AHI Calculation and Mask Opinion

Good Morning!

I hope to get the Encore software by the end of the month, but i've been trying to get a rough estimate if my AHI using the cruddy information displayed on my screen. The average as displayed since starting are:

Night Average AHI
8/11 22
8/12 17
8/13 16
8/14 15
8/15 17

Doing some quick calculations in Excel, I figured that to get those averages the actual AHI on those days would be somewhat around:

Night Estimated Actual AHI
8/11 22
8/12 12
8/13 14
8/14 16
8/15 21

Could anyone check my math on those? I certainly don't feel as good as I did the first couple of days, and I do notice I am having leak issues with my Quattro. I fix them when I notice them of course, but I wonder how many I am getting when I am asleep? This is kind of disappointing.

I was thinking of calling the DME and asking to switch masks. I like the FFM but if it is leaking to much, then it isn't doing its job. I was thinking of asking to try a ComfortGel, Comfortgel Blue, or Activia. Opinions? The mask I had during titration was a nasal one which is what got my AHI down to 1.1.

Thanks.
8/15

I called the DME and voiced my concerns that the average AHI did
not appear to be going down and the FFM may be having too many leaks as a possible cause Of this. They agreed and will come out on the 26th if it has not improved and fit me for a nasal mask and chin strap. I was really hoping to avoid a chin strap but if it turns out that and a nasal do the trick I just have to do it. At least they did not hassle me on the possible change out. Time to start researching nasal masks I guess. As a general observation, it seems resmed is usually more expensive and durable looking than respironics masks.

Mask2sleep wrote:Good Morning!

I hope to get the Encore software by the end of the month, but i've been trying to get a rough estimate if my AHI using the cruddy information displayed on my screen. The average as displayed since starting are:

Night Average AHI
8/11 22
8/12 17
8/13 16
8/14 15
8/15 17

Doing some quick calculations in Excel, I figured that to get those averages the actual AHI on those days would be somewhat around:

Night Estimated Actual AHI
8/11 22
8/12 12
8/13 14
8/14 16
8/15 21

Could anyone check my math on those?

It's entirely possible that I calculated it incorrectly, but calculating by hand, I come up with:

Night Estimated Actual AHI
8/11 22
8/12 12
8/13 14
8/14 12
8/15 25

I certainly don't feel as good as I did the first couple of days, and I do notice I am having leak issues with my Quattro. I fix them when I notice them of course, but I wonder how many I am getting when I am asleep?

It could be that you're sleeping through some pretty major mask leaks. You won't really know until you are able to get the software. (I know that you are planning to do that when you're able to.)

I was thinking of calling the DME and asking to switch masks. I like the FFM but if it is leaking to much, then it isn't doing its job. I was thinking of asking to try a ComfortGel, Comfortgel Blue, or Activia. Opinions? The mask I had during titration was a nasal one which is what got my AHI down to 1.1.

I think it would be a good idea to try another type of mask. The PAPCap chin strap works great for me, but just be aware that a chin strap doesn't work for everyone, especially if you're a major mouth-breather. Personally, I have MANY more events when I wear the Quattro than when I use nasal and nasal pillows masks, especially when I'm on my back. I have tried all sizes of that mask, and the only way I can get it to not leak is to tighten the bottom straps quite tight. My theory is that the bottom straps are pulling my jaw back, leading to airway obstruction. I don't have that problem at all with the Activa LT nasal mask or nasal pillows masks. I posted a thread about my experience with the Quattro, which ran several pages, with charts, etc.: viewtopic.php?f=1&t=48909. And here's a thread started by someone else that had the same experience: viewtopic/t54641/viewtopic.php?f=1&t=53276&p=493457.

I'm just wondering how they got your AHI down to 1.1 during the BiPAP titration study, yet your at-home AHI results have been so poor. This is especially odd, considering that your RDI during the diagnostic study was 17.1 [2 obstructive apneas, 34 hypopneas, 50 RERAs (Respiratory Effort Related Arousals), and 0 central apneas]. It is my understanding that your particular machine does respond to RERAs, which is (by far) the largest component of your RDI, so that's good. Have you double-checked that your pressure is set to 11/7, as prescribed? Are you using Bi-Flex? If so, I wonder if it might make any difference if that is turned off. Also, make sure your humidifier level isn't set too high, as that may cause more nasal congestion.

