I slept last night! Day #3 report and Questions

Settings: 7-12 cm (changed from 4-12 cm) (Titrated Pressure 7-8 cm)
Hours: 9.9
AHI: 1.9
Mask: Swift FX for Her

Question: What AHI am I shooting for? Yesterday my AHI was 0.4 with settings 4-12 cm. Yesterday, I found the Leak information (4.5L/min) by accident. Today I can't seem to find that menu - where is it? What is an acceptable Leak range? Do I need to do anything with my APAP when I get up at night or just remove mask? I think this restarts ramp (which I have set for 45 min).

Comments: I slept! I did get up twice due to thirst. Do I need to reset Humidity? I really like the nasal pillows. I am much more encouraged today. Any comments, suggestions are very much appreciated.
I'll check in later. Thank you very much! Hugs, Laurie

Laurie, I believe the leak rate on your machine shuld be zero, as the intentioanl leak rate is already factored in whenyou set up what kind of mask you are using. Your leak rate, added to your nightime thirst, may indicate that you are leaking air out of your mouth while you sleep.

Laura, I asked you, in your other thread:

Laurie, get into your Clinical Menu and see what your settings are. The S9 Autoset has the option of setting "minimum start", which is your ramp pressure. What is your Minimum Start pressure?

What is your EPR setting--1, 2, or 3? And which option--Ramp Only, Fulltime, and Off.

I think these settings will make a big difference in how you feel.

Do you have a copy of the Clinical Guide?

A AHI of under 5 is considered "medically acceptable" for treatment of sleep apnea. Though many of us feel better if it's lower than that, but it's an individual thing.

The way that ResMed's report leak rate, ideally you want to strive for 0.0 leaks (I think that not many people get this every night), and there is some magic number below which leaks are not considered a problem (ResMed people will have to chime in here, but I think it's something like 12 LPM). So you are doing fine with respect to that.

The dry mouth may indicate mouth breathing, but the overall leak rate doesn't suggest it. You will have to pull your graphs up on the computer and take a closer look to see if the leak rates might have spiked a bit.

When there is mouth breathing, people turn to chin straps and taping, but if the mouthleaking is relatively minor you may get away with something simpler like cramming a pillow under your chin when lying on your side until you get more used to keeping your mouth closed.

Overall, that is an awesome night!!!!!!!!! You slept long and well (some people struggle to sleep for months after starting CPAP!) and your AHI was very good. You will probably see it come down even more as you get used to the machine.


Remember, it's how you feel overall, and not the specific numbers that really make a difference. So how do you FEEL today? Use the numbers as trends, not a day to day "grade" for your quality of sleep.


Finally, you can expect to have some good nights and bad nights. Eventually the good outweigh the bad, but the bad can feel very bad when you are experiencing them. Keep in mind that you will get to the point where you can simply strap the mask on and go to sleep. You are well on your way.

Laurie1041 wrote: Question: What AHI am I shooting for?

You're really looking for trending data in the long run. And in the long run, the lower AHI, the better. But be aware of the fact that different companies use different algorithms to detect/count events. In this early stage, let your AHI encourage you to keep using the machine----typically folks say anything under 5.0 is good, but the closer to 0.0 the better. But don't get real worried (yet) if that AHI is bouncing around a bit from night-to-night particularly if (1) the AHIs are staying below 5.0 and (2) if you're feeling any better. If your AHI is good, but you're not feeling any better (or worse), then try not to get discouraged. Some of us do go through a real (and sometimes long) adjustment period. I know: I'm five weeks into therapy, my AHI's are usually really, really good, but I'm still not feeling any better than I did before starting CPAP. And during the first two or three weeks, I felt much, much worse than I did before starting CPAP. My overnight AHI numbers and this forum have been s Godsends in helping me keep my eyes on the long-term prize of better health for the next 30+ years instead of my current discomfort.

Yesterday, I found the Leak information (4.5L/min) by accident. Today I can't seem to find that menu - where is it? What is an acceptable Leak range? Do I need to do anything with my APAP when I get up at night or just remove mask? I think this restarts ramp (which I have set for 45 min).

The menu you're looking for is found by:

Step 1: Press the info button to get into the standard, short Sleep Quality menu.

Step 2: Press the info button and the "double check mark" button simultaneously for about 3 seconds. You may notice a tiny flicker in the menu you're looking at.

Step 3: Use the big round knob to scroll down from the top icon to the second one. At this point you should see the top of the Sleep Report menu. The 95% leak rate is at the bottom of the LCD at this point on my S9.

Step 4: Click the big round knob to get into the Sleep Report menu so that you can scroll all the way down to see the rest of the more detailed sleep report, which will include your AHI, the AI, and the CAI for the night. Once you're into the Sleep Report menu, you can also change the "Period" of data you're looking at if you want. It lets you choose between 1 day (data from noon to noon), 1 week (7 night averages), 1 month, and 3 months.

As for leak rate, well, obviously the closer to 0, the better. But I've noticed that my leak rates have kind of automatically been getting better without my worrying to much about them. I think it's because the Swift FX is a really good mask for me and I don't breathe through my mouth. I will say that getting the software and looking at the detailed leak graph is really helpful in deciding whether or not you really need to worry too much about leaks. The software also will report your median leak rate and your maximum leak rate for each night. My median leak rate has been 0.0 right from the start and the graphs clearly indicate that on bad nights I typically have 3 to 6 leaks, each of which seem to last no more than 5 or 10 minutes. And almost all of those leaks are well, well below the magic "red line" the ResScan software draws at 24 liters/min, which is what the S9 and ResScan seem to use as the bottom figure for "Large Leak" as near as I can tell from the documentation.

