Setting pressure with S8 autoset II

[rested gal]

My energy level has improved and I no longer make numerous visits to the bathroom. In fact I walked more than four hours yesterday around the city of Medellin stopping only for lunch. I don't own a vehicle and must walk to the bus and metro station... which I call forced exercise. My energy level is returning.

Glad to hear you are feeling an improvement in your energy level, Leo. Very good!

It appears the "Leaks" remain a problem however.

Yes, those leak rates of .46, .40, and .40 are not good at all. Something is still leaking air badly -- mask or mouth, or both.

If it were me, I'd try this first -- I'd try putting a homemade strap (or two) around the mask to see if stabilizing the nasal pillows better makes the leak rate drop to below .20.

Here's is a link to pictures of ways to route the extra straps:

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 a link showing how to tie the extra strap with a flat knot:

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

A leg cut from a pair of pantyhose tights makes a soft, stretchy homemade strap.

It also generally helps to have the main air hose hanging overhead, so the weight of the airhose doesn't pull at a mask when you turn over:

LINKS to Hose hangers and methods of managing the air hose
viewtopic.php?t=10640

Any suggestions on further changes would be appreciated. Should I drop the Max 15 to a lower number?

I'd keep the max at 15. I think it's good to have the max pressure set quite a bit higher than what the machine ever has to actually use for you. It's good to have an "un-needed" margin up there that doesn't even get used.

I wouldn't worry about the "HI" (Hypopnea Index) numbers. I do think you can probably get your "AI" (Apnea Index) down if you want to try increasing your minimum pressure. If it were me, I'd set the minimum at 10 or 11 cm H20.

First and foremost, though -- the leak problem needs more work.

If steadying the nasal pillows better with a homemade strap doesn't show drastic improvement in the leak rate, then you probably are leaking treament air out of your mouth (mouthbreathing in your sleep.) To find out if that's happening, you might want to consider tape over your mouth:

LINKS to: Mouth leaks - Air Leaks - Tape - DIY Guard
viewtopic.php?t=8011

I mouth-breathe during sleep. Tape is what I have to use, in order to not have to wear a Full Face mask. The Headrest mask you have is my favorite. That mask lets me sleep on my side with the side of my face snuggled down absolutely flat into the bed pillow. Taping my mouth each night, AND using a couple of homemade straps is worth it to me -- to have that kind of comfort with a mask.

[rbtgjns]

Night 9
Change of plan--been reading on the forum and decided to go for auto-mode with ERP @ 3 === actual min 13 when exhaling. Sleep study #3 pressure setting.

Autoset mode
Settling @ 10min
Min 16
max 20
EPR full time @ 3
pressure 95% 16
AHI 4.4
AI 0.9
HI 3.5
Usage 6:27 hrs.
mask activa--setting for ultra (tried ultra and found leaks too high, switched masks--forgot setting)
leaks 0.44 (forgot to clean activa mask before using and didnt wash face)

Conclusion---much improvement in AI & HI
PLAN----wash mask & face and repeat with all settings.

Sleep Quality--more rested..

[rbtgjns]

Night 10
Pressure @95% 16
leak 0.7l/s
mask activa
AHI 6.4
AI 0.8
HI 5.6
USAGE 6:52
setting autoset mode
min. 16.0
max. 20.0
mask mirage activa setting
EPR FULL TIME
EPR LEVEL 3

Sleep quality good
Plan continue with settings
Problem-- want to reduce mask leaks

[Colombia]

Rested Gal said: Yes, those leak rates of .46, .40, and .40 are not good at all. Something is still leaking air badly -- mask or mouth, or both.

Thanks for the information and links for further study.
I used masking tape last night in an attempt to check leakage via the mouth. I prefer sleeping on my stomach and have used a towel in the past to protect my mattress from liquid stains. I assume this is a result of breathing through the mouth.

I kept the mouth taped for most of the night with a noticeable reduction in "mask leakage". I plan to purchase something other than masking tape and continue with the testing. Again, the tape wasn't used the entire night since it became an irritant.

