What can I do?

[kuc-zzz]

I've been on CPAP for about 2.5 - 3 months now, but I still cant seem to get my AHI numbers down. I dont have any software yet, so i've just been reading the numbers off the LCD display every morning. I would greatly appreciate any helpful suggestions to get my numbers down!

Nov 23 leak - 0.04 AHI - 6.7 AI - 2.2 HI - 4.5
Nov 24 leak - 0.06 AHI - 7.3 AI - 1.4 HI - 5.9
Nov 25 leak - 0.04 AHI - 8.0 AI - 2.5 HI - 5.5
Nov 26 leak - 0.16 AHI - 6.5 AI - 1.6 HI - 4.9
Nov 27 leak - 0.06 AHI - 7.7 AI - 1.3 HI - 6.4
Nov 28 leak - 0.04 AHI - 9.2 AI - 1.4 HI - 7.8
Nov 29 leak - 0.00 AHI - 10.2 AI - 2.9 HI - 7.3

These numbers are typical of what I have been recording over the last couple of weeks. To a novice like me, it doesn't appear as if the leak rate with my Swift LT is an issue. Please Help!!

[RipVW]

Hello & Welcome, kuc-zzz! Glad you found this forum--SO much useful info and SO many helpful people here!

Your AHI might be due to incorrect pressure settings. I used my CPAP for over a year with the sleep study titrations before I found this forum, learned about data, then got an auto titrating machine that determined my old pressure was no where near what it needed to be to provide therapy and lower my AHI. My AHI averaged around 9+, now it's averages 0.4. Good luck!

"You are getting sleepy . . ."

[nightjar]

I've been on CPAP for about 2.5 - 3 months now, but I still cant seem to get my AHI numbers down. [. . .] I would greatly appreciate any helpful suggestions to get my numbers down!
[. . .]
These numbers are typical of what I have been recording over the last couple of weeks. To a novice like me, it doesn't appear as if the leak rate with my Swift LT is an issue. Please Help!!

I'm not sure how to interpret the leak readout on an S8, but others will know. I'll bet you're right, though, that it's not the mask.

What pressure is the machine set at? And is that figure what you were titrated at during your study, or have you made adjustments?

The folks who really know this stuff--and there are quite a few of them, though they don't always agree--will want that info, and probably a few other bits of data.

My guess, though, is that your pressure setting could go up at least a bit. But I'll let someone with more experience give you some real advice.

If you don't have a provider manual for your machine, let us know, and someone can send you one. (I may have instructions, but I don't think I have the particular manual for the machine.)

Nath

[Snoredog]

increase pressure by 1 cm until AI=.8 or .6
keep leak no higher than .06L/s
multiply leak rate by 60, compare to mask chart for pressure used.

[alnhwrd]

kuc-zzz,

What mask do you have selected? I don't know if the Elite II has the option of selecting the LT, the Elite that I have does not but the II might. Go into the mask selection section of the Clinician's menu and check to make sure it is. If so, your leak rate is fine. If not then it should be set to "Standard". (To access the Clinician's menu, press and hold the right and down buttons at the same time for a few seconds then scroll through the options. If you want to make changes, then please be sure to write down your current settings before doing so, so you can change them back if needed).

If leaking is not causing the high numbers, then you might benefit from a pressure adjustment. What pressure are you at now? How much are you sleeping? And how do you feel?

If it were me, I would adjust the pressure up .5-1cm for a week and see what happens. Then try it again until you get your AHI under 5.0 or your AI under 1.0. Remember that it is a Resmed, and they tend to inflate the HI numbers a bit, so I would focus on AI. Hope this helps.

[kuc-zzz]

Thanks for the warm welcome RipVW!

Nath, my machine is set at a pressure of 8. I have never gone into the clinicians menu to try and change any of the settings due to fear of screwing something up. I do have all the literature that came with the machine.

Snoredog - I'm sure I can find out how to access the clinicians menu on this forum and increase my pressure, but should I keep increasing it by 1cm H2O each night until my AHI comes all the way down? Or am I better off waiting a few days between pressure increases?

[nightjar]

Nath, my machine is set at a pressure of 8. I have never gone into the clinicians menu to try and change any of the settings due to fear of screwing something up. I do have all the literature that came with the machine.

It sounds as if you might have the clinician's (provider's) guide, but if it's not among the literature, I think alnhwrd posted instructions you can follow. (If you got the machine from cpap.com, you'll have the guide. If you got it from a DME, you almost certainly won't.)

Snoredog - I'm sure I can find out how to access the clinicians menu on this forum and increase my pressure, but should I keep increasing it by 1cm H2O each night until my AHI comes all the way down? Or am I better off waiting a few days between pressure increases?

