First night - how did I do?

Used a Resmed S8 Elite II with a Swift LT mask. DME was out of stock on the humidifier and hose cozy so I'll be a few days without them.
Woke up with a sore nose and I'll be trying various adjustments to the mask, but overall I think I got a pretty decent night sleep. I didn't take the mask off all night. I woke up enough to realize that I turned a few times and had one minor leak that I fixed.
I accessed the clinician's menu to look at some of the stats and am wondering if someone can help gauge 'how I did'...?

Leak: 0.06L/s
AHI: 24.5
AI: 4.3
HI: 20.2
Usage: 9h 2m

Thanks cpaptalk!
-Pete

If you wore the mask all night and slept all night, then I say you had a very good first night. I don't know what your AHI was before treatment so can't gauge how much you have improved. In general you'll want to drive that number below 5 (the established "normal" range).

I hope you're noticing a difference in how you feel with and without CPAP. I noticed a difference, even when my AHI was still in the 20s. I had to tweak some things to get to my current state. If you don't notice your numbers dropping within the week I would recommend reporting back into your DME or doctor to discuss. Don't wait too long on this--I had to have a pressure setting change, myself. With the right settings and mask CPAP has changed my life.

Often leaks are an issue. I don't have your brand of machine, so hopefully someone else will confirm that your .06 is reasonable or not.

Good luck!

chargen wrote:... Used a Resmed S8 Elite II with a Swift LT mask. ...

Pete, first greetings and welcome to the forum! I see this is your first post as a registered user. It appears you've monitored the board for a while, since you seem to know your way around your unit. So, good for you doing the research you need to maximize the benefit of your xPAP therapy!

You will want to access your profile and edit the equipment. It makes it easier for others to provide tailored responses to your questions. (Click on the "User Control Panel" link in the upper left of the window. Click on the second tab at the top. Click on the equipment profile tab on the left side. Select the equipment, mask, humidifier (when you get it) and software if you have any.

chargen wrote:... Woke up with a sore nose and I'll be trying various adjustments to the mask, but overall I think I got a pretty decent night sleep. ...

The hours certainly seem to indicate that. And for a first night with a new unit, that's not bad at all. Is this your first time on xPAP therapy. If so, you graduated to the head of the class, sir!

chargen wrote:... I didn't take the mask off all night. ...

Good for you. I still sometimes wake up feeling confined and need to get up and calm down a bit. And I've been doing this for almost 20 years! I can not imagine how someone that is very claustrophobic deals with it ... with a lot of courage, do doubt! So, congrats. It's a big first step.

chargen wrote:... I woke up enough to realize that I turned a few times and had one minor leak that I fixed. ...

Bingo! You just adjust, adapt and keep on snoozing! That's the way we all need to work with xPAP therapy.

chargen wrote:... I accessed the clinician's menu to look at some of the stats ...

Like I say, you did your homework.

chargen wrote:... and am wondering if someone can help gauge 'how I did'...? ...

I will give it a shot. I'll take them somewhat out of order.

chargen wrote:... Usage: 9h 2m ...

That's certainly plenty of time. And considering it was your first night with this unit, it's a great start.

chargen wrote:... Leak: 0.06L/s ...

ResMed reports in liters per second. The industry typically reports in liters per minute. (It's what respiratory therapists use to guage the oxygen rate for supplemental oxygen). So, that works out to ... 0.06l/s * 60s/m = 3.6l/m.

Typically you want to keep the leak rate below 30 to 35l/m. So, I would say 3.6l/m is exceptional!

chargen wrote:... AHI: 24.5 ...

Here's the number that's high. And frankly, it might be due to just starting to use xPAP therapy. The objective (the line in the sand) is to keep the AHI value below 5. Of course if your sleep study showed SEVERE apnea then this would seem much better. The good news is that it can get better.

chargen wrote:... AI: 4.3 ...

AHI, as you probably know, consists of the Apnea Index and the Hypopnea Index. So, it adds together the number of apneas (airflow stops due to either an obstruction or failure to make the effort to breathe - an obstruction is the most common reason) and hypopneas (the airflow is reduced due to a partial obstruction).

So, here your apnea index is 4.3. It's below the 5 mark, but the lower this goes, the less impact the AHI has on your sleep.

chargen wrote:... HI: 20.2 ...

And this is the Hyponea Index. Though 20.2 is high, it often does not lead to a O2 desaturation. Instead it might lead to an arousal. That is, when you struggle to bring in air, your body might move from a deeper level of sleep to a lighter level of sleep. It arouses you, but often will not awaken you. So, this impacts the quality of your sleep, but typically not the O2 levels in your blood.

At this point, I do not recommend changing any settings. Get used to the machine. Get used to the mask. And know that once you get your humidifer and you are better adjusted to xPAP therapy then you will probably see those numbers drop some.

If you have a follow up visit with your doctor you will want to discuss the numbers. It might be appropriate to increase the pressure to help reduce the number of apneas and hypopneas.

Again, welcome aboard!

Hi Pete, welcome to the forum.

I think you did great for a 1st night....usage of 9 hours, and keeping your mask on, because that is a real struggles for many newbies. The humidifier and hose cozy will make things more comfortable for you. And good for you, for getting a data capable cpap.

