Thanx + Questions

[PQG]

First of all, thank you all for emphasizing the need for a data capable machine. My sleep apnea was diagnosed as mild in 2005 and I have just been using a "jaw positioning device" until recently. A replacement dental device began irritating my gums and could not be corrected. So CPAP was next. As a Medicare patient I was required to have a recent sleep study; maybe because I had lost 30 lbs from 2005 to 2009 my AHI dropped from 17.4 down to only 5.4. But I guess because REM sleep = 0% I qualified for CPAP therapy. My sleep doctor says many with mild sleep apnea have been helped enormously with CPAP, and gave me a prescription for a basic machine (ResMed S8 Escape II per my DME), but due to reading this board I opted to pay the extra for an Elite II, plus got the RT to set up access to the Clinical menu.

I started CPAP a week ago and managed to solve some initial problems by re-reading lots of your posts. I had sinus surgery in 1995 (repair of septum, reduction of turbinates, removal of ethmoid sinuses) and recognized that kind of pain. Suggestions of nasal rinsing and benadryl at bedtime happily took care of it.

But now I'm flummoxed by the data I'm recording and hope you can point me in the right direction. I have recorded Efficacy Data but unfortunately can't make much sense of it (sorry, but can't afford the software right now). I don't know why my AHIs would shoot up from 5.4 to where they are below, nor do I know what to do with the Leak L/s info - I very much would appreciate some guidance, please.

Hope you can read this cut & paste from Excel (btw, forgot the benedryl on Thurs nite):

Tues Wed Thurs Fri
SMART
Mask Fit Excellent Very Good
Pressure 7.2
USAGE
Used Hrs 5 11 12 16
Usage 4/4 5/5 6/6 7/7
Usage 2.21 hrs 6.20 hrs 1:23 hrs 3:32 hrs
EFFICACY
Leak L/s 0.58 0.58 0.48 0.46
AHI 22.9 12.6 29.6 17.2
AI 7.2 3.1 12.2 7.6
HI 15.7 9.5 17.4 9.6

Also hope that my equipment info shows below - this is my virgin post so not so sure how it works.

Thanx so much for any help you can provide!

Pam

[Wulfman]

Hi Pam.

My intuition (and your numbers) tells me that you're probably mouth-leaking (nasal mask and high leak numbers).
I'd suggest either taping your mouth shut, using Polident adhesive denture strips to seal the lips or get a full face mask.


Den

[PQG]

Thanx Den - I rather suspected mouth leaks also but not sure why since the mask fit said "Excellent" and "Very Good" when I finally discovered it. I have tried to interpret the Leak L/s data without much success. Most everything I find I think is listed in L/min, and I can't quite get the conversion. I did notice this recent post about leak rates but again I don't seem to be able to compare the data to mine.

Here's one:

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

Thanx, Pam

[jules]

Resmeds report the excess in leak rate (95 %ile) over the mask in the machine menu. This is reported in l/sec not l/min

Say your leak rate was .50 reports, your pressure was 8 and your machine had "swift" in the menu.

Then you had a real flow rate of the machine of 0.50 * 60 + 29 or 59 l/min 5 % or more of the time.

These numbers are obtained from converting l/sec into l/min (multiply by 60), then adding on the leak rate from that chart.

The fit for the mask isn't measured when you are sleeping.

[Wulfman]

Well, assuming you have the correct mask selected in your machine, it will take into consideration the pressure and known "Vent Flow Rate" of the mask and come up with the numbers that it does...... "0.00" being no leaking. Numbers in the .20 or less are usually considered acceptable. Yours is about 2.5 - 3 times THAT. In any case, to convert liters per second to liters per minute, you'd multiply by 60.

Again, if you have the proper mask selected in the machine and you're getting no leaks, yours would be 0.00. Anything beyond that is "LEAKAGE".
Leakage can or will skew the other numbers. Gotta get the leaks fixed first because the loss of air pressure in the "circuit" is a detriment to your therapy.


