First Night w/ ResMed S9 Observations

[Perrybucsdad]

Well, first night done and I was able to keep the mask on all night... I consider that a major accomplishment. There were a few times I wanted to just take it off and go to sleep (assuming I would feel more rested without the machine than with), but I knew I had to get used to this one way or another so I stuck it out.

If you have been following my threads, you will remember that I had an AHI from sleep study of 23.3 and the doctor prescribed my range to be 4cmH20 - 14cmH20.

Last night, my AHI was 5.5 in that range. The 95% percentile flow was 12.5, Median at 9.4 and maximum at 13.8.

I did notice at times during the night that the device would wake me up and I had a sensation of being in a wind tunnel... I would assume from the data that this was due to the pressure increasing. I also had some issues with leaks when it increased the pressure. When I was fitted yesterday, the nurse had told me to not over tighten the mask as the Quattro FX needs to inflate with air and it seals the face with the air "pillow" that the mask creates. Tonight I plan on playing more with the Mask Fit feature of the S9 to make sure I have it where it should be. I did feel though that the mask was a bit tight, so I will have to experiment.

I had the humidity setting fairly low as I wanted to see how I would do, and although my lips were not dry, my throat was a little scratchy, so maybe up the humidity a little more.

I still had to get up I believe 3 times to pee last night, and some of the events, leaks, and pressure increases I can see timed with that. I also noted 2am and 3am in my mind as I know I was struggling a little at that time.

What concerns me though is the flow and the number of events last night. Some of the events I think are from my trips to the bathroom (does it count a disconnect of the tube as an event in ResScan?), but seeing all those double digit events (time length) has me a bit concerned. Should I leave the minimum setting alone tonight and give it another go, or should I increase the minimum up more near the median of 9.4 and then see what the AHI’s are tomorrow? This dumb Hungarian would think that in order to reduce the AHI’s you need to keep the airway open better and the best was would be to increase the min pressure. Thoughts? Below are a few charts of the details.

Thanks,

John

[Pugsy]

This dumb Hungarian would think that in order to reduce the AHI’s you need to keep the airway open better and the best was would be to increase the min pressure. Thoughts?

This is quite correct. When the minimum is too low the machine may not have adequate time to respond to events and they come and go before the machine gets to the needed pressure. So we have a little higher minimum to give it a head start.

Example.. I use APAP with 10 to 20 cm range. If I have the machine at 8 cm minimum I get a night like you showed. Improved from pre cpap but could stand improvement. 9 cm minimum helps even more but I still get a few clusters so I use 10 cm minimum and the clusters stay away and the machine sometimes goes much higher (18 cm) to deal with events on steroids. But most of the time I will be in the 12 cm range.

While we don't know where your sweet spot minimum should be. Obviously not 4 cm and frankly I would have been surprised if it had been. Your leak line is all over the place and it could impact the pressure somewhat. So that is a possible % pressure mitigating factor.

Sounds like you are going to be a hands on guy and I don't blame you. If this were my report (and I had one similar a couple of years ago) I would increase the minimum to 7 probably 8 and see how it goes.. I did all my adjustments without doctor input but when I went for 90 day follow up I told her what I was doing and why (I am worse in REM and sometimes those REM event are super hard to kill) and she said that I had done exactly what she would have suggested.

It isn't my place to tell you what to do.. only perhaps share my experience and thoughts and explain some of the whys.
Then let you make an educated decision on how to proceed.

[Perrybucsdad]

Thanks Pugsy... I wasn't looking for "this is what you need to do" but exactly what you stated which was here is what I did with mine and if I was on the right track.

I did send my data report over to the RT that is working with me to see what she says.

The one concerning thing I noticed though were all the central's that there were. I did have a brain hemmoragh back in 2000 and I'm flat out lucky to even be alive, and I think this is when most of my sleep apnea started (or got worse). I wonder if that may be part of the cause of the central's. It would be nice to understand better what causes them, so I'm going to be doing some research on that.

- John

[Pugsy]

If your centrals were much greater in number and occurring regularly every hour...then we worry but it is normal for some events to be classified as a central. If we turn over in bed it is common for us to hold our breath. The machine doesn't know what is going on past its sensors so it will flag a central when if this was a sleep study the tech would toss it out the window. Same thing with sleep onset centrals or sleep stage change centrals.

If you had a true central component (enough to worry about) the doctor probably wouldn't have prescribed such a range in pressures as the pressure increases could possibly make it worse.

[Perrybucsdad]

Thanks Pugsy.... so what about the slight scratchy/sorre throrat? Is that a possible result of the humidity being too low? I believe I had it on 3 (on a scale of 10 I think it goes up to).

[Pugsy]

so what about the slight scratchy/sorre throrat? Is that a possible result of the humidity being too low? I believe I had it on 3 (on a scale of 10 I think it goes up to).

Could be a little more humidity will help...but with full face mask and much mouth breathing some people just can't get enough added moisture in the air to offset the drying factor in mouth breathing. All depends on how much mouth breathing.

Sure wouldn't hurt to try more humidity though.

[Perrybucsdad]

I did notice as the night went on, my nasal passages opened up a bit and the nasal breathing was more comfortable. Being that I have a deviated septum, I didn't expect that. That was a plesant observation.

[Perrybucsdad]

One question for someone who understands the ResScan software better than myself.

In the Events chart (see below) what is the vertical scale represent? I thought at first it was seconds, but I haven't found anything that confirms that. Also, I would assume the number on the top of the event spike is the value?

[apneawho]

Dear Perrybucsdad,
You said you have an S9 Autoset but have S8 Autoset in your profile.

[Perrybucsdad]

Oops... need to fix that.

[rested gal]

In the Events chart (see below) what is the vertical scale represent? I thought at first it was seconds, but I haven't found anything that confirms that. Also, I would assume the number on the top of the event spike is the value?

The vertical scale for "Events" is in seconds, I think...as you surmised.

The number on top of an event spike is how many seconds that event lasted. The screen shot you posted shows two obstructive apnea events. One lasting 35 seconds; the other lasting 38 seconds.

[Emilia]

You could try using Biotene spray or gel to help with the dry mouth..... http://www.biotene.com/

[Perrybucsdad]

Interesting... I'll have to look for that. Do you use it before or after going to bed?

Also, my throat is now quite sore, so I don't know if I'm just coming down with something or what... great. It's that time of year I guess.