Please help me understand this RESMED data

Hi.

I'm new to this forum. I have a Resmed setup.

I did a trial with the gear for 4 weeks before purchasing it. I am a little concerned with the results over the last few nights.

Daily Usage 8:37
% Used Days >4hours 100%
Appnea Index 0.2
Hypopnea Index 6.1
AHI 6.3 (Less than 7)
Leak 95th% 3.6l/min
Pressure Median 10.6 95th% 13 Max 14.8

Machine is in autoset mode 6-15cmH2O

Now that doesn't look too bad to me - I have been told by my sleep clinic that AHI<7 is the goal.

Last night I didn't think I slept much and my AHI was through the roof - 15.1 with 2.4 apneas - at times when I KNOW I was awake. I was also having problems with leak last night - every time I moved it seemed to leak. it was 6l/min median.

The night before I slept pretty well but also had a high AHI of 7.5. In fact the last week my AHI has averaged 9.5

I think I need to adjust the pressure - a minimum of 10 would seem to me to be more on the money and maybe a maximum of 16 as I seem to have hit 15 a few times. Suggestions?

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CPAPopedia Keywords Contained In This Post (Click For Definition): resmed, AHI, Hypopnea

Welcome!

Others can give you more specific info about the Resmed but if my memory isn't way off, it looks to me like you've got a big leak problem. If that's the case, then AHI info may not be reliable. Generally if we have large leaks, we need to get those resolved first.

So hang in until one of our Resmed users drops by!

Mindy

Hi,
Sorry you're having problems! I think you can make some adjustments and do much better.
I'm not an expert at all, but there are many wise people on this forum.
Did you have a sleep study?If so, What is your titrated pressure?
I have pretty much the same equipment as you, and I really like it, especially the mask. It can do much better for you. That mask needs to be very loose in order to do it's job. Also, the forehead support has several adjustments on it. Please watch the DVD that comes with the mask for some excellent tips on how to wear it. If you don't have it, PM me, and I will send it to you.
Is your mouth dry when you wake up? You may be mouth leaking, many of us do. I use tape at night to get rid of the mouth breathing and that helps a lot. The yellow light bulb on the banner above will tell you all you need to know about taping.
I have never hear of under 7 being normal. Generally, under 5 is what you're looking for. You aren't getting good therapy at this point.
I personally think your range is too high on the autopap. Just from my experience, I had to raise my lower pressure up to 9 and top out at 14, but that's because my titrated pressure is about 12. You're lower pressure more than likely needs to be raised.
I found that using my machine at a constant pressure (CPAP Mode) worked much better for me. The pressure changes were causing events, apparently.
Others will weigh in, but these are just some things to think about.
Keep on trying, you will absolutley figure it out. Just takes a little education and a willingness to make some tweaks.
Welcome.
Lee Ann

bigk:

It looks to me like your mask is a full face, which would mean mouth leaks aren't the problem, but leaks in general could be. I agree that working on the leaks is important. As to the pressures, I'd move the bottom up to 8 or 9, try it a few days and see what your 95% pressure is. My experience with my Respironics auto was that moving the bottom up helped AHI a lot. I wouldn't worry about the top end as much. You may be spending time at 15 due to your leaks, or due to the machine over-reacting to events. By moving the bottom pressure up, you should find the machine responding more quickly to events.

Don't make too many changes at once, and take a few days between changes to really evaluate the results. I spent several months making minor adjustments in auto mode and then finally went back to CPAP at a slightly different pressure than during the sleep study. I can't prove it by the numbers, but I think I'm sleeping better with CPAP than when the machine was adjusting itself throughout the night.

Thanks Folks!

It is a nasal mask first off. The resmed Mirage Activa.

I was thinking I should up the lower pressure. I was thinking maybe 9 - Looking at the graphs I don't have much below 8.

Lee Lee wrote:Hi,
Sorry you're having problems! I think you can make some adjustments and do much better.
I'm not an expert at all, but there are many wise people on this forum.
Did you have a sleep study?If so, What is your titrated pressure?

I did have a sleep study - a home sleep study (I'm in Australia) it was through a Resmed Clinic. It was only to doagnose the apnea. They put me straight on an autoset machine.

I have pretty much the same equipment as you, and I really like it, especially the mask. It can do much better for you. That mask needs to be very loose in order to do it's job. Also, the forehead support has several adjustments on it. Please watch the DVD that comes with the mask for some excellent tips on how to wear it. If you don't have it, PM me, and I will send it to you.

I love the mask too - I tried one with nasal pillows and felt liek I was suffocating. I do have a CD/DVD that came with the mask. I had been meaning to look at it.

Last night in particular, it seemed to be leaking all the time every time I moved. I think I will watch the dvd and re-fit the mask.

Is your mouth dry when you wake up? You may be mouth leaking, many of us do. I use tape at night to get rid of the mouth breathing and that helps a lot. The yellow light bulb on the banner above will tell you all you need to know about taping.

I don't think I have a mouth leaking problem - no dry mouth.

I have never hear of under 7 being normal. Generally, under 5 is what you're looking for. You aren't getting good therapy at this point.
I personally think your range is too high on the autopap. Just from my experience, I had to raise my lower pressure up to 9 and top out at 14, but that's because my titrated pressure is about 12. You're lower pressure more than likely needs to be raised.

Resmed Clinic told me that 7 was in the normal range. I guess I WAS less than 5 but over the past week or so it has been climbing up. Maybe it is the mask.

It doesn't make much sense to me having the minimum at 6 so I agree I need to raise the minimum 0 I was thinking 9.

I found that using my machine at a constant pressure (CPAP Mode) worked much better for me. The pressure changes were causing events, apparently.