Den

[PQG]

Thanx to Den and Jules both for your knowledge about such things... I figured converting seconds to minutes involved multiplication by 60, but the result didn't seem very useful either, nor did anything about the "CPAP Mask Leak Rates" chart. Does the software explain all of this or are you guys just incredibly smart? I searched "leak rates" and read newbie info but just couldn't find this kind of info anywhere in the forum.

Happily, the mask selection is indeed "Swift" so looks like I'm off to the drugstore tomorrow in seach of something like polygrip strips because for now I like the Swift LT for HER and am resisting the idea of a full face mask...

You guys are the best!

Pam

[Wulfman]

Jules and I are both Respironics machine users, so what we've "learned" about ResMed machines has been by osmosis from this forum.
I've heard mixed things about the ResMed software. Some say that an adequate amount of data can be seen from the LCD screen. Personally, from what I've seen of the ResScan software reports posted on the forum, it's very confusing to understand. Frequent users of it may have a different opinion. It DOES show more detail in many respects, though. To me, Respironics' Encore Pro and Encore Viewer is easier to understand (but that's beside the point for your situation).

There is another method (tape) that many use and that is the "blue, easy release painter's tape" available in hardware stores or in the paint sections of bigger "box" stores (as I've gathered). I understand that it's easy on the lips when removed.


Den

[jules]

Actually with the swift (don't know about the LT - just know about the original one) - the mask would come dislodged easily from the nares with tossing and turning. You might want to get a package of elastic or something else stretchy (panty hose leg, panty, tights) to hold the mask in place without blocking the exhaust vents.

[PQG]

Thanx again to both Jules & Wulfman for explaining all this stuff. And to others for the great suggestions I've been reading here.

Somehow I thought that all my CPAP issues to date would be solved by taping my mouth shut. The tape seal held just fine, but somehow my numbers this morning were even worse. I suppose this means that I need to just forget nasal pillows, and try another mask (my DME said the Liberty would be her next suggestion) but I would really appreciate any final tricks or tips anyone might have. Here are my numbers from Sat & Sun nights:
Sat Sun
SMART DATA
Mask Fit Good Poor
Pressure 7 6.8
USAGE DATA
Used Hours 20 24
Usage 8/8 9/9
Usage 4.22 3:19
EFFICACY DATA
Leak L/s 0.58 0.6
AHI 16 17.1
AI 6.8 2.1
HI 9.2 15

I have a small face and small nares (using XS pillow cushions) and I suppose that the mask is just shifting around after I go to sleep. I sleep on my side, position myself carefully on the pillow, and don't toss and turn. I also secure my chinstrap on top of the headgear to help keep it in position.

Any ideas that I can try since it is now clear the problem isn't mouth breathing.

Thanx, Pam

[riverdreamer]

Jules mentioned above, you might want to try adding and extra soft strap across the pillows on your mask. You don't want to block the vents, but give just enough support to the pillows to keep them from shifting when you move.

Do you have an overhead hose system? I have heard some people do better with their hose routed down, but I have fewer leaks when my hose goes straight up to my hose support. It seems to pull less on my mask. If you can find a post by rested gal, she has links to adding straps made from tight legs, as well as hose support systems.

I love my Swift LT! I hope you can find a way to make it work for you. BTW, I do have the Rescan software, and have found it very helpful in seeing how leaks and pressure relate to events. I think it is all a matter of what you are used to. However, the LCD does give lots of data, and if you can get your numbers down, the software isn't necessary.

[PQG]

I did read that post but think maybe I confused it with rubber bands pulling the pillows closer together. Do you mean something that would go underneath the bottom of the nasal pillows and would then be tied at the top of the head?

It did also occur to me to try switching to the "small" sized pillows, rather than the XS, to see if they fill up the space better. If the small size is uncomfortable then so much for that idea.

Should I try both ideas together or one at a time?

Thanx much, Pam

[riverdreamer]

It always works better to try one thing at a time. That way, if you have problems, you know which it was. I did find I needed a medium pillow with the LT, while I used a small with the Swift II. Won't hurt to try. If it is uncomfortable, you can switch it back, and try the strap idea. There are all kinds of options, but I was thinking of a strap going behind your head to stabilize the pillows, rather than the rubber bands holding them together, unless you think the pillows are too far apart for you. You don't need it tight, just enough to keep them from moving so easily.

