Someone please help this Newbie!

Hi everyone, I'm a newbie at this and a newbie with CPAP. I was diagnosed with very severe OSA and went immediately to do a sleep study. My AHI (I think that is what the abbreviation is) at that time was 115/hr. They fitted me during my second sleep study with a nasal mask and CPAP with humidifier and titrated me at 11cm of H20. I finally got my cpap machine and mask 2 months ago.

I'm still restless though...I've recently managed to work the menu screen on my S9 and noticed that my AHI is averaging around 80 - 90 and my average hours of sleep is around 3-3.5 a night. Last night I saw my AHI as 80 with 3.5 hours of sleep and 0.0 leaks. I'm losing a bit of my mind with this. I've gone through my fourth mask...

1. Swift FX nasal pillow mask
2. Mirage liberty with headgear
3. Mirage Quattro full face mask
4. Quattro FX full face mask (which I love...much less bulky and user friendly than the Mirage Quattro)

I went to sleep last night with no leaks...woke up with no leaks...and still tired, confused, and with high AHI of 80???

Can someone tell me what I'm doing wrong???

Alex

What pressure or pressure range are you using?

That would be my first suspect to look at with an AHI that you report.

Do you have the software? If not, I would strongly suggest you get it. If you want it, look on this forum's first page for a thread started by Uncle Bob "I Love Titrations". In his profile signature is a way to obtain the software.

Clearly, with AHI in the 80-90s and no relief of symptoms in 2 months, SOMETHING is not working.

What does your sleep Dr say? You need to get him more involved (or re-involved) right away.

(Pugsy: She said 11cm...)

Hi Pugsy,

Since I'm at work I can just recall what I glanced at. I believe I saw 11cm for the pressure...I didn't see a range. Plus there was a 2.0 cm of EPR???

I noticed a simcard on the rear of the machine so when I get home tonight I'll check to see what software it uses. Thanks so much for the resource on the software!!!

You are most welcome. The software will work with your machine and data card.
Please keep us posted.
And yes, as Link pointed out, your doctor needs to be aware of what is happening. Also might be helpful if you get a copy of your sleep study to see what they found.

AHI of 80 with treatment is not good at all and needs immediate action to determine what is happening.

Don't wait until you get home. Call your doctor NOW and tell them that your AHI is 80 on the machine. Something is definitely wrong. You need to be seen by your doctor.

Janknitz wrote:Don't wait until you get home. Call your doctor NOW and tell them that your AHI is 80 on the machine. Something is definitely wrong. You need to be seen by your doctor.

I'm calling now...it's so weird. The sleep study I supposedly slept like a baby...all renewed with AHI less than 5 with 11 cm of H2O pressure. Now 2 months in and can't get a lick on a decent night's sleep. I'll keep you informed on what they say. Can me using a full face mask have anything to do with the pressure they prescribed me at? The 11cm of H2O of pressure was with a nasal mask.

There should be very little difference in AHI due to different masks...assuming leak rate is similar.

I'm not familiar with the Resmeds but isn't there a setting on them for mask type? I don't know if it would make that big a difference in AHI.

DoriC wrote:I'm not familiar with the Resmeds but isn't there a setting on them for mask type? I don't know if it would make that big a difference in AHI.

The mask setting in ResMed machines only affects the reported mask leak. It will not affect therapy and subsequent AHI. Doesn't even affect the leak itself, only the numbers that get reported. Mask chosen determines what ResMed automatically subtracts as intentional leak before reporting the excess leak.

Most definitely speak with your sleep doctor regarding this, with numbers like that your treatment is far from optimized.

Your situation, although worse than mine and for much longer, sounds very familiar. When I first started I was prescribed a pressure of 14 however was seeing my AHI between 17 and 43 and although I felt a bit better I knew things were less than ideal when I looked at the numbers and especially the data. I discovered this during my first week and wound up taking over my own settings after waiting for what I considered too lonh for the doctor to get back with what pressure I should be on. In the end I wound up increasing my pressure and found, over a few weeks, that it actually needed to 18 to adequately control my apneas. I had an AHI of 119 in my sleep study and now average 2.9 over the past 14 days.

