new member and cpap user

[flocof]

Hi there, I am wondering if anyone else has had a similar experience...I have recently been diagnosed with severe sleep apnea (60) I am in Australia and I had a sleep study then they lent me a S9Resmed autoset machine for 10 days to diagnose the pressure needed. I felt instantly better! much to the shock of the kids...I was the first one up every morning! unheard of in my house for many years. I used to sleep in and in and in on weekends, but never felt rested. Anyway, I then had to go to a supplier and they loaned me a machine for as long as I needed it . It is a Philips respironics cflex cpap, and the pressure is set at 13. However I do not feel as great as I did with the autoset. Do you think it is because of the machine? or maybe just that I got used to sleeping better? Don't get me wrong...I do feel a lot better than I used to and my AHI is now around 10. But I don't feel that wonderful burst of energy I did initially on the REsmed.
Thank you in advance for any information.

[josh73]

If you're like me, the EPR feature on the resmed helped a lot more than the CFlex I had during my titration night at the sleep lab.

[Pugsy]

AHI is now around 10

Your AHI is about twice what is generally accepted as satisfactory therapy. We like for it to be less than 5.

Check my signature line for your software options and links to SleepyHead. You can use it to get an idea what is going on with your therapy. We don't know what went on with the ResMed machine but I suspect you will feel better if you can get your AHI less than 5 and you may need a bit more pressure but you need to check your reports and make sure that leaks aren't the problem.

Please add your equipment to your profile so we can see it easily. Please use text because the images are small and we can't see model names.

Some people do find that they seem to do better with one machine over another. Different brands have different algorithms.

[flocof]

Thanks for that . I know the AHI is supposed to be around 5 or lower, but my doctor seemed satisfied with 10...! I have found out how to alter pressure, and already raised it from 12 prescribed to 13 and it made a huge difference, however when I tried to raise it to 13.5 I had leakage problems. I have made some cotton liners which help. However I will try to raise it to 13.5 again and see what happens. The data says that that there are no leaks.
I will look up what you suggested.

[flocof]

oh my! I have no idea what all that data you posted is about! way too technical for me
Actually I have figured out how to download the program, thank you sooo much !
I have uploaded data to the program and I do not understand what the readings are...Here they are for some help in reading them.
AI=7.82 HI=1.89 CAI=2.02 REI=1.01 VSI=0.00 FLI=0.00 PB/CSR=0.33%
Hope you can help!
Cheers

[Pugsy]

The % leak number showing on the machine's LCD screen is only the % of time spent in large leak. Pretty useless number because it takes a monumental leak (around 90 L/min) to be flagged as large leak.
I prefer to look at the leak line in the software reports to evaluate the leak or at least the average leak number.

Did you have any history of centrals in either one of your sleep studies? Don't know? You need to request copies of both of your studies.
Watch the ClearAirway events on your reports. If they start climbing very much if you increase your pressure then you need to back off the pressure.

Again please add your equipment to your profile...here's how
wiki/index.php/Registering_Equipment_in_User_Profile
Your machine will be found in the grouping beginning with PR System One....and is the PR System One Remstar Pro cpap with cflex..
Your mask....if we know what mask you are using perhaps someone could offer some ideas on how to prevent the leaks.

Play with the software. You will soon get a feel for it. Just look at the daily details. Look at the leak graph...does it spend much time up around 80 L/min? Look at the events graph...do you see clusters or groupings of events.? Do you see anything that might be when you were awake? Are you waking often?
Do you lay in bed fiddling with the mask a lot?
All that other stuff on the report can be put on the back burner for right now.
Just learn to evaluate the leak line and the events graph.

[flocof]

Thanks for your help, ok I have registered my machine and mask. I increased pressure to 13.5 last night and the CA increased from 2.02 to 4.16. Also leaks there are two lines the purple one varies from 0-28 . Last night my AHI increased to 15.5 with hypopnea 2.77 obstructive 8.57 clearairway 4.56
CA 33 events Hypopnea 22 events OA 68 events Pressure pulse 122 events RERA 1 event
Should I put the pressure back to 13 ?
I tried a gel liner last night and although it seemed to work in the beginning, I woke with a leak and took it off in the middle of the night and replaced it with my little home made cotton liner. That is the only time I woke up during the night. I only had one sleep study, I was wired up at the hospital and then slept at home. I was shown the data, but do not remember it. Apparently 95% of the time was on pressure 12 and that is what was prescribed, but I altered the settings to 12.5 felt better, then 13 and felt better still with lowered AHI.
Any advice will be much appreciated!