Question: What numbers I'm I looking for? Is the AHI the most important number?

Thanks again...

28 Oct

Press 10.8
Leaks .24
AHI 7.5
AI .3
HI 7.2

Usage 6:31

[TXLadybug]

I have this apap and am very pleased with it. Although, I have to say, I disagree with most of the folk's advice as to settings, based on my own experience only. Originally in Jan 09, I was titrated at a pressure of 11. I used the Resmed Autoset II w/ EPR set to 3, and it was fixed to cpap mode at pressure of 11. My AHI's regularly came in @ 9.0 and I still felt like a bus ran over me all the time. After several follow ups with my Sleep Dr./Pulmonologist, I was dissatisfied with my treatment and he was satisfied...... So, I solicited help from a knowledgeable apap user who helped me try several weeks of different settings.
After feeling a little better, I found another certified Sleep Dr. and made an appointment. I had the settings at 11 min - 16 max, and my stats were coming in pretty good - 5-7 AHI. Was gradually feeling better.

My new Sleep Dr. disagreed with this approach and we discussed and argued about it - Her philosophy was that I should not have a pressure of 11 being forced into my lungs full time, if this was not needed. I should only have the higher pressures going when the apneas/hypopneas required it. She said this apap was very good at sensing what was needed and getting things under control. I finally agreed to try it her way, but if it didn't work as well as what I had been doing, she would agree to change it back....She set it for min 9 - 20. My avg pressures now come in 13-14.5 daily. I don't have the software to track everything, but I do check my stats daily. My Avg AHI is now < 1.0 Yes, I really said less than 1.0 and my AI's regularly come in at between 0.00 and 0.5.

I also had a wise person tell me that changes should not be made more frequently than a week- as it may take your body that long to get used to the changes, and you cannot judge anything based on just one or 2 nights.

Good Luck!

[rbtgjns]

Hello to all---Interesting prior discussion about settings with outstanding results---wow. I gave this a try and it was not as successful. Autoset mode: min @9. max @20. ERP @3. Results pressure 12, leaks @ 0.16l/s (MASK ACTIVA WITH TIGHTENING STRAPS), AHI 12.9, AI 4.4, HI 8.5, USAGE 6.21 HRS. Quality--mildly tired.

So far best results have been with auto: min 16, max 20, ERP 3.

[rbtgjns]

Night 11

Autoset mode min 16, max 20 , ERP @3

PRESS: 16 @95%
LEAK : 0.36L/S TAPED MOUTH SHUT
MASK : ACTIVA SHALLOW
AHI: 9.2
AI: 2.3
HI: 6.9
USAGE: 8:21HRS
H3I HUMIDIFIER @ 3 W/AUSSI HEATED HOSE

NEW IDEA 5 POINT SCALE FOR SLEEP QUALITY--5=GREAT NIGHT SLEEP, 4=GOOD NIGHT SLEEP/ALMOST A 5, 3=ACCEPTABLE-NOT TIRED/FULLY AWAKE IN 10/15MINETS, 2=TIRED/TAKES 1/2 HR. TO GET GOING,BECOMES TIRED EARLY AFTERNOON, 1= VERY TIRED/LIKELY TO NEED A NAP IN TH PM.

LAST NIGHT SLEEP QUALITY : 3

[rbtgjns]

Night 12

autoset mode
min15,
max 20
ERP 2
pressure 95% @15
AHI 14.9
AI 2.4
HI 12.5
LEAK 0.40
MASK ACTIVA
USAGE 9.19 HRS

Quality-- 2 tired
Did Not Tape Mouth! Will tonight.

[Colombia]

Rbtgjns:

It appears we are both having problems reducing the air "leaks"
I've been taping my mouth for the last three nights which seems to help, but the leaks are
still high. I suspect my problem may be with the mask and "pillows" as I change positions during
the night.



31 Oct
Press 10.6
Leaks .30
AHI 4.7
AI 1.4
HI 3.3
Usage 7:30
I feel rested and no visits to the bathroom during the night.