Snoredog knows his stuff, and I'm sure he'll respond at some point. If it were me, though, I'd go with the 1 cm increase for a week or a few days, anyway, just to see for sure what it's doing. Seems to me that results from one night could be an aberration, so it's better to have a few night's data. Which, I think, is what alnhwrd's thinking probably is:

If it were me, I would adjust the pressure up .5-1cm for a week and see what happens.

Let us know how it goes . . . and welcome to the forum!

nath

[Julie]

Hi, you're wearing a nasal mask, and that's as likely the problem as anything else because a lot of us don't know (unless someone's told us) that we fall asleep, our mouths fall open and all the good Cpap air goes straight out, which is kind of pointless and useless. You need to look into a full face mask (the kind that not only covers your nose... as your mask actually doesn't even do, but also covers your mouth, so when it's open, you can still have full benefit of the machine). People also use special tape to keep their lips sealed overnight, and chin straps, but the straps aren't supposed to do a very good job as air can still leak out.

[kuc-zzz]

Alnhwrd, I do have the swift mask selected on my machine and I have done the "mask fit" procedure to make sure everything is dialed in properly.

I was experiencing some mouth leaks early on, so I ordered a hybrid mask. Unfortunately i just couldn't get used to the hybrid as I'm a side sleeper and I kept getting leaks! The hybrid also feels so heavy and cumbersome on your face compared to the swift LT. I have been focusing on keeping my tongue pressed up and back against the top of my mouth and I think this has done wonders to lower my mouth leakage based on my nightly leakage numbers.

I raised my pressure to 9cm H2O last night, but did not notice much of an improvement. I will give it a couple more nights before increasing the pressure again if the AHI numbers dont come down.

Stupid question - could too high of a pressure cause a higher AHI?? The prescription form my sleep doctor originally said 6cm H20 and gradually increase to 8cm H2O. The DME just set my machine for 8cm H2O right from the start...

[ozij]

Stupid question - could too high of a pressure cause a higher AHI?? The prescription form my sleep doctor originally said 6cm H20 and gradually increase to 8cm H2O. The DME just set my machine for 8cm H2O right from the start...

Very good question, the answer is yes! When we are not used to pressure blowing in, some of us may respond by not attempting to inhale - this is called a "pressure induced" apnea, or pessure induced central apnea. While it is true that most people do need more pressure, you may belong to the smaller group that needs less.

Your leak rate is excellent - no need for any multiplcation when a Resmed machine has Resmed mask dialed in.

Are you using the EPR? Does your machine report your average pressure? EPR causes a drop in exhale pressure - for some peole this drop lets apneas happen in exhale, and cacelling it gives better treatment for them.

Without having further data or info, if it were me, I would start with the doc's recommendation (without EPR): I would go back to 6, keep track of how I feel and of the results. If it not worse than now, I'd stay there - for a week or (preferrably) two since you may see improvement after a while.

If 6 is distinctly worse, don't stay there. Try 6.5, and repeat the above. For some people, a 0.5 cm increase is meaningless, for others it makes a difference.

Do you know why the doc. gave that recommendation?
O.





I

[maxhal]

My leak numbers and AHI numbers are alot like yours with my Swift II Nasal Mask. I upp'd my pressure to 13 from 12 with no change in results using the Swift. I also have a couple of FF Masks, which lower my HI numbers considerably. My AI's are around 1-2 with Swift but HI are around 6 - 8 nightly. It has to be the mouth coming open at night since my FF numbers are AI's at around 0-1 and HI's at 1-2. I put my pressure back to 12 without much change in results for either Swift or FF.

Taping the lips is annoying for me, doesn't get me the results I want, so I am waiting to try the pursleep PAP CAP chin strap to keep my mouth closed and my Swift numbers down, cause I love the nasal pilllow mask, but for now FF is a sound sleeping alternative.

[maxhal]

PS

There are instructions on how to modify your Hybrid on here, taking off the chin guard etc, etc. I have done that but haven't got it quite right yet. The Mirage Liberty is the FF Mask that I have a lot of success with , and I side sleep with no problems, no leaks, and what I have noticed in the last few days with the Liberty is that I have absolutely no face marks in the morning and I feel like it is pulled pretty tight to my face. Side sleeping brings out the mask marks something wicked, especially in the Swift, but I am really surprised with the Liberty results. I find the Liberty very similar to the Hybrid, I just can't get the Hybrid to stop leaking for me.

Try the Hybrid mods courtesy of Rooster viewtopic.php?f=1&t=14422&st=0&sk=t&sd=a