lot of new stuff to learn with the new bed companion of mine.

Peggy

[pjwalman]

My average AHI is down to 12.5 after last night, so at least I'm heading in the right direction, and I will be able to see if my feelings about that especially bad night will be confirmed by what they print out on Friday. I have decided to invest in the software and card reader, too, so I can understand a little better what's going on with me, figure out what maybe prompted a bad night, what made for a better one, etc. Do y'all just use a couple cards and write over the last week's one?

Thanks again for your help! I'll keep you posted on what the DME tech has to say on Friday. I don't know how it works, but I assume he will contact my physician if he thinks the AHI is high enough to warrant a change in the pressure.

Peggy

[rested gal]

I have decided to invest in the software and card reader, too, so I can understand a little better what's going on with me, figure out what maybe prompted a bad night, what made for a better one, etc. Do y'all just use a couple cards and write over the last week's one?

You don't need two cards. The one card in the machine will overwrite the older detailed data automatically as it fills, whether it was being downloaded or not. If you don't want to miss seeing any of the details before the older ones get overwritten, just download the card every five days. Even once a week would probably catch it all.

Thanks again for your help! I'll keep you posted on what the DME tech has to say on Friday. I don't know how it works, but I assume he will contact my physician if he thinks the AHI is high enough to warrant a change in the pressure.

That's probably how it would go, yes. While you're there, ask the DME to give you a print-out of the "Full Details" report when he does the SmartCard download. The "Full Details" report from Encore Pro (which is what the DME will be using to download the SmartCard) will be more than 3 pages. That won't be an unreasonable request, as it won't be more than about 10 to a dozen pages at most.

If what he hands you consists of only three pages or less, ask him to please go back and print out the "Full Details" report..not just the "Summary" or "Trend" report. You want the "Full Details" report that includes pages 4 and higher.

[MrGrumpy]

Well, I got into my menu today, and I'm thinking my four-day average is not that great. An average of 15 on the Apnea Index and 34.5 on the Leakage. Is that typical of a first week? With that kind of leakage, should I definitely push for a different mask? Could I have caused that high a number just from my few times I moved the mask to get it more comfortable to to wipe up drool? (Gross visual there. Sorry!) Still averaging 15 apneas an hour, obviously there will need to be some tweaking by the doctor or is that acceptable since it's much lower than my apneas before treatment? I know, I know. I should just wait to see what the tech says on Friday, but I'm not very patient, guys. If anyone has any feedback for me, I'd sure appreciate it.

Thank you!

Peggy

Those are poor scores. AHI should be less than 5, with minimal to none of your AHI coming from the AI (apnea index). Most of my AHI is from the HI score...hypopnea index. To me, an AHI of 4 is still poor if my Apnea Index is 1.

Also your leak rate is poor. While techically not over the top, the general recommendation is the lower the leak the better. I feel best when my leak rate is below .10, definitely below .20. If it gets to .30 or more, I feel like crud for that day.

Looks like you have some tweaking to do somewhere.

Eric

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

[rested gal]

Also your leak rate is poor. While techically not over the top, the general recommendation is the lower the leak the better. I feel best when my leak rate is below .10, definitely below .20. If it gets to .30 or more, I feel like crud for that day.

You're using a resmed machine, Eric. Peggy (and Wulfman) are using Respironics machines. The two manufacturers figure leak rate differently.

Your machine has your mask's exhaust vent rate already subtracted (if you chose the correct mask in your mask settings options.) Their machines include the usual exhaust vent rate of most masks in the total. They don't have to mess with a "mask setting."

Your machine figures leak in liters per second.
Their machines figure leak in liters per minute.

For the machine, mask, and pressure she's using, Peggy's leak rate doesn't look bad, imho.

[Wulfman]

I don't have a 90% pressure number, I guess because I am not using the Auto feature, just straight CPAP, pressure of 11, ramp of 30 minutes starting at 5. Could it be all those apneas are occuring during the ramp period? Would it help if I bumped up the starting pressure of the ramp time?

Good to know that's not bad for leakage of the mask. I will try to quit fussing with it and see if that number improves. Seems like the darned things keeps slipping, though, so maybe I just need better headgear technique.

Oh. And, yeah, I messed up my terminology. It's the AHI index, not the AI index. Sorry! A lot of new stuff to learn with the new bed companion of mine.

Peggy

That explains (and eliminates) some possibilities.