Now the numbers...the one thing that the veterans kept repeating to me when I started was "don't just focus on the numbers". Of course I did anyway, and became obsessed with them.

Caveat: I'm not sure where these "standards" came from, but they are often repeated here. "AHI of 5 is good. AI of l is good. Leak rate of .2 l/sec. on a ResMed is good. HI of 10 is ok on a Resmed because of the algorithms of that brand."

Honestly, for the 1st week or so, I wouldn't worry about the numbers, nor would I change your settings. Your body needs time to get used to breathing this new way. See what the trend is for a few days, I suspect you will see the AHI numbers drop.

You've had an excellent first night, just staying connected over 9 hours. CONGRATULATIONS!

With time, you'll be able to tweak your pressures to bring your AHI to the goal of below 5--but don't get all wigged out over that for a while yet. Just keep doing what you're doing. It usually take 7-10 days just for your body to respond to the therapy or any change you make--so watch this number for at least a week or so before considering changes.

Your leaks should be below 0.24l/second for effective therapy on ResMed machines--so you're doing very well there also.

Keep up the good work!

OMG - I envy you! First night and 9 hours. That's the toughest part - keeping the mask on. It's downhill from here

Scarlet834 wrote:If you wore the mask all night and slept all night, then I say you had a very good first night. I don't know what your AHI was before treatment so can't gauge how much you have improved. In general you'll want to drive that number below 5 (the established "normal" range).

From my sleep lab report (from memory - it's around here somewhere, but I can't put my hand on it right now) the AHI was in the moderate range, so I think it was around the same. So I'm looking for this to decline with usage. Thanks for the info!

Scarlet834 wrote:I hope you're noticing a difference in how you feel with and without CPAP. I noticed a difference, even when my AHI was still in the 20s. I had to tweak some things to get to my current state. If you don't notice your numbers dropping within the week I would recommend reporting back into your DME or doctor to discuss. Don't wait too long on this--I had to have a pressure setting change, myself. With the right settings and mask CPAP has changed my life.

I didn't notice much of a difference after the sleep lab visit with the cpap machine, certainly not any sort of dramatic difference like some people notice. I'm imagining that my experience will be more gradual and moderate, and I will keep looking for signs of improvement. My follow up appointment with the sleep Dr is still a few weeks away, so that will be a good opportunity.

Thanks.

-Pete

chargen wrote: I didn't notice much of a difference after the sleep lab visit with the cpap machine, certainly not any sort of dramatic difference like some people notice. I'm imagining that my experience will be more gradual and moderate, and I will keep looking for signs of improvement. My follow up appointment with the sleep Dr is still a few weeks away, so that will be a good opportunity.

Thanks.

-Pete

John has given you much very detailed and apt advice (as usual). I didn't have a sleep doctor myself, nor any indication that someone would follow up with me for several months unless I yelled. So, I didn't want you to simply plow through indefinitely if there was an easily correctable issue. I'm glad you have a set follow up appointment, and I'm sure you'll find yourself in the best place for you and glad that you are there. I had zero difference at the sleep lab, too, although I did experience a night-and-day difference when the correct home settings for me were finally attained. You seem to have a great attitude and I'm sure you'll be successful in your therapy. There are many knowledgeable veterans on this board who will help you along the way. (I consider myself a cheerleader who sometimes has experiences that might help.)

Thanks for the in-depth reply, John!

JohnBFisher wrote:

chargen wrote:... Used a Resmed S8 Elite II with a Swift LT mask. ...

Pete, first greetings and welcome to the forum! I see this is your first post as a registered user. It appears you've monitored the board for a while, since you seem to know your way around your unit. So, good for you doing the research you need to maximize the benefit of your xPAP therapy!

You will want to access your profile and edit the equipment. It makes it easier for others to provide tailored responses to your questions. (Click on the "User Control Panel" link in the upper left of the window. Click on the second tab at the top. Click on the equipment profile tab on the left side. Select the equipment, mask, humidifier (when you get it) and software if you have any.

Everything is still on trial right now, when I'm settled on equipment I'll certainly fill in my profile. Thanks for the suggestion.

JohnBFisher wrote:

chargen wrote:... Woke up with a sore nose and I'll be trying various adjustments to the mask, but overall I think I got a pretty decent night sleep. ...

The hours certainly seem to indicate that. And for a first night with a new unit, that's not bad at all. Is this your first time on xPAP therapy. If so, you graduated to the head of the class, sir!

Aside from one very restless night using a cpap machine in the sleep lab this was my first night with cpap therapy.

JohnBFisher wrote:

chargen wrote:... I didn't take the mask off all night. ...

Good for you. I still sometimes wake up feeling confined and need to get up and calm down a bit. And I've been doing this for almost 20 years! I can not imagine how someone that is very claustrophobic deals with it ... with a lot of courage, do doubt! So, congrats. It's a big first step.

I haven't really felt claustrophobia with cpap equipment. I guess I'm a bit lucky in that regard.

JohnBFisher wrote:

chargen wrote:... I woke up enough to realize that I turned a few times and had one minor leak that I fixed. ...