One thing I did find, and some others have found the same as well, is that the EPR does affect the pressure needed and therefore the AHI that will be achieved at a given pressure. It seems that for some of us the decrease in pressure during exhale due to the EPR makes it easier for an obstruction to occur. The EPR does make breathing easier and I do find that when using it I feel like I slept better IMHO because I am not fighting against the machine as much, but I do need to increase pressure to compensate for this.

If you are concerned, or unable to increase the pressure, then you can change the EPR to a lower value or off altogether as this may also help to reduce your AHI, although it is unlikley to be enough.

An AHI of more than 30 would still result in a diagnosis of severe sleep apnea and definitely requires some adjustment. I would discuss this with your sleep doctor as soon as possible. I question why no one checked up on your treatment during the early stages, however this does not seem to be all that unusual unfortunately since each DME has varying degrees of caring for things other than profit.

People have already mentioned a couple of possibilities: the EPR, and that your titrated pressure is not right.

I don't know why, but I have found that a full face mask does yield a higher AHI for me, and seems to require greater pressure. It shouldn't be the case, just my own experience.

DoriC wrote:I'm not familiar with the Resmeds but isn't there a setting on them for mask type? I don't know if it would make that big a difference in AHI.

Hi Dori,

Yes..there is a mask setting. I have it currently under Full Face which is recommended for this mask under the S9 guidelines.

tschultz wrote:Most definitely speak with your sleep doctor regarding this, with numbers like that your treatment is far from optimized.

Your situation, although worse than mine and for much longer, sounds very familiar. When I first started I was prescribed a pressure of 14 however was seeing my AHI between 17 and 43 and although I felt a bit better I knew things were less than ideal when I looked at the numbers and especially the data. I discovered this during my first week and wound up taking over my own settings after waiting for what I considered too lonh for the doctor to get back with what pressure I should be on. In the end I wound up increasing my pressure and found, over a few weeks, that it actually needed to 18 to adequately control my apneas. I had an AHI of 119 in my sleep study and now average 2.9 over the past 14 days.

One thing I did find, and some others have found the same as well, is that the EPR does affect the pressure needed and therefore the AHI that will be achieved at a given pressure. It seems that for some of us the decrease in pressure during exhale due to the EPR makes it easier for an obstruction to occur. The EPR does make breathing easier and I do find that when using it I feel like I slept better IMHO because I am not fighting against the machine as much, but I do need to increase pressure to compensate for this.

If you are concerned, or unable to increase the pressure, then you can change the EPR to a lower value or off altogether as this may also help to reduce your AHI, although it is unlikley to be enough.

An AHI of more than 30 would still result in a diagnosis of severe sleep apnea and definitely requires some adjustment. I would discuss this with your sleep doctor as soon as possible. I question why no one checked up on your treatment during the early stages, however this does not seem to be all that unusual unfortunately since each DME has varying degrees of caring for things other than profit.

Thanks for your advice...

I am super concerned with this and the doctors aren't of much help. I called them yesterday to inform them of what I'm going through but haven't gotten a call back. I looked up last night's figures:

Hours Slept: 4.2 hrs
mask fit (happy face)
AHI: 79.2
Pressure: 11.0
Leak: 0.0L
Total AI: 74.7
Central: 0.0

Then the settings on my s9 and this is what it says line by line...its hard for me to make sense of it:

Set Pressure: 11cm
Start Pressure: 4cm
EPR: Full-time
EPR Level: 3
EPR Inhale: Med
Mask: Full Face
Climate Control: Auto
Sleep Quality: Usage
Smart Start: Off

Any help with these figures would be very educational to me. Thanks so much...

Off hand without seeing the report graphs it sounds like the 11 cm pressure is not sufficient to ward off events
BUT
given the severity of what is going on with you, I would suggest that you post a screen shot of the report with the graphs and get some better informed ideas.

From what you say with numerical data, we can't blame it on centrals and can't blame it on leak, that pretty much leaves pressure...

Maybe the EPR of 3 is affecting things. It does relate to a 3 cm drop in pressure during exhale. Effectively lowering the pressure by 3 for the amount of time during exhale...

Do you use the ramp? If so how long?

I would want to see the report in graph form to be able to say with more certainty but sure sounds like the pressure isn't warding off the events.