AHI 131 !! - Help me understand my SleepStudy & CPAP results

Pugsy · Post by **Pugsy** » Fri Apr 19, 2013 8:57 pm

If you stay with the 50 series (if you have the 650 now) you can use the 750 with existing humidifier.
Now if you change totally to the 60 series you will need a new humidifier too. The 2 series aren't cross compatible.

Kenwood · Post by **Kenwood** » Sat Apr 20, 2013 2:21 pm

Yesterday, I received a brand new pillow (from Pugsy's DME) for the Swift FX she sent me two weeks ago.

So last night was my first tryout with this new mask. Pugsy wanted to see which nasal pillow mask would be better. I gotta say...I like em both! I slept great and comfortable - as on the weekends, I get to sleep in. I had great night with the new mask. Had some clusters around 6:30am. Almost no leaks - but one at 5:15am, but that was probably me during my sleep (arm or pillow pushing on the mask.). With a solid leak line averaging at the 37 L/min line. I'm going to wear the SwiftFX for the next week. My initial opinion - the SwiftFX fits just a tad better - as sometimes the Aloha pillow feels "weighed down" by the hanging hose (pulling the pillow) when you change positions. I hope that makes sense, its tough to describe. It's nice to finally have options...instead of trying to find a mask that "sucks less"...like I was with the FFM's!

Once again.....Thank You Pugsy!!! Big HUG

Friday night's data - Night #1 with Swift FX Nasal Pillow:

Pugsy · Post by **Pugsy** » Sat Apr 20, 2013 5:49 pm

Tough life having to choose between 2 really good masks isn't it?
I really liked the Aloha and it ran a real close second to my Swift FX. I just have this thing about having the least amount of stuff stuck on me as possible.
My very first primary mask was the Swift LT (long before the Swift FX was ever released). It's a great mask too but there's more "stuff" on my face...I always felt that the Aloha was like a new an improved Swift LT.
The Aloha was a little (tiny bit) more stable than the Swift FX but I gladly gave up a little more stability for less on my face with the Swift FX.
Now with the Tap Pap I swapped the headgear of the Swift FX for a mouth guard and I am fairly content.
Now if someone would just figure out a way to secure nasal pillows without the need for some sort of anchor I would think I was in heaven. I have an idea but haven't had time to experiment with the Tap Pap. More on that later when I have time.

caffeinatedcfo · Post by **caffeinatedcfo** » Sat Apr 20, 2013 6:16 pm

Damn reading this I'm getting excited to try the Swift FX tomorrow nite during titration.

Kenwood · Post by **Kenwood** » Sat Apr 20, 2013 9:16 pm

Quote pulled from Pugsy's "Auto adjusting pressures" thread......

Pugsy wrote:
Kenwood wrote:.....now I see where some of Pugsy's comments came from in my Thread!
Partly but not entirely. It's something that has been on my mind recently and finally decided to act upon it and do a bit of education in the process. Just got lucky with the one report that showed the clusters so figured I would take the time to do a bit of in service.

Not everyone can get an auto adjusting machine for whatever reasons. DME is maybe a jerk and doctor not helpful and not deep enough pockets to go the out of pocket route. Also some people really don't necessarily deal with auto adjusting pressures as easily as others. Maybe the range the machine wants to go to in an effort to kill some snores takes a person in to aerophagia territory and the aerophagia is much worse than letting a couple of snores of flow limitations slide that might not even grow up to be a full fledged event. Maybe they are sensitive to the variations in pressure and again chasing a snore that may not grow up to be worth chasing might create more of a sleep disruption than the snore would cause.

I know several people who feel more rested on cpap mode than they do in apap mode.

You never know...you might not do well with an auto adjusting machine chasing those snores of yours...heck for all I know they may not even be the kind of snores that the machine will try to kill. If insurance picks up the tab that's one thing but if it doesn't...that's a mighty pricey experiment out of pocket.

