AI and new machine

[raylo]

Let's see, it has been over a month. I finally got the software for my S8Elite II. It showed my really bad leak rates in the first fewdays (flexifit 407), then somewhat better leak rates after new masks (actival LT and micro- huge improvements for me) .In those early days my AI (not ahi) was mostly in the .6 to 1.0 range, even with pretyy high leak rates. Then they turned on the EPR like they were supposed to in the first place. My AI rate started to sneak up with EPR set on 2, it got to between 1.6 and 2.2. I went another week or so and had follow up vist with Doc. He had them turn on my access to EPR (I was about to do it myself, but held back because I knew the follow up was coming). He also turned my pressure up to 9 from 8. My leak rates ranged .2 to .4, so I decided to try the Swift LT. Much, much more comfortable and less leaks.

Anyway, I turned EPR down to 1, figuring that would always give me at least 8. My AI stayed alittle high right around the 1.6 to 1.8 range with a couple of spikes until I really figured out the Swift (leaks now range .06 to 0.0). I turned off the EPR altogether and had an AI of .6 for one night. WooHoo - I'm thinking I have this thing nailed. the next two nights 1.8 and 1.6, dang.

Now for more info, my AHI even on the resmed has been in total 9.0 or less. The apneas seem to occur (on the four nights I had detailed data) at nearly hourly intervals with some clusters.

I feel better than I did before cpap, but not as good as I sometimes have since it started. I'm having some daytime sleepiness.

My questions: should I fret over these apneas? Is there a chance that just continuing the way I am will eventually calm things (in my titration in the sleep lab 8cm led to 0 ahi)? If I do chase them, how best to do it?

I am going to buy a second machine, out of pocket (I do some travelling). Should it be an auto? If I do get an auto - do I save on software and go with the resmed or should I get an Intellipap or a Sandman auto?

Any advice/help would be appreciated.

[mindy]

Hi,

Personally, I wouldn't sweat the small difference in AI between the settings -- they're all under 5. IMHO, we all seem to respond a little differently and I don't shoot for 0 AI although I seem to be getting closer. Also, a reminder to change settings no more often than once a week or, preferable, 2 weeks.

Buying an Auto doesn't do any harm because it can be used in either mode (if you can set bottom and top pressure the same or there is a setting for CPAP mode, you're all set). There may be a bit of a higher price to get the auto but you will then have the most flexibility.

As to which brand --- I have only used the Respironics Auto with A-Flex and Sandman Auto and prefer the latter. It seems like quite a few people like the Intellipap, too.

Mindy

[rested gal]

I feel better than I did before cpap, but not as good as I sometimes have since it started. I'm having some daytime sleepiness.

There can be soooo many reasons for feeling good/not so good on different days. Or for having some daytime sleepiness. CPAP (autopap, in your case) can be doing its job like a champ, but other factors be making a person feel sleepy, or not energetic. Could be the result of poor sleep hygiene, extra stress in one's life, or health/medication issues that have nothing to do with how the OSA therapy is going.

My questions: should I fret over these apneas?

I wouldn't. It wouldn't be concerned one bit to see my AHI varying 2 or 3 whole points from night to night. Your variation in numbers isn't much variation at all. Good to hear that you nailed the leak problem you were having. Good to hear that your doctor upped your pressure to 9. And very good to hear you are well aware of how your EPR setting could have an impact on what pressure you're really getting at the end of exhalation. You've been doing your research, for sure!

Is there a chance that just continuing the way I am will eventually calm things (in my titration in the sleep lab 8cm led to 0 ahi)? If I do chase them, how best to do it?

I wouldn't chase the few apneas you're seeing on your home data at all. Our treatment machines at home are not measuring or marking things the same way it's done in a sleep study. Looks like your AI is plenty low enough at home. I'd relax and not worry at all about the variations you've been seeing in your data.

I agree with Mindy. The slight variations you've posted for your Apnea Index look perfectly reasonable, normal, and to-be-expected to me. Wouldn't bother me at all. If I saw those numbers, yet felt daytime sleepiness creeping back in, I'd not be worried about my cpap treatment. I'd figure that was working effectively. I'd turn my attention toward other things -- other possible medical issues (low thyroid, perhaps? GERD? anemia? back, hip, or shoulder pain interfering with good sleep? the list could go on and on...)

Could be simply that sleep hygiene needs to be worked on:
http://www.evms.edu/sleep/disorders-hygiene.html

An online sleep hygiene test:
http://psychologytoday.tests.psychtests ... gTest=1329