Bingo! You just adjust, adapt and keep on snoozing! That's the way we all need to work with xPAP therapy.

chargen wrote:... I accessed the clinician's menu to look at some of the stats ...

Like I say, you did your homework.

chargen wrote:... and am wondering if someone can help gauge 'how I did'...? ...

I will give it a shot. I'll take them somewhat out of order.

chargen wrote:... Usage: 9h 2m ...

That's certainly plenty of time. And considering it was your first night with this unit, it's a great start.

chargen wrote:... Leak: 0.06L/s ...

ResMed reports in liters per second. The industry typically reports in liters per minute. (It's what respiratory therapists use to guage the oxygen rate for supplemental oxygen). So, that works out to ... 0.06l/s * 60s/m = 3.6l/m.

Typically you want to keep the leak rate below 30 to 35l/m. So, I would say 3.6l/m is exceptional!

That's great to hear! Hopefully I can stick with the Swift LT nasal pillow style to have minimal skin contact and a good low leak rate.

JohnBFisher wrote:

chargen wrote:... AHI: 24.5 ...

Here's the number that's high. And frankly, it might be due to just starting to use xPAP therapy. The objective (the line in the sand) is to keep the AHI value below 5. Of course if your sleep study showed SEVERE apnea then this would seem much better. The good news is that it can get better.

I'll keep an eye on this, but also try not to live by the numbers, but to focus on how this makes me feel to start with.

JohnBFisher wrote:

chargen wrote:... AI: 4.3 ...

AHI, as you probably know, consists of the Apnea Index and the Hypopnea Index. So, it adds together the number of apneas (airflow stops due to either an obstruction or failure to make the effort to breathe - an obstruction is the most common reason) and hypopneas (the airflow is reduced due to a partial obstruction).

So, here your apnea index is 4.3. It's below the 5 mark, but the lower this goes, the less impact the AHI has on your sleep.

chargen wrote:... HI: 20.2 ...

And this is the Hypopnea Index. Though 20.2 is high, it often does not lead to a O2 desaturation. Instead it might lead to an arousal. That is, when you struggle to bring in air, your body might move from a deeper level of sleep to a lighter level of sleep. It arouses you, but often will not awaken you. So, this impacts the quality of your sleep, but typically not the O2 levels in your blood.

At this point, I do not recommend changing any settings. Get used to the machine. Get used to the mask. And know that once you get your humidifer and you are better adjusted to xPAP therapy then you will probably see those numbers drop some.

Great, thanks for the suggestion!

JohnBFisher wrote: If you have a follow up visit with your doctor you will want to discuss the numbers. It might be appropriate to increase the pressure to help reduce the number of apneas and hypopneas.

Yes, in a couple of weeks. I'll prepare that to ensure I get the most out of the visit.

JohnBFisher wrote:Again, welcome aboard!

[/quote]

Thanks again, John!!!

-Pete

KatieW wrote:Hi Pete, welcome to the forum.

I think you did great for a 1st night....usage of 9 hours, and keeping your mask on, because that is a real struggles for many newbies. The humidifier and hose cozy will make things more comfortable for you. And good for you, for getting a data capable cpap.

Now the numbers...the one thing that the veterans kept repeating to me when I started was "don't just focus on the numbers". Of course I did anyway, and became obsessed with them.

Caveat: I'm not sure where these "standards" came from, but they are often repeated here. "AHI of 5 is good. AI of l is good. Leak rate of .2 l/sec. on a ResMed is good. HI of 10 is ok on a Resmed because of the algorithms of that brand."

Honestly, for the 1st week or so, I wouldn't worry about the numbers, nor would I change your settings. Your body needs time to get used to breathing this new way. See what the trend is for a few days, I suspect you will see the AHI numbers drop.

Thanks for the reply, Katie. Being employed in the IT field and being a geek in general, I partially feed on stats and numbers. I'll try not to obsess about these numbers though
This is an awesome community - a unique forum on the Interent, so I'm sure I'll be posting more and contributing to the community in the future!

-Pete

Scarlet834 wrote:... I consider myself a cheerleader who sometimes has experiences that might help. ...

Posh! I've watched your posts. You provide an accurate report of your experiences to help others. You encourage others. No, I learn from your posts as do many other readers. The first time the teacher tells you that he/she can not learn anything from the student is the moment you should change to another teacher!

JohnBFisher wrote:

Scarlet834 wrote:... I consider myself a cheerleader who sometimes has experiences that might help. ...

Posh! I've watched your posts. You provide an accurate report of your experiences to help others. You encourage others. No, I learn from your posts as do many other readers. The first time the teacher tells you that he/she can not learn anything from the student is the moment you should change to another teacher!

How nice to hear that, John. Thank you!

Pete you did extremely well for a first night. 9 hours compliance is amazing, and the sore nose is to be expected. Yes, numbers at the beginning don't mean that much, but after a while if it doesn't go down, I'd take a careful look at the hypopnea index (HI), and see if some minor adjustment can bring that down, as it will have an impact long term on quality of sleep. It may be just a minor setting issue. At any rate, good going, and welcome to the hose and mask society.