I believe you can clear the screen each day. Then keep the daily results in a log.

Or much better, get the software. The "Daily Details" chart is invaluable IMO and you don't get that off the display.

Thanks for the replies.

Your calculation good very well be right. Either way, any AHI over say..... 0 is bad in my book, and having them so high is definately right out and worrisome.

When the Quattro leaks around the nose I correct that quickly because it blows in my eyes and it wakes me up. More often it leaks in the lower area, either around the chin, or the cheeks. The chin is minor, but around the cheeks is a pretty loud blow. Sometimes my wife will poke me and say "Leak" and i'll fix it, so I know it is happening while I sleep sometimes. I figure since on titration they used a nasal and went so well, maybe that will fix it. Well, more of a hope I guess.

They'll be bringing some nasal masks and a chin strap. If it works, i'll upgrade to a papcap probably.

I will check out those links you posted, thank you.

My machine is set to 11/7, I confirmed that after the tech left and have done so since then. BiFlex is set to 3. Ramp is set at 20 minutes. Humidifier is set to 3. I know the humidifier is working because the tank is losing water volume, but my mouth seems really dry each morning besides that fact, even when I tried it at a 5 just to see what would happen. I woke up once and caught myself mouth breathing, though I wasn't congested. Also.. embarassing to say, one time I woke up and had a little... drool... so I assume my mouth had to of been open for that. Ah sleep apnea, what a humourous little ailment you are, it makes once feel so attractive.

As of last night I stopped using the ramp, the immediate pressure doesn't bother me much. However sometimes I do fixate on the sensation of the different inhale/exhale pressure, and and while i'm in that anxious state its almost like I have to make myself breathe. When I relax I just do it naturally of course. Weird. Do you think I should turn off Bi-Flex entirely or turn it down a notch?

Other than what it says on cpap.com, I don't know much about my machine and couldn't say if it does anything special about RERAs or not. That would be pretty nifty if it could.

I hope to order the software within 2 weeks.

Thank you.

I've never used a Respironics machine myself, so all I know is what I've read in the manuals and on the forum. I can't really guide you regarding Bi-Flex and whether a different setting might actually make a difference. Perhaps someone with more Respironics System One knowledge/experience can weigh in here regarding that. Different EPR (exhalation relief) settings on the ResMed machines do affect my own results, but I know that Respironics' Flex works differently.

The System Leak being reported on your machine's LCD isn't going to give much helpful information since those are 7- or 30-averages. Until you get the software, I don't think there's any way to know how much leaks may be influencing your AHI. But, out of curiosity, what have your System Leak results been each day?

I remember reading that you usually sleep on your back. You might try restricting yourself to side-only sleeping and see if that makes any difference. I used a homemade tennis ball setup to do that:



I cut a hole in the bottom of a tube sock, guided an old belt through the sock, put in two tennis balls, and secured the tennis balls in place with three rubber bands. I wore it wrapped around my upper body, just under my armpits, with the tennis balls on my upper back. You could try that, or a backpack filled with something that will keep you on your side.

If I restrict myself to side-only sleeping with the Quattro, my results are acceptable. When on my back, my results with that mask are terrible. And I'm not the only one who has reported that. I do not have the same problem with the nasal and nasal pillows masks. You may want to try side-only sleeping as an experiment for a few nights, to see if you get any different AHI results. You could sleep with your mask hanging over the edge of your pillow to minimize mask displacement when side sleeping.

Mask2sleep wrote:Also.. embarassing to say, one time I woke up and had a little... drool... so I assume my mouth had to of been open for that. Ah sleep apnea, what a humourous little ailment you are, it makes once feel so attractive.

Well, if it makes you feel any better, you're not the only one!

I made a conscious effort to sleep on my side last night, so i'll check the AHI when I get home from work. Hopefully the average went down. I always sleep on the edge of my pillow, so I didn't have much problem with the mask being in the way in that regard.

I got the mask to stay on good and snug last night and didn't adjust it once for leaks, so hopefully i'll see some improvement. Thanks for the suggestion on the tennis balls.

The System One only has a "large leak" 7 and 30 day average, and it has been hovering around 1%, which doesn't seem like much to me.

Have a good morning.