compliance data help needed

[bnebz]

Please help to explain the compliance data from 12 day auto pap trial
AHI 8.3
average auto pap pressure 6.3
average 90th percentile pressure 9.5
% time at max set pressure 6%
average system leak 45 l/min
average 90th pcentile system leak 64 l/min
%time with excessive leak 11%
average number of sense awake detections 12 per night

my questions..the 90th percentile comparisons are they compared to all population or just his 90th percent?
if his % if average is 6.3 why is 90% up to 9.5?
system leak 45 l/min seems alot to me..yet insurance company refuses to pay or make dme try any other full face masks..(tried 3..f&P and hybrid, nose not an option )
is 11% excessive leak too much?
what should be done to lower AHI? cant hadle pressure rate bove 10..produces more leaks, central apneas, frequent mask adjustments, and poor compliance
this sese awake detections..is that the same as arousals?
thanks..just trying to figure what i should do now..my family doc is ok with this report..should i be?

[jules]

I would want to see graphs not just summaries.

the 90 %ile refers to your time. 90 % of the time you were at or below this number.

[alnhwrd]

Welcome! If you can, please fill out your profile, preferably in text, so that people can see what mask, machine etc you are using. That information allows for more intelligent answers to your questions, ones that contain fewer guesses .

The goal of CPAP therapy is to bring your AHI, that first number on your list, down below 5.0. If your machine can do this, then your therapy is considered to be successful. Without knowing the equipment you have it is difficult to do more than guess, but if you are leaking alot then the first step is to control those leaks.

I'm not a doctor, but if the machine is controlling 90% of your apneas at 9.5, thats probably where your pressure or range of pressures need to be set at or near. Since you have stuck with it for 12 days(congrats!), you can stick with it for another 12, and then the next 12, and the next. Unless your AHI was low to start with you are getting some benefit now, so please stick with the treatment and learn to overcome the hurdles. Good luck!

[Mike@TibroMedical]

those leak rates arent good, what F&P mask did you try? the hybrid is junk, F&P mask like the 431 were designed for high pressure and 10 isnt insanly high so that tells me that if you had the 431 you might have been wearing it to low on your face and it would leak, or if you had the 432 which im not a fan of either... What DME company are you with? I give out mask's to my new pt's all the time even if we cant bill need to get the mask that will help them be compliant, and resp, resmed, F&P, all have replacement programs that within in 30 days if there mask isnt good enough they will give the DME company a free one to replace it, so when you switch they arent out anything except time...

[neverbetter]

Surprised you would call the Hybrid junk... I have 14 masks in my drawer and the hybrid is by far the best one for me. My pressure is 18 /20 and I now have a little beard. The 431 wasn't the worst I've tried, either.
Everyone has that 30 day program that I know of.

[Hawthorne]

In my experience the Hybrid is not "junk". It works well for me. My F & P 431 also works well for me and my 90% pressure is 12 - average 11.2 (not extremely high). They are 2 of the few full face masks that work for me.

Masks are a very individual matter I have discovered after 7+ years treating my sleep apnea. What does not work well at all for one works very well for others.

[bnebz]

F&P hc234 unit, with full face mask of F&P also , believe it is 431, Pressure currently 9.5, sleep doc said to take a break due to hoarseness cused by auto pap...the masks have all been troublesome with freq leaks..every hour, and since i have chronic dry throat..this adds to it so i drink every hour..less sleep than before cpap, and no noted positive results from cpap... i have the uppp procedure in july, and gastric bypass in oct.. so i am thinking of returning all this and forgetting about it till i loose weight..maybe it will be all cured ? My dme stinks..only F&P units and 5 types of masks..if i return this and find i need it again it cert. wont be with this dme... i found out by reading their progress note that they reported to my insurance co that i feel better, can sleep all night and it is my spouse with the noise issues... none of which has been said so my insurance co is refusing any other masks or treatment changes...

[Mike@TibroMedical]

Surprised you would call the Hybrid junk... I have 14 masks in my drawer and the hybrid is by far the best one for me. My pressure is 18 /20 and I now have a little beard. The 431 wasn't the worst I've tried, either.
Everyone has that 30 day program that I know of.

I am sorry let me start over again, I forget my opinion's on mask are based off them being successful with pt's. I think the concept of the Hybrid is genius, but it can be a complicated mask and with senior's being most the people I work with they don't like it for some reason I do have some pt's with them but I usually get a call within a few days wanting to switch to something else. So I've learned to naturally avoid it lol. 431 is better then the 432 in my book. The quattro right now is my star player I love those things Resmed did good, same with the new Activa LT, that mask is INCREDIBLE!