Another point I wanted to make is that sometimes we have to compromise. Pick our most important battles to fight and devote our energy to those battles instead of spreading our energy out trying to fight battles that we have little chance of winning. Like the one I face.....is tonight going to be a night where my machine wants to go really high or not?
I have no way of knowing what the future holds so I do the best I can with the information I have and the tools at my disposal.
I can be perfectly happy with a fixed pressure...cpap or bilevel. I might trade off a rare cluster if I did but unless there are a lot of them every night (which I already know isn't common for me) I could do quite well with fixed pressures.
That's why I went ahead and bought the 660 PR S1 from Mark. I was curious about the heated hose feature more than I was worried about the lack of auto adjusting pressures. I already knew what to expect and what I was going to need to do.
For me it really wasn't an issue. Even if I could afford to order the 760 I can't..no RX..and I can't afford it anyway.

Now that the 760 has a PS min and a PS max...that means I can have my desired 4 cm PS instead of starting out the night at 2 cm default and have it roam around...it will be perfect and that was really the only reason I preferred the S9 VPAP Auto..that and the ClimateLine. Just a silly little preference that only matters while awake which is maybe 5 minutes as it never takes me long to go to sleep. One of these days I will spot a killer deal on a 760 on craigslist nearby.

So it wasn't just you that prompted this thread but your situation got me to thinking.
I don't want people to think that just because they don't have a machine that has auto adjusting ability means that they can't have the "best" therapy. It can be done..might take just a bit of time and a little tweaking but it can be done.
I don't always have the prettiest of reports even in auto adjusting mode...sometimes I probably need a little higher EPAP to start with but those times are rare and I really don't feel horrible with a not so pretty report so it just isn't that big of a deal.

Number one goal in my book...again like I say often...good quality sleep. If I don't have that then it doesn't matter how perfect the reports are.

Pugsy,

We have solved my major leak issues (Pugsy takes a bow)...so my Sleepyhead results are now accurate and can now be trusted. What's your assessment on my CPAP needs. I've read the quoted post over and over again. Me being me.....I would love to have the best machine in the S9 VPAP Auto. We both know I'll be on CPAP for the rest of my life. People that have an AHI 131 rarely get off the hose. I want to make the right choice while I can. How long do people usually stick with a machine till they need another. Since you have used both, what would be the benefits of the S9 versus say the cheaper PR 750 BiPap Auto? I still need to talk with my new DME (I called too late on Friday) about my machine predicament. So we know now that CPAP has opened my nasal passages and I've used my nose every night. Are MY "snores" really snores? Or are the just vibrations caused by just breathing cause I have this super long uvula. As I can make that snore vibration sound when I'm awake.

Pugsy · Post by **Pugsy** » Sat Apr 20, 2013 10:37 pm

Kenwood wrote:Are MY "snores" really snores? Or are the just vibrations caused by just breathing cause I have this super long uvula.

I don't know. I wish I could tell you with certainty but I don't know.

The S9 VPAP Auto isn't twice the machine despite the twice the price. Don't get sucked up in that way of thinking.

When comparing the VPAP Auto to the 750...the only advantage is the ClimateLine heated hose thing and the ability to have a fixed pressure support and that is only an advantage if you happen to prefer more than 2 cm default in PS despite what you set the max PS at. I am talking a very minor comfort feature that doesn't impact quality of therapy.
There are minor pros and cons with either machine but none are deal breakers. The lack of a heated hose on the 750 isn't a deal breaker especially if you don't really have any issues with rain out or humidity delivered. It's important to me in the winter because I like lots of humidity and a cold bedroom. The first winter with the 750 I fixed that with the stand alone Hybernite heated hose. I should have done it back with my other machines...it would have saved me a lot of irritation.

Now with the new PR S1 760 machine...it has a heated hose option now so that is no longer ...and it has the ability to set PS minimum and maximum so I think it can be made to be fixed if minimum and maximum can be set to equal each other. I haven't had access to a 760 to check it out and I haven't been able to get my hands on a provider/clinical manual to see what it says.

My DME now supplies PR S1 machines...I will try to get over by their office one day this next week and pick his brain about the PS min and max to make sure that the machine will do what I think it will do.

You won't be displeased at all with the S9 VPAP Auto but I don't think you would be missing anything if you got a 760.

