Machine ain't cutting it

I just got the data disc to my RT and the data shows that I am still having many episodes per night. I have been using the Quattro full mask and when I was tested and anayzed I was on the FX Nasal Pillows. I am going to do the FX for the weekend and bring back the data to the RT. I hope it is an issue with the Pillows vs full mask. Here are the results: I don't have a clue what they mean but the RT wants me to do the FX before he discusses the issue with me? Can anyone interpret these for me in laypersons terms?

Thanks,

John

7/14/2010 - 7/22/2010
Device Settings
Therapy Mode: CPAP Set Pressure: 7.0 cmH2O EPR Mode: FULLTIME
EPR Level: 2.0 cmH2O
Pressure - cmH2O
Median: 5.4 Maximum: 7.0
Leak - L/min
Median: 0.0 95th Percentile: 6.0 Maximum: 20.4
AHI & AI - Events/hr
Apnea index: 19.2 AHI: 25.8 % Time in Apnea: 14.5
Hypopnea index: 6.6
Usage
Used Days >= 4 hrs : 8 Used Days < 4 hrs : 1 % Used Days >= 4 hrs : 88
Days not used: 0 Total days: 9 Median daily usage: 7:41
Total hours used: 63:49 Average daily usage: 7:05
Name: Mr John Doe
Patient ID:
Date of Birth:
Report prepared by:

John,

You haven't filled in your profile, so it's difficult to tell if you have a CPAP machine or an auto-machine being run in CPAP mode. I don't know what machine you have to tell if the 20 lpm on the leak data is over and above the acceptable leak rate for that mask or it IS the leak rate which is well within the acceptable leak rates for that mask.

Your pressure looks to be too low. Did the RT raise it?

If you have an APAP, it would make sense to run it in APAP mode to determine where your pressure needs really are.

I'm sure people who are more expert at this will weigh in.

thegrons wrote:I just got the data disc to my RT and the data shows that I am still having many episodes per night. I have been using the Quattro full mask and when I was tested and anayzed I was on the FX Nasal Pillows. I am going to do the FX for the weekend and bring back the data to the RT. I hope it is an issue with the Pillows vs full mask. Here are the results: I don't have a clue what they mean but the RT wants me to do the FX before he discusses the issue with me? Can anyone interpret these for me in laypersons terms?

Thanks,

John

7/14/2010 - 7/22/2010
Device Settings
Therapy Mode: CPAP Set Pressure: 7.0 cmH2O EPR Mode: FULLTIME
EPR Level: 2.0 cmH2O
Pressure - cmH2O
Median: 5.4 Maximum: 7.0
Leak - L/min
Median: 0.0 95th Percentile: 6.0 Maximum: 20.4
AHI & AI - Events/hr
Apnea index: 19.2 AHI: 25.8 % Time in Apnea: 14.5
Hypopnea index: 6.6
Usage
Used Days >= 4 hrs : 8 Used Days < 4 hrs : 1 % Used Days >= 4 hrs : 88
Days not used: 0 Total days: 9 Median daily usage: 7:41
Total hours used: 63:49 Average daily usage: 7:05
Name: Mr John Doe
Patient ID:
Date of Birth:
Report prepared by:

The way I read it, you're hardly getting ANY therapy. (pressure)
At the bare minimum, I'd suggest turning the EPR "OFF". At a setting of "2", it's dropping your effective exhale pressure by 2 cm.


Den

Yeah, something needs adjusting. Did your machine or report give an actual value /number for leakage?

Oh, sorry, now I see where you reported your leakage. The mask may make a difference. As someone else said, 7 cmH20 is a small amount of pressure to reduce by 2 with EPR. You may not need expiratory relief at that pressure. I feel like you will end up getting your pressure bumped up. Good luck, keep us posted.

Thanks it is a ResMed S8 Elite II CPAP with the Quattro full mask. I can drop the EPR to 1 if you all think that would make a differnce, also at night for the first 5 minutes I adjust the mask while the machine is on and that might skew the numbers as well as my waking 5 times to go to the bathroom?

I am going to do the FX pillows, they seem to ram more air down the lungs.

Would you all advise against myself reducing the EPR?