I've never used Ramp, so I can't say from personal experience whether that lower pressure affects the numbers. I THINK it might affect the numbers but that would depend on whether you got to sleep during that 30 minutes or if it was misreading your "awake" breathing patterns. If you could skip the Ramp for a few nights, that might give some indications.

Den

[pjwalman]

I ended up with an average AHI of 10 when I went in for my one-week appointment with the DME. The apneas range from 1.6 to 9.2, most days being in the 3-5 range. Strangely enough, the 9.2 came from a one-hour nap, and it kind of skewed the average. The hypopneas range was from 1.3 to 3.8.

The tech was happy to let me trade out my small Quattro for a medium to save my poor abused nose bridge, and it seems to be working much better for me even though technically their measurements said I should be a small. And I got my new Hybrid over the weeked, so I'm looking forward to trying that out this week to see if I can handle it with the degree of stuffiness that is par for the course for me.

So, overall, the tech was pretty pleased with how the first week looked, was thrilled that I'd used the CPAP every day and averaged over eight hours (when figuring in naps), and I guess the next step is that she forwards it on to the sleep doc to see if he has any modifications. She made a note about the aerophagia problems I'm having, but I think that's pretty common when people start out. And also she mentioned to him that I'm wondering about the high amount of centrals on the sleep study, so now at least it's flagged and I can make sure it will be examined if it wasn't carefully examined previously by the doc that interpreted the study.

My EncoreViewer software and card reader came over the weekend, so I am looking forward to getting it installed today and figuring it out so I can start keeping track myself of what's going on.

Thank you again for all your support and help!

Peggy

[NightHawkeye]

My EncoreViewer software and card reader came over the weekend, so I am looking forward to getting it installed today and figuring it out so I can start keeping track myself of what's going on.

Good plan. That average AHI of 10 is way too high! They start people on CPAP who have AHI's far less than that. The software should provide some clues though.

Aerophagia, by the way, doesn't get any better the longer you're on treatment. You can get used to it though (sort of), or you can try to resolve it.

Regards,
Bill

[pjwalman]

Oh, crud! The aerophagia doesn't get better as you get used to the machine??? [Expletive!!!] I've been telling myself just to be patient.

I'm sleeping on two pillows to prop my head, I've raised my humidity, and I'm still getting up and walking bent over for a while and dealing with all the other lovely side effects which I'm sure you are quite aware of. Any tricks, NightHawkeye?

Peggy

[geoDoug]

The appropriate thing to ask, as Den would say, "Is this my therapy or yours?"

My followup to that would be asking with a smile on my face, "Let me ask you this: if this was your therapy, would you want the best therapy possible?" Any thinking human who understands the importance of health care will say yes. Then I'd ask, "Would you agree that knowing the information in the advanced menu is a necessity for good therapy?" (If they answer "no" to that one, simply ask them why the menu exists if you don't need the information.) The person asking the questions is the one controlling the conversation!

Good customer service is all about disarming people--usually through a smile and "killing 'em with kindness." It's one of the most valuable skills I've ever learned, since interactions are two-way. That means the same concept applies to both the customer and the company.

Doug.

[NightHawkeye]

I'm sleeping on two pillows to prop my head, I've raised my humidity, and I'm still getting up and walking bent over for a while and dealing with all the other lovely side effects which I'm sure you are quite aware of. Any tricks, NightHawkeye?

Just two that work consistently for me:
1) APAP mode
2) BiPAP mode

If your pattern of events is such that you don't require much pressure for a good part of the night, then APAP works. (I suspect that most folks fall into this category, but don't really know for sure.) The fewer hours you're being pumped full of air, the less aerophagia you get.

If your pattern of events requires a relatively constant pressure through the night, then BiPAP works by reducing pressure only on exhale. Result is again lower overall pressure throughout the night and so less aerophagia.

Regards,
Bill

[Wulfman]

Oh, crud! The aerophagia doesn't get better as you get used to the machine??? [Expletive!!!] I've been telling myself just to be patient.

I'm sleeping on two pillows to prop my head, I've raised my humidity, and I'm still getting up and walking bent over for a while and dealing with all the other lovely side effects which I'm sure you are quite aware of. Any tricks, NightHawkeye?

Peggy

This subject has filled lots of threads on the forum. I've never experienced it, but from all that I've read, the solution is very individualistic......and the spectrum being from lower pressure......straight CPAP......different APAP settings.......to Bi-PAP. (among many others)

If you go to the Search function and search on "aerophagia", you'll see what I mean.


Den