Frustrated with Inconsistent Results - Any Advice?

I have been using my setup (S8 Elite II, Mirage Quattro full face, H4i) for over a month. My machine was set at pressure = 6 for the first month with these results:

• Monthly average:
  Leak = .10 (daily numbers vary from .00 to .22
  AHI = 15.9 (daily varies from 7.4 to 27.3)
  AI = 7.2 (daily varies from 1.2 to 13.9)
  HI = 8.6 (daily varies between 5.2 to 15.7)

There has been no correlation between leaks and the other numbers. Some of my lowest numbers occurred on nights with higher leaks. Average nightly use is 7.5 hours.

After seeing these results, my doctor increased the pressure to 8, and my numbers rose. The best night on the new pressure was:

• Leak = .00
  AHI = 22.4
  AI = 11.6
  HI = 10.8

I have researched this site for help and still can't make sense of my results. Any suggestions?

I think the resmed machines count more hypopneas than other machines. The apneas are more troubling.

Have you seen any trending ? Gradually getting lower or higher? Numbers taken while you are awake will be off - as you use it more you should get better numbers. Did you see this trend on your lower pressure? IT might take a while to get used to higher pressure, I suppose.

Sounds like you should go back down on pressure?

If you had the software you might see that there are certain times that shoot up your AI - which might give more insight.

Just a few uneducated guesses...

"Have you seen any trending ? Gradually getting lower or higher? Numbers taken while you are awake will be off - as you use it more you should get better numbers. Did you see this trend on your lower pressure?"

There was no trending. It would go up or down by the day. Both the best and worst numbers were in the last week on the old pressure.

Do you use EPR? If so, what setting? If you're using EPR, at a pressure of 6 or even 8, you're getting less (and very little) therapy pressure when you exhale.


Den

"Do you use EPR? If so, what setting? If you're using EPR, at a pressure of 6 or even 8, you're getting less (and very little) therapy pressure when you exhale."

Yes, EPR Level 3, Inhale = Medium. Should I try it with the EPR off?

Wulfman wrote:Do you use EPR? If so, what setting? If you're using EPR, at a pressure of 6 or even 8, you're getting less (and very little) therapy pressure when you exhale.

Den

Does one need therapy when one exhales? I have never heard that before - but I have never heard a lot of things!

Was there are reason for the EPR being engaged? I know my doc specified that it be turned off. I don't know his reasoning for this but I can say I don't have any cardiac issues. Actually, I find EPR effective if I use nasal pillows but not effective when I used a full face mask. Reducing your EPR setting might be something to try.

dkdc wrote:

Wulfman wrote:Do you use EPR? If so, what setting? If you're using EPR, at a pressure of 6 or even 8, you're getting less (and very little) therapy pressure when you exhale.

Den

Does one need therapy when one exhales? I have never heard that before - but I have never heard a lot of things!

Absolutely! The principle of Bi-PAP/Bi-Level therapy is that you set your EPAP (exhale) pressure where it treats/eliminates apneas. Since ResMed machines are like mini-Bi-Level machines (where they actually drop the exhale pressure by a set number of centimeters of pressure), they follow the same principle that applies to Bi-Level machines. Anything (exhale pressure) less than that (for whatever reason) is ineffective therapy.


Den

HalleysMom wrote:"Do you use EPR? If so, what setting? If you're using EPR, at a pressure of 6 or even 8, you're getting less (and very little) therapy pressure when you exhale."

Yes, EPR Level 3, Inhale = Medium. Should I try it with the EPR off?

Only if you want better therapy. Otherwise, if you "need" EPR (and I can't imagine why at those low pressures), you need to raise your CPAP pressure (at least) by the number you're using for your EPR setting.


Den

Wulfman wrote:

dkdc wrote:

Wulfman wrote:Do you use EPR? If so, what setting? If you're using EPR, at a pressure of 6 or even 8, you're getting less (and very little) therapy pressure when you exhale.

Den

Does one need therapy when one exhales? I have never heard that before - but I have never heard a lot of things!

Absolutely! The principle of Bi-PAP/Bi-Level therapy is that you set your EPAP (exhale) pressure where it treats/eliminates apneas. Since ResMed machines are like mini-Bi-Level machines (where they actually drop the exhale pressure by a set number of centimeters of pressure), they follow the same principle that applies to Bi-Level machines. Anything (exhale pressure) less than that (for whatever reason) is ineffective therapy.

Den

I still don't get it - but that is ok. EPR seems to make it much more tolerable for me. I guess since I don't bipap I don't understand those machines. My epr setting is just a cm lower than my initial pressure setting - so maybe you are right.

Have you tried lowering or turning the EPR off? My husband's Respironics machine uses the Flex feature(same as EPR) and he did much better at a pressure of 12cms when he lowered it gradually and then turned it off completely. It didn't seem to match his breathing pattern. One of Den's many suggestions I followed with success.

i noticed that as your pressure increased your leak average decreased. i think this would make your machine more accurate in recording events. so it may be that you're just now getting into better therapy which is giving you a clearer picture of what you've been dealing with all along.

after 3 months of basically working with the pressure, humidity, leaks, etc. i think i finally have it all worked out and have it set up right for me. lately, i have also noticed an increase in my AHI. then again, i have also put on about 10 lbs lately so that might be part of the equation.

but, more important than the numbers, i feel like i'm getting better sleep and feeling better overall.

so, for now, i'll just keep things as they are and monitor how i feel. maybe in another month or two, i'll revisit the point, especially if i can lose some weight.

hope this helps!

I've got the same cpap machine as you have, and to me, your AHI seems pretty high.
I'm no doctor, but to me, I think you need to raise your pressure. Check with your doctor first, (of course!!!) but a pressure of only 6 doesn't sound like you're getting much benefit of your therapy.

Komodo wrote:I've got the same cpap machine as you have, and to me, your AHI seems pretty high.
I'm no doctor, but to me, I think you need to raise your pressure. Check with your doctor first, (of course!!!) but a pressure of only 6 doesn't sound like you're getting much benefit of your therapy.

It was 6 and then it was raised and the ahi got worse