[Pugsy]

Your machine shown in your profile is the wrong one. In the equipment drop down menu look for the PR System One Remstar Pro CPAP with CFlex. That is the one to choose. I know that you don't have that older machine (long ago discontinued) because you are reporting CA Index and the older machine didn't score those events. If you will change it ...it will lessen confusion later if someone else chimes in.

Could you post one of your single nights daily detailed graph please? Instructions at the bottom of this post.

Your AHI points to probably needing more pressure for the obstructive events but I am concerned with the Clear Airway events which are open airway events (possibly centrals) and we don't want to make them worse with more pressure if these are related to the pressure. Don't increase the pressure any more for sure for the time being. There is a small percentage of CPAP users who develop centrals or open airway cessation of breathing as a response to the cpap pressure and will get worse if pressure is increased. You may or may not be in that small group but we sure don't won't to go killing obstructive events with more pressure and start populating open airway events.

I think you should advise your doctor about what is going on here. At least keep your doctor in the loop. He may or may not be concerned with the clear airway events.
Has there been any mention of central apneas in your prior sleep studies? What was your diagnosis?

Your Clear Airway (very possibly central) numbers are getting awfully close to where some concern will be present until either explained away or doctor is not worried. Some of those clear airway events may not be real...they might be when you are in sleep stage transition or semi awake. That is one reason I asked to see a detailed report...so we can get an idea when they are occurring. Are they in clusters or spread out over the night? Do you wake often during the night? Stay awake for a while if you do?

Here is how I post images of reports.
Open the image to full size so it is easily read.
I use Vista snipping tool to create a screen shot and crop the image at the same time.
Prt/scr key will also take a screen shot if using XP. If laptop is used sometimes the Fn key has to be pushed at the same time as the prt/scr key
I think windows 7 Home Premium has the snipping tool, Basic may not.
Once the screen shot is created save it in jpg format.
Upload the image to a host site. I use Photobucket it is free, there are others.
Once the image is uploaded then copy the ENTIRE IMG address. Be sure to include the opening and closing IMG in brackets. Paste that copied address into a post here.
Use the preview button. If you can't see the image try again because if you can't see it we can't.

[flocof]

Hi, I have just received my new machine in the mail. I now have a resmed S9 autoset with humidifier. I cannot wait to use it tonight! Hopefully it will be as great as it was before.... I am hopeful and very excited. That is why I have not followed through with the charts etc. I am hoping as it is autoset that all will be fine now..?? Will post tomorrow and let you know. My next appointment is not until three months time.
Thanks for all your advice and input.

[Pugsy]

Good luck with the Autoset. You can still use SleepyHead with it.
ResMed calls their clear airway events "centrals". So watch that number. If you are having pressure induced centrals the APAP may increase the pressure to treat the obstructive events and the centrals may increase. If the centrals aren't pressure induced then they shouldn't increase dramatically. No way to know for sure till you use the machine. If you need a lot more pressure to get the obstructive components down to acceptable levels (below 5 AHI not counting central index) and you see a marked increase in central index....tell your supplier and/or your doctor (don't wait 3 months) because APAP may not be the best option for you.

Get copies of your sleep studies...look to see if there is any mention of centrals or if your diagnosis has anything other than Obstruction Sleep Apnea in it.

[flocof]

Well I slept ok, except that I was so used to the noisier machine and mask that it took a long time to get to sleep . Then I don't know what happened because the sd card did not record any data and it seems I can't get the info from the machine either. Have looked at the card and put it on unlocked. Hopefully the data will download tonight...

[Pugsy]

The S9 machines are shipped with the default setting for Sleep Quality to "Usage" which will only gather hours of use data. You probably should go into the clinical menu step and make sure that Sleep Quality is set to "ON" so that the machine will show full data.
This may explain why no data from last night. Also when checking the data on the LCD screen be sure and check it before noon because at noon the LCD day begins again and it goes back to zero.

Here's how with pictures.http://www.apneaboard.com/ResMed/ResMed ... Setup.html
There is a video on your machine at the bottom.

You can request a copy of the Clinical/provider manual from this location. Just scroll down to near the bottom for directions. http://www.apneaboard.com/CPAP%20Adjustment.htm

[flocof]

Hi again...The machine wouldn't let me set time, so I had to erase data and reset time to Australian time as USA is totally different. Have reset everything now and should get data tonight. Hopefully I got everything right this time. The only thing I am unsure about is the EPR setting?

[chunkyfrog]

EPR= exhalation pressure relief.
Set at 1=1cm less pressure when you exhale; 2=2 cm; 3=3 cm.
At a 3, for a cpap pressure of 13, your exhale pressure is 10.
Nice comfort feature, especially when getting started.
Lots of folks turn it down or off after a while; I left it on.

[flocof]

Thanks for that, as it is an autoset machine, what should I set the EPR at? my non autoset machine was pressure 13.