[CPAP] Reversely proportional Leakage and AHI Values.

[herbm]

Well cool. I thought I had tried that but guess I need to re-read the manual.

SleepyHead is trivial to download. It's on SourceForge.net (a very safe site).

To get Rescan there is a private link here somewhere on this forum -- search for the Rescan request thread -- and you can download if once you know the direct link.

SleepyHead is OPEN SOURCE FREE SOFTWARE. (Rescan isn't.)

[robysue]

Everyone here wants to help A LOT so you are likely going to get lots of answers.

Usually you can only get those leak NUMBERS IF you are running the software so that confused us.

The machine itself doesn't show a "number", just the Green Happy Face or the Red Frowny Face which is much like the "Check Oil" light on an automobile -- once that comes on something is WRONG and needs immediate attention.

No, this is NOT true. If you get into the detailed Sleep Quality Report on the Resmed S9 machines, you will get a number for the leak rate. And that number is the 95% leak rate.

Mr Red Frowny and Mr Green Smiley show up in the short version of the Sleep Quality report. And it's important to understand that Mr Red Frowny shows up when the leak rate is AT or ABOVE 24 L/min for at least 30% of the night. In other words, Mr Red Frowny shows up when the so-called 70% leak rate is AT or ABOVE 24 L/min. If the 70% leak rate is below 24 L/min, then Mr. Green Smiley shows up.

You can get the AHI numbers (approximately) from the S9 Autoset display, so with the leak "numbers" thrown in it isn't clear what you are seeing.

It is perfectly clear what those numbers mean if you read the labels on the numbers and if you read the documentation. The leak rate number in the detailed Sleep Quality Report is the the 95% leak rate. For example, if the leak rate in detailed Sleep Quality report is 8.4 L/min, that means that your leak rate was AT or BELOW 8.4 L/min for 95% of the time the machine was running. And hence your leak rate was also ABOVE 8.4 L/min for no more than 5% of the night.

[Ramen Bear]

Hello guys! Sorry I came back just now.

Robysue was right. I had to increase the pressure to 20 and my AHI went below 5.0.
My only problem is that my lungs feels like it's been stretched or something.
It's hard to describe but in a sense, breathing is somewhat hard when I inspire.
I'm beginning to think that AHI number is okay even if it's high as long as my snoring is muffled.
If I sleep quiet then it means that I am breathing fine.
I'm probably just obsessing with these numbers I find in the machine.
I would just follow the prescription and visit the doctor with the SD card after 6 months.

[robysue]

Hello guys! Sorry I came back just now.

Robysue was right. I had to increase the pressure to 20 and my AHI went below 5.0.
My only problem is that my lungs feels like it's been stretched or something.

It's worth reporting your discomfort to the sleep doc. Be specific in how you are describing it---tell him that at 20cm your lungs feel like they're being stretched and that it's hard to inhale.

Your current machine is only capable of going up to 20cm of pressure. So right now there's no room at the top if things take a turn for the worse.

Your high pressure needs combined with your on-going discomfort indicate that you might be more comfortable and get better therapy from a bilevel device rather than Resmed S9 AutoSet that you are currently using. The Resmed bilevels that would be compatible with your humidifier are the Resmed S9 VPAP S and the S9 VPAP Auto. The VPAP S is a fixed bilevel machine: There's one pressure for IPAP and one for EPAP and they can differ by (much) more than the 3cm that the AutoSet's EPR allows. The VPAP Auto allows you to set up a range of pressures for both EPAP and IPAP; in other words, you start off with a minimum EPAP/IPAP, and as events, snoring, and flow limitations happen, the machine adjusts both the EPAP and IPAP (at the same time) as needed to take care of the events.

In the US one of the criteria for switching people from CPAP/APAP to bilevel is a required pressure of 15+cm with on-going difficulties/discomfort breathing with the machine at the required pressure. Many labs will switch from a CPAP titration to a bilevel titration once the patient hits 15 or 16 cm of pressure---particularly if there is any evidence that the patient is in discomfort.

I'm beginning to think that AHI number is okay even if it's high as long as my snoring is muffled.

How high is high? And what was your AHI on your diagnostic sleep study? If "high AHI" on your machine means an AHI between 4 and 6 and your diagnostic AHI > 30, then, yeah, it's probably ok. But if "high AHI" on your machine means that the AHI is often above 10, then it's not really "ok".

And the snoring really should be essentially gone rather than merely muffled. I don't mean "no snoring at all ever," but realistically you should not be snoring (even if it is muffled) for most of the night on most nights.

I'm probably just obsessing with these numbers I find in the machine.
I would just follow the prescription and visit the doctor with the SD card after 6 months.

Given the combination of:

• a pressure need of 20cm to get the AHI around or below 5
  
• a feeling of "my lungs feel stretched"
  
• a feeling that inhaling is uncomfortable
  
• continued evidence of muffled snoring
  
• a "high AHI" as reported by the machine
  

I personally think you should NOT wait for 6 months before seeing the doc. I think you need to call and see if you can get a follow-up much sooner than that. A switch to bilevel may very well be recommended and if you need the bilevel to increase your comfort and lower the AHI, it's silly to wait for six additional months before bringing that idea up with the sleep doc.