Newbie w/ Sleepstyle 254

So I've finally gotten to the US to pick up my Fisher and Paykel Sleepstyle 254 and have used it a few nights. Since it's an auto-PAP and I had issues with mouth leaks above 8.0 cmH2O I did get a chinstrap which I've had no problem using, although I'm not sure that it's helped.

So far I've had three nights...the first without the chinstrap I had an AHI of 1, the second and third with a chinstrap, AHI of 5 and 4 respectively. I've currently got the APAP set at 4-15 cmH2O. There is also a setting that I'm not sure of the meaning of in the clinician's setup: A: 10 cmH2O.

I have a leakage of 46 last night.

First off, what is that setting that I don't know about?

2. Is there something I can do to reduce my AHI below 1?

first get the leaks under control then worry about lowering the AHI

if your machine is like others, it is UNDER reporting AHI in the presence of big and large leaks so those numbers you are seeing for AHI might be VERY deceptive

I'm thinking that a setting of 4 - 15 cm is too wide and that 4 cm is too low as a minimum.

Your leak rate seems high and it could be because the pressure is adjusting and changing all night and may be causing leaks. What was your titrated pressure? Most think that your minimum should be set 1 or 2 cm below your titrated pressure or at your titrated pressure and 2 to 3 cm above your titrated pressure. That way you get to the therapy pressure that works for you sooner and you get the benefit of the auto. Most people also find it difficult to breathe at 4 cm so set their minimum higher. I was titrated at 11 cm and have my machine set at 10.5 to 13 cm. That range works well for me.

I don't know what that 10cm is on your machine. Not many on the forum are familiar with F & P machines, although I think they make very good machines. Hopefully this will bump the thread up and someone who uses this machine may see it.

I haven't had a sleep test to determine a titrated pressure yet.

I'm currently on vacation so haven't downloaded the data to view it yet, but I'm home tonight so will do so then. I'm curious what my machine is trying to get up to, as in my trial I never had anything more than 8.0 cmH2O because at 9.0 I was getting bad mouth leaks and didn't have a chinstrap yet.

Your auto will tell you what your 90%/95% pressure is ( at least that how the machines I know report it). That means that you spend 90%/95% of the night or less at that pressure. Your titrated pressure would be that or a cm or so higher or lower.

After a week on an auto, you will have a fairly accurate titrated pressure. You may not need a sleep study to get a titrated pressure since you are using an auto. The time on an auto, may well be a more accurate titrated pressure since you are in a more normal environment than a sleep lab. I am assuming you have had the PSG so that other sleep issues are ruled out.

It will be interesting to see what your data tells you.

jules wrote:first get the leaks under control then worry about lowering the AHI

if your machine is like others, it is UNDER reporting AHI in the presence of big and large leaks so those numbers you are seeing for AHI might be VERY deceptive

Jules, could you please explain how leaks cause under reporting of AHI. Not wanting to argue about it but I have never heard of that before. Bottom line, I have been really lax on my leaks because my face has been changing so much from losing lots of weight. So now I am worried that I am doing something stupid once again. thanks

I was seriously considering buying this machine. I am anxious to know your progress with it.

The 'leaks' of 40 l/m may be normal.

I looked at my report to understand what you see. That air that is blowing out your mask? That is the leak. As pressure increases, the amount of air that goes out also increases. Take a look at the mask pamphlet to see what it says is normal for the pressure. 40 is probably good for 14 but you -should- be around what the pamphlet says. If you see spikes on the leak rate to say 70ish - now that is a leak.

Usually, No (keeping AHI below 1). Keep them below 5.

That setting at 10 is the apnea cap. Not normally messed with.
viewtopic/t49753/Apnea-Cap.html

Your pressure range of 4-15 is a lot but understandable since you do not have a study. Usually, people do not have such an big range. Are you maxing out? Are you comfortable at 4? You got the software?

If it is really leaking above a certain pressure, that is a symptom that you may have the wrong mask. Some masks don't work well at higher pressures.

Thanks for the replys (just a quick note as I just got home with the CPAP).

However, I'm disappointed to find out I _don't_ have the software. I was under the impression it was included with this machine.

Joe50 wrote:

jules wrote:first get the leaks under control then worry about lowering the AHI

if your machine is like others, it is UNDER reporting AHI in the presence of big and large leaks so those numbers you are seeing for AHI might be VERY deceptive

Jules, could you please explain how leaks cause under reporting of AHI. Not wanting to argue about it but I have never heard of that before. Bottom line, I have been really lax on my leaks because my face has been changing so much from losing lots of weight. So now I am worried that I am doing something stupid once again. thanks

at any given time when the machine creates a data point it will only mark it with one thing - for example: leak or apnea - my understanding is leak "wins" on the report - but I could be wrong

it will always report leak with the leaks are too high

why don't you post some daily output from the software and get people to comment on your leak graphs etc.

Okay, got the software and took a look at the data from the first week.

First, the mask, while leaking more than it should, is not leaking 'excessively'.

Second, my AHI has stabilized around 3, but the vast majority of events are hypopneas. Anywhere from a third to a half of both events are above my APAP limit (though for the hypopneas that hasn't stopped the APAP from going above 10 cm H2O.

I have some SensAwake events (average 2/hr) but the pressure doesn't seem to drop when they occur. Is the pressure drop shortlived enough that it wouldn't show up significantly on a graph?

Is it reasonable to expect a CPAP machine to get the AHI down to 1 or so?

I have raised the min pressure to 6.5, but haven't adjusted the APAP cap.

I can't answer lot of your questions because I am not familiar with your machine.

I do know that it is possible to get an AHI below 1 with cpap therapy. I am almost always below 1. It is even possible to get an AHI 0f 0 but that doesn't happen very often. I've had it few times in the over 2 years I have been monitoring my data. An AHI around 3 is very good.

Some days I get an AHI of 2 or 3 but haven't been above that in a long time (years).

HOWEVER, I don't worry if I am any number above 5 with my AHI unless it goes on for a week or more. Then I start watching what is happening in my life, tweaking settings to try and bring it down and keeping a log of how I am feeling as I tweak, as well as analysing my data.

We do have sleep apnea after all so 0 AHIs will not be common. There are so many variables with sleeping - stress, eating or drinking late at night, not getting enough sleep, being ill, etc. that things will vary some.

curious where you got the software, as it seems to be somewhat difficult to get...
although if you were to search around here it is out there...
are you running under Windows 7? wondering if it works for you there, mine works but I cannot view the graphs.
I would not stress over the leak rates; I am usually in the 50's for leak and ahi us < 5 98% of the time...
once or twice I have had an ahi of 0 but usually 2 -3.
Have not used the software in a few months, but do not think I have ever had a leak rate as low as you write of.