Now if you could find a killer deal somewhere on the S9...yeah go for it but while its nice...it really isn't twice the price nice and that's pretty much what it would cost out of pocket unless you got the insurance to swing for it.

You know if you think you might want to have a back up machine then you could always get the S9 VPAP Auto with low hours on it from some place like secondwind if you could find one that suits your pocketbook and then you would have a chance to try it and see if it really is that much better for your needs. There are differences in the algorithms between the two brands...same as with the cpap/apap machines but I suspect that most people would do well with either.

You are like me...drawn to the ResMed machine because you hear so much good stuff about them and you are curious...will I feel even better with the more expensive machine? You know what...I feel the same with either machine.
I got my VPAP Auto off a craigslist deal or I would never have been able to afford it.

Do I still think you would benefit from auto adjusting? Yeah...even if those snores wouldn't prompt the machine to increase the pressure you wouldn't be "what iffing". It would give you peace of mind if nothing else but that could be a real expensive peace of mind and you are the only one who can decide what it is worth to you.
I did my own what iffing too. What if I felt hugely better with that high dollar S9? I got my answer. I don't but I have never begrudged the money I spent for the VPAP. Peace of mind was worth it to me.

You know you could try another 1 cm EPAP...see if the snores reduce anymore.

Kenwood · Post by **Kenwood** » Sun Apr 21, 2013 12:28 pm

I think I'm gonna stick with the Phillips Respironics line with leaning towards the PS S1 750 Auto and less towards the PS S1 760 Auto. As the 760 is about $700 more on CPAP.com.....I'll talk to my DME about both tho. It's the end of Spring with Summer about ready to start here in the hot dessert of PHX. So I don't really know if the heated hose feature would be a benefit to me. But Humidity factor is SUPER important as that had what helps me use my nose and open my nasal passages all day and night long. But I prefer COOL air not warm air.

Kenwood · Post by **Kenwood** » Sun Apr 21, 2013 12:52 pm

Another great night using the Swift FX mask. It's a super comfortable nasal pillow mask. I'm sleeping more comfortable. I'm just all around rested and happy.

Saturday night's data - Night #2 with Swift FX Nasal Pillow:

Kenwood · Post by **Kenwood** » Sun Apr 21, 2013 12:59 pm

Look at the difference in my AHI and LEAK numbers for the "Last 7 days" that I have been using the Nasal Pillows versus the FFM in the "Last 30 Days" that also INCLUDES the last weeks numbers!!! 95% Total Leaks = 42 versus 106

Kenwood · Post by **Kenwood** » Sun Apr 21, 2013 1:02 pm

Here are my overall charts for 2 months on CPAP. Look at the difference of the last week using the pillows versus FFM:

Pugsy · Post by **Pugsy** » Sun Apr 21, 2013 1:27 pm

Looking good with the Swift FX there.
You're a poster child for nasal pillow mask for sure.
1....you aren't mouth breathing much if any at all
2....you are sleeping much better
3.... leaks are pretty much non existent
4....the direct application of humidified air helps with nasal congestion that you thought you couldn't get rid of and was causing mouth breathing
5....higher pressures don't always equal the nasal pillows flying out the nose and across he bedroom like a balloon that you stick a pin in
6....you are now a happy camper and feeling good...no more struggles.

This is the way cpap therapy should and can be if a DME would just use some common sense and make an effort to help someone instead of telling someone with leaks well over 100 L/min for half the night that "no, your leaks aren't a problem at all". Not waking you up a gazillion times...not impacting therapy pressures...idiots.

Oh, I forgot the sub optimal EPAP pressure...mix that in with massive leaks...no wonder you were struggling.

Kenwood · Post by **Kenwood** » Sun Apr 21, 2013 1:51 pm

Pugsy wrote: 4....the direct application of humidified air helps with nasal congestion that you thought you couldn't get rid of and was causing mouth breathing

This is a MAJOR life altering factor in my overall happiness. I was miserable not being able to breath through my nose for the last decade. Now factor in going from an AHI of 131 to present day. Feeling rested in the morning, no more waking up with headaches and not been so dead tired in the morning - total life changer.