Good luck!

[rested gal]

The others are giving you good suggestions about handling mouth leaks. And it does seem that the problem now might be the nasal pillows getting dislodged during the night (or at least on the night of tape, but leak of .58.)

You can see drawings of several ways to route a homemade strap to stablilize nasal pillows better, kind of cradling them, here:

Using homemade straps -- useful for stablilizing masks other than just the one shown.
Using one or two homemade straps with the Headrest nasal pillows mask.
http://www.tnlc.com/Lara/laura/osa/aura-strap6ways.jpg

And the best way to tie the extra strap -- holds well, yet is easy to adjust during the night and easy to untie in the morning:

DoubleStart Knot How to tie a flat knot behind head when using a homemade strap.
http://www.fieggen.com/shoelace/doublestartknot.htm

Another thing that I thought of, that might be causing your high AHI even if mouth leaks are controlled and the nasal pillows stay put -- do you have the exhalation relief called "EPR" turned on? If so, you might want to increase your CPAP pressure a full cm, or two, or three to match EPR's exact cm drop. Or, just turn EPR off if you can breathe out ok against the pressure you were prescribed.

The lower pressure EPR keeps in place for a certain amount of time (or until you start to inhale, whichever comes first) might be allowing your airway to collapse (apnea) so that you can't get a new inhalation started when you're ready to inhale. That might be why so many apneas are showing up on your data.

My thoughts (just opinion..I'm not a doctor) about EPR:

Nov 2008
viewtopic/t35923/viewtopic.php?p=310021#p310021

Aug 2008
viewtopic.php?p=289264#p289264

Oct 2006
viewtopic/t14479/viewtopic.php?p=121621#p121621

Oct 2006
viewtopic/t14479/viewtopic.php?p=121625#p121625

Dec 2007
viewtopic.php?p=231782#p231782

_____________________________________________

EPR and C-flex:
Aug 2008
viewtopic.php?p=289251#p289251

Feb 26, 2009
viewtopic.php?p=342731#p342731

[roster]

Welcome fellow Tar Heel,

Did your sleep study give you any insights on Positional Sleep Apnea? About 40% of patients are though to have PSA. With PSA, the patient's apnea is less severe sleeping on either sides or tummy as compared to back.

Once I knew that I had PSA, I was able to make some adjustments that made the CPAP therapy easier and more effective.

[PQG]

Oh my. Lots of suggestions so I plan on at least some of them doing the trick!

Although my AHI, AI and HI numbers were significantly better last night, the leak rate was still 0.58 L/s, the mask fit was "Very Poor" and for the first time I had rainout. I had been routing the hose down (and under the covers) but tried Riverdreamer's suggestion of routing it up over my head. Guess I'll route it back down & under the covers again (or get one of those hose covers for it).

Dang, I just now realized that I made 2 changes last night, instead of the recommended one at a time - I also changed out the nasal pillows from the XS to the Small ones (as well as re-routing the hose). The Small pillows seemed comfortable so will continue to use them. A related strategy will be to use one of those inventive straps that Jules mentioned - Rested Gal's excellent illustrations give me lots of options.

But the one I'm going to try tonight is Rested Gal's suggestion about the EPR settings. EPR has been set at 3 so I'll just turn it off entirely and see what happens. The problem seems bizarre but also makes some sense so we shall see... Would it be possible that this situation might also affect the machine's sense of time elapsed? For instance, last night I went to sleep around 1:00 AM (with the equipment) and work up close to 6:00 AM (when I took it off), but the machine only shows usage of 1.12 hours. It has reflected signficiantly less hours than I actually used it on several other nights as well. What could be going on here?

And Hey to Rooster in Sofa NC - I'm from Triangle, NC, and I'm definitely one of those 40% PSA types that does significantly better on my side. Fortunately I haven't moved around much once I've gotten the equipment on and settled in.

I'll report tomorrow about no-EPR effect!

Thanx, Pam