Success? First Night on Autoset II

Any comments on our first night results?

My main questions are (after the details below):
What is a good leak level to aim for?
What can you do about dry mouth - does he need to turn up the humidity?
Is there any reason to adjust the settings if we continue to have results like this for a week (should we aim for a lower AHI)?


I think my husband had a good first night with the Autoset II last night - AHI of 2.1, down from 38 in his sleep study. However, I asked him to rate how he felt after he got up and showered compared to most mornings - 0 for worse, 1 for the same, or 2 for better - and he said he felt the same. He complained that it was very hard to fall asleep and he felt like he was tossing and turning. He only took the mask off once to wipe out some liquid - he's not sure if it was rainout or drool. He said he woke up with a very dry mouth, but those were the only complaints.

The AHI and pressure leak graphs indicate he went to bed a little before 9 pm but didn't fall asleep until 11 pm, then woke up at around 5:30 am.

Humidifier was set to level one.

Here are the key summary stats:

PRESSURE (cmH2O)
Min-Max pressure: 4 - 20
Med pressure: 8.0
95th %ile pressure: 10.6
Max pressure: 12.6

LEAKS (L/min)
Med: 1.2
95th %ile: 3.6
Max: 54

AHI & AI (events / hr.)
Apnea index: .1
Hypoapnea index: 2.2
AHI: 2.3

USAGE
Total Hours: 8.59 (however, it appears he was only sleeping for 7 hours)

Thanks!

Is he using a FF mask? Sounds like he is since you mentioned not knowing if the moisture in the mask was condensation or "drool."

The leak rate looks high, so that might be skewing the AHI data. If he had a nice low leak rate, the AHI looks excellent. But with those leaks, the AHI might be in some doubt. With a ResMed machine, and with the correct mask dialed in, the leak rate should be zero. I'd at least want the leak rate to be no more than .20 if it were me. Any leak rate of .40 l/s or higher is way too much leak with a ResMed machine.

Since it was his first night and he removed the mask at least once, possibly that accounts for some of the high leak...while the mask was off.

Very dry mouth -- if not using a FF mask, my guess would be a lot of mouth breathing was going on. However, if he was wearing a FF mask, then turning up the humidity should help that. It's been my experience though, that despite good humidification, breathing through the mouth when wearing a FF mask can be very drying. You're still getting treatment with the FF mask and mouth-breathing, but the air flow will dry the mouth.

Next problem could be... if he does turn up the humidity, he might get to experience the "joys" of rainout. Most annoying. If a good hose cover doesn't allow him to use a higher heat setting on the humidifier without causing rainout, I see a heated hose (sleepzone.com.au -- heated cpap tube) or Repti heat cable in his future.
LINKS to discussions about the Aussie heated hose - to prevent rainout
viewtopic.php?t=5305

Personally, I'd want to set the minimum pressure up at least a couple of full cm's higher. Not because of his AHI, which was very low (unless it was an artificially low AHI due to the leaks.)

For now, I'd work on first things first -- getting the leak rate down before messing with pressure tweaks.

Confused... since when does a ResMed report leaks in L/min rather than L/sec. Does that happen only when using a FF mask?

ResMed has some suggestions about humidity, and I think they recommend starting higher than level one:

http://www.resmed.com/us/patients_and_f ... -faqs.html

There it says: "Start the setting at “3” and adjust for comfort."

Thanks Rested Gal for the great advice. I wasn't sure if that was a high leak rate - there was one huge spike when he took the mask of in the middle of the night, plus we just got it yesterday and of course turned in on and off a couple times while in training and then at home when we were figuring it out. I'll see what the leak rate does tonight and focus on getting that down. I didn't know that leaks can artificially lower the AHI either. I want to get him at least a cover for the hose, and then the heated hose if we have more trouble with a higher humidity.

Tattoo - When we downloaded the data to the ResScan software, it summarized the leaks in leaks / min. You are right the units on the machine's screen are leaks / sec.

Thanks again.

[quote="jnk"]ResMed has some suggestions about humidity, and I think they recommend starting higher than level one:


link deleted


Thanks jnk -
Interesting, the RT told us to set it at 1 and this link says to start at 3. We will follow this tonight.

Rested Gal - And yes, it is a full-face mask. Mirage Quattro. They switched to it from a nasal mask in the sleep study because he started breathing out of his mouth and obviously he is still breathing from his mouth with the full face mask. I think he has a bad deviated septum.

It's also been suggested to keep the machine lower than the bed to prevent rainout.

tattooyu wrote:Confused... since when does a ResMed report leaks in L/min rather than L/sec. Does that happen only when using a FF mask?

You can set it either way. The machine's default is L/sec so it is very confusing to translate when the report is L/min.

M.

hose head wrote:...You can set it either way...

Where? I missed this setting this.

Second Night on Autoset II - not so successful

We turned up the humidifier to level 3, and as expected, rainout was a big problem. So I am off today to get some materials to make a temporary cover for the hose. And we will run a space heater in the room tonight. Any tips about best material to use and how to secure it? I suppose I will get some flannel and a needle and thread. I saw a couple other posts with some ideas, but I don't have time right now to look them up.

Funny thing is, the AHI still only went up to 3. However, when I looked at the detail graph, it was clear that there were big chunks of time where he wasn't asleep! So no apneas or hypoapneas.

So the summary data is somewhat useless unless there has been significant sleeping happening. This is obvious, but I had not considered this.

As the resident lazy cheapskate, I bought some cheap stretchy headbands and snipped them with scissors to make ready-made tubes to slip over my hose for anti-rainout protection.

Hose covers at the dollar store!!! - topic started by rickskids
viewtopic.php?p=418994#p418994

CPAP on the Cheap and Creative Modifications - topic started by YawnGirl
viewtopic.php?p=423426#p423426

If hose covers don't get the job done:
LINKS to discussions about the Aussie heated hose - to prevent rainout
viewtopic.php?t=5305

macmermaid wrote:Second Night on Autoset II - not so successful

Funny thing is, the AHI still only went up to 3. However, when I looked at the detail graph, it was clear that there were big chunks of time where he wasn't asleep! So no apneas or hypoapneas.

So the summary data is somewhat useless unless there has been significant sleeping happening. This is obvious, but I had not considered this.

On my husband's reports, he usually has most of his events towards morning and his AHI is between 0.5-1.7. He will tell me in the morning about those occasional nights he was awake for some part of the night. Is your husband telling you he was awake? RG once explained to me why apneas appear more towards morning,something about REM? Perhaps she'll explain it again for my review as well.

While I bought some thick fleece and sewed a cover, you could just cut the tops off some athletic socks (sew 'em together to create a long tube) and thread the hose thru 'em. I secure each end with a small ponytail scrunchie so cold air doesn't get inside my cover. The idea is to insulate the plastic of the hose (so it doesn't get cold like the room temp) so that the warm, moist air inside the hose doesn't condense on the cold plastic into 'rain'. If that happens, the air pressure is reduced...something to be avoided. Some knee socks would work but be more expensive.