Kenwood · Post by **Kenwood** » Sun Apr 21, 2013 4:28 pm

.....just amazed my thread has been viewed over 5,000 times!

Kenwood · Post by **Kenwood** » Mon Apr 22, 2013 8:25 am

Pugsy wrote:You know you could try another 1 cm EPAP...see if the snores reduce anymore.

I bumped my EPAP pressure from 16 to 17 and my first night shows almost no snores. I don't even think those were snores last night, but nose sniff's that registered. I will see how that pressure works out this week while I continue using the SwiftFX. Had a couple leaks last night (stomach sleeper with my face into my pillow - so those are probably caused by me), but still a very steady leak line most of the night.

Sunday night's data - Night #3 using higher EPAP 17 with Swift FX Nasal Pillow:

Pugsy · Post by **Pugsy** » Mon Apr 22, 2013 8:49 am

Well..I guess those were snores on those other reports that would probably have triggered a little more pressure if you had an auto adjusting machine.
I had been wondering for a while if we wanted to try to reduce the snores...just in case. I hadn't pushed it because you were feeling great and sleeping great. Didn't want to upset the apple cart trying to fix something that may not have been that big of a deal anyway.
But I am glad you were willing to try it. I am pretty sure you have found your sweet spot with this machine. I don't know if 0.5 less EPAP would have also given this great report but this sure looks really good.
My gut told me the snores would likely respond to a little more pressure but I couldn't be sure. Guess we know now huh?

I wouldn't worry about the leak..it isn't big enough to negatively impact therapy no matter what the cause.
You know it's funny but your timeline for leaks is a lot like mine. I almost always have one about 90 minutes into therapy after first sleep onset. Sometimes around 60 minutes and sometimes around 120 minutes but almost always some sort of leak during that time frame where the first REM cycle is likely to happen.
My theory is (theory only because I have to proof) is that with REM sleep I likely relax my mouth a bit and that is when I experience a little mouth breathing. Tiny amount...always seems to correct itself and then may happen again during a time frame where REM is likely to occur a little later on during the night.
I have a report from last night showing 3 such little time frames...first one is always the "worst"...

So...while auto adjusting machine might be nice for some situations and allow maybe a slightly less EPAP to be used for a good bit of the night...it isn't the end of the world if you don't have one right now. You see that you can get great therapy with what you have right now. I don't think that your EPAP is going to be a whole lot lower though...the machine probably can't respond quickly enough to allow for a 13 or 14 EPAP.
Do the math if and when you can get DME and insurance on board for the Auto Bilevel. It's always a good idea to have a back up machine if at all possible anyway. It might cost you less in the long run to just buy a gently used machine, or new if that is what you want, out of pocket. Then you could get the Auto and use it and see if it scratches the curiosity itch that I know you have. I know you have it because I would have it if I was in your shoes...the old "what if" thing.
It's not something that you just have to do tomorrow though...you can afford to wait and do the math and figure out what hurts your wallet the least.

AHI 131 !! - Help me understand my SleepStudy & CPAP results

Re: AHI 131 !! - Help me understand my SleepStudy & CPAP results

Re: AHI 131 !! - Help me understand my SleepStudy & CPAP results

Re: AHI 131 !! - Help me understand my SleepStudy & CPAP results

Re: AHI 131 !! - Help me understand my SleepStudy & CPAP results

Re: AHI 131 !! - Help me understand my SleepStudy & CPAP results

Re: AHI 131 !! - Help me understand my SleepStudy & CPAP results

Re: AHI 131 !! - Help me understand my SleepStudy & CPAP results

Re: AHI 131 !! - Help me understand my SleepStudy & CPAP results

Re: AHI 131 !! - Help me understand my SleepStudy & CPAP results

Re: AHI 131 !! - Help me understand my SleepStudy & CPAP results

Re: AHI 131 !! - Help me understand my SleepStudy & CPAP results

Re: AHI 131 !! - Help me understand my SleepStudy & CPAP results

Re: AHI 131 !! - Help me understand my SleepStudy & CPAP results

Re: AHI 131 !! - Help me understand my SleepStudy & CPAP results

Re: AHI 131 !! - Help me understand my SleepStudy & CPAP results