They saw me 3 times over the duration of the trial and did ask if I wanted to try CPAP rather than autoset - but the APAP was working so well I didn't see the point. What CPAP pressure would you try?

Others will weigh in, but these are just some things to think about.
Keep on trying, you will absolutley figure it out. Just takes a little education and a willingness to make some tweaks.
Welcome.
Lee Ann

The whole reason I am doing this is to eliminate my snoring. I don't feel *THAT* much better really. I will persevere. My wife deserves some peace after 25 years. LOL.

Thanks for the welcome!

Your leak rate is too high. I see ResScan is reporting the Leak rate as Litres per MINUTE. I'm used to working w/AutoScan 5.7 which reports the Leak rate as Litres per SECOND. But it isn't so high that the Elite shouldn't be able to adequately compensate for it. That compensation may well be what is raising your reported pressure data.

An AHI of <=5.0 is considered "normal" for the general non-OSA population. Your AHI of 6.3 isn't that much over the "norm" to be of great concern at this point in your therapy.

It "might" be taking your Elite too long to respond adequately to your pressure need when an apnea occurs. I wouldn't get too aggressive in raising your lower set pressure. At most I would narrow the split to 8 cms for the lower range, not 10 cms.

The high hypopneas suggest the leak rate may be causing the "chasing" to higher and higher pressures.

HOWEVER, be aware that wearing your Elite for extended periods when awake can REALLY screw up your data and report out of sight hypopneas! I've had that happen to me several nights when I fought to stay awake to watch a night time football game. If I knew how to scan and post my nightly data I'd show you two recent ones. The data from the awake periods was outta sight!!!! I've also had it happen to a lesser degree when I've laid in bed TRYING to sleep but being wide awake much to my dismay.

I wouldn't raise the upper pressure. Not yet anyway. Keep in mind as we get more and more comfortable w/our CPAP and our mask we are more inclined to relax better in our sleep and are more inclined to move into comfortable positions whereas when we first start CPAP it is like that darn mask and hose ENCOURAGE us to sleep on our backs more than we normally would and to stay in one position longer.

The key is how are you feeling? How rested are you feeling? Are you feeling more rested than prior to starting CPAP? If so you ARE making progress (just not as fast as you want). I hope BillBolton responds to your post. He's more knowledgeable about pressures and responses than I am.

I did have a fairly crappy sleep last night. I know I was awake for much of it. and YES definitely this morning there were a truck load of apneas when I KNOW I was awake.

I was going to change the lower pressure to 9. That was my thought and leave the top pressure at 15.

I am also going to try and fit my mask again. The 6.3 is the average over 23 or so nights. What is worrying me is that a week ago it was 5 and the last 7 days it has averaged 9 - so it is trending up.

a leak of 3.6l/min is 0.06l/sec - is that really too high? I guess it is a lot.

No, not way too high. But the Resmeds subtract the "allowed vent/leak rate" from the reported leak rate so you don't have to subtract like you do w/the Respironics. A pressure range of 9 cms to 15 cms for a week sounds like a reasonable way to go, better than jumping so quickly to 10 for the lower pressure. Like I said tho, BillBolton is much better at this pressure range, pressure change and cause and effect w/the Resmeds than I am.

Thanks Slinky - I hope he chimes in....

I do too. I haven't had much reason to use my auto in auto mode or to adjust my pressures. I was started at 6 cms based on a difficult titration, pressure raised to 7 cms "by guess and by gosh" and then raised to 8 cms after an at home loaner autoPAP (before I bought my Vantage). Setting my Vantage at 7 cms to 11 cms wasn't successful, it raised my AHI. Turned out that going to straight CPAP at 8 cms AND using EPR at 1 (had quit using Ramp and EPR long ago) was JUST the "tweaking" I needed to get my AI to 0.0 and HI to <=0.3. (Of course, that time span also included finding "the" right mask and the mask and I cementing our friendship via a few "mask tweaks" too).

Shucks, why not just PM w/a copy of your original thread including your machine, mask and any additional info you think pertinent? He's a great guy. When he gets your PM he will respond. Sometimes he doesn't drop in to the forum real often or is out of town for a short while.

By the way, BillBolton is a fellow Aussie, as is .... heck, if I try to list them all I'll leave someone out again.

What made you settle on 8? was that your median or maximum?

I didn't. My sleep doctor did. Raise the pressure to 8 cms, that is. The loaner was a Respironics pre-M Series w/C-Flex and I didn't have the software for it so had to rely on his reading and interpretation of the downloaded results from the auto. The 8 cms made such an improvement and I was still having mask selection and adjustment problems then that it was obvious I needed to get the mask and leaks under control before "we" were going to be able to effectively tweak my therapy any further.

It was difficult being a "patient" patient one week at a time!!! And there were a few times I got disgusted w/being "patient" and just said to heck w/it I'm doing better than I was and didn't stay in touch w/my sleep doc or sleep lab or try any "tweaking" on my own to make things easier.

I'm fortunate to have had a good sleep doctor and a good sleep lab. Now my sleep doctor has left that sleep lab and for the time being is out of town. BUT the new sleep doctor at the sleep lab is the one who casually made a comment that it took me a few days to "pick up on" and the idea to turn EPR on again. I just tried 1 as my first attempt and it turned out to be "the" ticket.

I just don't get how you can do all this without being able to tweak your own machine. It must involve so many visits to a DME and sleep doctor over there. Crazy.

bigk wrote:Pressure Median 10.6 95th% 13 Max 14.8

Machine is in autoset mode 6-15cmH2O

As others have mentioned already, anything scored when you are awake is basically meaningless data.

You also do need to get any leaks under control before you can be in a position to realistically interpet any trends in respect of AHI data.

Cheers,

Bill