Comments: I slept! I did get up twice due to thirst. Do I need to reset Humidity? I really like the nasal pillows. I am much more encouraged today. Any comments, suggestions are very much appreciated.

A higher humidity level might help the thirst. Also making sure you drink enough water during the day will help. I usually make sure that I drink a glass of water shortly before heading to bed too. That doesn't usually cause me any problems with waking up needing to go to the bathroom. But your mileage may vary.

It also sounds to me like you're off to a good start. I wish you the best of luck and sincerely hope that you have NONE of the problems I've been dealing with in my own adjustement to CPAP.

Laurie,
I think I personal messaged you about that manual, do you know how to check your messages?

glad you slept!

KatieW wrote:Laura, I asked you, in your other thread:

Laurie, get into your Clinical Menu and see what your settings are. The S9 Autoset has the option of setting "minimum start", which is your ramp pressure. What is your Minimum Start pressure?

What is your EPR setting--1, 2, or 3? And which option--Ramp Only, Fulltime, and Off.

I think these settings will make a big difference in how you feel.

Do you have a copy of the Clinical Guide?

A AHI of under 5 is considered "medically acceptable" for treatment of sleep apnea. Though many of us feel better if it's lower than that, but it's an individual thing.

Hi KatieW,
OK, I am reading the Clinical Guide and checking my settings. This is what I have so far:

Minimum Setting 7.0 cm
Maximum Setting 12.0 cm
EPR at "2" Fulltime.
Ramp is at 5.0 cm for 30 minutes. ( I don't see an option for Ramp Only, Fulltime, and Off). I'll have another look.
Leak data for last night is 14.1L/min.
AHI is 1.8

What exactly does "Leak" refer to? Is it a leak from the nasal pillows or my mouth or both?

Any information would be greatly appreciated! Thanks, Laurie

What exactly does "Leak" refer to? Is it a leak from the nasal pillows or my mouth or both?

The S9 takes into account the expected leak rate (needed for exhaust flow) from the mask into account before reporting the leak numbers. So the (positive) leak number that is reported is from *any* kind of a leak that is above and beyond the expected exhaust flow leak number. The machine can't determine whether the larger than expected leak is because there's air blowing out your mouth or whether one of the nasal pillows has gotten jostled and is no longer properly sealed against your nostril.

To figure out whether you're mouth breathing or not, you'll likely need to look at the detailed Leak Flow graphs in ResScan. Are you leaking all the time? Or only part of the time? How long is the biggest leak? If the biggest leak is not that long and the maximum leak is not that high, you can probably ignore the leak rate for now. But if you're leaking all night long, you probably want to do something about it. That's my two cents.

Those numbers look great! An AHI of 1.8 is fabulous! Your leak rate is fine, as all masks have an anticipated leak rate. 14.1 is low to my thinking. My leak rates are generally around 24 which is acceptable for my Intellipap, according to DeVilbiss.

Personally, I couldn't do ramp at 5 for 30 mins. I started off with my ramp set at 5 but it moved up to 6 and then OFF. I only had it on for about 10 minutes anyway since I fall asleep so quickly. Now I just jump in at 7.

You are doing great..... Here's to many more good nights of sleep!

Emilia wrote:Those numbers look great! An AHI of 1.8 is fabulous! Your leak rate is fine, as all masks have an anticipated leak rate. 14.1 is low to my thinking. My leak rates are generally around 24 which is acceptable for my Intellipap, according to DeVilbiss.

Interpretation of leak data depends on both the machine and the mask. Many machines, such as the intellipap, simply measure the entire leak rate---both the mask's intentional exhaust leak rate at a given pressure and any additional leaks on top of that. In that case, Emilia's 14.1 is a very low and hence, very good leak rate for her mask.

But the OP is using an S9. With the S9, you set a mask type that gives the machine a reasonably good estimate of the mask's intentional exhaust flow and the machine subtracts that estimate off of the leak number and only reports the part of the leak rate that it believes is due to real leaks. Hence on an S9, a 95% leak rate of 14.1 L/min means that 5% of the time, the S9 was detecting a leak that is 14.1 L/min ABOVE the rate the mask the mask is supposed to leak due to the designed exhaust flow. And while the S9 won't report that as "bad" with the red frowny face on the short version of the Sleep Quality menu, it's also not an exceptionally low leak either.

I appreciate all the information.

With respect to the Leak, I understand that the S9 is calibrated for different types of masks and therefore a Leak of 14.1 is not so good. It didn't sound good. Not horrible, but certainly not optimum.

Perhaps I'll try the small pillows tonight. I am using xtra small. That's all I can think of unless the leak is from my mouth. I really don't want to tape my mouth closed - I guess there are chin straps.

OK, Laurie don't freak out, it's only night #4 and I am just starting out! OK I feel better!

Think Marley's ghost from the classic Christmas Carol

You don't seem to be leaking much if, so if you are mouth breathing, then just try propping your mouth shut with a pillow and good positioning.

My guess is that this will improve over time without having to do very much.