VPAP Numbers

[lakeoso]

I was hoping someone might be able to look at some numbers from my partner's vpap and tell me if it is working or not. I do not think it is based on the "whistling"/"Wheezing" happening intermittently thruout the night... We have tried tightening the full-face mask but then it hurts...

The numbers being reported are:

Apnea Index 7.1
Hypopnea Index 0.4
AHI 7.5
Obstructive 2.4
Central 4.5
Unknown 0.0

Device settings:
Therapy Mode: VAuto Pressure Support: 4.0 CmH2O Min EPAP: 8.0 cmH2O
Max IPAP: 13.4 cmH2O
IPAP -cmH2O
Median: 13.3 95th percentile: 13.3 Maximum 13.3
EPAP -cmH2O
Median: 9.4 95th percentile 9.4 maximum 9.4
Leak - L/min
Median: 14.4 95th Percentile: 16.8 maximum 22.8
Tidal Volume - ml
Median: 620 95th Percentile: 980 Maximum: 1560
Minute Ventilation - L/min
Median: 15.4 95th Percentile: 34 Maximum:37
%Spontaneous cycled breaths: 98


No one seems to be concerned that these are wrong, but sleeping next to him, I am, I dont think its set right or working right but I am not educated enough to look at these numbers and know anything. Any thoughts on this would be GREATLY appreciated.

[RandyJ]

Assuming that your VPAP is an S9, if you go to that screen that displays results, change "1 day" to "1 week" you can see average results for past 7 days. Those numbers might be more useful.

It seems pressure was maxing out this one night, but there were also some centrals, so before making changes it might be useful to see 7 day average data.

[LakeOso]

Thanks, randyj.

I went and looked at the info screen (it is indeed a S9 Vpap Auto) and changing the report from 1 day to 1 week shows an identical AHI of 7.6. Just looking at all the numbers on this site that still seems high, but this is HALF what it was when they changed the min epap 5 and ipap to 20 and pressure support to 4. The sleep clinic seems to be fine with this, but sleeping next to him, I can TELL things are not o.k... Here are some screen captures of the resscan, so really, any information is good, even if its that i am worrying over nothing...

[RandyJ]

It sounds like leaks might be an issue, even though the average is under 24L/min. You might want to look into a mask liner from padacheek.com that will allow you to tighten, if necessary, without it being painful. Some of the whistling/wheezing you are hearing could be mask leaks.

My gut tells me that a little more EPAP and IPAP are worth trying, as long as the central index does not go above 5. However, there are more experienced users than me (Pugsy is one) who will read this and perhaps comment.

So hold off on making any changes until others comment in this thread and can give their input.

I will check back to see posts later...

[Pugsy]

The presence of the yellow events..unknown apneas...usually means a big leak...big enough that the machine can't tell what type of apnea it is.

Could you show us the leak line graph?
Also the pressure line graph?

The obstructive apneas we would address with a little more EPAP (assuming that leaks are removed and the OAs are from less than optimal EPAP pressure and not simply less than optimal pressure due to leaks being big).

So leaks need to be addressed first...mask liner...different mask????
Then if leaks are staying below 24 L/min for the bulk of the night and obstructive apneas are still predominant...maybe EPAP at 9 instead of 8 will do the trick. I don't think it would take much more EPAP to do a better job preventing the OAs and hyponeas.
The Centrals we just keep one eye on for right now...we don't treat them with more pressure and unless you start having a LOT more of them we don't normally do anything about them.

[RandyJ]

Increasing EPAP from 8 to 9 seems reasonable to me. After a week or so you could reevaluate.

This is the liner I used with my full face mask: http://padacheek.com/PAC_Maskliners.html

She has liners for most masks, just scroll down.

[LakeOso]

Pugsy,

Thank you for the suggestions! I have ordered another mask (A comfortgel full face mask) for him that will be here tomorrow and I adjusted the epap up to 9 from 8. And I took randy's suggestion and ordered some of those great pads (I wish I would have known about that place a year ago!). I will also monitor closely the central #. Honestly, why they don't give patients a way to do this easily is beyond me... I am also grateful for the folks that posted the link to Reslink because I would just not have known any of this without it.

I will post the leak and pressure line graphs on here tomorrow. And I really, REALLY can't thank you folks enough! Worrying has kept *ME* from sleeping so we were both a wreck.

[LakeOso]

Randy & Pugsy,

Adjusting the epap seemed to work perfectly... look at the difference last night...


and events:



That happened after adjusting the mask (using some tissue paper to reduce the stress points, but I did order the same thing you did, Randy, and it should be here in a few days) and increasing the Epap 1 point.

Those numbers are NIGHT and DAY comparatively and he seems to have slept a LOT better!

Again, I can not thank you enough for this. We have struggled with the sleep clinic for months and they kept indicating that everything was o.k. and that those numbers were fine, yet, I knew they weren't just by the sounds of hiroshima and nagasaki going off next to me. Then I was able to download the reslink software so I could look at what was happening and I knew it didn't seem right, but it REALLY is only due to you two that it seems to be fixed, so thank you, thank you, thank you!! I will, of course, keep an eye on the numbers from now on, but wow, what a difference, even I feel like I slept soundly for the first time in months!

[RandyJ]

That 1cm of increased EPAP seemed to do it... Pugsy was right on the mark there.

If that cluster of centrals around 5 a.m. was due to being close to waking, I wouldn't worry about them at all. The gold standard for successfully treated apnea is an AHI of less than 5, and if he feels good and rested (sometimes feeling rested takes anywhere from a few nights to months of successful treatment), all the better.

The mask liner from Padacheek really helped me with leaks, and it feels great between the mask and your skin.

[DoriC]

I know how it feels to finally be able to get some sleep after months of anxiety caring for my hubby's therapy. His data looks much better and you're lucky to have Randy and Pugsy watching over you! Now if I'm seeing only 4hrs of sleep(1-5) then you'll have to work on that. Good luck and keep us posted. BTW, I was awake most of last night because Mike was leaking all night and I couldn't fix it! Don't know why it happened but I don't get as anxious about it now. Pugsy taught me about "alien nights"!