Thanks,

John

thegrons wrote:Thanks it is a ResMed S8 Elite II CPAP with the Quattro full mask. I can drop the EPR to 1 if you all think that would make a differnce, also at night for the first 5 minutes I adjust the mask while the machine is on and that might skew the numbers as well as my waking 5 times to go to the bathroom?

I am going to do the FX pillows, they seem to ram more air down the lungs.

Would you all advise against myself reducing the EPR?

Thanks,

John

As I said, I think you should turn it OFF. And, if by chance, the Ramp feature is activated, turn that OFF, too.
Adjusting the mask while it's running is probably only going to affect your leak numbers.......you need to get more air to bring your AHI down.

Den

Is there a difference in pressure between the full mask and FX pillows? Can I get away with keeping the EPR at 1 with the FX pillows? It seems that the nasal pillows force more air down the airway than the full face mask?

thegrons wrote:Is there a difference in pressure between the full mask and FX pillows? Can I get away with keeping the EPR at 1 with the FX pillows? It seems that the nasal pillows force more air down the airway than the full face mask?

You have the option/ability to change it. Try it at "1" and see how it feels. You also need to be monitoring and recording your morning statistics in the LCD screen (if you're not already).......and not wait for your RT to download your data card.


Den

Thanks for the advice, I will change the EPR to 0 on the full and 1 on the FX pillows. I don't know how to read the data on the LCD and don't expect anyone to tell me here on the board since it would probably take pages. I will ask my RT.

Thanks!

Dont' be surprised if the RT tells you that you CAN'T and shouldn't get the data on your own. It's not true, but I'll bet a doughnut you will be told that.

So, Resmed experienced folks--is his leak rate too high?

John, your pressure is pretty low, so that may be a factor in not getting effective therapy. Adding ramp and EPR to such a low pressure probably does affect your AHI a lot.

If the Resmed experts think the leak rate is too high, the FX may help, as some people can acheive NO leaks on that mask if it's well-fit and positioned properly. Quattros tend to leak and there's more surface area to leak from.

thegrons wrote:Thanks for the advice, I will change the EPR to 0 on the full and 1 on the FX pillows. I don't know how to read the data on the LCD and don't expect anyone to tell me here on the board since it would probably take pages. I will ask my RT.

Thanks!

The instructions have been posted many, many times on the forum. Also, there are links (like the following) where you can download the clinical/setup manuals and save them for future reference.

Also, if/when you're switching masks, be sure to change the mask setting in the machine configuration.

Den



http://www.apneaboard.com/CPAP%20Adjustment.htm

Also.......

1. Accessing the Clinical Menu

Turn on the device and wait until the standby (RAMP/SETTLING) screen appears on the LCD.
At this stage you can adjust the ramp/settling time.

Press the DOWN and RIGHT keys simultaneously for 3 seconds to access the clinical menu.


2. Changing Options and Settings.

Press the LEFT (menu) key to access the SETTINGS menu screen.

Use the UP and DOWN keys to scroll through the RESULTS, OPTIONS and SERVICING menu screens.

From a menu screen, use the LEFT (enter) key to access the parameters in that menu.

Use the UP and DOWN keys to scroll through menu parameters.

Use the LEFT key to view or change each parameter setting as required.

Press the RIGHT (exit) key until you return to the standby (RAMP/SETTLING) screen.


.

John,

Please check your PMs. (private messages)


Den

The 95% for leaks is 6, which is still pretty low. I don't think leaks are your problem.

Your avg pressure is low because of the EPR. I agree, turn it off.

I get the best therapy with the Quattro.

If turning off the EPR doesn't help a lot, your pressure is probably too low. Do you have your titration study?

Ask the RT if you can borrow an auto machine for a week. My titration was at 13.0. My ASV auto averages 12.8 most nights - darn close!

Thanks All;

My study was done with the FX nasal cushions and they determined that 7 was enough. I have a BIG problem with breathing through my mouth and even a chin strap won't keep it shut. I thought a little pressure relief with the nasal cushions might help with this. I am going to try the Quattro tonight with 0 EPR and then Sat and Sun with the FX and a setting of 0 EPR and then 1.