Help me please, new user, new to message board

[Pugsy]

Can someone provide the link on how to change my pressure with my machine?

http://www.cpap-supply.com/Articles.asp?ID=130

Oops, so sorry, I thought I had already given you that. Just scroll down till you see the ResMed stuff.

[firehawk12]

Hi, sorry to hijack the thread a little bit, but is there somewhere I can look to see what these acronyms (AHI, AI, HI) mean? I just bought an S8 Elite and I'd like to interpret the data to see if it's working for me.

Thanks.

[Pugsy]

Hi, sorry to hijack the thread a little bit, but is there somewhere I can look to see what these acronyms (AHI, AI, HI) mean? I just bought an S8 Elite and I'd like to interpret the data to see if it's working for me.

our-collective-cpap-wisdom/sleep-apnea- ... tions.html

AI - Apnea index, number of apnea events per hour

HI - Hypopnea index, number of hypopnea events per hour

AHI - sum total of the AI and HI events per hour

other terms and acronyms at the above link

[firehawk12]

Lovely, thanks!

Edit - I take it then that clearly the lower the numbers, the better?

[Pugsy]

Edit - I take it then that clearly the lower the numbers, the better?

Yep, the lower the better in regards to the reduction of OSA events. Bear in mind that the goal is not just a low number all by itself. We want good restorative sleep so that our bodies aren't under the stress of obstructive events thus preventing further damage.

So look at the numbers in conjunction with how you feel. If we have other issues that affect how we sleep or other physical problems, the greatest numbers in the world won't guarantee success.

[TylersDad]

Here is my update.

1) Still waiting on the software and the card reader. The ETA from Australia was 5 - 7 working days so it should be any day now.

2) My AHI has averaged well above 20 each night (over the past week and 1/2). It has been fairly constant. The highest number has been 30 and the lowest night was 21.4.

3) My leak rate has ranged from .00 (on two occasions) to .4. Even on the two nights my leak rate was .00, my AHI's were 21.4 and 25.3.

4) I think I feel worse with the machine than I did before the machine. I actually dream ALOT more and I sleep harder so I think I am getting more sleep, but I feel worse.

5) Is it just me or does it feel like when you have the full facemask on that you are being deprived of air or oxygen? I am very comfortable with the mask and it certainly does not affect my sleep, but it just seems like I am being choked or something.

I think I am ready to try Pugsy's recommendation of moving my pressure up to 9 for a few nights.

Is this still the best action? Any thoughts?

Thanks for the suggestions and help as always.

[Wulfman]

Here is my update.

1) Still waiting on the software and the card reader. The ETA from Australia was 5 - 7 working days so it should be any day now.

2) My AHI has averaged well above 20 each night (over the past week and 1/2). It has been fairly constant. The highest number has been 30 and the lowest night was 21.4.

3) My leak rate has ranged from .00 (on two occasions) to .4. Even on the two nights my leak rate was .00, my AHI's were 21.4 and 25.3.

4) I think I feel worse with the machine than I did before the machine. I actually dream ALOT more and I sleep harder so I think I am getting more sleep, but I feel worse.

5) Is it just me or does it feel like when you have the full facemask on that you are being deprived of air or oxygen? I am very comfortable with the mask and it certainly does not affect my sleep, but it just seems like I am being choked or something.

I think I am ready to try Pugsy's recommendation of moving my pressure up to 9 for a few nights.

Is this still the best action? Any thoughts?

Thanks for the suggestions and help as always.

I think (if it were ME) I'd be bumping up the pressure some.

With regard to the Quattro, I've written about my experience before......when I used mine, I didn't think there was enough CO2 washout......and consequently I felt like I wasn't getting as much AIR as I was with the Ultra Mirage Full Face.

Are you using EPR? At that low of a pressure you're using, EPR will drop it even more on exhale.


Den

[TylersDad]

I have the EPR set on 3. Should this help or hurt with the feeling that I am not getting enough air?

I changed from 8 to 9 on my pressure setting last night and it was worse. My numbers are higher. My numbers last night were:

Leak - .02
AHI - 35.4
AI - 2.9
HI - 32.5

Does this mean I went the wrong way and should have gone down by one?