[Wulfman]

Surprised you would call the Hybrid junk... I have 14 masks in my drawer and the hybrid is by far the best one for me. My pressure is 18 /20 and I now have a little beard. The 431 wasn't the worst I've tried, either.
Everyone has that 30 day program that I know of.

I am sorry let me start over again, I forget my opinion's on mask are based off them being successful with pt's. I think the concept of the Hybrid is genius, but it can be a complicated mask and with senior's being most the people I work with they don't like it for some reason I do have some pt's with them but I usually get a call within a few days wanting to switch to something else. So I've learned to naturally avoid it lol. 431 is better then the 432 in my book. The quattro right now is my star player I love those things Resmed did good, same with the new Activa LT, that mask is INCREDIBLE!

Mike,

Have you had many complaints about the Quattro leaking at the elbow? (front of the mask)
If so, what have you done about it?
If you'll do a forum search on "Teflon", you'll find alot of posts about the notorious leaking problems people have had with theirs and how they used the "Teflon tape fix".

I have a Quattro, too, but my favorite is the Ultra Mirage Full Face (UMFF).

Den

[Mike@TibroMedical]

Yes actually that is a common problem, the thing that fixes it for me is replacing the valve and cover that's in the elbow. They have to be in perfect shape and working perfect for their to be no leak. If that valve for some reason or another isn't opening all the way(which can be something as simple as just needs to be cleaned) it cause's a bottle neck which increase's pressure. So that pressure finds the easiest way out right at the swivel. that teflon Idea sounds like it would take care of the problem for good though I like that Idea!

[Hawthorne]

Your generalizatons about masks are what I was questioning when I commented that I liked the Hybrid.

You said most of your clients were seniors and they, for some reason don't like the Hybrid. I will be 70 years old next month. I bought the Hybrid, as my backup mask so I would have a full face mask when needed, abour a year ago. I really like it.

My point being, that you generalize too much about masks. When I commented on your post about the Hybrid earlier in the thread, I pointed out that masks are very individual.

Your statement about seniors is, again, a generalization. Seniors are also very different and individual. Generalizations , about masks or about seniors, is something that I have to point out again as not being a very effective or accurate way for a DME to view things cpap.

[Mike@TibroMedical]

I mean no disrespect by any means, but I have to disagree. generalizing is the only way to keep your head above water in my career. I do 50 mask fitting's on existing pt's a month, and 40 new setup's a month and in that month If I leave 20 hybrids with pt's that think they will like it and I get 16 of them back with in weeks wanting to try something else, It's my job to mentally note that. and Push a mask that has a much higher success rate and will still offer the same type May it be a Pillow's or nasal, Full face. Because it's my job to share MY knowledge with them and help them make a better decision. Like I said I have a few pt's that do like their hybrid. But to say "Generalizations , about masks or about seniors, is something that I have to point out again as not being a very effective or accurate way for a DME to view things cpap" I feel is completely backwards.

For example: I have a pt that come's in and wants to try an Opus pillows mask(red flag in my head cause not a good success rate) I would ask what it was they liked about the opus, usually they just want a pillows type mask. My next step would be to ask them questions about how they sleep? move around allot? sleep on your back more? or on your side more?

Now say this pt tell's me they don't move around a ton, and they sleep on their side most the night. I can take that info and tell them that their is a pillows type mask that would work allot better for you being a side sleeper it also has double the success rate then the opus.

Was that wrong of me to generalize that? Should I give him the Opus cause that's what he wants... Knowing that the swift 2 would be hands down better for him and less of a hassle....

Cause I wouldn't be doing my job if I did. I even profit more off the opus but Id still recommend the swift 2

now I apologize that I am bringing my opinions here I need to remember that I am not at work and that allot of people do have mask work well that I probably wouldn't have suggested lol. I mean no offense by it I swear!

[Hawthorne]

I understand that you mean no offence. None taken. I know that you are doing your job well when you share your patient experience with a particular mask with your patients and suggest possible alternatives. I'm just saying there is really no way to really tell if any individual, senior or not, may or may not have success with a certain mask.

I have read many very negative reviews on cpap.com, from purchasers of certain masks and I decide I will try it anyway and it turns out well.

I am just hoping that you say to your senior patients (or any age patients) that, while the Hybrid does not work well for some people, it does work for some and it may work very well for them.

I don't think anyone should "write off" a mask because a DME says it doesn't work or that most seniors don't like it.

To me, it would be better to let them trial it at home, say for a week, and come to their own conclusions. I have a DME who lets me do that regularly and I sure appreciate it. They charge me $20 to try it and they take it back in a week if I don't find it useful. They take off the $20 trial fee if I decide to keep it. I know they are not out much if anything, given the policy of mask manufacturers who supply DMES.