[Guest]

Can I join this discussion with a question? I'm using a S8 autoset II and expected that it would always adjust itself to stop apneas, but the detailed graphs show that I have bursts of 10-20 or more apneas 2 - 3 times a night -- each burst lasts 1/2 hour or more. During these bursts there's not much change in leakage, and the auto pressure only changes a little -- not enough to stop the apneas. So I now think that I'll have to adjust it by increasing the min pressure and/or the EPR (which is currently = 3). I've increased the min pressure to 9 (after trying 6 and 7 which didn't help) , and will leave it there a few days before making any new adjustments. My main question is: what's the best approach to adjusting it -- change EPR first then work on increasing the min pressure, or the other way around, or both together? Also, why doesn't the S8 automatically increase pressure to stop these apnea bursts -- I thought that that was what it was supposed to do. thanks ...

[mike134x2]

Can I join this discussion with a question? I'm using a S8 autoset II and expected that it would always adjust itself to stop apneas, but the detailed graphs show that I have bursts of many apneas 2 - 3 times a night -- each burst lasts 1/2 hour or more. There's not much change in leakage, and the auto pressure only changes a little -- not enough to stop the apneas. So I now think that I'll have to adjust it by increasing the min pressure and/or the EPR (which is currently = 3). I've increased the min pressure to 9 (after trying 6 and 7 which didn't help) , and will leave it there a few days before making any new adjustments. My main question is: what's the best approach to adjusting it -- change EPA first then work on increasing the min pressure, or the other way around, or both together? Also, why doeasn't the S8 automatically increase pressure to stop these apnea bursts -- though that that was what it was supposed to do. thanks ...

[Pugsy]

My main question is: what's the best approach to adjusting it -- change EPR first then work on increasing the min pressure, or the other way around, or both together? Also, why doesn't the S8 automatically increase pressure to stop these apnea bursts -- I thought that that was what it was supposed to do.

You mention detailed graphs. It would be most helpful to see them. I would suggest that you start a new thread with your questions and also those graphs so that suggestions won't get lost here and it will be less confusing.

You didn't mention your maximum pressure. Do a search for forum posts here regarding the auto units A10 algorithm. There are some situations that the machine will not respond to events if the pressure is above 10 cm because the events may not meet certain criteria. This may or may not be what is going on with you. You may just need a little more minimum pressure or changing the EPR. Seeing the actual graphs helps rule out a few things.

[rbtgjns]

NIGHT 13
AUTOSET MODE
MIN 16, MAX 20
PRESSURE 16 @95%
MASK ACTVIA STANDARD
LEAKS .44L/S
AHI 10.3
AI 2.6
HI 7.7
USAGE 7:04 HRS
HUMIDIFIER @ 3
SLEEP QUALITY 2 TO 3
TAPED MOUTH CLOSED--PAPER TAPE
QUESTION---AT HIGHER PRESSURE DO LEAKS INCREASE?
Is there data that addresses this quesion?

[rbtgjns]

NIGHT 14

AUTOMODE 16 MIN, 20 MAX
ERP 3
PRESSURE 95@ 16
MASK ACTIVA NASAL STANDARD--HEADGEAR TIGHTER
LEAKS 0.28 (IMPROVED RESULTS)
AHI 7.4
AI 0.7
HAI 6.7
USAGE 7 08HRS.
SLEEP QUALITY 2 TO 3
TRIED RESPRONICS COMFORT GEL (S) LEAKS TOO MUCH W/O UNCOMFORTABLE TIGHT HEADGEAR

[rbtgjns]

night 15

autoset mode
h4i humidifier set at III
Aussi hose
min 16
max 20
mask ultra mirage II (thought had better results with this previously)
ERP @2
Press 95% @ 16
leaks 0.44l/s
AHI 10.7
AI 2.8
HI 7.9
USAGE 7:08
Quality-- 2 poor--back aches, slow to awaken
Plan--use activa mask (for comfort), see new sleep Doc. 11/12
question do I have the right CPAP machine--should I switch to CPAP mode--