What does it mean when the HI is so high? It is proportionately much higher at all times than the AI is?

Please help.

Thanks.

[Wulfman]

I have the EPR set on 3. Should this help or hurt with the feeling that I am not getting enough air?

I changed from 8 to 9 on my pressure setting last night and it was worse. My numbers are higher. My numbers last night were:

Leak - .02
AHI - 35.4
AI - 2.9
HI - 32.5

Does this mean I went the wrong way and should have gone down by one?

What does it mean when the HI is so high? It is proportionately much higher at all times than the AI is?

Please help.

Thanks.

An EPR setting of 3 will result in a 3 cm. drop in pressure when you exhale......taking your effective pressure down to 5 cm. when you were at 8 cm. and now 6 cm. when you are at 9 cm. Both of those pressures may be too low to prevent events.

One night doesn't give an accurate picture (just like a one-night sleep study doesn't).

For all intents and purposes, if one of those pressures is your titrated or prescribed pressure, then you would want to choose your EPR setting so that your exhaled pressure doesn't fall below that. So, if you want to keep your EPR setting at "3", then you'd need to set your CPAP pressure at 11 or 12. Or, if you want to try a different EPR setting, make sure you calculate for it when you set your CPAP pressure. OR......you can try turning EPR "Off" and see what that does to your numbers (and how you sleep with it).


Den

[ozij]

You can also set EPR at 1 or 2.

O.

[alnhwrd]

TD,

Den and Oz are right about adjusting or turning off EPR. After that I would track my data for a week and see where you are. Too many changes too fast can make it hard to figure out what is working and what is causing new problems. I would also start a sleep diary and record your nightly numbers and how you slept, how you felt when you got up, and any other sleep related info. Also, if you are sleeping on your back you are more likely to have apneas. This is because gravity works on the throat and neck tissue to make it more likely to collapse. You might have better success sleeping on your side. Good Luck!

Alan

[Pugsy]

Ditto to what Den said.

Regarding HI and AI numbers. Some people just have more hypopneas than apneas.
I happen to have more apneas and comparatively rare hypopneas. This was seen on my sleep study also.

So if you had more hypopneas on your sleep study than apnea events, then it would stand to reason that the same would carry over to home therapy.

ResMed machines also tend to score HI a little differently and sometimes higher so... that may also factor in to the HI numbers BUT you still are reporting way too many hypopneas and they can be just as damaging as apneas.

[Agape=Love]

I urge you to upgrade to "Auto" if you have medicare you most likely will have to come out of pocket. If you have private insurance you should be able to upgrade.

What I have done with CPAP patients that are seeing no benefit or just non-compliant is put them on a trial use Auto. Usually 1-2 weeks depending on patient data/subjective results (I prefer Respironics REMstar Auto M Series with A-Flex using Encore Pro Software). I then take the report to the physician who signed the order for CPAP and demonstrate the obvious advantage of Auto. I then get the physician to write a "medically nessacary" letter to insurance company to upgrade machine. With physician letter and Encore report I have been able to upgrade every patient using this method.
If you or your DME would like help with this process let me know, more then happy to help. (It takes more effort on the DME's part if they care about you and the service they provide it should be worth it!)

Agape!

[TylersDad]

Update - I had to go to my Dr today for something else and I spoke to him about my high numbers and what the DME told me about "trialing" a auto machine for a couple of weeks. He said at the numbers I was reporting to him, the therapy was not being effective. The Dr said he thought that was the best route and I have an appt with the DME for Friday to get me an auto machine to try.

When I changed to 9 cm, my numbers got much worse and I felt worse and had trouble sleeping where I have not had trouble sleeping at 8cm. I guess a part of that was that my leaks got worse at 9cm. It is amazing how one number on the setting can make the leaks that much worse. I feel for you folks that are set at a much higher number, I have no idea how you control the leaks.

Thanks for everyones help and suggestions.

[ozij]

Friday is soon, but it bears remembering that ResMed's let you raise pressure in 0.2 increments.
My PB only let me do it in 0.5 - so that's what I did when I made changes.

O.